[Usefulness of early exercise test after anterior infarction in the diagnosis of multivessel disease]. / Utilidad de la prueba de esfuerzo precoz postinfarto anterior para detectar enfermedad multivaso.

OBJECTIVE: The aim of the present study was to determine the reliability of early exercise test to detect multivessel disease in survivors of an uncomplicated first anterior Q-wave myocardial infarction. METHODS: Among 100 consecutive patients 64 (aged 55 +/- 10 years) were included in the study. Thirty-four patients (53.1%) received thrombolytic therapy and this was considered successful, by means of non-invasive criteria, in 24 patients (37.5%). A standard symptom-limited exercise test, 11-15 days after myocardial infarction, and coronary arteriography, < 72 hours later, were performed in all patients. RESULTS: On exercise test 6 (9.3%) patients developed significant ST segment depression, 48 (75%) significant ST segment elevation, 5 (7.8%) ST depression in inferior leads together with ST elevation in anterior leads and 3 (4.6%) angina. Of the 18 patients with multivessel disease 5 (27.8%) developed ST depression, 10 (55.5%) ST elevation, 1 (5.5%) ST depression in inferior leads together with ST elevation in anterior leads and 1 (5.5%) angina. CONCLUSIONS: Our study indicates that ST depression in a symptom-limited exercise test performed early after an anterior Q-wave acute myocardial infarction is unusual and has low sensitivity (27.8%) to detect multivessel disease. ST elevation is the more common finding in this test (75%) and has no relation with the severity of CAD.

[Long-term follow up of Doppler parameters of ventricular diastolic function after myocardial infarct]. / Evolución a largo plazo de los parámetros Doppler de función diastólica ventricular tras un infarto del miocardio.

Forty-two survivors of a first transmural, noncomplicated myocardial infarction underwent mitral flow pulsed-Doppler studies both at predischarge time and 1 year later, in order to assess the long-term evolution of diastolic parameters in the absence of reinfarction or revascularization procedures. Results showed a decrease of mean value of E wave peak velocity (59.6 +/- 14 cm/sec vs 46.8 +/- 13 cm/sec, p < 0.001). Mean value of A wave peak velocity remained stable (59.4 +/- 16 cm/sec vs 58.8 +/- 13 cm/sec, p = 0.86). The mean value of the E/A ratio showed a significant decrease during follow-up from an initial value > or = 1 to a final value < 1 (1.08 +/- 0.4 vs 0.82 +/- 0.2, p < 0.01). From the point of view of individual results, only 8 of 22 patients with an E/A ratio > or = 1 before discharge presented the same ratio value 1 year later, whereas only 1 patient with a E/A ratio < 1 before discharge presented a > 1 value of this ratio in the late study. It is concluded that during the first year of evolution after transmural, nonrevascularized, noncomplicated infarction, the left ventricle filling pattern displays a significant change from predischarge phase (mainly protodiastolic with predominant E wave) to late follow-up (mainly telediastolic with predominant A wave). Different hypotheses to explain these results are discussed.

[Echocardiography during transesophageal atrial pacing. Its applicability and diagnostic value]. / Ecocardiografía durante la estimulación auricular transesofágica. Aplicabilidad y valor diagnóstico.

INTRODUCTION AND OBJECTIVES: Atrial pacing has been proposed as an alternative method to the isotonic exercise, to induce ischemia, and, joined to two-dimensional echocardiography, as one of the main modalities in stress echo. In order to analyse its applicability and diagnostic value in assessing coronary artery disease this study was undertaken. PATIENTS AND METHODS: 52 patients referred to coronarography for suspicion or evaluation of ischemic disease, were submitted to this technique. RESULTS: The study was completed in 44 patients (applicability rate of 84,7%). The results obtained showed a sensitivity, specificity and diagnostic accuracy for the regional wall motion abnormalities echocardiographically detected, of 88%, 68% and 79%, respectively. When electrocardiographic changes or presence of angina during atrial pacing were added to echocardiographic data, sensitivity increased to 96%. In 41 patients in which a conventional stress test was available, sensitivity was 55% electrocardiographically, 33% clinically and 68% globally. CONCLUSIONS: It is concluded that transthoracic two-dimensional echocardiography during atrial pacing is a safe, highly sensitive method for coronary artery disease detection. The limitations of the method for its routine clinical application are also analysed.

Transdermal scopolamine as treatment of bradyarrhythmias.

Fifteen patients with different degrees of chronic bradyarrhythmias of supraventricular origin were studied with Holter monitoring before and during application of a transdermal patch of scopolamine. No changes were found in the mean or minimal heart rates, standard deviation of the RR interval, or the degree of bradyarrhythmia. It is concluded that transdermal scopolamine is not an adequate treatment of chronic symptomatic bradyarrhythmias.

[Intravenous verapamil in hypertrophic myocardiopathy. A study using Doppler ultrasound]. / Verapamil intravenoso en la miocardiopatía hipertrófica. Estudio mediante ultrasonidos-Doppler.

The effect of one intravenous dose of verapamil on left ventricular diastolic and systolic flow was studied by Doppler-echocardiography in 31 patients with hypertrophic cardiomyopathy. On diastolic flow, verapamil induced a decrease in "a" wave velocity (1.02 + 0.37 vs 0.91 + 0.29 m/seg, p less than 0.01), and in its relation with maximal protodiastolic velocity (1.08 + 0.56 vs 0.89 + 0.37, p less than 0.01), and a shortening in the isovolumic relaxation period (0.076 + 0.031 vs 0.068 + 0.02, p less than 0.05). On the ejection flow, verapamil decreased the peak velocity (2.82 + 1.28 vs 2.42 + 1.18 m/seg, p less than 0.001). Nor age, sex, ventricular mass, gradient, neither hypertrophic cardiomyopathy's classification relates with changes after intravenous verapamil. There were no adverse effects. This study by Doppler-echocardiography confirms the beneficial ++ effect of intravenous verapamil in patients with hypertrophic cardiomyopathy not only on gradient reduction but also in the improvement on left ventricular diastolic function.

[Clinical study of a new anti-arrhythmic drug: propafenon. Short and long-term results]. / Estudio clínico de un nuevo fármaco antiarrítmico: propafenona.

Fifty patients with atrio-ventricular arrhythmias were treated with the new antiarrhythmic drug propaferon. A dose of 70 mg (1-1.5 mg/kg), was injected slowly into a vein (2-3 min), in 16 cases. In the other 34 cases a dose of 450-900 mg/24 hours was given orally. Propafenon is a drug which acts on the permeability of the membrane and also as a local anaesthetic. Its efficiency has been demonstrated in the treatment of arrhythmias. In our series, ventricular arrhythmias were suppressed in 76.8% of the cases (33 patients), while the ventricular extrasystoles were reduced in 18.6% of the cases (8 patients). There was no action in 4.6% of the cases (2 patients). The drug was not useful in the treatment of atrial arrhythmias. Unwanted side-effects (arterial hypotension, conduction disorders, etc.), were not seen when intravenous doses of less than 2 mg/kg, were administered. However, electrocardiographic changes (widening of the QRS, prolongation of the PQ interval, etc.), were observed in those patients who received doses greater than 450 mg/24 hours. In these patients, there was a close correlation between the dose administered and the prolongation between the dose administered and the prolongation of the conduction times. We believe that the amount of myocardial degradation and the age of the patient are directly related to the appearance of conduction disorders. This relation is greater when a larger dose is administered. The advantages that this new drug has over other antiarrhythmics are the methods of administration (oral and intravenous). Both these methods may be used simultaneously to maintain a stable sinus rhythm or the rapid intravenous method may be followed by the oral maintenance one.

[The influence of cardiac frequency on the hemodynamic consequences of mitral stenosis (author's transl)]. / Influencia de la frecuencia cardiaca en la repercusión hemodinámica de la estenosis mitral.

In eleven patients with isolated mitral stenosis and regular sinus rhythm a right cardiac catheterization was performed and the wedged pulmonary capillary pressure recorded at rest and during electrical pacing of the right atrium at successive frequencies of 100, 120, 140, and, occasionally, 160 and 180 beats/min, while cardiac output was estimated by the Fick's principle. In all cases a significant elevation of pulmonary capillary pressure with a simultaneous reduction in cardiac output was obtained. The rise of wedged pulmonary pressure was proportional to the increment in cardiac frequency and related also to the calculated area of the mitral valve. The influence of active atrial contraction upon pulmonary pressure and cardiac output is discussed and comparisons with other studies are made. Emphasis is made on the value of atrial pacing as a diagnostic method in mitral stenosis, especially in cases in whom classical effort manoeuvres can not be applied or are insufficient to rise cardiac frequency.