Recurrent pericardial effusion with a common clinical disorder.

We present a case of recurrent pericardial effusion in a patient with Down's syndrome in whom the underlying cause was not considered because of unfamiliarity with the care of people with Down's syndrome. The diagnosis hypothyroidism only became apparent by means of a routine panel of biochemical tests.

Angiographically assessed coronary arterial patency and reocclusion in patients with acute myocardial infarction treated with anistreplase: results of the anistreplase reocclusion multicenter study (ARMS).

In this open multicenter study, 156 patients with acute myocardial infarction received 30 U of anistreplase intravenously over 5 minutes within 4 hours of the onset of chest pain. The patency of the infarct-related vessel was determined by coronary angiography 90 minutes after anistreplase treatment, and also 24 hours after treatment, in patients with a patent infarct-related vessel at 90 minutes, to assess the reocclusion rate. The investigators categorized the infarct-related vessel as patent or occluded, and 2 independent cardiologists graded the infarct-related vessel according to the Thrombolysis in Myocardial Infarction (TIMI) perfusion criteria. At the 90-minute assessment, 106 of 145 evaluable patients (73%) had patent infarct-related vessels, and 39 of 145 (27%) had occluded infarct-related vessels. Of the 139 independently assessed patients, 98 (71%) had TIMI grades 2 or 3 and 41 (29%) had TIMI grades 0 or 1. At the 24-hour assessment, 98 of 102 patients (96%) had a patent infarct-related vessel, and reocclusion had occurred in 4 of 102 patients (4%). Of the 94 independently assessed patients 90 (96%) had TIMI grades 2 or 3, and 4 (4%) had TIMI grades 0 or 1. The reliability of noninvasive parameters as indicators of achieved patency of the infarct-related vessel was estimated by means of correlation with patency assessed by coronary angiography. A significant correlation of 0.62 was found. The patency rate of 71 to 73% after use of anistreplase in patients with acute myocardial infarction corresponds with findings in earlier studies. The low reocclusion rate of 4% after use of anistreplase probably reflects the prolonged action of anistreplase.

Variant forms of angina pectoris.

3 patients with different clinical and electrocardiographic manifestations of coronary artery spasm are discussed. All 3 patients had anginal attacks at rest. In addition, 2 of these patients, who did not have significant preexisting narrowing of their coronary arteries, also had anginal pain related to exercise. During pain, 1 patient showed ST-segment elevation, the other ST-segment depression, while the third showed ST-segment depression shortly followed by ST-elevation on the electrocardiogram. At coronary angiography, spontaneous or induced spasm of one of the major coronary arteries could be demonstrated in all 3 patients. In 2 cases, sublingual nitroglycerin failed to completely relieve the spasm. This raises the question whether a residual stenosis after NTG conclusively proves a fixed organic narrowing. It is concluded that the clinical spectrum of spasm of the coronary arteries is wider than was originally reported by Prinzmetal and coworkers. Clinical and electrocardiographic manifestations are probably dependent on the site and severity of the spasm, which may cause different degrees of myocardial ischemia.