RESUMEN
Routine questioning may be inadequate to identify angina pectoris or prolonged discomfort due to myocardial ischemia. The clinician must ask patients if they have had any unpleasant sensations in the chest, neck, throat, jaw, arms, elbow, wrist, or back that they have not noticed previously. Once the patient uses a word to describe the discomfort, the physician should use the same word and inquire about the duration of the discomfort and precipitating causes, including the less common and unusual ones discussed in this editorial.
Asunto(s)
Angina de Pecho/diagnóstico , Lenguaje , Humanos , Pautas de la Práctica en MedicinaRESUMEN
Among 5,207 adult patients who underwent cardiac surgery, postoperative constrictive pericarditis was recognized in 11 patients (0.2% incidence rate). Seven patients had coronary arterial bypass grafting and 4 had valve replacement; the pericardium was left open in all cases. The average interval between surgery and presentation of pericardial constriction was 82 days (range 14 to 186). M mode echocardiography revealed epicardial and pericardial thickening in 7 cases and variable degrees of posterior pericardial effusion in 5 cases. Cardiac catheterization demonstrated uniformity of diastolic pressures with a characteristic early diastolic dip and late plateau pattern. Two patients responded to medical therapy for chronic pericarditis. One patient had a limited parietal pericardiectomy followed by recurrent constrictive pericarditis that eventually stabilized with medical therapy. The other 8 patients required radical pericardiectomy. The pathophysiology of constriction after surgery is unclear. Its clinical expression involves a wide spectrum of presentation and therapeutic response. Constrictive pericarditis may be a complication of cardiac surgery in spite of an open pericardium and should be considered in postoperative patients who present with deteriorating cardiac function.
Asunto(s)
Puente de Arteria Coronaria/efectos adversos , Prótesis Valvulares Cardíacas/efectos adversos , Pericarditis Constrictiva/etiología , Complicaciones Posoperatorias/diagnóstico , Corticoesteroides/uso terapéutico , Adulto , Anciano , Cateterismo Cardíaco , Digoxina/uso terapéutico , Diuréticos/uso terapéutico , Ecocardiografía , Electrocardiografía , Femenino , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Pericarditis Constrictiva/diagnóstico , Pericarditis Constrictiva/tratamiento farmacológico , Complicaciones Posoperatorias/tratamiento farmacológicoAsunto(s)
Cardiopatías/complicaciones , Procedimientos Quirúrgicos Operativos , Anciano , Anestesia/efectos adversos , Arritmias Cardíacas/complicaciones , Arritmias Cardíacas/etiología , Enfermedades de las Arterias Carótidas/complicaciones , Enfermedad Coronaria/complicaciones , Electrocardiografía , Endocarditis/prevención & control , Bloqueo Cardíaco/complicaciones , Cardiopatías Congénitas/complicaciones , Cardiopatías/cirugía , Insuficiencia Cardíaca/complicaciones , Enfermedades de las Válvulas Cardíacas/complicaciones , Humanos , Hipertensión/complicaciones , Enfermedades Pulmonares Obstructivas/complicaciones , Cuidados Posoperatorios , Cuidados Preoperatorios , Embolia Pulmonar/etiología , Síndrome de Dificultad Respiratoria/etiología , Choque/etiología , Procedimientos Quirúrgicos Operativos/efectos adversosRESUMEN
Seventy-five patients with chest pain due to prolonged myocardial ischemia (group I, n=45) or acute myocardial infaction (group II, n=30) were treated with continuous intravenous infusion of nitroglycerin. Pain relief was achieved immediately or after titration in 40 of 45 group I patients and 22 of 30 group II patients. Of the 29 group I patients who received narcotic analgesics for pain relief prior to the nitroglycerin infusion, 20 experienced a decrease in narcotics required for pain relief while intravenously receiving nitroglycerin. Twenty-four of 28 group I patients and 14 of 19 group II patients who had angina refractory to multiple doses of sublingual nitroglycerin received relief with intravenous administration of nitroglycerin. This data suggests that intravenous administration of nitroglycerin is useful, adjunctive therapy for chest pain even when refractory to multiple doses of sublingual nitroglycerin.
Asunto(s)
Angina de Pecho/tratamiento farmacológico , Nitroglicerina/administración & dosificación , Enfermedad Aguda , Presión Sanguínea/efectos de los fármacos , Enfermedad Coronaria/tratamiento farmacológico , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Infusiones Parenterales , Infarto del Miocardio/tratamiento farmacológicoRESUMEN
An echocardiographic correlate for a post-valvulotomy mid-systolic click is described. Simultaneous echocardiographic and phonocardiographic studies demonstrated that the click was temporally related to a sudden midsystolic posterior motion of part of the mitral valve apparatus. This temporal relationship suggests that the sudden change in position of portions of the mitral valve resulted in the loud midsystolic click. In our patient the sudden leaflet movement associated with the click was apparently a localized abnormality.
Asunto(s)
Ecocardiografía , Auscultación Cardíaca , Ruidos Cardíacos , Prolapso de la Válvula Mitral/diagnóstico , Válvula Mitral/cirugía , Adulto , Femenino , Humanos , Prolapso de la Válvula Mitral/etiología , Estenosis de la Válvula Mitral/cirugía , Complicaciones Posoperatorias/diagnóstico , Periodo PosoperatorioRESUMEN
The value of coronary bypass surgery has been studied carefully during the last decade. Four methods, none perfect, have been used to compare the results of such surgery with the results of medical therapy. New data are likely to be merely supportive rather than the outcome of a definitive study with a new and a acceptable experimental design. It is therefore time to analyze the available data in light of the treacherousness of the disease and to determine if a clear trend is evident. There appears to be sufficient evidence to state that properly performed coronary bypass surgery will increase coronary blood flow and relieve angina pectoris in 90 percent of patients; total relief of angina can be expected in 60 percent and partial relief in 30 percent. Compared with modern medical therapy, properly performed coronary bypass surgery appears to prolong the life of patients who have obstruction of the left main coronary artery or triple or double vessel disease. There is not adequate evidence to state that the procedure will prolong the life of patients with single vessel obstruction. However, patients with single vessel obstruction and unacceptable angina pectoris should be considered for bypass surgery (especially patients with obstruction of the left anterior descending coronary artery). In practice, at Emory University Hospital, Atlanta, bypass surgery is recommended for young people with few symptoms if compelling obstructing lesions are present and in older patients only if their symptoms require it. Medical therapy is given before and after bypass surgery. When bypass surgery is performed in an excellent fashion (operative risk 1 percent) a great deal of "controversy" about this problem vanishes.
Asunto(s)
Puente de Arteria Coronaria , Enfermedad Coronaria/mortalidad , Angina de Pecho/cirugía , Enfermedad Coronaria/tratamiento farmacológico , Muerte Súbita/etiología , Estudios de Evaluación como Asunto , Humanos , Esperanza de Vida , Estudios Retrospectivos , Estadística como Asunto , Factores de Tiempo , Estados Unidos , United States Department of Veterans AffairsRESUMEN
Four cases are presented of aortic root dissection after aortocoronary bypass surgery in which the origin of the intimal tear was at or very near the aortic site of saphenous vein anastomosis. Two cases were documented at autopsy. In one of two cases diagnosed with aortography, the patient underwent surgical correction and survived. All patients had long-standing severe hypertensive cardiovascular disease or severe generalized atherosclerotic disease, or both. Clinical awareness of aortic dissection after coronary bypass surgery in this group of patients should make early diagnosis with successful surgical correction feasible.
Asunto(s)
Aneurisma de la Aorta/etiología , Disección Aórtica/etiología , Puente de Arteria Coronaria/efectos adversos , Anciano , Angina de Pecho/cirugía , Aorta Torácica , Rotura de la Aorta/etiología , Arteriosclerosis/complicaciones , Humanos , Hipertensión/complicaciones , Masculino , Persona de Mediana Edad , Complicaciones PosoperatoriasRESUMEN
A patient had a ruptured ventricular septum due to an acute anterior myocardial infarction. An aortic balloon pump was inserted and a subsequent phonocardiographic study was made showing inflation and deflation sounds and the diastolic pulse wave generated. This study defines the extra sounds and pulses generated by such a device so that they may be better understood for clinical interpretation.
Asunto(s)
Circulación Asistida , Defectos del Tabique Interventricular , Contrapulsador Intraaórtico , Fonocardiografía , Anciano , Defectos del Tabique Interventricular/etiología , Defectos del Tabique Interventricular/cirugía , Humanos , Masculino , Infarto del Miocardio/complicacionesRESUMEN
This study of 24 women under age 40 years with myocardial infarction demonstrates that even in young women myocardial infarction is most commonly due to coronary atherosclerotic heart disease. Other causes of coronary occlusion were documented in 17% of these patients, indicating that these lesser causes of myocardial infarction are more common in young women than in older persons or in young men. In those patients with coronary atherosclerosis one or more significant risk factors could usually, but not always, be documented. The clinical manifestation of the coronary occlusion in the study group was not unlike its manifestation in groups of different ages or sex, or both.
Asunto(s)
Infarto del Miocardio/etiología , Adolescente , Adulto , Factores de Edad , Angiocardiografía , Arteriopatías Oclusivas/complicaciones , Arteriopatías Oclusivas/patología , Angiografía Coronaria , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/diagnóstico por imagen , Enfermedad Coronaria/etiología , Vasos Coronarios/patología , Femenino , Humanos , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/patología , Miocardio/patologíaAsunto(s)
Puente de Arteria Coronaria , Enfermedad Coronaria , Adulto , Anciano , Angina de Pecho/tratamiento farmacológico , Angina de Pecho/mortalidad , Angina de Pecho/cirugía , Puente de Arteria Coronaria/métodos , Puente de Arteria Coronaria/mortalidad , Enfermedad Coronaria/tratamiento farmacológico , Enfermedad Coronaria/mortalidad , Enfermedad Coronaria/cirugía , Electrocardiografía , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/tratamiento farmacológico , Infarto del Miocardio/mortalidad , Infarto del Miocardio/cirugía , Cuidados Posoperatorios , Cuidados Preoperatorios , Propranolol/uso terapéuticoRESUMEN
A patients is described with postinfarction ventricular septal defect in whom the perforation was successfully closed within 24 hours of septal rupture. This presents the second such case reported in the literature. Adjunctive measures consisting of myocardial revascularization and intracoronary infusion of mannitol were thought to be important in the successful outcome of the operative procedure. The importance of complete preoperative cardiac catheterization with coronary arteriography is stressed. The theoretical role of endothelial and myocardial cellular edema as a cause of depressed myocardial function immediately following an ischemic insult is proposed as a practical consideration in the high mortality associated with this condition. Methods used to prevent or reverse such cell swelling are described. The details of the operation in which viable ventricle myocardium was used to fill the septal defect are presented.