RESUMEN
Six young cocaine users, median age 35.5 years (range 27 to 44 years) experienced acute myocardial infarction. The close temporal correlation in two cases between cocaine use and clinical infarction and the relative paucity of atherosclerotic blockage of the coronary arteries in the others, as demonstrated by autopsy or angiography, suggest that cocaine, either by a mechanism of coronary artery spasm or by increased myocardial oxygen demand consequent to hypertension and tachycardia, is implicated in the precipitation of these infarctions.
Asunto(s)
Cocaína , Infarto del Miocardio/inducido químicamente , Trastornos Relacionados con Sustancias/complicaciones , Adulto , Humanos , MasculinoRESUMEN
Since our initial report in 1984 of six patients with AMI temporally related to cocaine use, we have observed 19 additional patients in whom ischemic chest pain syndromes occurred shortly after intranasal or IV use of cocaine or after smoking the drug. Seventeen patients (89 percent) developed non-Q wave infarction and two had Q-wave infarction. One patient manifested angina with striking ST-segment elevation. None of the patients had diabetes or hypertension, and all but one were cigarette smokers. The serum cholesterol level was 162 +/- 7 mg/dl. Four of the five patients who consented to coronary angiographic studies displayed normal coronary arteries, and one showed proximal stenosis of the right coronary artery. The cold pressor test was performed in seven patients; none had angina or ECG changes induced by cold stimulation. We conclude that T-wave infarction is a common form of an acute cardiac event related to cocaine abuse, and its pathogenesis may involve that of the cocaine-induced coronary vasospasm.
Asunto(s)
Cocaína/efectos adversos , Electrocardiografía , Infarto del Miocardio/inducido químicamente , Trastornos Relacionados con Sustancias/complicaciones , Adulto , Vasoespasmo Coronario/inducido químicamente , Femenino , Humanos , Masculino , Infarto del Miocardio/diagnóstico , FumarRESUMEN
Thirty-five consecutive patients with acute subendocardial infarction admitted to the coronary care unit during a 15-month period were identified and analyzed for location of infarction, and for the in-hospital course in terms of recurrent chest pain, the occurrence of a second infarction, and the clinical status at the end of hospitalization. Thirteen patients developed a transmural infarction sometime between 3 and 21 days (average, ten days) after the initial subendocardial infarction. The transmural infarction was defined by a separate episode of severe and prolonged chest pain, late development of QRS alteration, and an appropriate elevation of the creatine phosphokinase concentration. Our experience with acute subendocardial infarction, hertofore regarded as a relatively benign event, indicates that the immediate prognosis of the patient who sustains his first episode of subendocardial infarction is not at all benign, and, indeed, subendocardial infarction frequently heralds transmural infarction within the acute phase of the disease.
Asunto(s)
Infarto del Miocardio/patología , Anciano , Creatina Quinasa/sangre , Electrocardiografía , Femenino , Humanos , Masculino , Infarto del Miocardio/diagnóstico , Pronóstico , Recurrencia , Factores de TiempoRESUMEN
Although the existence of the postmyocardial infarction syndrome has now long been questioned, the Dressler symptom complex remains widely accepted as a distinct clinical entity. A patient is described whose twenty-five-year follow-up adds to our argument that there is no late or separate multisystem autoimmune disease following acute myocardial infarction. It is suggested that the Dressler complex is an entity that has neither vanished nor been vanquished but one that may never have existed.
Asunto(s)
Enfermedades Autoinmunes/etiología , Infarto del Miocardio/complicaciones , Pericarditis/etiología , Anciano , Femenino , Estudios de Seguimiento , Humanos , Infarto del Miocardio/epidemiología , Síndrome , Factores de TiempoAsunto(s)
Enfermedad Coronaria/complicaciones , Aneurisma Cardíaco/diagnóstico , Ventrículos Cardíacos , Adulto , Anciano , Cardiomegalia/diagnóstico por imagen , Electrocardiografía , Aneurisma Cardíaco/diagnóstico por imagen , Auscultación Cardíaca , Frecuencia Cardíaca , Humanos , Cinetocardiografía , Persona de Mediana Edad , Infarto del Miocardio/complicaciones , Fonocardiografía , RadiografíaAsunto(s)
Cardiomiopatías/fisiopatología , Corazón/fisiopatología , Hemodinámica , Presión Sanguínea , Arteria Braquial , Cateterismo Cardíaco , Gasto Cardíaco , Cineangiografía , Electrocardiografía , Pruebas de Función Cardíaca , Frecuencia Cardíaca , Ventrículos Cardíacos , Hemodinámica/efectos de los fármacos , Humanos , Isoproterenol , Masculino , Miocardio/metabolismo , Consumo de Oxígeno , Esfuerzo Físico , Arteria Pulmonar , Pulso ArterialAsunto(s)
Angina de Pecho/diagnóstico , Enfermedades Torácicas/diagnóstico , Enfermedad Aguda , Anciano , Angina de Pecho/diagnóstico por imagen , Angiografía Coronaria , Puente de Arteria Coronaria , Enfermedad Coronaria/complicaciones , Electrocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/complicaciones , Dolor , Vena Safena/trasplante , Síndrome , Enfermedades Torácicas/diagnóstico por imagen , Trasplante AutólogoAsunto(s)
Cardiomiopatías/fisiopatología , Pulso Arterial , Adulto , Arritmias Cardíacas/fisiopatología , Presión Sanguínea , Cateterismo Cardíaco , Gasto Cardíaco , Cardiomegalia/etiología , Cardiomiopatías/complicaciones , Cardiomiopatías/tratamiento farmacológico , Ventrículos Cardíacos/fisiopatología , Humanos , Masculino , Ouabaína/uso terapéuticoAsunto(s)
Glicósidos Digitálicos/administración & dosificación , Cardiopatías/tratamiento farmacológico , Hemodinámica/efectos de los fármacos , Administración Oral , Animales , Cateterismo Cardíaco , Gasto Cardíaco/efectos de los fármacos , Cardiomiopatías/tratamiento farmacológico , Enfermedad de Chagas/tratamiento farmacológico , Enfermedad Coronaria/tratamiento farmacológico , Glicósidos Digitálicos/farmacología , Digoxina/administración & dosificación , Perros , Electrocardiografía , Humanos , Hipertensión/tratamiento farmacológico , Masculino , Insuficiencia de la Válvula Mitral/tratamiento farmacológico , Ouabaína/administración & dosificación , Consumo de Oxígeno , FonocardiografíaRESUMEN
Mechanical complications of acute myocardial infarction (AMI) such as a ventricular septal defect (VSD) usually occur within the first week. In the thrombolytic era, the incidence of a VSD has not increased, but has been reported to occur earlier than previously described. We report an unusual case of an elderly Caucasian female with an acute anterior wall myocardial infarction treated with thrombolytic therapy. Her AMI was complicated by pulmonary edema secondary to a VSD and a left ventricular aneurysm five weeks later. Prompt diagnosis, immediate surgical closure of the VSD, and aneurysmectomy resulted in her complete recovery.