[Early pericarditis in myocardial infarct].
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Biomedical subjects
Publications and source records attributed to N Lisin.
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The post-infarction syndrome was observed in 8 out of 138 consecutive patients with acute myocardial infarction; 24 other cases of the post-infarction syndrome diagnosed over the preceeding 3 years were also reviewed. In order to determine the clinical significance and the prognosis, this group of 32 was compared to another of 105 patients with myocardial infarction without pericarditis, with respect to age, sex, medical history and characteristics of the underlying necrosis (location and size). Several clinical signs are discussed. This study showed the post-infarction syndrome was associated with large infarcts, the course of which was marked by arrhythmias, conduction defects and haemodynamic problems. A considerable inflammatory syndrome was often observed. The relation between the post-infarction syndrome and early pericarditis is not proved; on the other hand, a close correlation between late pericarditis, atrial fibrillation and left pleural effusion was demonstrated. The long term prognosis of infarcts complicated by the post-infarction syndrome is without doubt determined by the size of the necrosis and by the presence of ventricular aneurysms which are frequently associated.
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A single dosis of disopyramide (100 mg), given intravenously in 10 min to 30 patients admitted in the coronary or respiratory care unit, induces a reduction of cardiac output of 13.4%, which is highly statistically significant, without altering the systemic and pulmonary pressures. The heart rate is also slightly diminished.
The incidence, the evolution and the prognosis of conduction disturbances associated with myocardial infarction are described in a serie of 450 consecutive unselected patients hospitalized in a coronary care unit. Pacemaking does not seem to influence largely the natural history of myocardial infarction with conduction disturbances, which is essentially determined by myocardial power failure. Indications of insertion of a pacing catheter are presented.
As a clinical feature, and sometimes as a feature of the special mechanical tests of ventilation, bronchospasm has been found by the authors to be associated with pulmonary embolus. Bronchospasm was found to be the commonest feature in the 45 patients studied. The sudden onset of bronchospasm must be regarded as strong evidence for pulmonary embolus, especially in patients with a past history of bronchitis. The mechanism of these asthma-like features is discussed. The authors impugn the adrenergic system both to explain the bronchial overactivity of the patients with pulmonary embolus, and to understand how the attack commences.
The intravenous injection of disopyramide (1.5 mg/kg) induces the return to sinus rhythm in about 60% of arrhythmias. When there exist perturbations of the cardiac rhythm, secondary to recent myocardial infarction, the percentage of success reaches 70%. The drug induces the disappearance of the extrasystoles in 80% of the cases, whatever the nature of the underlying cardiopathy. Although the secondary effects of the drug are slight, it is advisable to administer the substance in a slow intravenous injection (5 minutes), while controlling the arterial pressure and the E.C.G.