Symptomatic sinus node dysfunction after heart transplantation.

When donor hearts are studied systematically after transplantation, by programmed electrical stimulation, sinus node dysfunction has been found to be common though data regarding symptoms related to this phenomenon are not available. In this case report we describe a heart transplant recipient who experienced serious symptomatic sinus node dysfunction associated with transient atrial fibrillation 17 days after cardiac transplantation; there was no evidence of donor heart rejection. Intracardiac electrophysiology testing confirmed sinus node dysfunction of the donor heart, but only with relatively rapid atrial pacing rates.

Acute myocardial infarction: period prevalence, case fatality, and comparison of black and white cases in urban and rural areas of South Carolina.

Community surveillance revealed 1085 prevalent cases of acute myocardial infarction (AMI) during 1978 in urban metropolitan Columbia and rural Pee Dee areas of South Carolina. Six hundred fifty-eight hospitalized cases met our criteria and were classified as definite or probable. Death certificates identified 427 who died before admission to the hospital and who were classified as unvalidated. However, there is need to verify death certificate diagnosis in out-of-hospital deaths which account for approximately two thirds of total cases in blacks and about one third of white cases. Other findings were: White males had higher AMI rates in the rural Pee Dee area than in urban Columbia, while black males and black females had higher rates in Columbia than in the Pee Dee area and white females had similar rates in both areas. Rates for out-of-hospital AMI mortality were higher in blacks than in whites. Out-of-hospital AMI mortality rates in Columbia and the Pee Dee area were four times higher than in Minneapolis-St. Paul in 1978. For definite and all criteria AMI, white males had the highest rates, double the black male rate except for all criteria AMI in Columbia, where white male and black male rates were similar. Urban cases of both races experienced more anterior infarctions than rural cases.

Full recovery from severe orthostatic hypotension after vacor rodenticide ingestion.

A patient who had severe orthostatic hypotension secondary to ingesting Vacor, a rodenticide containing N-3 pyridilmethyl-N'-nitrophenyl urea (PNU), fully recovered from this initially disabling condition 11 months after poisoning. Initial treatments with elastic stockings, fludrocortisone acetate, and dihydroergotamine mesylate resulted in no obvious improvement of his orthostasis. Findings from a hemodynamic study performed with the patient was severely orthostatic suggested functional impairment of vascular adrenergic nerve terminals as a major lesion. A similar study after recovery from orthostasis showed that the baroreceptor reflex mechanism returned to normal. This report shows that initially severe and disabling orthostatic hypotension may not be a hopelessly permanent sequela of PNU intoxication and that a gradual, spontaneous full recovery from orthostasis is possible.

Increased fatality and difficult diagnosis of in-hospital acute myocardial infarction: comparison to lower mortality and more easily recognized pre-hospital infarction.

We studied 510 patients in the Columbia, South Carolina metropolitan area with documented acute myocardial infarction (AMI) in 1978 to investigate differences in clinical characteristics and outcome between patients who experienced AMI while inside the hospital (IN-AMI) and those who experienced AMI outside the hospital environment (EX-AMI). Mortality for IN-AMI patients (66%) was significantly higher (p less than 0.0001) than for EX-AMI patients (22%), and remained higher (p less than 0.05) even after exclusion of high-risk IN-AMI patients (surgical patients, those with serious underlying noncardiac illness, and those with underlying cardiac illness as the reason for hospital admission). Medical IN-AMI patients experienced fewer typical forms of AMI symptoms (p less than 0.05) and did not reach an intensive care unit significantly sooner than did EX-AMI patients. Time from onset of AMI symptoms to death was not significantly different between IN-AMI and EX-AMI groups (p = 0.22). Therefore AMI occurring during hospitalization was associated with poor early prognosis even after exclusion of high-risk patients. These results emphasize the need for improved approaches to prevention, identification, and management of AMI patients.