Archivos del Instituto de Cardiología de México
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Arch Inst Cardiol Mex · May 1993
Review Case Reports[High doses and the rapid infusion of streptokinase for the treatment of massive pulmonary thromboembolism].
We report the case of a 65 year old woman with no prior cardiac or pulmonary disease, who suffered pulmonary embolism (PE); diagnosis was made on the basis of the existence of risk factors, clinical, radiographic and electrocardiographic features, and a lung scan with perfusion defects and normal ventilation. PE was considered massive because the patient developed acute respiratory failure that required tracheal intubation and mechanical ventilation as well as obstructive shock, electrocardiographic and echocardiographic data of right ventricle overload, and pulmonary hypertension, with pulmonary artery pressure of 38 mmHg. She received an initial treatment with high doses (1,500,000 UI) and rapid infusion (1 hr) of intravenous streptokinase (SK) followed by heparin anticoagulation. ⋯ In this report SK at high doses and rapid infusion showed effectiveness and security. We emphasize the usefulness of echocardiography as a diagnostic aid in patients with a previously healthy cardiopulmonary system, as well as the possible role of electrocardiogram as an early indicator of pulmonary reperfusion. This could be the first report of successful thrombolysis with high doses and rapid infusion of SK in massive PE.
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Arch Inst Cardiol Mex · Mar 1993
[Conduction disorders at multiple levels during the acute phase of a myocardial infarct: an electrophysiological study].
Forty patients with a diagnosis of acute myocardial infarction (anterior 24, and inferior 16) were studied. Of these patients, 37.5% manifested second and third degree atrioventricular (AV) block as a complication; another 30% showed complete right bundle branch and left anterior hemiblock. Right bundle branch and left posterior hemiblock were evidenced in 12.5% of the subjects. ⋯ The His bundle electrogram registered multiple levels of AV block, 70% with troncular and infrahisian block that gave way to sudden AV block. The mechanism responsible for this block was considered to be a functional longitudinal dissociation of conduction system due to an acute ischemic injury of the His bundle, more than a sudden and simultaneous failure of all the bundle branch of His. We conclude that electrophysiologic studies are a useful procedure for identification of a group of patients with multiple AV conduction disturbances that have a less favorable prognosis than those with only suprahisian level of block.
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Arch Inst Cardiol Mex · Mar 1993
[Cardiogenic shock in acute myocardial infarct. Its coronary angioplasty treatment].
Ventricular dysfunction is the most common cause of in-hospital death in patients with acute myocardial infarction. When cardiogenic shock is manifested the mortality is very high. Seven patients with cardiogenic shock complicating acute myocardial infarction were treated with emergency coronary angioplasty. ⋯ The hospital mortality was 29%. Of the patients who survived 4 are in functional class I and one in functional class II (NYHA). Coronary angioplasty therapy in patients with cardiogenic shock complicating acute myocardial infarction plays a decisive role in the reduction of mortality.
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Arch Inst Cardiol Mex · Sep 1991
Case Reports[Pulmonary thromboendarterectomy as a treatment of chronic pulmonary arterial hypertension secondary to unresolved pulmonary thromboembolism. A preliminary report].
This is a preliminary report of our initial experience with thromboendarterectomy in the treatment of four patients with chronic major-vessel thromboembolic pulmonary hypertension. Before surgery, these patients all had severe pulmonary hypertension and cor pulmonale as well as significant abnormalities in lung function (mechanics and gas exchange). ⋯ The remaining three surviving patients have shown a remarkable improvement in both, pulmonary hemodynamics and lung function which has been translated in an also significant improvement in their clinical condition. Although there is still a significant risk involved with this procedure, the thromboendarterectomy represents a reasonable and useful therapeutic approach for selected patients with this deadly form of chronic pulmonary hypertension in which other forms of treatment have proved to be unsuccessful.