Peter Carson

Platelet size in myocardial infarction

The mean platelet volume and platelet count were measured serially in 100 patients soon after myocardial infarction and again at a follow up clinic about seven weeks later. The results were compared with those in age matched controls. The mean platelet volume after infarction (mean 9.07 fl (SE 0.08] was significantly greater than in the controls (8.32 fl (SE 0.07); p less than 0.001), and was still raised at the follow up clinic (8.69 fl (SE 0.10); p less than 0.01). The mean platelet count on admission (275 X 10(9)/1 (SE 7] was significantly lower than in the control group (295 X 10(9)/1 (SE 5); p less than 0.05) and fell significantly during admission, with a mean change of -36 X 10(9)/1 (95% confidence limits -26, -45; p less than 0.01). At the follow up clinic the platelet count had risen to a level not significantly different from the admission value. As larger platelets are haemostatically more active, the finding of an increased mean platelet volume after myocardial infarction provides further evidence that abnormal platelet behaviour may be implicated in the process of infarction.

High mean platelet volume after myocardial infarction: is it due to consumption of small platelets?

Seventy nine men surviving after sustaining a myocardial infarction in 1982, and who had at that time had raised mean platelet volumes compared with controls, were followed up after 18 months. The shape of each mans platelet distribution curve was calculated from the mean platelet volume, platelet count, and platelet distribution width. The calculated curves were in close agreement with the curves plotted by the Coulter counter from the raw data. These curves did not differ significantly from those of a current control group, but the curves plotted from the variables measured at the time of myocardial infarction in 1982 showed a deficit of platelets in the volume range 5-12 fl amounting at maximum to 30% (p less than 0.0001); there were no significant differences above 12 fl. The deficit of small platelets became more appreciable during initial admission, was less at one months follow up, and had disappeared at one year. The deficit of small platelets is probably an effect rather than a cause of infarction.

Cardiac catheterisation by the Judkins technique as an outpatient procedure.

OBJECTIVE--To assess the safety and cost benefit of left heart catheterisation by a modified Judkins technique performed as a day patient procedure. DESIGN--Review study of case notes of consecutive patients examined by the procedure over three years (January 1984 to December 1986). SETTING--Outpatient referrals in a regional cardiac centre within a district general hospital. PATIENTS--Nine hundred patients aged 18-76 (mean 54) selected at a previous clinic as suitable for the procedure. MAIN RESULTS--Eight hundred and fifty patients (94.4%) were discharged home on the day of the procedure. Forty others (4.4%) could not be discharged owing to complications during or just after the procedure. Of these patients, two died (0.2%), six suffered a myocardial infarction (0.7%), and two had major vascular complications. The remaining 30 patients were admitted because of chest pain without infarction (10 cases), minor vascular incidents (six), haemorrhage at the puncture site (five), arrhythmia (four), pulmonary oedema (three), and contrast reaction (two). Ten patients were admitted for either urgent coronary artery bypass grafting or social reasons. CONCLUSIONS--Cardiac catheterisation is safe as an outpatient procedure in most cases. Beds are spared and roughly 35,000 pounds is saved for every 500 procedures performed.

Morale in coronary patients following an exercise programme

Abstract Coronary patients, eligible to follow an exercise rehabilitation programme, were assigned at random to exercise and control groups. In the first part of this study, items of a morale questionnaire and performance scores on a cycle ergometer were inter-correlated for 52 patients. Results repeated those of a previous study in which the questionnaire was shown to have high reliability. Workload achieved was significantly correlated with “morale” scores. In the second part of this study 15 exercise patients and 8 controls completed the morale questionnaire at the beginning and at the end of a 3-month period corresponding to the exercise programme. Exercise patients scored higher than controls, and both groups improved in morale over the period. The fall in anxiety scores for the exercise patients was significantly greater than for the controls. Apparently the chief psychological effect of the exercise programme was to give confidence to the patients.

Course of patients discharged early after myocardial infarction.

Two hundred and seventy-one (76%) out of 358 survivors of infarction were discharged by the eighth hospital day, and 251 (93%) of them survived to six weeks after discharge. Six of the 20 patients who died between discharge and six weeks did so after readmission and 14 died as outpatients. All these patients who died at home had transmural infarction and four had diabetes. In inpatients successful resuscitation occurred mainly within the first 48 hours, with only three successful long-term results from all the patients who suffered arrest later. This suggests that more prolonged inpatient care would not have reduced the late mortality. These figures justify continuing with an early discharge policy for most patients, but coronary care should probably be more prolonged for patients with diabetes.

Exercise after myocardial infarction: long-term rehabilitation effects.

Long-term effects of an exercise programme for patients who had experienced myocardial infarction were investigated. Questionnaires were sent to 305 patients who during a three and a half year period had been invited to participate. Replies from 58 exercised patients, 13 who had dropped out, 75 controls and 69 who declined the invitation were analysed. The amount of exercise now being taken was positively correlated with scores on cardio-vascular and general health, and negatively correlated with symptoms during exercise and taking medication. The exercised group differed from the other groups in that a greater proportion were still taking heavy exercise. The latter scored significantly higher than the rest of the patients on most of the measures used. For effective long-term rehabilitation the problem of encouraging and enabling patients to continue vigorous exercise needs to be resolved.

Dissecting aneurysm of a right-sided descending aorta with a left-sided aortic arch

A 66-year-old man presented with myocardial infarction. Chest X-ray showed a large mediastinal mass. Aortic dissection was suggested by a past history of chest trauma, but the mass was in a very atypical site. Dissection of an abnormally placed right-sided descending aorta was confirmed by computed tomography. The aortic arch lay on the left side. This rare combination of congenital and acquired heart disease led to diagnostic difficulty.

High mean platelet volume after myocardial infarction

retrospective study and a graph of symphysisfundus height was not used. Dr Neilson and colleagues admit that mothers who may have been referred before 34 weeks with suspected intrauterine growth retardation were not included in their study and report that of six babies with intrauterine growth retardation who died three died before 34 weeks. Gentz et al have pointed out that in a Swedish study nearly half the stillbirths occurred before admission and 80O, of these fetuses died before the onset of labour. Yet use of the symphysis-fundus graph in their hands can detect intrauterine growth retardation as early as 28 weeks (16 000 deliveries). No serious student of intrauterine growth retardation can afford to neglect reading Westins account of his work. Symphysis-fundus graphs are simple to use and indicate in a much more specific way in each patient when to refer for an ultrasound check. This is much better than an expensive, time consuming routine test which may be done too late. IAN KENNEDY