The effects of long-term antithrombotic treatment on left ventricular thrombi in patients after an acute myocardial infarction.

Sixty patients (48 men and 12 women; aged 36 to 72 years, mean 48 +/- 9), who survived an acute anterior myocardial infarction and in whom left ventricular thrombus was detected by cross-sectional echocardiography 1 to 2 days before they were discharged from the hospital, were prospectively studied. All had evidence of left apical wall motion abnormalities. They were randomly divided into three groups of 20 patients each. Group A was given a full dose of oral anticoagulants, group B was given aspirin, 650 mg/day, and group C received no antithrombotic therapy. Echocardiography was performed every 3 months in all patients, and they were followed for 9 to 24 months (mean 16 +/- 5 months). Twelve patients in group A had complete resolution of the thrombus and three had a significant decrease in the size of the thrombus (greater than or equal to 50% of initial thickness) during the first trimester after acute infarction. In group B the thrombus resolved in nine patients and was significantly diminished in four during the first trimester of follow-up. In group C the thrombus resolved in two patients during the first trimester and showed a significant decrease in size in two patients during the second trimester of follow-up. Two patients in group C initially had recurrent transient cerebral ischemic attacks, which did not recur after aneurysmectomy. One patient in group C had a peripheral embolic episode in the femoral artery.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of nifedipine on the sick sinus syndrome.

The effect of nifedipine (N) on sinus node (SN) function was studied in 15 patients (9 males, 6 females) sixty-two to seventy-six (mean 68.1 +/- 11) years old, with sick sinus syndrome (SSS). SSS was characterized electrophysiologically by a prolonged corrected sinus node recovery time (CSNRT greater than 535 msec) and/or prolonged sinoatrial conduction time (SACT greater than 125 msec), assessed by applying premature atrial stimulation. Ten mg N was given sublingually, and CSNRT and SACT were again evaluated sixty minutes after N administration, and again ten minutes after 1.5 mg atropine (A) was given IV. Heart rate increased significantly after N (p less than 0.005), systolic blood pressure (SBP) diminished significantly (p less than 0.005), and CSNRT and SACT shortened significantly (p less than 0.005, p less than 0.005) and became normal in 7 and 5 patients respectively. After A administration, a further significant increase of heart rate (p less than 0.005) and decrease of CSNRT (p less than 0.005) and SACT (p less than 0.005) were observed. CSNRT and SACT became normal in 8 and 7 patients respectively. SBP remained stable.

Atrial septal defect and constrictive pericarditis. An unusual combination.

We describe a case of atrial septal defect associated with constrictive pericarditis. This combination is extremely rare and clinically misleading, since it may simulate other more common conditions. A variety of techniques, such as computerized tomography, echocardiography and cardiac catheterization were necessary for establishing the right diagnosis. Although there are suggestions of a possible association of atrial septal defect with pericardial disease, it is difficult to prove that this combination is other than coincidence.

Arrhythmogenic right ventricular dysplasia: case report presentation and review of the literature.

A man complaining of palpitations was found to have ventricular tachycardia (VT) with LBBB configuration. From the investigations which followed, he was diagnosed as having arrhythmogenic right ventricular dysplasia (ARVD). The patient has been treated with amiodarone and propafenon for 7 months without VT recurrence. ARVD and Uhl's anomaly, which is its most extreme form, may be familial and represent an important cause of sudden death among young people: Prophylactic antiarrhythmic therapy and sometimes surgical treatment are required in case of refractory VT.