Clinical logistics in treadmill exercise stress testing.

The predictability as to a positive or negative outcome of treadmill exercise stress testing in 341 consecutively studied patients referred for diagnostic purposes is presented. A clinical decision as to the result was derived by asking 2 simple questions and reviewing the pretest ECG. Additional clinical logistics included the type of physician ordering the study, smoking history, symptoms, and basic patient history. The predictable accuracy was 77.7% for the total patient group and 81.5% when the questionable cases (reflecting a neutral or ambivalent cardiologist's opinion) were eliminated.

Acute myocardial infarction secondary to coronary vasospasm during withdrawal from industrial nitroglycerin exposure--a case report.

Industrial exposure to nitrates is known to produce acute and chronic effects on the cardiovascular system. A case of acute inferior myocardial infarction in a young, otherwise healthy, white male that occurred during the usual weekend withdrawal period is presented.

Severe postoperative hemorrhage attributed to single-dose parenteral ketorolac-induced coagulopathy.

Ketorolac is a nonsteroidal antiinflammatory drug that has been used as a postoperative analgesic since its introduction in the US in 1990. Although hemorrhagic side effects secondary to its use have been consistently described in the medical literature, its attendant complications have been commonly unappreciated by the medical profession. Two catastrophic, near-fatal, hemorrhagic postoperative events are described in which the use of ketorolac was unquestionably contraindicated.

Errors of computer electrocardiography.

A review of 6938 computer-generated electrocardiogram interpretations was undertaken by a single cardiologist. The computer-assisted program correctly interpreted 51.6% of the tracings. One or more corrections were necessary in 48.4%. The greatest number of incorrect interpretations involved repolarization (T wave) abnormalities, followed by ST segment changes. It is mandatory that computer-generated ECG interpretations be reviewed by an experienced electrocardiographer. Reliance on nonreviewed ECG interpretations may result in incorrect diagnoses that could lead to inappropriate management decisions.

Cholestyramine therapy for quinidine-induced diarrhea. Case reports.

The effective use of quinidine as an antiarrhythmic agent is frequently curtailed by one of its most common side effects-relentless diarrhea. Seven patients are described in whom diarrhea was quickly and completely controlled by the use of cholestyramine resin. To date, this is the only therapy reported to be effective for this purpose. It has proven to be safe, well tolerated, and continuously effective in these cases.