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Acute myocardial infarction and left bundle branch block.

Complete left bundle branch block often masks old as well as acute myocardial infarctions. However, a diagnosis of acute myocardial infarction in the presence of complete left bundle branch block can be made when the acute injury current is large enough to modify the secondary repolarization abnormalities of left bundle branch block. Under these circumstances the classical ST-T changes of an acute infarction may evolve in serial electrocardiograms.

Angina Pectoris, Variant↗
PubMed1981

[Graphics].

Explore the source record for details and available documents.

Angina Pectoris, Variant↗
PubMed1980

Prinzmetal's angina with Torsade de Pointes ventricular tachycardia.

Two cases of Prinzmetal's angina with Torsade de Pointes Ventricular Tachycardia are described. The patients had severe obstructive coronary disease and developed the arrhythmias while on large doses of conventional antiarrhythmic therapy. Each patient developed multiple episodes of Torsade de Pointes which had to be terminated with defibrillation or right ventricular endocardial pacing. Both patients underwent successful aortocoronary by-pass graft surgery. The possible relationship of prolonged repolarization by the antiarrhythmic therapy and coronary occlusion to the development of Torsade de Pointes is discussed.

Adult↗
PubMed1981

[Unstable angina pectoris--surgical treatment].

While, initially, emergency revascularization was expected to improve significantly the poor outlook in unstable angina, simultaneous advances in medical management led to controversial reports on the results of medical versus surgical therapy. Controlled randomized studies, especially the National Heart, Lung and Blood Institute Trial from 1972 to 1976, led to the conclusion that there is no evidence that emergency revascularization is superior to vigorous medical treatment. This conclusion is not universally accepted because surgical and anesthetic methodology has since been further developed, especially with the use of cardioplegia and intraaortic balloon-pumping. Our own results appear to confirm that patients with unstable angina can undergo surgery without elevated mortality, but that non-fatal perioperative infarction still occurs somewhat more frequently than in stable cases.

Angina Pectoris↗
PubMed1981

Indications and selection of patients for coronary artery bypass graft surgery.

Patients with chronic stable angina who have coronary artery bypass graft (CABG) surgery for the relief of symptoms are asymptomatic after one year in about 75% of cases. The indications for surgery in unstable angina are unclear. CABG has not shown to benefit patients with Printzmetal angina or who survived an episode of ventricular fibrillation. CABG for acute myocardial infarction is a contentious issue, buy an operative death rate of 5.2% with a late mortality of 1.1% has been reported. There is still debate about the usefulness of CABG in promoting life expectancy. Improved longevity is clearly seen in left main and triple vessel disease.

Angina Pectoris↗
PubMed1980

Ventricular ectopy and sudden death.

The occurrence of certain complex forms of chronic ventricular arrhythmias or high frequency of less complex forms constitutes an independent risk factor for subsequent sudden death proportional to the degree of host organic heart disease. Currently, grade is probably best defined by referring to either simple or complex ventricular arrhythmias--complex forms being a combination of Lown's modified grades 3, 4, and 5, plus bigeminy. Frequency may provide an equally good expression of the information contained in gradation analysis, but one must recognize the potentially important transient advanced grades which may occur when overall frequency is low. The importance of such transient events has not yet been determined. The recently emphasized problem of spontaneous variation of frequency has yet to be resolved, both in terms of the patient who is not on drug therapy and those who are on long-term, steady-state therapy. For purposes of risk assessment for sudden death, until some of the controversies mentioned are resolved, the best compromise between accuracy, limitations, and economics remains the use of a single 24-hour Holter monitor analyzed for both frequency and the occurrence of complex or advanced grades. The goal of treatment should be a marked reduction or abolition of chronic VPDs, but if this is not successful, simply maintaining therapeutic blood levels of antiarrhythmic drugs may afford some protection against symptomatic or potentially lethal arrhythmias. The roles of provocative testing employing exercise, psychologic stressing, or electrophysiologic testing to identify high risk individuals are all being intensively investigated at the present time.

Angina Pectoris, Variant↗
PubMed1980

The role of platelets in acute vascular events.

Platelets are postulated to have an important role in acute and chronic cardiovascular events. Clinical events may result during the sequence of platelet activation reactions of adhesion, aggregate formation, release of granular constituents, thromboxane A2 formation, microembolization and platelet vascular occlusion. For example, sudden death may occur in patients with increased platelet sensitivity to catecholamine stimulation, platelet aggregate formation and thromboxane A2 generation resulting in ischemic ventricular arrhythmia induced by small-vessel platelet microembolization and local thromboxane A2 vasoconstriction. Whereas angina might be manifest if the microemboli disaggregated and vasospasm were transient, myocardial infarction would follow extensive permanent occlusion of small vessels or localized narrowing by vasospasm and extension of platelet thrombus formation at the site of intimal thickening. Platelets may also have an important role in atherogenesis through the mediation of the platelet-derived growth factor in the proliferative smooth muscle cell intimal lesion. Direct experimental and indirect clinical studies support the concept that platelets are important in cardiovascular events, but the relationship to spasm and to other possibly even more important mechanisms is not clear. Acute myocardial infarction and mural thrombogenesis appear to have the greatest evidence of being platelet-related.

Acute Disease↗