Mario Puletti

Acute myocardial infarction: Sex-related differences in prognosis

In 641 patients (535 men and 106 women) with acute myocardial infarction (AMI), a mortality of 16.63% was recorded among the former and one of 42.45% among the latter. No significant difference was observed in the age groups up to 40 years, in the group from 41 to 55 years, and in those over 71; the difference between percentages (17.09 vs 38.23) was instead statistically significant (p less than 0.01) in patients in the age group from 56 to 70 years. This difference was significant (p less than 0.01 or 0.001) with regard to mortality in diabetics (21.36% vs 46.34%), nondiabetics (13.09% vs 30.36%), hypertensives (19.72% vs 37.70%) and nonhypertensives (12.86% vs 36.11%), as well as in patients with previous infarction (33.36% vs 81.82%) and in those with first infarction (12.18% vs 31.39%). Since this phenomenon does not seem related to any particular feature of infarction nor to a particular predisposition to specific causes of death, the reasons for such severe prognosis in women require clarification.

Alternans of the ST segment and T wave in acute myocardial infarction

A case of isolated alternans of the ST segment and T wave in a man with myocardial infarction is reported. Based on the previous experimental reports, the hypothesis is advanced that delayed and blocked (2:I) activity of the ischemic area may be responsible for the phenomenon observed.

Infarct as a Stress Agent: Life History and Personality Characteristics in Improved versus Not-Improved Patients after Severe Heart Attack

Fifty-eight male subjects admitted to an intensive coronary care unit were interviewed and underwent psychometric testing on the second--third day after a severe heart attack (infarct). Seven-ten days following admission, the clinical condition of the patients was evaluated by the attending cardiological staff and rated on a three point scale. The patients were divided, on the basis of the clinical rating, into two groups: improved (N = 25) and non-improved (N = 33). Life history characteristics, MMPI personality profiles, and State-Trait anxiety scores were then compared for the two groups. The not-improved group showed the higher scores on almost all the MMPI scales, higher anxiety scores and more work-related problems than the improved group. Such data give some empirical support to the hypothesis that the physiological and hemodynamical conditon of the cardiac patient is in some way correlated with the patients style of coping with stress, and his history of previous life stress situations.

Atrial repolarization: Its role in ST elevation

In four patients, ectopic supraventricular rhythm (or beats) with cephalad anomalous atrial activation and, generally, a short PR, were always associated with an ST elevation in the leads with a negative P wave. An inverted Ta wave appears to be responsible for the ST elevation.

Complete atrioventricular block with QRS complexes of variable amplitude

Nonrespiratory QRS amplitude variations related to PR interval length were observed in a case of complete atrioventricular (AV) block with narrow QRS complexes. This electrocardiographic pattern was studied, taking into consideration the greater deflection of the ventricular complexes (R- or S-wave) on each standard lead and by analyzing three groups of QRS (A, B, C) divided in relation to the different timing of the atrial systole. A significant variation appears in the entity of the mitral flow, as assessed by Doppler echocardiography evaluation, related to PR interval length, and a significant inverse correlation was found between QRS variability and ventricular diastolic filling.