Left anterior descending coronary artery bridge. A cause of early death after cardiac transplantation.

Immediately following orthotopic transplantation, a patient suffered left pump failure, which resulted in death. Autopsy of the donor heart revealed a proximal left anterior descending artery bridge with a thrombus causing segmental distal anteroseptal infarction. In this case report, myocardial coronary bridges and their clinical implications are reviewed. Myocardial bridging and acute coronary obstruction should be considered in the differential diagnosis of patients with acute pump dysfunction following orthotopic cardiac transplantation.

Intravenous adenosine as first-line prehospital management of narrow-complex tachycardias by EMS personnel without direct physician control.

This study was conducted to evaluate the safety and efficacy of intravenous adenosine therapy for prehospital treatment of narrow-complex tachycardias with a presumptive field diagnosis of paroxysmal supraventricular tachycardia (PSVT) by paramedics without direct physician control. A ten-month prospective case series was designed in an urban EMS system that has paramedics operating under standing orders before physician radio contact. All patients with PSVT field diagnosis were included. Diagnosis of PSVT was made by regular, narrow-complex tachycardia with a heart rate greater than 160 beats/min by field ECG. Interpretation was performed solely by paramedics; ECG transmission was not available. In hemodynamically stable patients, vagal maneuvers were followed by intravenous placement and administration of adenosine was recommended by the manufacturer. If three adenosine boluses failed to convert the arrhythmia, patients were monitored and transported, with electrical cardioversion available. Data collection included demographic, history, medications, vital signs, and EGG tracings. Of 14 included patients, 31 were correctly diagnosed with PSVT (75.6%), with mean ventricular rate of 205 beats/min (SD 7 beats/min); one had sinus tachycardia; nine had atrial fibrillation (AF) (22%). Of the 31 cases correctly diagnosed as PSVT, 28 converted to sinus rhythm after adenosine (90.3%). Of those converted, 16 required a single dose (57.1%), nine required one additional dose (32.1%), and three required two additional doses (10.8%). None reverted to PSVT after adenosine conversion during the study period (conversion to arrival at emergency department). No significant difference in length of asystolic pause or in outcome was detected between the true PSVT cases and the AF cases receiving adenosine.(ABSTRACT TRUNCATED AT 250 WORDS)

Subarachnoid hemorrhage simulating myocardial infarction.

We describe a patient with a subarachnoid hemorrhage that presented with electrocardiographic evidence of transmural myocardial infarction. The patient was found to have normal coronaries and on autopsy revealed generalized myocytolysis with no evidence of transmural myocardial infarction. This case illustrates the value of acute coronary angiography in patients with altered mental status and suspected myocardial infarction.

Prevalence of antibodies to the human immunodeficiency virus in Dominicans and Haitians in the Dominican Republic.

Few patients with the acquired immunodeficiency syndrome have been reported in the Dominican Republic, although they share the island of Hispaniola with Haiti, which has numerous cases. Prevalence of antibodies to the human immunodeficiency virus in serum samples from Dominicans tested from 1983 through 1985 was low in comparison with that of clinically healthy Haitians working in the country. The Haitians, who gave no history of any known risk factor, had a seroprevalence to the virus of more than 10%. Only Dominican homosexuals had a high rate of seropositivity (19%); intravenous drug abusers, healthy heterosexuals, female prostitutes, and other subgroups had virtually no evidence of antibodies to the human immunodeficiency virus. These results suggest that passage of the acquired immunodeficiency syndrome retrovirus between populations in two countries on the same island did not occur except by known risk practices. They emphasize that the extent of viral transmission in Haiti is greater than that observed in the Dominican Republic.

Quilotorax congénito. Diagnóstico y tratamiento prenatal. Reporte de un caso / Congenital chylotorax. Diagnostic and prenatal treatment. Report of a case

Se presenta un caso de quilotórax diagnosticado por ultrasonido en la semana 32 de gestación, evacuado por punción bajo control ultrasónico a la semana 34. Hubo reabsorción del líquido y expansión pulmonar subsiguiente. Por cesárea electiva realizada en la semana 38 se obtuvo niño de 3.260 gramos, en buenas condiciones, que presentó un leve cuadro de dificultad respiratoria