[Temporal electric stimulation and right ventricular extension in acute postero-inferior myocardial infarction. Influence on clinical characteristics and prognosis]. / Estimulación eléctrica temporal y extensión ventricular derecha en el infarto agudo de miocardio postero-inferior. Influencia sobre las características clínicas y el pronóstico.

In 386 patients with acute inferior myocardial infarction (AIMI) who were admitted to our institution from 1984 to 1990, temporary pacemaker (TP) was required in 34 patients (9%) due to disturbances in the genesis and/or conduction of the electric stimulus (Group I). The remainder, 352 AIMI, conform the Group II. Each group was divided into groups depending on the presence (Groups Ia and IIa) or absence (Groups Ib and IIb) of right ventricular necrosis (ECG criteria: ST elevation greater than 0.1 mV in a V3r and V4R). Clinical data (cardiovascular risk factors, history of myocardial infarction or angina, CPK and CK-MB peak, Killip class, atrioventricular block and right ventricular infarction) and hospital mortality rate and its cause were analyzed. The Group I patients related to Group II had significantly higher diabetes rate (p less than 0.01), CPK and CK-MB peak (p less than 0.001), Killip class (p less than 0.001), right ventricular involvement and atrioventricular block (p less than 0.001), the mortality rate equally was statistically higher (Group I, 11 patients, 31%, versus group II, 38 patients, 11%) (p less than 0.001). The Group Ia patients related to Group Ib had a higher CPK and CK-MB peak (p less than 0.001), Killip class and atrioventricular block (p less than 0.001). The mortality rate was statistically equal. The group IIb patients related to Group IIb patients had a higher CPK and CK-MB peak (p less than 0.001), without differences in the mortality rates.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical and prognostic implications of age in acute myocardial infarct]. / Implicaciones clínicas y pronósticas de la edad en el infarto agudo de miocardio.

The purpose of this study was to evaluate the clinical characteristics and the factors related to early mortality in the acute myocardial infarction of the geriatric population. We studied 814 consecutive patients with their first acute myocardial infarction admitted to the coronary care unit at tha Hospital General de Galicia. 401 patients were older than 65 years (Group A) and 413 were younger (Group B). Group A was found a significantly lower percentage of males (64.7% versus 88.4%; p less than 0.001) and smokers (46.7% versus 72.7%; p less than 0.001; and older patients showed a greater incidence of diabetes mellitus (28.1% versus 15.2%; p less than 0.001) and arterial hypertension (45.6% versus 31.7%; p less than 0.01). In the geriatric population, the clinical course of the acute myocardial infarction is characterized by a greater incidence of heart failure (35.3% versus 11.1%; p less than 0.001), cardiogenic shock (18% versus 5.7%; p less than 0.001) and post-acute myocardial infarction angina pectoris (18.3% versus 12.2%; p less than 0.05). Early mortality (first month) was significantly higher in elderly patients (22.7% versus 6.3%; p less than 0.001). The multivariate analysis by stepwise logistic regression identified cardiogenic shock, age and heart failure as the only independent predictive variables for early mortality. We conclude that early mortality in the acute myocardial infarction is high and related to severe degrees of pump failure and age.

[Images of magnetic resonance and computerized axial tomography in a case of subacute post-myocardial infarct heart rupture]. / Imágenes de resonancia magnética y tomografía axial computadorizada en un caso de rotura cardíaca subaguda postinfarto de miocardio.

In a patient with clinical and hemodynamic criteria of cardiac tamponade, during the acute phase of myocardial infarction, a two dimensional echocardiographic study showed pericardial effusion with an echo-dense mass in the pericardial space. Subacute ventricular free-wall rupture diagnosis was suspected. A cardiac computerized tomography (CT) and magnetic resonance (MR) study was made. CT showed an elevated density (32 HU) of pericardial effusion suggesting hemopericardium. RM imaging showed a very high and homogeneous signal in the pericardial space consistent with a methemoglobin phase clot. Anatomic confirmation was not possible.

[40 years' experience in the surgical treatment of constrictive pericarditis]. / Cuarenta años de experiencia en el tratamiento quirúrgico de la pericarditis constrictiva.

In order to know early and late results of pericardiectomy on the treatment of chronic constrictive pericarditis in the Instituto Nacional de Cardiología Ignacio Chávez, we review the records of 58 patients with the diagnosis of constrictive pericarditis who underwent surgical treatment between 1947 to 1987. Tuberculosis was the most frequent cause (68.3%) followed by idiopathic cases (24.1%). Preoperatively 3.4% were in New York Heart Association Class I, 31% in Class II, 48.3% in Class III and 17.2% in Class IV. There were 4 in-hospital deaths (overall operative mortality 6.89%). Operative mortality in the last ten years was 0%. Low output was the most common nonfatal complication of pericardiectomy (15.5%). Accidental right atrial tear happened in 8.6%. Mean post-operative follow-up was 5.6 +/- 6.3 years (longest 25.6 years). Mortality per patient year was 2.04%. Actuarial survival estimates were 82% and 71% at 5 to 10 years respectively. Postoperatively 76% were in New York Heart Association Class I (p less than 0.001), 16% in Class II (p less than 0.001), 8% in Class III (p less than 0.001) and none in Class IV (p less than 0.05). Operative mortality, long-term survival and post-operative functional Class were not significantly influenced by preoperative functional Class nor by the duration of symptoms. We conclude that pericardiectomy is an effective treatment of symptomatic chronic constrictive pericarditis because it provides an important and durable improvement in symptoms and functional Class, and it has a low operative mortality.

[Electrocardiographic aspects of right ventricular repolarization in interauricular septal defect]. / Aspectos electrocardiográficos de la repolarización ventricular derecha en la comunicación interauricular.

In order to know the value of a peculiar right ventricular repolarization in the diagnosis of atrial septal defect. We studied-one hundred patients with main right bundle branch block and atrial septal defect confirmed by cardiac catheterization. The peculiar right ventricular repolarization consist in a straight and long S-T segment (longer than 160 msc) that form a 60 degrees or greater angle with the ascendent branch of the T wave. This electrocardiographic sign was found in 82 patients (sensitivity 82%). There were no differences between the age groups or the pulmonary pressure levels. In sixty five patients with main right bundle branch block without atrial septal defect, this peculiar right ventricular repolarization was investigated. It was found in fourteen cases (specificity 78.4%). Positive predictive value was 85.4%, negative predictive value 73.9% and diagnostic efficiency 80.6%. When the atrial septal defect was repaired (76 patients), the peculiar right ventricular repolarization disappeared in 87.7% of the cases (p less than 0.0001). It can be concluded that the peculiar right ventricular repolarization, in presence of main bundle branch block supports the diagnosis of atrial septal defect.

[Value of the DI and AVL leads in the diagnosis of infarction of the right ventricle]. / Utilidad de las derivaciones DI y AVL en el diagnóstico del infarto del ventrículo derecho.

The present study attempts to analyze the sensitivity and specificity of the S-T segment depression in I and a VL leads in the diagnosis of postero-inferior myocardial infarction with right ventricular extension. Thirty four specimens from autopsies performed in the Instituto Nacional de Cardiología Ignacio Chávez with histopathological evidence of postero-inferior myocardial infarction, with an adequate clinical, enzymatic and electrocardiographic documentation were studied. In 23 the postero-inferior myocardial infarction had extended to the right ventricle (group I) and in ll only left ventricle was involved (group II). There were not significative differences in severity and extension of coronary obstructions between the two groups studied. Sensitivity of S-T segment depression in DI lead ad diagnosis of right ventricular extension had 82.6%, specificity 90.9%, positive predictive value 95%, negative predictive value 71.4% and diagnostic efficiency 85.2%. Sensitivity of S-T segment depression in a VL lead as diagnostic of right ventricular extension was 91.3%, specificity 81.8%, positive predictive value 91.3%, negative predictive value 81.8% and diagnostic efficiency 88.2%.

[Long-term course of infarct of the right ventricle]. / Evolución a largo plazo del infarto del ventrículo derecho.

The long-term evolution of 36 patients surviving the phase of hospitalization after a postero-inferior infarction with extension to the right ventricle was studied. Patients included 7 women and 29 men with a mean age of 55 years. Follow-up time averaged 39 months (range: 4 to 78 months). The evolution of acute phase was analyzed and correlated with mortality, complications and long-term evolution of functional capacity. Mortality at the end of follow-up period was 5.5%. Five patients developed another myocardial infarctions (16%). No patient manifested right heart failure; in one case tricuspid regurgitation was evident. The majority of the patients (55.5%) were in functional class I of the NYHA, while 36.6% were in class II and 8.3% in class III. We conclude that long-term mortality of those patients with right ventricular infarction is not greater than that of other patients with myocardial infarction, and that the great majority have a favorable evolution in regard of functional capacity. Impared function is generally due to left ventricular failure secondary to the severity and extension of coronary lesions. The subgroup of patients with severe right ventricular dysfunction during the acute phase of the infarction did not have a worse long-term prognosis.