RESUMO
The choice therapy of malignant pericardial effusion is controversial. Pericardiocentesis is usually successful in alleviating tamponade, but unfortunately, that tamponade recurs frequently and patients are then again exposed to a critical situation and need hospitalization. Several different approaches have been advocated in order to prevent reaccumulation of the pericardial fluid, most of them quite cumbersome. We present our experience with intrapericardial administration of cisplatin. There were 6 patients, and the primary tumor was breast carcinoma in 2, lung in 1, ovary in 1, mediastinal fibrosarcoma in 1, and unknown in 1. Administration of cisplatin was virtually uneventful and painless, and there were no recurrences, with a survival of 2 to 18 months (mean 5.6).We conclude that intrapericardial cisplatin is safe and effective in treating malignant pericardial tamponade and preventing recurrence.
Assuntos
Antineoplásicos/uso terapêutico , Tamponamento Cardíaco/tratamento farmacológico , Tamponamento Cardíaco/etiologia , Cisplatino/uso terapêutico , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/tratamento farmacológico , Derrame Pericárdico/tratamento farmacológico , Derrame Pericárdico/etiologia , Adulto , Idoso , Feminino , Neoplasias Cardíacas/secundário , Humanos , Masculino , Pessoa de Meia-Idade , PericárdioRESUMO
Tobacco smoking is a strong independent factor for atherosclerotic disease, equivalent to hypertension or high cholesterol levels. Middle age people are especially involved, with a mortality rate of about 20% as a consequence of smoking, and a mean loss of life expectancy of 20 years. There is a positive correlation between smoking and severity of atherosclerotic disease in the coronary and cerebral arteries, and the aorta. It has been shown that smoking cessation clearly enhances the prognosis of patients with myocardial infarction. Twice a increase in mortality rate has been found among nonstopping smokers compared with those who stopped smoking eight years after myocardial infarction. In addition, progression of atherosclerosis as shown by angiography is slowed by stopping to smoke. As the coronary risk factors act in a synergistic way, a comprehensive approach to the patient is recommended, especially in smokers with myocardial infarction. It is justified an intensive intervention because of the advantages in this population. The physician should clearly communicate to the patient the need of stopping to smoke, which carries sometimes as beneficial effects as other interventions. A wise use of replacement therapy with transdermal nicotine, together with other useful measures, allows us to manage patients with a broad margin of safety, especially in coronary patients, who win most benefit from ceasing to smoke.
Assuntos
Isquemia Miocárdica/prevenção & controle , Abandono do Hábito de Fumar , Prevenção do Hábito de Fumar , Doença da Artéria Coronariana/etiologia , Doença da Artéria Coronariana/prevenção & controle , Humanos , Pessoa de Meia-Idade , Infarto do Miocárdio/prevenção & controle , Prognóstico , Fatores de Risco , Fumar/efeitos adversos , Fumar/fisiopatologia , Abandono do Hábito de Fumar/métodosRESUMO
BACKGROUND: The pattern of left ventricular filling by Doppler examination is frequently abnormal in myocardial infarction. PURPOSE: To relate the different patterns of left ventricular filling to the clinical course of acute myocardial infarction. PATIENTS AND METHODS: We have studied 133 patients with acute myocardial infarction. Three different patterns of mitral flow were defined by Doppler examination: Type I has an E/A ratio lesser than one, and a deceleration time of the E wave longer than 180 ms; Type II has either an E/A ratio greater than one or a deceleration time shorter than 180 ms; Type III has an E/A ratio greater than 1.6 and a deceleration time shorter than 180 ms. We also determined the pulmonary wedge pressure through a pulmonary artery catheter simultaneously with the Doppler examination on 22 occasions in 11 patients. RESULTS: Mortality rate was 13%, 9% and 35% respectively in Type I, II and III (P=0.007). After logistic regression analysis of determinants of death, including all eight variables related with mortality on an univariate analysis, only Killip class and the presence of a Type III pattern of the mitral flow remained significant (P=0.0004 and P=0.019 respectively). Pulmonary wedge pressure was 8.4+/-6.1 mmHg in Type I, 21.0+/-7.3 mmHg in Type II, and 22.4+/-7.1 mmHg in Type III (P=0.0017). CONCLUSION: Type III pattern of left ventricular filling is an independent predictor of death. Type I and II had no significant differences on prognosis. Type I is associated with a normal pulmonary wedge pressure.
Assuntos
Infarto do Miocárdio/fisiopatologia , Disfunção Ventricular Esquerda/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Ecocardiografia Doppler , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infarto do Miocárdio/complicações , Infarto do Miocárdio/tratamento farmacológico , Variações Dependentes do Observador , Prognóstico , Pressão Propulsora Pulmonar , Terapia Trombolítica , Disfunção Ventricular Esquerda/diagnóstico por imagemRESUMO
We analyzed the transmitral flow pattern on admission in 95 patients with acute myocardial infarction. Nineteen patients had a restrictive pattern, defined as a peak early to peak atrial filling wave ratio greater than 1.6, plus an early wave deceleration time shorter than 180 ms. Restrictive pattern, compared with nonrestrictive one, was associated with the development of heart failure (42 versus 11%, p = 0.001) and greater in-hospital mortality (32 versus 7%, p = 0.002). After multivariate analysis, it remained significantly predictive of death (p = 0.028). We conclude that a restrictive pattern of left ventricular filling in patients with acute myocardial infarction is an independent predictor of early outcome.
Assuntos
Cardiomiopatia Restritiva/diagnóstico por imagem , Ecocardiografia Doppler , Hemodinâmica/fisiologia , Valva Mitral/diagnóstico por imagem , Infarto do Miocárdio/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo/fisiologia , Cardiomiopatia Restritiva/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Infarto do Miocárdio/fisiopatologia , Prognóstico , Função Ventricular Esquerda/fisiologiaRESUMO
A 15-year-old-female admitted after ingesting 5 milligrams of digoxin, presented atrial tachycardia with 2.0 degree atrioventricular block and frequent ventricular premature complexes. Serum digoxin determination at admission was 16 ng/ml. Two hours following the administration of 2 amp of Fab antidigoxin (160 milligrams) the arrhythmias disappeared and remained asymptomatic until discharge.
Assuntos
Digoxina/imunologia , Digoxina/intoxicação , Fragmentos Fab das Imunoglobulinas/administração & dosagem , Adolescente , Digoxina/sangue , Eletrocardiografia , Feminino , Humanos , Intoxicação/diagnóstico , Intoxicação/terapia , Tentativa de SuicídioRESUMO
We analyzed the significance of the initial electrocardiogram on the clinical outcome of 205 consecutive patients with a first myocardial infarction. Three different patterns of the electrocardiogram were defined: (A) Tall symmetric T waves in the involved leads; (B) ST segment elevation > 0.1 mV in two or more adjacent leads; and (C) ST segment elevation together with distortion of the terminal portion of the QRS complex in two or more adjacent leads. Twelve patients were considered to have an initial 'A' electrocardiogram, 151 an initial 'B' electrocardiogram, and 42 an initial 'C' electrocardiogram. Four factors were significantly related to mortality: age, ST, Killip class and electrocardiographic pattern. The mortality rate was 0% in group A, 7.9% in group B, and 26.2% in group C (P = 0.0019). Patients with type C electrocardiograms had a significantly worse Killip classification and a significantly higher sum of ST segment elevation. Among patients with inferior infarction, the mortality rate was 1.4% in type B vs. 24.1% in type C (P = 0.0005). Among patients with anterior infarction, the mortality rate was 13% in type B vs. 30.8% in type C (P = 0.089). We conclude that the pattern of the initial electrocardiogram is a strong predictor of outcome in acute myocardial infarction, especially if it is inferior.
Assuntos
Eletrocardiografia/classificação , Infarto do Miocárdio/fisiopatologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Previsões , Bloqueio Cardíaco/fisiopatologia , Humanos , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/classificação , Infarto do Miocárdio/tratamento farmacológico , Variações Dependentes do Observador , Prognóstico , Edema Pulmonar/fisiopatologia , Taxa de Sobrevida , Terapia Trombolítica , Resultado do TratamentoRESUMO
A 54 years-old man with a history of migraine, suffered from chest pain together with ST-segment elevation related to the intake of drugs against migraine attacks. The coronary arteriography showed normal coronary arteries. We suggest coronary artery spasm as the most probable cause of ischemia. We conclude that vasoactive drugs against migraine must be utilized with caution, or even avoided in patients with chest pain suggestive of myocardial ischemia.
Assuntos
Angina Pectoris Variante/induzido quimicamente , Ergotamina/efeitos adversos , Transtornos de Enxaqueca/tratamento farmacológico , Vasoconstritores/efeitos adversos , Acetaminofen/administração & dosagem , Analgésicos não Narcóticos/administração & dosagem , Angina Pectoris Variante/diagnóstico , Combinação de Medicamentos , Ecocardiografia , Eletrocardiografia , Ergotamina/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Supositórios , Vasoconstritores/administração & dosagemRESUMO
We analyze the influence of age in the evolution of patients with acute myocardial infarction admitted to our Coronary Care Unit throughout two years (1990 and 1991). All 542 patients admitted during this period were classified in three groups: 299 less than 65 year old (group A), 170 between 65 and 74 year old (group B), and 73 with 75 year old or more (group C). Aged patients had a worse clinical condition, with significantly more previous heart failure, diabetes or hypertension, and the Killip's class was worse in group C than in group B, and worse in this than in group A (p = 0.00000). The mortality rate was 6.7% in group A, 12.9% in group B, and 31.5% group C (p = 0.00000). After a multivariate analysis, only three factors were significantly associated to prognosis: previous stroke, Killip's class, and group of age. Fibrinolytic therapy and coronary arteriography were less frequent with old people (p = 0.00000 and p = 0.00000 respectively). We conclude that age is an independent factor of prognosis during myocardial infarction. Old people have a worse clinical condition and the treatment is less aggressive than in young people.
Assuntos
Infarto do Miocárdio/mortalidade , Fatores Etários , Idoso , Distribuição de Qui-Quadrado , Feminino , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/classificação , Infarto do Miocárdio/diagnóstico , Prognóstico , Fatores de Risco , Espanha/epidemiologiaRESUMO
Seven patients with ongoing angina with ST-segment elevation, refractory to oral nifedipine and intravenous nitroglycerin, were treated by adding intravenous beta-blockers. Chest pain resolved in all of them in a few minutes, and myocardial infarction did not develop in 5 patients. We recommend this approach for patients to whom thrombolytics are contraindicated or have been very recently administered, although further investigation is needed to extend its application more widely. It does not preclude the use of other therapies, if considered necessary.
Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Angina Pectoris/tratamento farmacológico , Infarto do Miocárdio/prevenção & controle , Nitroglicerina/uso terapêutico , Antagonistas Adrenérgicos beta/administração & dosagem , Adulto , Angina Pectoris/diagnóstico , Contraindicações , Quimioterapia Combinada , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Nitroglicerina/administração & dosagem , Terapia TrombolíticaRESUMO
Puncture of a femoral artery for left heart catheterization is considered a relative contraindication for thrombolytic therapy for some days. We treated 9 patients with systemic thrombolysis who had undergone left heart catheterization in the previous hours. Four patients developed a large hematoma, but only 1 required transfusion. We suggest that thrombolytic therapy can be administered soon after left heart catheterization by the femoral approach, provided that continuous care can be taken over the puncture site.
Assuntos
Cateterismo Cardíaco , Hematoma/induzido quimicamente , Infarto do Miocárdio/tratamento farmacológico , Estreptoquinase/efeitos adversos , Ativador de Plasminogênio Tecidual/efeitos adversos , Ativador de Plasminogênio Tipo Uroquinase/efeitos adversos , Adulto , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
A young patient with systemic lupus erythematosus was admitted to our hospital because of acute myocardial infarction, and treated by thrombolysis. Coronary angiography revealed a significant stenosis of the left anterior descending artery, together with an intraluminal thrombus. Clotting studies demonstrated an anticoagulant factor suggestive of lupus erythematosus. We conclude that thrombolytic therapy can be useful in patients with systemic lupus erythematosus who present with acute myocardial infarction, although some caution is needed in treatment.