R. Joe Noble

Emergency percutaneous transluminal coronary angioplasty in acute myocardial infarction: a 3 year experience.

In 151 patients experiencing acute myocardial infarction, emergency coronary angioplasty was performed as primary therapy. Overall, angioplasty was successful in 132 patients (87%); it was successful in 91 (85%) of 107 patients with a totally occluded infarct-related artery and in 41 (93%) of 44 patients with a subtotally occluded infarct-related artery. After successful angioplasty, mean residual stenosis was 29% (range 0 to 70). Eighteen patients were in cardiogenic shock (12%) including four patients receiving cardiopulmonary resuscitation during the angioplasty procedure. Hospital mortality was 9%, with 7 of 13 deaths occurring in patients presenting with cardiogenic shock or intractable ventricular arrhythmia. Hospital mortality was 5% in patients with successful angioplasty versus 37% in those with unsuccessful angioplasty (p less than 0.001). In the immediate period after angioplasty, left ventricular ejection fraction was significantly lower for patients with lesions of the left anterior descending artery (34 +/- 10%) than for patients with lesions of the left circumflex or right coronary artery (43 +/- 11%). In patients with successful angioplasty, significant improvement in left ventricular ejection fraction averaged 13 +/- 12% (p less than 0.001) for those with lesions of the left anterior descending artery and 10 +/- 12% (p less than 0.001) for those with lesions of the left circumflex or right coronary artery. Repeat coronary angiography was performed in 85 (70%) of 121 patients who had successful angioplasty and survived hospitalization without requiring bypass surgery; restenosis was found in 26 (31%), and angioplasty was repeated in 22 patients, successfully in each.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of recurrent ventricular tachycardia and fibrillation with aprindine

Twenty-three patients with recurrent ventricular tachycardia or ventricular fibrillation, or both, were treated with aprindine, a new antiarrhythmic agent. It was found that: (1) no patient had a recurrence of ventricular fibrillation after aprindine therapy was begun, except as a terminal event subsequent to the development of acute myocardial infarction and cardiogenic shock or refractory congestive heart failure; (2) 6 patients experienced ventricular tachycardia after the loading dose, but with continued aprindine therapy the ventricular tachycardia was suppressed in 3 of these 6 patients, and a fourth patient was asymptomatic during brief paroxysms of ventricular tachycardia; (3) in 2 patients, aprindine was ineffective and was discontinued; (4) electrical cardioversion was not required in any patient receiving aprindine; (5) premature ventricular extrasystoles were decreased in 18 of the 23 patients treated with aprindine; (6) aprindine was discontinued in 1 patient because of intolerable side effects, although ventricular arrhythmias were suppressed in this patient; and (7) 5 patients died from acute myocardial infarction or severe heart failure while receiving aprindine.

Aprindine for treatment of supraventricular tachycardias. With particular application to Wolff-Parkinson-White syndrome.

Abstract Ten patients with recurrent or continuous Supraventricular tachycardia difficult to control with conventional antiarrhythmic agents were treated with aprindine, a new antiarrhythmic drug. Nine patients had Wolff-Parkinson-White syndrome. An electrophysiologic study was performed before and during oral administration of aprindine. At the time of the first study, circus movement Supraventricular tachycardia was initiated in Patients 1 to 8. During administration of aprindine, circus movement Supraventricular tachycardia could no longer be initiated in Patients 1 to 4 but was initiated with difficulty in Patients 5 and 6 and with greater ease in Patients 7 and 8. In Patient 9, aprindine therapy slowed the ventricular response during atrial flutter from 1:1 conduction over the accessory pathway to 2:1 conduction over the normal pathway; in Patient 10, it slowed the ventricular rate during atrial fibrillation from 140–180 to 80–100 beats/min. Patients 1 to 6, 9 and 10 had an excellent clinical response, but treatment with aprindine was discontinued in Patients 7 and 8. Electrophysiologic evaluation revealed that aprindine produced complete block or increased refractoriness of the accessory pathway in an antegrade direction in all patients and in a retrograde direction in all but two (Patients 7 and 8) tested. Aprindine also slowed conduction in the accessory pathway and, when Supraventricular tachycardia could still be initiated, it occurred at a slower rate. Neurologic side effects occurred primarily during the initial administration and dose adjustment of aprindine.

Left atrial myxoma infected with histoplasma capsulatum

A patient is presented in whom a left atrial myxoma was found to be infected with Histoplasma capsulatum. Histoplasmosis has not been previously associated with this tumor, nor has any fungus without preceding bacterial endocarditis and long-term antibiotic therapy. The clinical course in foru previously reported cases of bacterially infected myxoma is reviewed. There have been 18 prior cases of Histoplasma endocarditis and in two the patients have survived. Their clinical presentation and response to therapy are also reviewed, and pertinent therapeutic conclusions drawn. The role of echocardiography in this patients evaluation and the ultimate successful therapy are discussed.

Noninvasive documentation of Prinzmetal's angina

A 57 year old women with substernal nonexertional chest pain and angiographically patent coronary arteries was evaluated with two dimensional echocardiography and myocardial perfusion scintigraphy after provocation of pain with methacholine. Simultaneous with the development of angina pectoris, the electrocardiogram demonstrated S-T segment elevation in leads II, III and aVF, followed by atrioventricular block. The echocardiogram revealed akinesia of the previously normally contracting left ventricular posterior wall during pain followed by hyperkinesia after the administration of nitroglycerin. Perfusion imaging suggested reversible inferior wall hypoperfusion. Thus, these studies provided noninvasive documentation of segmental left ventricular dysfunction and hypoperfusion during variant angina.

Return to Work After Successful Coronary Angioplasty: Comparison Between a Comprehensive Rehabilitation Program and Patients Receiving Usual Care

The effects of a 12-week exercise training and cardiac education program on short-term and long-term employment and realted measures of quality of life were compared in a nonrandomized study. Eighty-three trained patients and 92 patients who received, usual physician care (usual care) after successful percutaneous transluminal coronary angioplasty (PTCA) were studied. Data, were collected from medical files and by a before-and-after PTCA questionnaire. At baseline, groups did not differ with respect to age, medical status, occupational status, level of income, presence of risk factors for coronary disease, and patients perception of health. Of those working full time before PTCA, 11% of the patients in the trained group and 23% of the patients in the usual care group did not resume their work status after 18 months of follow-up. At 18 months after PTCA, 37% of the trained vs 52% of the usual care patients quit working (P