The incidence and management of life-threatening arrhythmias occurring during the course of acute myocardial infarction - abstract

During the last decade the early detection and successful treatment of life-treatening arrhythmias have resulted in a significant reduction in the mortality rate of patients with myocardial infarction. The purpose of this study was to determine the incidence of these dangerous arrhythmias and to explore the possibility of producing a similar reduction in mortality rate with our limited resources. Since the 1st July, 1971, all patients with clinical diagnosis of acute myocardial infarction have been admitted to a coronary bed in either the intensive care unit or one of our general medical wards. Each be is fully equipped with a cardioscope for the continual monitoring of the patient's electrocardiogram, a defibrillator/cardioverter and the necessary anti-arrhythmic drugs and resuscitative equipment. During the first 7 months of this project a total of 24 patients with unequivocal evidence of myocardial infarction were admitted to the study and their rhythm was continually monitored for period varying from at least 48 hours up to 21 days. Four patients died from cardiogenic shock and in addition 2 of these patients had bronchopneumonia. Nine of the 24 patients showed a significant rhythm change (40 percent) and of these, 5 patients (20 percent) had a life-threatening arrhythmia. These included (a) fast atrial fibrillation, (b) sinus bradycardia with Stokes-Adams attacks, (c) complete heart block with Strokes-Adams attack, (d) ventricular tachycardia and (e) ventricular fibrillation were treated with a combination of practolol and digoxin with cardioversion being reserved for resistant cases. Sinus bradycardia was treated with frequent doses of atropine (0.6 mgm. I.M. 2 to 6 hourly) and complete heart block was controlled by transvenous endocardial pacing. Lignocaine was used as the drug of choice for ventricular tachycardia and so far there have been no cases of ventricular tachycardia which have been resistant to this drug. Ventricular fibrillation was treated with immediate defibrillation starting at an energy level of 300 Watts Seconds. It is concluded that serious arrhythmias do occur in at least 20 percent of our patients with acute myocardial infarction and we have demonstrated that these can be successfully treated here (AU)

Pleural mesothelioma associated with massive hepatic calcification and unusual metastases

A case of diffuse, malignant, pleural mesothelioma is reported in a 60-year-old Negro man. The clinical picture was most unusual; when the patient presented initially with chest pain, the radiographic appearances in the chest were normal, but extensive liver calcification was demonstrated. The latter was subsequently shown to be caused by metastases from the mesothelioma which took 2 more years to produce clinical and radiographic changes in the chest. There was microscopic evidence that the extensive liver calcification was dystrophic in nature and had resulted from marked degenerative changes and necrosis in the metastatic malignant pleural mesothelioma. Radiographs of the skeleton revealed focal, translucent lesions with sclerotic margins in the right seventh rib and the right iliac. Microscopic examination showed these bony lesions to be metastases. No previous report of secondary deposits in bone producing such radiographic appearances could be found in the literature (AU)