[The mechanism producing nausea during ventriculography performed with ioxaglate: the implications of a randomized study]. / Mecanismo de producción de las náuseas durante la ventriculografía realizada con ioxaglato: implicaciones de un estudio randomizado.

INTRODUCTION: The mechanism of ioxaglate-induced nausea has not been fully elucidated. Recent studies have demonstrated that serotonin is one of the principal neurotransmitters of emesis in humans. On the other hand, the greater capacity of ioxaglate to stimulate vomiting has been ascribed to its great ability to inhibit cholinesterase. METHODS: To determine if oral metoclopramide (a serotonin receptor-blocker) is effective in the prophylaxis of ioxaglate-induced nausea during left ventriculography, 637 of 711 consecutive eligible patients were included in a prospective study. Patients were randomized to receive, 60-90 minutes before the procedure, either diazepam 10 mg p.o. (control group [n = 315]) or diazepam 10 mg p.o. plus metoclopramide 10 mg p.o. (metoclopramide group [n = 322]). RESULTS: The two randomized groups were similar in relation to baseline clinical and hemodynamic characteristics. Nausea was documented in 103 patients (16.1%) with similar incidence in the two groups (control group: 16.8%, metoclopramide group: 15.5%; p = NS). Nausea duration was also similar (56 +/- 63 s vs 52 +/- 63 s; p = NS). When patients with and without nausea were compared, the following variables showed a significant difference between the two groups: male gender (86% vs 76%; p < 0.05), age (53 +/- 10 yrs vs 56 +/- 9 yrs; p < 0.05) and body surface area (1.84 +/- 0.2 m2 vs 1.78 +/- 0.1 m2; p < 0.01). Stepwise multiple regression analysis identified low age (p = 0.02) and male gender (p = 0.06) as independent predictors of nausea. The incidence of nausea was 24% in males < or = 45 yrs vs 9% in females > 45 yrs (p < 0.05). CONCLUSIONS: Prophylaxis with oral metoclopramide did not reduce the incidence of ioxaglate-induced nausea during left ventriculography. This data do not support a role of serotonin in the production of nausea by ioxaglate. Low age an male gender are independent predictors of nausea apparition during left ventriculography. A cholinergic mechanism is probably involved in the capacity of ioxaglate to stimulate vomiting.

Obstruction of aortocoronary bypass due to blunt chest trauma.

We report the first case in the literature of acute myocardial infarction due to blunt chest trauma in a patient with saphenous vein aortocoronary bypass to the anterior descending coronary artery. Angiograms demonstrated two stumps - aortic and coronary - suggesting that the primary obstruction was at the graft level with subsequent anterior descending occlusion. A large left ventricular aneurysm developed. As his clinical situation was stable, early aneurysmectomy was not done, and the patient is asymptomatic 15 months after the trauma.

[Coronary angiography and hemodynamic parameters in patients recovered from a myocardial infarction]. / Coronariografía y parámetros hemodinámicos en pacientes recuperados de un unfarto de miocardio.

The hemodynamic findings of a group of 112 patients with a prior history of myocardial infarction have been reviewed. The patients have been classified in three subgroups: anterior (48 cases), posterior (43 cases), and biventricular electrical infarction (21 cases). There was only one female in the 112 cases. There was a good correlation between the electrical region of infarction and ventricular asynergy localized to the same territory (76.65, and 90 %, respectively), as well as significant involvement of the corresponding coronary artery (89.88 and 100 %, respectively). A high percentage of patients with significant lesions of the coronary artery opposite the infarction was found (48 % in anterior necrosis, and 76 % in posterior lesions). In five cases the coronary vessels had no abnormalities. Ejection fraction and postangiography end diastolic pressure were the parameters of ventricular function most constantly altered. From this study it appears particularly relevant that there is a low incidence of women: there exists a good correlation between the infarct, the zone of asynergy, and the affected coronary; the number of affected coronaries increases with age; there are significant lesions in the opposite coronary, and there is a greater alteration of ventricular function in patients with biventricular infarction, followed by patients with anterior infarction.

[Left ventricular aneurysm. Correlations with coronary arteriography (author's transl)]. / Aneurisma ventricular izquierdo. Correlación con la coronariografía.

Ventricular aneurysm is the most severe segmental disorder of ventricular function. A group of 45 patients with ventricular aneurysms have been evaluated, correlating a total of 80 aneurysmatic segments with cineventriculographic findings. Seventy-one percent of the patients had multiple lesions. Except for three patients with normal coronary blood supply and apical aneurysm there was a positive correlation between the remaining aneurysmatic segments and significant lesions in the corresponding arteries. As in the three cases with normal coronary arteries, associated spasm was suspected in other eight cases showing significant vessel stenosis of less than 75 percent of the lumen. Detection of ventricular aneurysm in the cineventriculographic examination is highly suggestive of severe arterial damage.

[Distribution of significant coronary lesions in patients with rheumatic valvular heart disease. Study of 300 consecutive cases (author's transl)]. / Distribución de las lesiones coronarias signifcativas en los pacietes con valvulopatía reumática. Estudio de 300 casos consecutivos.

Associated coronary atherosclerosis in patients with rheumatic valvular heart disease is an important finding under prognostic and therapeutic viewpoints. Selective coronary angiography was carried out in 300 patients with rheumatic valvular disease (157 cases with associated mitral and aortic lesions; 57 cases with aortic regkurgitation; 35 cases with aortic stenosis; 31 cases with mitral stenosis, and 20 cases with mitral regurgitation). Significant coronary atherosclerosis occurs in 11 percent of all patients. The distribution of the lesions was as follows: anterior descending artery (56 percent); right coronary artery (47 percent); circumflex artery (28 percent); marginal artery (22 percent); oblique branches (19 percent), and common left trunk (3 percent). Lesions in the common left trunk were only present in association with aortic regurgitation. Fourty-four percent of patients with significant atherosclerosis showed multiple lesions, and there was a distal coronary tree appropriated to coronary bypass in 78 percent of the cases. The distribution of significant coronary lesions in patients with rheumatic valvular heart disease is similar to that observed in patients with ischemic heart disease. The frequent finding, however, of a short common left trunk and/or a left coronary prevalence in patients with aortic lesions is stressed under diagnostic and therapeutic viewpoints.

[Angiographic mitral regurgitation in patients with chronic ischemic cardiopathy. Coronarioangiographic and ventriculographic correlations (author's transl)]. / Insuficiencia mitral angiográfica en la cardiopatía isquémica crónica. Correlación con la coronariografía y ventriculografía.

Mitral regurgitation in patients with chronic ischemic cardiopathy may occur following dysfunction of the papillary muscles and left ventricular impairment. A total of 291 patients with significant coronary lesions and absence of associated cardiopathies are reviewed. Patients were divided into three groups: Group A, formed by 241 cases without mitral regurgitation; group B, including 42 patients with slight mitral regurgitation, and group C, formed by eight patients with moderate or severe mitral regurgitation. Significant differences between groups A and B in relation to the number of affected coronary arteries, inferior or anterolateral akinesia-dyskinesia, and left ventricular enlargement were observed. There were no significant differences between groups B and C, though all patients of the last group had two or three affected coronary arteries. Angiographic mitral regurgitation following chronic ischemic cardiopathy is uncommon, especially moderate or severe degrees of regurgitation. Mitral regurgitation is related to the number of affected coronary arteries, presence of inferior or anterolateral akinesia-dyskinesia, and enlargement of the left ventricle. Clinical signs of significant mitral regurgitation may suggest the existence of coronary lesions, at least in two vessels.

[Left ventricular function and state of the coronary tree in patients with significant coronary lesions (author's transl)]. / Estado del árbol coronario y de la función ventricular izquierda en los pacientes con lesiones coronarias significativas.

The prognosis of patients with ischemic cardiopathy is mainly based upon the number of affected vesssels, the state of the distal coronary tree, and the left ventricular function. Coronary arteriographies and ventriculographies corresponding to 274 consecutive patients (January, 1975-October, 1978) with significant coronary lesions are reviewed. A singles vessel obstruction was registered in 36.5 percent of the patients; obstruction of two vessels was present in 28.5 percent, and of three vessels in 29.9 percent. The common left trunk was obstructed in 5.1 percent of the cases. The anterior descending coronary artery was affected in 78 percent of the patients, and the left coronary artery, circumflex, first marginal branch, and first diagonal branch showed narrowing in 62, 34, 36, and 26 percent, respectively. The distal tree of the above mentioned arteries was appropriate for coronary bypass operations in 51, 49, 50, 38, and 10 percent of the arteries, respectively. On the basis of coronary angiographic and ventriculographic criteria 117 patients (43 percent) were not candidates to coronary bypass surgery. The ejection fraction was less than 0.40 in 22 percent of the cases, and below to 0.30 in 12 percent (34 patients). The outstanding finding in the present series was the impairment of the distal coronary tree due to advanced atherosclerosis.