RESUMO
Although intracoronary thrombus formation plays a major role in acute transmural myocardial infarction (MI), its occurrence in unstable angina (UA) and nontransmural MI has not clearly been established. To determine whether intracoronary thrombus does occur in these syndromes, coronary arteriography was performed before, during, and after intracoronary nitroglycerin and streptokinase infusion in 17 patients. None of the 8 patients with nontransmural MI and 1 of the 9 patients with UA responded to intracoronary nitroglycerin. Seven of 8 patients with nontransmural MI and 4 of 9 patients with UA responded to streptokinase infusion with opening of an occluded vessel, an increase in stenotic diameter, dissolution of an intracoronary filling defect, or a combination of these. Serial opening and closing of ischemia-related vessels occurred spontaneously and in response to streptokinase in some patients in whom thrombolysis was demonstrated. Evidence of thrombolysis was not seen in any patient studied longer than 1 week from the onset of the rest pain syndrome. The finding of thrombolysis in several patients with nontransmural MI and UA suggests that intracoronary thrombus formation plays a pathogenetic role in some patients with these ischemic syndromes.
Assuntos
Angina Pectoris/etiologia , Doença das Coronárias/complicações , Infarto do Miocárdio/etiologia , Adulto , Idoso , Angiografia Coronária , Doença das Coronárias/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nitroglicerina/uso terapêutico , Estreptoquinase/uso terapêuticoRESUMO
Evaluation of a patient with tachycardia upon swallowing offers evidence of its origin from the left atrium. The tachycardia appears to arise from an automatic focus discharged after mechanical stimulation by the esophagus. Despite a left atrial origin for this arrhythmia, it does not fulfull previously described electrocardiographc criteria for "left atrial rhythms."
