Cor et vasa
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The association between recent atrial fibrillation during the course of acute myocardial infarction and pericarditis or pericardial effusion occurring during the hospital phase of myocardial infarction was studied by means of serial echocardiographic examinations in 192 patients presenting with their first myocardial infarction. Clinical pericarditis was found in 8%, echocardiographic effusion in 43%, and atrial fibrillation in 5% of all patients. ⋯ Thus, pericarditis might play a role in the development of recent atrial fibrillation during the course of myocardial infarction. Recent atrial fibrillation may be a sign of pericardial effusion which may be otherwise silent.
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Randomized Controlled Trial Clinical Trial
The effect of allopurinol on free oxygen radicals in myocardial reperfusion.
The transmyocardial turnover of lactate, oxidized and reduced glutathione, malondialdehyde, and the isoenzyme CK-MB before and after restoration of myocardial blood flow was studied in 18 patients undergoing coronary artery surgery. Of this number, ten patients were given oral allopurinol preoperatively; the remaining patients made up the control group. Allopurinol significantly reduced the levels of free oxygen radicals. The enzymatic methods employed did not make it possible to evaluate the protective effect of allopurinol on reperfusion myocardial injury.
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Values of capillary refill time (CRT) were used for evaluation of skin microcirculation in the lower extremities severed by arteriosclerotic disease. The authors examined 133 extremities in 83 arteriosclerotic patients and 84 extremities of 50 healthy volunteers as a control group. To define the stage of the disease, walking distance, rest pain, level of arterial occlusion and the ankle/arm Doppler index (AAI) were considered. ⋯ A correlation was found among AAI, walking distance and CRI (r = 0.50). An extremely low CRI (under 0.55) was found on extremities without palpable femoral pulsations. After operation, a significant increase of CRI was observed (p less than 0.01).
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Ten patients with severe pulmonary hypertension due to Toxic Oil Syndrome underwent cardiac catheterization to analyse the acute effect of intrapulmonary injection of 1.25 mg of enalaprilat. Haemodynamic parameters were obtained at basal state, 15, 30, 45 and 60 minutes after administration of the drug. Enalaprillat did not produce any statistically significant changes in pulmonary pressures and resistances or cardiac output. This lack of response is unknown but may be related to the presence of endothelial damage and fixed pulmonary vascular lesions observed at autopsy in three patients.
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The authors studied the pulmonary haemodynamic response to exercise in eleven patients with toxic oil syndrome (TOS) (mean age 38.3 +/- 15.7 years; 10 women, 1 man) and abnormal pulmonary diffusing capacity (39.1 +/- 10.3% of predicted value) without clinical evidence of pulmonary hypertension. Eight patients had normal pulmonary pressure at rest (mean PAP less than 25 mmHg) and three showed mild pulmonary hypertension. ⋯ Pulmonary artery oxygen saturation decreased from 72.9 +/- 1.9% at rest to 52.3 +/- 10.1% during exercise (p less than 0.01). In conclusion, in this subset of TOS patients, an early diagnosis of their subclinical pulmonary hypertension can be made on the basis of the presence of dyspnoea and abnormal pulmonary diffusing capacity for carbon monoxide and can be then confirmed with the exercise haemodynamic test.