British heart journal
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British heart journal · Mar 1979
Arterial counterpulsation in severe refractory heart failure complicating acute myocardial infarction.
The role of arterial counterpulsation was sought in 100 patients with severe refractory cardiac failure complicating myocardial infarction. Seventy-four were in shock and 26 were not. Average duration of counterpulsation was 7.0 days. ⋯ Early coronary artery bypass surgery performed alone in 9 patients did not influence survival or functional status. Complications of counterpulsation occurred in 17 patients in shock and in 2 patients not in shock, all but 6 on the first day; none directly caused death. Counterpulsation is an effective and safe adjunct to medical treatment of complicated infarction provided the intervention is prompt.
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Eleven patients were studied and a total of 144 Wenckebach cycles in the AV node and 118 Wenckebach cycles in the His-Purkinje system were analysed to determine the incidence of typical and atypical Wenckebach periodicity, with particular emphasis on one variant of atypical Wenckebach that may simulate a Mobitz type II block. This pseudo-Mobitz II pattern was defined as a long Wenckebach cycle in which, at least, the last three beats of the cycle show relatively constant PR intervals (variation of no more than 0.02 s in surface leads and no more than 10 ms in His bundle electrograms) and in which the PR interval immediately following the blocked beat is shorter than the PR interval before the block by 0.04 s or more. ⋯ The pseudo-Mobitz II pattern was seen in 19 per cent of atypical AV nodal Wenckebach periods and in 17 per cent of atypical His-Purkinje system Wenckebach cycles. The need to discern a 'classical' Mobitz II block from a pseudo-Mobitz II pattern, especially in the setting of an acute inferior myocardial infarction, is emphasised.
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Myoglobin levels were assayed in each urine specimen voided during 12 hours before and 48 hours after routine cardiac catheterisation in 146 patients using an indirect haemagglutination method detecting concentrations in excess of 0.015 mg/ml. Myoglobinuria was found in only one patient before but in 39 patients after cardiac catheterisation (27%), either in the first (34 patients) or the second (5 patients) post-catheterisation urine sample. Once detected, myoglobin was present in all subsequent urine specimens for the next 3 to 22 hours (mean 11.8 hours). ⋯ This patient, who had severe aortic stenosis and atherosclerotic heart disease, excreted 130 mg myoglobin. Patients with myoglobinuria required longer screening time to complete the procedures undertaken than those in whom myoglobin was not detected--15.6 +/- 1.4 and 11.1 +/- 0.6 minutes, respectively (mean +/- SE:P less than 0.01). We conclude that myoglobinuria is not uncommon after cardiac catheterisation, and that though the myoglobin detected may be released from skeletal muscle, it could be partly or wholly of cardiac origin and indicate transient, and presumably reversible, myocardial injury.
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British heart journal · Apr 1978
Echocardiographic analysis of posterior mitral leaflet movement in mitral stenosis.
Echocardiographic analysis of the movement of the posterior mitral valve leaflet in 60 patients with lone mitral stenosis, 35 patients with aortic stenosis, and 18 patients with aortic and mitral stenosis showed a spectrum of initial posterior mitral valve leaflet movement in early diastole. The classical anterior movement was seen in 36 out of 60 patients with mitral stenosis (60%), and 8 out of 16 patients with aortic and mitral stenosis (50%). Normal posterior movement was present in all patients with lone aortic stenosis but was also seen in 10 patients (17%) with mitral stenosis and 6 patients (33%) with aortic and mitral stenosis. ⋯ Patients with anterior movement had a mean calculated mitral valve area from cardiac catheterisation significantly smaller than the rest (P less than 0.001), but neither biphasic nor posterior movement excluded severe mitral stenosis. The distinction between patients with mitral stenosis and initial movement of the posterior mitral valve leaflet and patients with left ventricular discompliance is possible when there is sinus rhythm. Late diastolic anterior movement of the posterior mitral valve leaflet during atrial contraction is diagnostic of true mitral stenosis.