Pericardial effusion as an early complication of acute myocardial infarction

Two days after an acute myocardial infarction, a patient developed pleuropericarditis. A negative lung scan and echocardiographic evidence of pericardial effusion were instrumental in making the diagnosis. Steroid therapy led to a dramatic resolution of the signs and symptoms. Pericardial effusion is usually a late complication of myocardial infarction (Dressler's syndrome), but the increasing use of echocardiography may demonstrate that it occurs early in the course.

Electrophysiologic properties of coffee in man

There is no information on the effects of coffee on the human conduction system. His bundle electrograms were obtained in 12 patients before and 20 minutes after the ingestion of coffee containing 150 mg caffeine. Antegrade and retrograde refractory periods were obtained with the extrastimulus method. The effective and functional refractory period of the atrioventricular node decreased after coffee ingestion. This improvement in conduction is probably mediated by a release of catecholamines.

Hemodynamic effects of phentolamine in valvular abnormalities

Seven patients with mitral insufficiency and seven patients with aortic insufficiency were studied by right and left heart catheterization. Hemodynamic observations were made during a control period and during the infusion of phentolamine. Significant declines in the pulmonary artery mean pressure, left ventricular end diastolic pressure, peripheral resistance, and arteriovenous oxygen difference were seen in both groups. The cardiac index increased significantly in the two groups. Phentolamine therapy produced favorable hemodynamic effects because of its vasodilating action as well as its positive inotropic effects.

Premature hair graying: a probable coronary risk factor

Hypertension, diabetes mellitus, hypercholesterolemia, and smoking are known coronary risk factors. It has been our impression that premature graying of the hair also predisposes individuals to myocardial infarctions. To test this hypothesis, we evaluated all of the patients under the age of 50 who were admitted to the coronary care unit between 1974 and 1976 with a proven diagnosis of a myocardial infarction. There were 50 patients. Thirty-eight did not have premature graying. Twelve of the male patients (24%) had virtual total graying of the hair which made them appear older than their stated age. The graying in these patients started on the average at 29 years. Five of these patients state that other family members had premature hair graying. The incidence of diabetes, hypertension, and smoking was similar in those with and without premature hair graying. This preliminary study suggests that premature graying of the hair is associated with premature cardiovascular disease. It should probably be regarded as a coronary risk factor and used to identify patients at increased risk.

Hemodynamic effects of morphine in cardiac disease

The hemodynamic effects of intravenous morphine were documented by right heart catheterization in six patients with an acute uncomplicated transmural myocardial infarction one to three days after the onset of symptoms. Intracardiac pressures, brachial artery pressure, and cardiac output were determined before and 15 minutes after the termination of the morphine infusion. Five milligrams morphine was given intravenously over a 10-minute period. The brachial artery pressure fell from a mean of 78 to a mean of 73 mm Hg (NS). As a result or morphine administration, the average cardiac index decreased from 2.68 to 2.31 liters/min-m2 (P is less than 0.05), and the stroke index decreased from 27 to 22 ml/beat-m2 (P is less than 0.05). Only small changes were observed in the intracardiac pressures.

The effect of phentolamine on intra-Hisian conduction

A His bundle electrogram was obtained in a 70 year old male with syncopal episodes. A split bundle of His deflection was recorded. After the intravenous administration of phentolamine, a marked shortening of the H-H' interval was observed. This signifies an improvement in conduction at the bundle of His level.