Anterior S-T changes during acute inferior myocardial infarction

We investigated the clinical course of 57 patients with acute inferior myocardial infarction as regards anterior S-T segment depression. Thirty of them showed S-T segment depression greater than or equal to 0.15 mV in at least 2 precordial leads, and 27 did not exhibit such changes. Twenty-seven patients underwent post-infarction exercise stress test. Furthermore, coronary arteriographic findings and left ventricular performance were evaluated in 8 of these patients with and in 8 without anterior S-T segment depression. Patients with anterior S-T segment depression showed greater inferior S-T segment elevation on admission ECG and deeper Q wave in lead aVF in ECG tracings recorded 1 month later. Higher incidences of in-hospital angina (10/30 vs 2/27, P = 0.01) and of late development of cardiac failure (5/21 vs 0/19, P = 0.03) were found among patients with anterior S-T segment depression. They showed a higher overall coronary score (82.4 +/- 31.0 vs 32.5 +/- 28.9, P = 0.002) and left anterior descending artery score (44.1 +/- 20.7 vs 8.5 +/- 16.1, P = 0.0009) and a reduced ventricular performance, evaluated by ventriculography score (49.5 +/- 2.7 vs 51.8 +/- 2.4, P = 0.05). A higher incidence of mitral regurgitation, secondary to papillary muscle dysfunction, was also found among patients with anterior S-T segment depression (4/8 vs 0/8, P = 0.04). Furthermore, the degree of anterior S-T segment depression in each of these subjects was closely correlated with the corresponding difference from normal ventricular score (r = 0.86, P less than 0.01). Finally, no difference between the two groups of patients was found as to incidence of positive exercise stress tests.

Clinical hemodynamic and angiographic findings in 94 patients with old myocardial infarction. Comparison with 79 patients with coronary artery disease and no myocardial infarction

Clinical, hemodynamic, coronary arteriographic, and ventriculographic findings of 94 patients (pts) with coronary artery disease (CAD) and old myocardial infarction (MI) have been described and compared with those of 70 pts with CAD and no previous MI. Pts with old MI presented a more compromised functional and hemodynamic status, with a higher incidence of NYHA class III-IV pts (40%), symptoms of left ventricular (LV) failure (31%), cardiomegaly (70%), higher left ventricular end-diastolic pressure (LVEDP) (19.6 +/- 9.6 mmHg, p less than 0.05), compared with 32%, 22%, 54% and 16.0 +/- 6.8 mmHg respectively in CAD pts with no MI. MI pts presented more severe CAD, higher incidences of three vessel disease (56%, p less than .005) and of left anterior descending (LAD) (34%) and right coronary artery (RCA) (36%) occlusions, compared with 34%, 6%, and 9% respectively in pts with no MI. Furthermore, pts with old MI showed more diffused and severe LV segmental wall contraction abnormalities, with higher frequencies of LV aneurysm (31%) and of pts with asynergy of more than 2 LV segments (26%), compared with 1% and 3% respectively in pts with no MI. Within the group with old MI, LVEDP was higher in pts with anterior (A) (22.0 +/- 11 mmHg, p less than .02) and anterior ł diaphragmatic (AłD) (21.5+/- 7.9 mmHg, p less than .05) MI, compared with pts with diaphragmatic (D) MI (16.6 +/- 7.1 mmHg); furthermore, LVEDP increase was significantly correlated with the severity and the extent of LV asynergy. In A and D MI, LAD and RCA stenoses or occlusions were prevalent respectively; pts with AłD MI showed larger numbers of coronary stenosis (3.05) and occlusions (1.05) per patient. The coronary artery supplying the infarcted area showed stenosis (greater than 75%) in 95.6% and was normal in 2.2% of cases. Thus, pts with CAD and old MI, and particularly of AłD and A MI, show a more compromised hemodynamic status and more severe degrees of CAD and of LV segmental wall contraction abnormality, which are responsible for their poor prognosis, compared to pts with CAD but no old MI.

Hemodynamic and ventilatory effects of intravenous salbutamol in patients affected by cold

Hemodynamic and ventilatory effects of i.v. administration of salbutamol (3 micrograms/kg body weight) have been studied in 6 patients affected by chronic obstructive lung disease. A fall of mean pulmonary arterial pressure (PAP), pulmonary vascular resistances index (PVRI), left ventricular end-diastolic pressure (LVEDP) and systemic vascular resistances index (SVRI) have been found significant. Furthermore, heart rate (HR), cardiac index (CI) and left ventricle dp/dt max (LV dp/dt max) were early and remarkably increased. At 30 min after drug administration such effects disappeared in all patients. Regarding the ventilatory data, the authors assume that a significant and precocious FEV1 and vital capacity increase was still present at 30 min. Hemodynamic effects can be related to either an increased venous return due to peripheral vasodilatation or to a beta 1-cardiac receptor stimulation.

Hemodynamic response to exercise after propranolol in patients with mitral stenosis

Hemodynamic response to exercise before and 10 minutes after propranolol (5 mg intravenously) was studied in 10 young patients with pure mitral stenosis who had normal sinus rhythm and no cardiac failure. After propranolol the mean heart rate and cardiac index at rest were lower than during the control state (respectively, 95 +/- 4 versus 82 +/- 3 beats/min, P less than 0.005; 3.4 +/- 0.2 versus 2.8 +/- 0.1 liters/min per m2, P less than 0.025). As a result, the mean pulmonary wedge pressure and mean mitral valve gradient at rest were lower (respectively, 22 +/- 2 versus 18 +/- 2 mm Hg, P less than 0.005; 24 +/- 2 versus 17 +/- 2 mm Hg, P less than 0.001). During exercise after propranolol the values of pulmonary wedge pressure and mitral valve gradient were lower than control values during exercise (respectively, 39 +/- 3 versus 30 +/- 2 mm Hg, P less than 0.005; 44 +/- 3 versus 32 +/- 3 mm Hg, P less than 0.005), again because of the lower heart rate and cardiac index (130 +/- 6 versus 104 +/- 6 beats/min, P less than 0.001; 4.6 +/- 3 versus 3.7 +/- 2 liters/min per m2, P less than 0.01). Left ventricular end-diastolic pressure and stroke index showed no significant changes. Thus, propranolol may benefit patients with pure mitral stenosis with sinus rhythm and no cardiac failure whose symptoms occur during those reversible conditions characterized by an increase in heart rate or cardiac output, or both.