[A right atrial thrombus in transit: its echocardiographic diagnosis 72 hours before a pulmonary embolism]. / Trombo en tránsito en aurícula derecha: diagnóstico ecocardiográfico 72 horas antes de un embolismo pulmonar.

We report a case of a 72-year-old woman with coronary artery disease in whom a thrombus in transit in the right atrium was diagnosed accidentally. After 72 hours of treatment with intravenous anticoagulants she developed a pulmonary thromboembolism resolved with systemic fibrinolysis. This is a rare case in which such a diagnosis preceded an embolic event. This fact raises the controversy about the best therapeutic management of this unusual form of thromboembolic illness.

Doppler transmitral flow pattern is an independent prognostic factor in acute myocardial infarction.

We analyzed the transmitral flow pattern on admission in 95 patients with acute myocardial infarction. Nineteen patients had a restrictive pattern, defined as a peak early to peak atrial filling wave ratio greater than 1.6, plus an early wave deceleration time shorter than 180 ms. Restrictive pattern, compared with nonrestrictive one, was associated with the development of heart failure (42 versus 11%, p = 0.001) and greater in-hospital mortality (32 versus 7%, p = 0.002). After multivariate analysis, it remained significantly predictive of death (p = 0.028). We conclude that a restrictive pattern of left ventricular filling in patients with acute myocardial infarction is an independent predictor of early outcome.

[A new classification of lower infarcts with important prognostic significance]. / Uma nueva clasificación de los infartos inferiores con importante significación pronóstica.

BACKGROUND: The initial therapy of acute myocardial infarction is often determined by the electrocardiogram. OBJECTIVE: To evaluate a classification of inferior myocardial infarctions according to the first electrocardiogram. DESIGN AND SETTING: Prospective study in a coronary care unit. PATIENTS: 116 patients admitted due to a first acute myocardial infarction of the inferior wall. METHODS: "Type 1" electrocardiogram was defined as ST segment elevation without distortion of the QRS. Patients were considered "type 2" when, besides ST segment elevation, they presented a distortion of the terminal portion of the QRS complex in two inferior leads. MAIN RESULTS: Twenty-nine patients (25%) were considered "type 2". These patients were older and had worse Killip class than "type 1". The mortality rate was 1.2% in "type 1", and 24.1% in "type 2" (p = 0.0002). After multivariate analysis, which included Killip class, age, smoking, type of electrocardiogram and fibrinolysis, the type of electrocardiogram remained significantly predictive of death (p = 0.014). CONCLUSIONS: We conclude that "type 2" electrocardiogram is an independent predictor of adverse outcome in inferior infarctions. Further investigation is needed concerning its implications in the clinical management of these patients, although reperfusion therapy is warranted.

[Variant angina pectoris related to the treatment of migraine]. / Angina variante en relación con el tratamiento de la migranña.

A 54 years-old man with a history of migraine, suffered from chest pain together with ST-segment elevation related to the intake of drugs against migraine attacks. The coronary arteriography showed normal coronary arteries. We suggest coronary artery spasm as the most probable cause of ischemia. We conclude that vasoactive drugs against migraine must be utilized with caution, or even avoided in patients with chest pain suggestive of myocardial ischemia.