[The effect of myocardial infarct on the employment situation of patients]. / Impacto del infarto de miocardio en la situación laboral de los pacientes.

INTRODUCTION AND OBJECTIVES: The impact of acute myocardial infarction in labour activity changes from one country to another as well as patients' characteristics. Our purpose was aimed to learn the main demographic, professional, clinical and therapeutic variables which might affect the return to work after suffering a myocardial infarction in our environment. METHODS: 584 patients treated consecutively in our Coronary Unit for 4 years, aged under 65, were studied. The following aspects were analyzed: age, sex, previous ischaemic heart disease, previous working condition, professional level, economical area of labour activity, main therapeutic procedures and complications, number of days of sick leave, posterior labour status and date of invalidity or death, should it occur. The minimum follow up period was two years. RESULTS: 65.3% of patients were regularly working before suffering the myocardial infarction. Mean length of sick leave after myocardial infarction was 243.9 days although it changed according to age and economical areas. 56.6% of the patients returned to work according to age (odds ratio = 0.92), high professional status (odds ratio = 2.14), economical area of services (odds ratio = 2.03), and the presence of previous anginal attacks (odds ratio = 1.73). CONCLUSIONS: In our environment, patients less likely to resume their work after suffering a myocardial infarction are older, working in agricultural and industrial areas, with a lower professional level and without known ischemic heart disease antecedents.

[Early discharge in uncomplicated acute myocardial infarction]. / Alta precoz en el infarto agudo de miocardio no complicado.

INTRODUCTION AND OBJECTIVES: The length of hospital stay for uncomplicated myocardial infarction is still a debatable issue. Our study tries to establish the rate of patients amenable early discharged and the safety of this practice. PATIENTS AND METHODS: We studied retrospectively the clinical features, in-hospital events and 30-day follow up of 238 patients discharged early (5 or 6 days) during the last three years. These patients were compared with the remaining group of 929 patients discharged after a conventional stay (mean 10.4 days) in the same time frame. RESULTS: The mean hospital stay in the early discharged group was 5.4 days. They had no ischemic, arrhythmic or haemodynamic complications in the acute phase. In the 30-day follow up there was only one death (at the 14 th post-myocardial infarction day) and 17 readmissions to the hospital, none with re-infarction. By contrast, there were 14 deaths and 43 readmissions among the patients with the standard stay at the hospital. CONCLUSIONS: At least 20% of patients with uncomplicated myocardial infarction can be discharged early. This practice seems to be safe in low risk groups, and is not associated with a higher rate of complications when compared with longer hospital stays.

A new electrocardiographic approach to identify the coronary artery responsible for acute inferior myocardial infarction: a study in 100 patients.

OBJECTIVE: The objective of this study is to analyze the value of the electrocardiogram in the identification of the coronary artery responsible for acute inferior myocardial infarction. MATERIAL AND METHODS: One hundred consecutive patients with acute inferior myocardial infarction were studied, 67 with a lesion in the right coronary artery and 33 in the circumflex artery. The ST segment changes in the inferior, lateral, precordial and right-chest leads were analyzed, as well as the arithmetic sum of the ST segment in the inferior and V2 leads (II + V2, III + V-2 and aVF + V2). We also developed a diagnostic process based on a stepwise approach of three electrocardiographic criteria: a) elevation of the ST segment in DI; b) arithmetic sum of the ST magnitude in DIII + V2 < 0; c) depression of the ST segment in V4R. RESULTS: This study shows that the most useful parameters to predict (with a specificity of 100%) the lesioned coronary artery in acute inferior myocardial infarction are: a) the arithmetic sum of the ST segment: aVF + V2 > 0, for the right coronary artery; b) the arithmetic sum of the ST segment: III + V2 < 0, for the circumflex artery; c) the arithmetic sum of the ST segment: aVF + V2 > 1 mm, for the proximal right coronary artery. CONCLUSIONS: The incorporation of these three criteria in an algorithm diagnostic system allows us to locate the coronary artery responsible for acute myocardial infarction with 100% sensitivity and specificity.

Electrocardiographic diagnosis of the responsible coronary artery in acute inferior myocardial infarction through right chest leads V3R-V8R. A prospective study.

In order to identify the electrocardiographic changes that occur in right-chest leads V3R-V8R for the most significant diagnosis of the responsible coronary artery of acute myocardial infarction, the authors performed a prospective study on 66 patients in whom coronary arteriography was done between the first and twelfth weeks after suffering the infarction. Electrocardiograms were done within the first six hours after the onset of symptoms. Lesions of the right coronary artery were found in 46 patients--27 at a proximal level and 19 at a distal one--and in 20 patients the circumflex coronary artery was injured. The electrocardiographic findings were studied in 2 groups of leads: V3R-V4R and V5R-V8R. An ST elevation equal to or higher than 0.5 mm and the presence of Q waves in V3R-V4R are specific markers of lesions of the right coronary artery (P < 0.001). Lowering of the ST segment in V3R-V4R is a specific marker of a circumflex artery lesion (P < 0.001). An ST elevation equal to or higher than 1 mm in V3R-V4R is specific for a proximal lesion of the right coronary artery (P < 0.001). No specific marker for a lesion of the distal right coronary artery was identified, its more significant characteristic being an "isoelectrical" ST segment (between 0 and 0.4 mm), an rS morphology and positive T waves in V3R-V4R.

Diagnostic value of the arithmetic sum of the ST segment of inferior and V2 leads, II + V2, III + V2 and aVF + V2 in identifying the artery responsible for inferior acute myocardial infarction.

In order to evaluate electrocardiographic changes in the diagnosis of the artery responsible for inferior myocardial infarction, a prospective study was performed on inferior and V2 ST segment deviation and its correlation using the arithmetic sum: II + V2, III + V2, and aVF + V2. A group of 66 patients with inferior acute myocardial infarction (AMI) was studied. A standard 12-leads electrocardiogram was performed within six hours of the onset of chest pain. Coronary arteriography was performed on each of the patients between one and twelve weeks after infarction. Right coronary artery (RCA) lesion was found in 46 patients, 27 at a proximal level and 19 at a distal level; in 20 patients the left circumflex coronary artery was affected. The isolated value of the magnitude of the inferior ST segment is not an efficient parameter for identifying the artery responsible for inferior AMI. In lead V2 all the patients with a lesion of the left circumflex artery showed ST segment depression > or = 1 mm (P < 0.001) and all those presenting ST segment elevation had stenosis of the proximal RCA. The most useful parameters for identifying the artery responsible for inferior AMI, with 100% specificity are: (1) for occlusion of the RCA, the arithmetic sum of ST segments: aVF + V2 > 0, with 86.9% sensitivity (P < 0.001); (2) for occlusion of the left circumflex artery III + V2 < 0, with 90% sensitivity (P < 0.001); and (3) for proximal occlusion of the RCA: aVF + V2 > or = 1, with 96.2% sensitivity (P < 0.001). No specific marker was observed for distal occlusion of the RCA. The value of the arithmetic sum of the ST segment: III + V2 between 0 and 0.9 was the most significant, with 94.7% sensitivity and 95.7% specificity (P < 0.001).

[Mitral insufficiency caused by isolated rupture of the papillary muscle secondary to blunt thoracic trauma]. / Insuficiencia mitral por rotura aislada de músculo papilar secundaria a traumatismo torácico cerrado.

We report a patient suffering from mitral insufficiency after isolated rupture a papillary muscle as a result of a car accident with blunt chest trauma. The diagnosis is often difficult due to related multiple lesions which vary the clinical picture. Physical exploration, electrocardiogram, enzymatic and nuclear scan lack adequate sensitivity and specificity. Echocardiography appears to be the most reliable noninvasive diagnostic method now available.

[Depression and elevation of the ST segment in the V4R lead during the stress test of a patient with a proximal lesion of the right coronary artery]. / Descenso y elevación del segmento ST en la derivación V4R durante la prueba de esfuerzo de un paciente con lesión proximal de la arteria coronaria derecha.

We report a patient with a proximal right coronary artery lesion in whom opposite shifts of ST segment in V4R lead were observed during and after exercise. ST-segment depression was provoked by exercise, while ST-segment elevation appeared in the recovery phase. We speculate that different degrees of myocardial ischemia (non-transmural vs transmural) may explain this apparently paradoxical response.