Echocardiographic prediction of the final event in patients dying of acute myocardial infarction.

From an autopsy series of 346 patients who died of acute myocardial infarction, we selected 36 cases for whom echocardiographic data preceding death were available: 17 cases died from a rupture of the left ventricular free wall (group A) and 19 from pump failure (group B). Our aim was to investigate whether any echocardiographic parameter could predict the final event. The total wall motion score, regional wall motion score index and percent of abnormally contracting myocardium were calculated. Diastolic and systolic volumes, ejection fraction and the eccentricity index, as a rough indicator of the left ventricular shape, were also estimated. Interventricular septum and posterior wall thicknesses were also measured. All measured parameters were similar in both groups except posterior wall thickness. Even though an unavoidable selection bias is present in our series, we failed to identify any echocardiographic predictor of the final event in this patient group.

[ST segment elevation after elective electric cardioversion]. / Sopraslivellamento del tratto ST dopo cardioversione elettrica elettiva.

From a group of 142 patient with atrial fibrillation or atrial flutter treated with DC shock, we selected 5 cases who showed a marked ST segment elevation immediately after electrical cardioversion. Only two patients, who received high voltage DC shock (950 and 1220 Joules) revealed prolonged and significant increase of CPK values. Our data suggest that ST segment transitory elevation after DC shock should probably not be considered a sign of myocardial injury even though this could be the case when high voltage DC shocks are used.

[Fibrinolysis and hemorrhage after streptokinase in acute myocardial infarct]. / Fibrinolisi ed emorragie dopo streptokinasi in corso di infarto miocardico acuto.

The purpose of this study is to analyze the relationship between occurrence of hemorrhagic complications, kinetic of fibrinogen degradation-regeneration and the changes of prothrombin time (PT), partial thromboplastin time (PTT), after intravenous administration of Streptokinase (SK), 1.500.000 U., in acute myocardial infarction. 45 selected patients with acute myocardial infarction had pretreatment analysis and serial post-SK measurement of fibrinogen levels, PT, PTT (for 48 hours). Basal fibrinogen levels were 3.2 g/l and displayed significant depression for 18 hours (0.30-0.46 g/l) and normalization after 30 hours from SK infusion. Similar behaviour showed PT and PTT. Minor bleeding was identified in 25 patients. In bleeders mean fibrinogen levels, PT, PTT before and maximum changes after SK were not significantly different compared with non bleeders. We conclude that SK infusion produces important and prolonged changes of fibrinogen levels, PT, PTT; hemorrhagic risk is not related, however, to the extent of lytic state, but probably to pre-existent vascular derangement, predisposing to bleeding complications during fibrinolytic therapy. Therefore we believe to be prudent to delay the infusion of heparin for 12-18 hours after SK administration, when fibrinogen levels are beginning to increase.

[Equilibrium angioscintigraphic evaluation of sequential changes in right ventricle function in patients with lower myocardial infarct and ischemic co-involvement of the right ventricle: long-term study]. / Valutazione angioscintigrafica all'equilibrio delle variazioni sequenziali della funzione ventricolare destra in pazienti con infarto miocardico inferiore e coinvolgimento ischemico del ventricolo destro: studio a lungo termine.

The purpose of this study was to define the sequential changes in global and regional right ventricular function, using equilibrium gated radionuclide angiography, following transmural inferior myocardial infarction (IMI) and associated ischemic right ventricular involvement. 24 patients with IMI underwent radionuclide angiography within 72 hours of onset of chest pain; subsequent studies were done at 13 +/- 5 days and at 6 +/- 2 months. Scintigraphic evidence of ischemic right ventricular involvement was defined by depression of right ventricular ejection fraction (less than 40%) and regional wall motion abnormalities (hypo-a-dyskinesia of right ventricular free wall). Significant improvement of global right ventricular ejection fraction was observed in 15 patients at the second study, and in 21 patients at the third study. Right ventricular regional wall motion showed similar improvement from the initial to the final studies. Significant changes in right ventricular function occurred without concurrent changes in global and regional left ventricular ejection fraction. We concluded that patients with IMI and ischemic right ventricular involvement show frequently improvement of global and regional right ventricular function over time. This changes tend to occur early and without significant modifications in left ventricular function. The good prognosis observed in our patients, despite the high incidence of in hospital complications, might be related to the improvement of right ventricular function.

[Isolated right ventricular infarct. Description of a case]. / L'infarto ventricolare destro isolato. Descrizione di un caso.

We report a case of extensive isolated right ventricular infarction, which was the result of proximal occlusion of a small right coronary artery in a dominant left coronary arterial system. The diagnosis and treatment of right ventricular infarction are discussed and the literature is reviewed.

Large right atrial thrombosis. Rare complication during permanent transvenous endocardial pacing.

Right atrial thrombosis is a rare complication of permanent endocardial pacing. We report two cases with large right atrial thrombi which occurred during permanent endocardial electrical stimulation. Both patients were women, aged 83 and 89 years, who died suddenly, respectively, one month and 24 days after pacemaker implantation. At the time of death the two patients were in severe persistent refractory congestive heart failure despite appropriate medical treatment. At necropsy large mobile right atrial thrombi were found in both cases.

[Anomalous origin of the right coronary artery from the main pulmonary artery. Report of the case (author's transl)]. / Origine anomala dell'arteria coronaria destra dal tronco dell'arteria polmonare. A proposito di un caso.

A case of anomalous origin of the right coronary artery from the main pulmonary artery in a 22 y.o. female is reported. The patient underwent successfully surgical correction by reimplantation of the anomalous vessel to the ascending aorta. The literature has been reviewed; the clinical features, the surgical approach and technique are described.