Monte Malach

Acute myocardial infarction in a city hospital

Abstract 1. (1) A clinical evaluation of 264 proved cases of acute myocardial infarction in a city hospital during a one-year period is presented. 2. (2) Previous findings of a greater incidence of this disease in males, Hebrews, patients with a familial history of cardiovascular disease, previous evidence of coronary artery disease or diabetes mellitus are supported. 3. (3) A very low incidence of acute myocardial infarction in Negroes was observed. 4. (4) A greater number of older patients was noted in our series than in previous reports. 5. (5) Painless cardiac infarction was observed in 21 per cent of our patients. 6. (6) We observed a greater survival rate in patients who were hypertensive on admission or at some time during the hospital course than in normotensives or hypotensives. 7. (7) The grave prognosis of shock accompanying myocardial infarction is confirmed. 8. (8) Twenty-nine per cent of our patients had an elevated hemoglobin on admission, which elevation was transient. 9. (9) We observed three cases of cardiac rupture; these cases received no anticoagulants but were given ascorbic acid. 10. (10) A significantly greater survival rate was observed in patients who received vitamin C. 11. (11) The high mortality rate (47 per cent) was attributed to the age of the patients, more critically ill patients, lack of private nursing care, a city hospital ward population, and a high incidence of congestive heart failure, prolonged fever, and tachycardia.

Polarizing Solution in Acute Myocardial Infarction

Abstract A study is presented on the effect of a polarizing solution, consisting of potassium, glucose and insulin, compared with a control solution on the occurrence of life-threatening arrhythmias and mortality rate in acute myocardial infarction. All patients were continuously monitored in a coronary care unit. The incidence of life-threatening arrhythmias, which include ventricular tachycardia, ventricular fibrillation, increasing heart block and ventricular arrest, was greater in those patients who received the polarizing solution (45%) than in the control group (15%). The mortality from arrhythmias was about the same in both series (12.7 vs. 14.8%). There is no apparent protective effect from the routine use of polarizing solution.

Acute myocardial infarction in a City Hospital: V. Follow-up study of one hundred thirty-one survivors∗☆

Abstract 1. 1. A 5-year follow-up study of 131 survivors of acute myocardial infarction in a city hospital during a 1-year period is presented. 2. 2. The mortality rate was 28 per cent at 1 year and 49 per cent at 5 years. Seventy per cent of the deaths occurred in the hospital. Eighty-eight per cent of deaths were due to recurrent myocardial infarction and/or congestive heart failure. 3. 3. Pre-existing hypertension, angina pectoris, or congestive heart failure, location of the acute infarction or cardiomegaly during hospitalization, did not significantly affect the long range outcome. Previous myocardial infarctions adversely affected the 5-year survival rate of the acute infarction. 4. 4. Pre-existing angina pectoris was absent in one-fourth of cases 3 and 5 years after discharge, while pre-existing hypertension disappeared in one-half at 3 years and one-fourth at 5 years. 5. 5. Angina pectoris appeared for the first time in over half of the patients by 3 and 5 years after discharge. Hypertension was first noted in 25 per cent of patients at 3 years and 50 per cent at 5 years. 6. 6. Congestive heart failure was demonstrated objectively in 68 per cent of the cases at 3 years and 33 per cent at 5 years. 7. 7. Cardiomegaly was noted roentgenographically in 46 per cent at 3 years and 77 per cent at 5 years and was apparently associated with coronary artery disease alone in 8 per cent and 28 per cent respectively. 8. 8. The electrocardiogram revealed no evidence of infarction in 13 per cent at 3 years and 20 per cent at 5 years.

Acute myocardial infarction in a city hospital: IV. Clinical-pathologic correlations∗

Abstract 1. 1. A correlation of the clinical and pathologic features of sixty-four patients with acute myocardial infarction who came to autopsy in a city hospital during a one-year period is presented. 2. 2. The absence of cardiac hypertrophy in coronary artery disease without heart failure or hypertension is reaffirmed. 3. 3. The anterior wall was involved three times as often as the posterior wall, reflecting the poorer prognosis of patients with infarction of the anterior wall. 4. 4. Acute coronary thrombosis was observed forty-one times in thirty-seven patients, an incidence of 58 per cent. 5. 5. The acute thrombi were located principally in the anterior descending and right main coronary arteries and were associated with coronary sclerosis in all but one patient. 6. 6. Myocardial rupture was demonstrated in 4.7 per cent, despite administration of vitamin C but without anticoagulant therapy. The established clinical background of myocardial rupture was observed. 7. 7. Pulmonary thromboembolism was observed in 14 per cent, and was associated with (a) pulmonary infarction in only two of the nine patients, (b) the larger myocardial infarcts, and (c) a correct antemortem diagnosis in one patient. 8. 8. Encephalomalacia was noted in eleven of the fifteen patients whose brain was examined and was associated with cerebral thromboernbolism in two and with congestive heart failure and cerebral sclerosis in the others. 9. 9. The size of the infarct was small in 10 per cent, medium in 29 per cent and large in 61 per cent, and had positive correlation with the occurrence of pain in the chest. 10. 10. Mural thrombosis occurred twenty-five times in twenty-one patients, was predominantly left ventricular and was associated with large myocardial infarcts. Only a minority of these patients received anticoagulation therapy. 11. 11. Death was sudden in 60 per cent, being due to ventricular arrhythmia, myocardial rupture or pulmonary thromboembolism, and non-sudden in 40 per cent, being explained principally by shock and congestive heart failure. 12. 12. Electrocardiographic diagnosis of the acuteness of infarction was correct in 72 per cent, but in no case was a tracing completely normal. 13. 13. Accuracy of the clinical localization of the individual infarct was 71 per cent.

Acute myocardial infarction in a city hospital. II. Experience with anticoagulants.

Abstract 1. (1) The experience with anticoagulants in 66 patients as compared with 198 untreated during one year at a large municipal hospital has been presented. 2. (2) Anticoagulants did not improve the survival rate in this series. 3. (3) There was but one major hemorrhagic complication, i.e., hemopericardium without myocardial rupture, related to the use of these drugs, and this complication was not contributory to death. We observed three cases of cardiac rupture in patients who did not receive anticoagulants. 4. (4) The incidence of minor hemorrhagic complications, i.e., hematuria, in the treated group was of the same order as that previously reported by others.