[Pericarditis in the acute phase of myocardial infarction: incidence and clinical significance]. / Pericarditis en la fase aguda del infarto de miocardio: incidencia y significado clínico.

STUDY OBJECTIVE: To evaluate the incidence and the clinical significance of pericarditis in the acute myocardial infarction. DESIGN: Retrospective study. SETTING: The Coronary Care Unit of a University Hospital. PATIENTS AND METHODS: We have studied 668 consecutive patients with their first acute myocardial infarction admitted at the Coronary Care Unit, Hospital General de Galicia, Santiago de Compostela, Spain, in the years 1983 to 1988. Pericarditis was defined as the presence of a pericardial friction rub on auscultation during the hospital course. Pericarditis was noted in 86 patients (12.8%), who were considered as group A. The remain 582 patients were considered as group B. Statistical analysis was carried out using the BMDP statistical package. MAIN RESULTS: Pericarditis occurred in 12.8% of the patients. Patients with, compared to those without, pericarditis had a lower age (59.0 +/- 12.4 years; p = .0005), and a higher percentage of males (86.1% versus 75.6%; p = .038), an a higher percentage of smokers (63.9% versus 48.6%; p = .01). The delay to the hospital admission was greater in group A (12.6 +/- 18.5 hours versus 8.0 +/- 11.7 hours; p = .0024). Pericarditis more often occurred in the setting of anterior wall myocardial infarction and in Q-wave infarct. The group A had a higher CPK peak (1877.5 +/- 1548.9 UI/L versus 1240.2 +/- 961.5 UI/I; p = .001) and a higher peak of CK-MB (213.7 +/- 134.7 UI/L versus 160.8 +/- 112.9 UI/L; p = .001). In-hospital mortality was significantly lower in group A (6.9% versus 17.2%; p = .016). The multivariate analysis by stepwise logistic regression identified the Q- wave myocardial infarct, the age, the delay to the hospital admission, the peak of MB creatine kinase and location of infarct as the only independent predictive variables for the pericarditis occurrence. CONCLUSIONS: We conclude that the pericarditis in the setting of Q-wave myocardial infarction, with anterior wall location, and is related to transmural extension of the myocardial necrosis.

[Myocardial infarct in the geriatric patient: the short- and mid-term prognostic factors]. / El infarto de miocardio en el paciente geriátrico: factores pronósticos a corto y medio plazo.

The purpose of this study was to investigate the clinical features and the prognostic factors related to early and late mortality in the acute myocardial infarction (AMI) in the geriatric population. We have studied 208 consecutive patients with AMI admitted to the Coronary Care Unit at the Hospital General de Asturias. Two groups were selected: group A included 102 patients older than 65 years; and 106 were younger (group B). In the group A was found a significantly lower percentage of males (52.9% vs 89.6%; p less than 0.0001) and smokers (45.1% vs 89.6%; p less than 0.0001); and older patients showed a greater incidence of diabetes mellitus (30.7% vs 16%; p less than 0.01). In the geriatric group, the clinical course of AMI is characterized by a greater incidence of heart failure (50% vs 29.2%; p less than 0.002) and cardiogenic shock (22.5% vs 7.5%; p = 0.002). Early mortality (first month) was significantly higher in elderly patients (36.3% vs 7.5%; p less than 0.001); and this increased mortality rate is partially related to an increased incidence of heart pump failure, despite having a smaller enzymatic infarct size by CPK peak (1,062 +/- 1,017 U/l vs 1,579 +/- 1,428 U/l; p less than 0.005). The multivariate analysis by stepwise logistic regression, selected diabetes mellitus, heart failure and peri-infarct bundle branch blocks as the only independent predictive variables for the early mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical and prognostic implications of age in acute myocardial infarct]. / Implicaciones clínicas y pronósticas de la edad en el infarto agudo de miocardio.

The purpose of this study was to evaluate the clinical characteristics and the factors related to early mortality in the acute myocardial infarction of the geriatric population. We studied 814 consecutive patients with their first acute myocardial infarction admitted to the coronary care unit at tha Hospital General de Galicia. 401 patients were older than 65 years (Group A) and 413 were younger (Group B). Group A was found a significantly lower percentage of males (64.7% versus 88.4%; p less than 0.001) and smokers (46.7% versus 72.7%; p less than 0.001; and older patients showed a greater incidence of diabetes mellitus (28.1% versus 15.2%; p less than 0.001) and arterial hypertension (45.6% versus 31.7%; p less than 0.01). In the geriatric population, the clinical course of the acute myocardial infarction is characterized by a greater incidence of heart failure (35.3% versus 11.1%; p less than 0.001), cardiogenic shock (18% versus 5.7%; p less than 0.001) and post-acute myocardial infarction angina pectoris (18.3% versus 12.2%; p less than 0.05). Early mortality (first month) was significantly higher in elderly patients (22.7% versus 6.3%; p less than 0.001). The multivariate analysis by stepwise logistic regression identified cardiogenic shock, age and heart failure as the only independent predictive variables for early mortality. We conclude that early mortality in the acute myocardial infarction is high and related to severe degrees of pump failure and age.

[Myocardial infarct in diabetes mellitus: short- and long-term prognostic factors]. / Infarto del miocardio en la diabetes mellitus: factores pronósticos a corto y largo plazo.

To determine the evolution of acute myocardial infarction in patients with diabetes we study 207 consecutive patients with myocardial infarction. Using WHO's criteria 23% of our cases were diagnosed of diabetes mellitus. Diabetic patients were older than non diabetic (67.9 +/- 10 years vs. 62.4 +/- 11 years, p less than 0.05) and had a higher ratio of females (52% vs. 21%, p less than 0.001). Cigarette smoking was infrequent in diabetic population. Incidence of other risk factors was comparable. Despite an increased proportion on no q-wave myocardial infarction in the diabetic patients (12.5% vs. 6.9%, p NS), the site of infarction was similar into the two groups. Acute phase mortality was higher in the diabetic group (37.5% vs. 16.3%, p less than 0.001). This increased mortality is, partially, related to an increased incidence of pump failure, but a multivariate analysis using stepwise logistic regression, selected diabetes as an independent predictor of prognosis. Survivors were followed for 41 +/- 20 months; diabetic patients showed a poor prognosis with a higher incidence of congestive heart failure (42.8% vs. 13.7%, p less than 0.01), reinfarction (16.6% vs. 8.5%) and death. Cox proportional hazard model selected diabetes as an independent predictor of survival. We conclude that patients with diabetes mellitus constitute a subgroup into the myocardial infarction population; this subgroup had greater mortality than non diabetic patients in relation to increased incidence of pump failure, but multivariate analysis indicates that other factors not considered in the present study may play a role in their poor prognosis.

[Smoking among health professionals at hospitals in Asturias]. / Estudio del tabaquismo en profesionales sanitarios del medio hospitalario de Asturias.

The smoking habits of 454 doctors and 332 nursing staff members of 11 hospitals from Asturias, Spain, were studied. The mean age of the physicians was 35 +/- 8.6 years (22 to 68 years) and of the nurses was 31.8 +/- 7.3 years (19 to 60 years). 54% of doctors and 57.2% of the nurses were found to have a smoking habit (daily and occasional); and was similar in both sexes. In this survey, the 54.1% of the cardiologists were smokers (daily smokers: 39.6%; occasional smokers: 14.6%; ex smokers: 25%; non smokers: 20.8%). In conclusion, the example of the health professionals in the hospitals from Asturias is negative due to higher rate of smokers. The health professionals should be involved in an active and exemplary way against this habit.

[Endocarditis caused by Coxiella burnetii in aortic prosthesis. Presentation of a case with a fatal course]. / Endocarditis por Coxiella burnetii sobre prótesis aórtica. Presentación de un caso de evolución fatal.

A case of endocarditis caused by Coxiella burnetii in a patient with an aortic Starr-Edwards prosthesis is described. The diagnosis was made by detecting high titres of antibody against Coxiella burnetii phase I antigens. After 15 weeks of chemotherapy with tetracycline and cotrimoxazole, aortic prosthetic valve replacement was carried out because of haemodynamic deterioration and he died 4 days later. The histologic picture of the excised valve was consistent with endocarditis. Coxiella burnetii should be considered in the differential diagnosis of culture-negative endocarditis in our country, especially when the patient has not receiving antibiotic treatment in the last 2 weeks.