[Angiographic correlation of ST segment depression in exercise test in precardial electrocardiography leads after inferior wall acute myocardial infarction]. / Correlación angiográfica del descenso del segmento ST con el ejercicio en derivaciones precordiales después de un infarto agudo de miocardio inferior.

OBJECTIVES: This study was aimed to establish the angiographic correlation of the exercise-induced ST segment depression in precordial leads after an uncomplicated inferior wall myocardial infarction. METHODS: We studied retrospectively 67 patients with a recent inferior wall acute myocardial infarction who took an exercise stress test following Bruce protocol and a coronary angiography within 3 months. Four groups were defined according to the ST segment response to exercise: group I, no ST segment changes; group II, ST depression in leads V1-V4; group III, ST depression in leads V5-V6; and group IV, ST depression in leads V1-V6. RESULTS: There were no significant differences among the groups for clinical and exercise variables, except for age (groups I and II were significantly younger than groups III and IV). The prevalence of multivessel coronary artery disease (two- and three-vessel disease) was 21%, 18%, 52% and 72% for group I to IV respectively (p = 0.007). The prevalence for left anterior descending coronary artery disease was 5%, 9%, 35% and 50% for group I to IV respectively (p = 0.01). By multivariate logistic regression analysis, only age > 60 years (p = 0.002) and exercise group III and IV (p = 0.02) were independent predictors for the presence of multivessel coronary disease. Whereas an ST exercise response type I or II in a patient < or = 60 years virtually excluded the presence of multivessel disease (negative predictive value, 0.90), an ST exercise response type III or IV in a patient > 60 years strongly suggested the presence of multivessel disease (positive predictive value, 0.72). CONCLUSIONS: Age and exercise-response of ST segment in precordial leads are useful variables for predicting the presence or absence of multivessel coronary artery disease after an uncomplicated inferior wall acute myocardial infarction.

[Embolism due to cholesterol crystals]. / Embolismo por cristales de colesterol.

We present a case of cholesterol crystal embolization confirmed histologically by skin biopsy and by the presence of a yellowish microemboli with a refringent look lodged inside a retinal arterioles. The presence of a typical clinic case history, together concurrent risk factor (coronarography, implantation of stent and anticoagulation) supported the diagnostic suspicion. Although it is a serious illness, often with a fatal evolution, the patient has followed a favourable clinic course.