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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

One hundred and nineteen episodes of accelerated ventricular rhythm (less than 125/min) were noted in 37 patinets with acute myocardial infarction during a 1 year period. The incidence was 12.7 per cent. Twenty-seven episodes of fast ventricular tachycardia (less than 125/min) were noted in 16 of these patients. Eighteen patients had anterior myocardial infarction and 19 inferior myocardial infarction. The mechanism of onset of accelerated ventricular rhythm was classified as escape in 65 episodes. Ventricular premature beats were noted close to episodes of accelerated ventricular rhythm in 31 patients and fast ventricular tachycardia in 14 patients. The morphology of accelerated ventricular rhythm was similar to the ventricular premature beats in 27 patients and similar to the fast ventricular tachycardia in 12. In 11 patinets the morphology of ventricular premature beats, accelerated ventricular rhythm and fast ventricular tachycardia were all the same. In six patients the coupling time of the ventricular premature beats and the onset of the accelerated ventricular rhythm were the same. In seven patients the morphology of the accelerated ventricular rhythm and fast ventricular tachycardia were the same, and the rate of the accelerated ventricular rhythm was exactly half that of the fast ventricular tachycardia. There were three deaths due to shock and heart failure. Three episodes of fast ventricular tachycardia progressed to ventricular fibrillation and were successfully cardioverted. It is concluded that accelerated ventricular rhythm and fast ventricular tachycardia were all the same. In six patients the coupling time of the ventricular premature beats and the onset of the accelerated ventricular rhythm were the same. In seven patients the morphology of the accelerated ventricular rhythm and fast ventricular tachycardia were the same, and the rate of the accelerated ventricular rhythm was exactly half that of the fast ventricular tachycardia. There were three deaths due to shock and heart failure. Three episodes of fast ventricular tachycardia progressed to ventricular fibrillation and were successfully cardioverted. It is concluded that accelerated ventricular rhythm is a relatively common complication of both anterior and inferior myocardial infarction. The high incidence of concomitant fast ventricular tachycardia, the frequency of ventricular premature beats with similar morphology and coupling time, and the instances of two arrhythmias having common rate multiples, suggest that at least in some instances accelerated ventricular rhythm may represent an ectopic focus with exit block.
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PMID:Incidence and description of accelerated ventricular rhythm complicating acute myocardial infarction. 4 3

A pair of 37-year-old identical twins with diabetes mellitus are described. One of the brothers was admitted for heart failure without pain, and autonomic neuropathy was found. The clinical diagnosis was inferior myocardial infarction with anteroseptal healed myocardial infarction. Cardiac catheterization revealed triple coronary vessel involvement. The diagnosis was confirmed at autopsy after sudden death. The other brother was also examined by cardiac catheterization, which revealed total right coronary occlusion and hypokinesis of the wall. There had been no previous pain nor upper body discomfort until that time in either twin. Thus, genetic factors should possibly be considered in the genesis of asymptomatic or silent myocardial infarction.
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PMID:Painless myocardial infarction in identical diabetic twins. 186 90

A case of inferior myocardial infarction in a 77 years old woman suffering from angina pectoris for 8 years, is reported. The clinical course was complicated by mild heart failure secondary to interventricular septum repture, diagnosed by Doppler-echocardiography. The patient was discharged in III-IV NYHA class with medical therapy. Then, unstable hemodynamic conditions and episodes of angina pectoris occurred again. Five months after acute myocardial infarction, echocardiography confirmed the interventricular septum defect. An echocardiographic control, performed 17 months after the acute episode, documented, besides previous data, the presence of a pseudoaneurysm of the inferior wall with a large cavity in communication with the left ventricle.
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PMID:[Echocardiographic diagnosis of rupture of the interventricular septum and release into the wall of the left ventricle (with formation of pseudoaneurysm) in inferior myocardial infarction]. 226 60

The serial Q-T interval changes were studied in 29 survivors of acute transmural anteroseptal (11 patients), extensive anterior (10 patients), and inferior (8 patients) myocardial infarctions admitted 4 to 48 hours after the acute episode. Q-T prolongation evidenced by abnormal Q-T ratio was a constant and almost universal feature detected in 28 (97.06%) patients. The maximum Q-T prolongation was observed on an average about 36 hours after the onset of acute episode. Patients with anterior myocardial infarction had significantly higher Q-T ratios than inferior myocardial infarction group. There was a rapid decline towards normal in anteroseptal and inferior myocardial infarction groups in which it settled during initial six days, whereas, in extensive anterior myocardial infarction group, it took a longer time beyond six days to settle. The normalization of Q-T interval did not correspond to settling down of the elevated ST segment. Patients having ventricular tachyarrhythmias (VT and frequent VPBS) (14) had significantly higher Q-T ratios than those without arrhythmias. Further, the Q-T ratio was significantly higher in patients with VT (4) than in those with frequent VPBs (10). Alterations in Q-T ratio were not related to severity or extent of infarction and occurrence of heart failure. It is concluded that prolongation of electrical systole (Q-T interval) is a constant phenomenon after acute transmural myocardial infarction, magnitude and time course of its alterations being related to location of infarct and its electrical complications. It does not seem to have any correlation with mechanical complications of infarction.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Q-T interval changes in acute transmural myocardial infarction. 273 89

Using hemodynamic monitoring by flow-directed heart catheterization in acute myocardial infarction, left ventricular dysfunction can be analyzed and quantified. Differential therapy concerning substitution of volume and administration of drugs with influence on pre- and after-load is facilitated. Since the introduction of the Swan-Ganz flow-directed catheter the monitoring has been technically improved with the additional advantage of lower incidence of catheter-induced arrhythmias and the possibility to measure the pulmonary capillary wedge pressure. The Swan-Ganz thermodilution catheter further improved the technical assessment of cardiac output. Using hemodynamic monitoring during acute myocardial infarction different phases of cardiac failure can be discerned, e.g., backward failure with increased filling pressure, foreward failure with decreased cardiac output, and cardiogenic shock with the combination of both. In some cases a hyperkinetic hemodynamic status is observed. The differential diagnosis of pulmonary embolism, and cardiac and pulmonary shock can be clarified. Complications of myocardial infarction as acute mitral insufficiency due to papillary muscle rupture in inferior myocardial infarction, rupture of the septal myocardium in septal infarction, as well as myocardial rupture with pericardial tamponade show characteristic diagnostic findings. Drug therapy with influence on pre- and after-load and therapy with positive-inotropic agents can be adjusted to the individual hemodynamic status and to the monitored drug effects.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Uses and risks of hemodynamic monitoring by inflow catheter in acute myocardial infarct]. 306 63

The effect of anterior ST segment depression in inferior myocardial infarction on early complications and long-term prognosis was studied. A modification of the Minnesota Code was used for grading the extent of ST segment depression in leads V2 to V4 on the first hospital electrocardiogram. In 267 patients with acute inferior myocardial infarction, 107 had isoelectric anterior ST segments, 84 had minor (less than or equal to 0.5 mm) depression, and 76 had major (greater than 0.5 mm) depression. Patients with anterior ST segment depression had higher serum enzyme levels, higher Norris coronary prognostic indices, and more frequent cardiac failure during the acute stages, but similar 28 day case fatality rate (11.1%) compared with patients without anterior ST segment depression (12.6%). In the subsequent four years total cardiac death rates were not significantly different and the pattern of survival was not influenced, but there was a higher fatal re-infarction rate in patients with major anterior ST segment depression. Thus, anterior ST segment depression in inferior myocardial infarction was associated with more severe infarction in the early phase but was not a reliable marker of high risk after recovery. Selection of patients for further investigation should not be based on this observation alone.
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PMID:Anterior ST segment depression in inferior myocardial infarction: effect on complications and long-term survival. 346 15

This retrospective study was undertaken to determine whether there was any difference in the clinical characteristics of and prognosis in white patients admitted to the Intensive Coronary Care Unit (ICCU) at Tygerberg Hospital with acute non-transmural, transmural anterior and transmural inferior myocardial infarction (MI). The three groups were carefully matched, taking into consideration the possible influence of previous MI and congestive cardiac failure (CCF). There were 187 patients with non-transmural MI, and 176 with transmural anterior and 209 with transmural inferior MI. Patients with acute transmural anterior MI had the worst prognosis while at the ICCU, at 3 months' follow-up and at long-term follow-up (mean 22,2 months). This group had the greatest frequency of CCF, cardiogenic shock, acute pericarditis, ventricular premature beats, ventricular tachycardia, left anterior hemiblock and complete left bundle-branch block and the highest mortality. Acute transmural inferior MI was responsible for the highest frequency of ventricular fibrillation in the ICCU and had a worse prognosis than non-transmural MI. Acute non-transmural MI resulted in the highest incidence of early and late myocardial reinfarction; although death in the ICCU was least frequent, mortality among this group had increased dramatically by 3 months' follow-up. Hence, acute non-transmural MI is not benign and an unstable period exists for 3 months thereafter. Because of this, more aggressive diagnostic measures should be instituted during this period in order possibly to improve prognosis in this group. It would appear that this is the first such study undertaken in South Africa.
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PMID:Clinical characteristics of and prognosis in acute transmural anterior, transmural inferior and non-transmural myocardial infarction. A comparative retrospective study. 398 33

The finding of ST segment depression (reduced ST) in the anterior leads during acute inferior myocardial infarction is a common clinical sign. Nevertheless, its significance is not yet well established. To evaluate the significance of this finding, 58 patients with acute inferior myocardial infarction, who has an electrocardiogram within 8 hours from the onset of the disease, were divided into 2 groups: group A (14 patients with anterior reduced ST less than 1 mV) and group B (44 patients with reduced ST greater than or equal to 1 mV in one or more anterior leads). All patients subsequently underwent coronary angiography and left ventriculography, mean 50 days after acute myocardial infarction. reduced ST was not predictive of left anterior descending coronary artery disease. On the contrary, a significantly higher rate of 2-3 vessel disease (p less than 0.05) and of critical stenosis or occlusion of the right or circumflex coronary artery (p less than 0.05) was found in group B. Peak CK level was significantly higher (p less than 0.01) in this group as well. No significant difference was found in ejection fraction and anterior wall motion abnormalities, whereas a higher number of patients in group B showed a depressed function of the postero-basal segment (p less than 0.05). During 6 months follow-up, 2 patients in group A and 24 in group B experienced cardiac events (angina, reinfarction, heart failure, coronary artery by-pass grafting, cardiac death) (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical and hemodynamic implications of anterior ST segment depression in inferior myocardial infarct]. 400 63

Prognostic differences between patients with anterior or inferior myocardial infarction are often related to such variables as previous infarction or the size of the myocardial infarct. We examined the determinants of mortality in 997 hospital survivors of acute Q wave infarction (anterior in 449, inferior in 548) who, although not preselected, were well matched with respect to age, sex and prior infarction or congestive heart failure. Additionally, there was no significant difference in peak serum creatine kinase (CK) between the groups with anterior and inferior infarction (1,459 +/- 1,004 versus 1,357 +/- 1,036). Among the patients with anterior infarction who died during the 1 year follow-up period, 56% died in the first 60 days after hospital discharge compared with 18% of those without inferior infarction (p less than 0.01). Survival curves then became nearly identical at 3 months, and remained so until 1 year when the total mortality rate was 10% for the anterior and 7% for the inferior infarction group (p = NS). Variables associated with heart failure during the hospital phase were more prevalent in anterior infarction, but rales above the scapulae during the hospital stay (p less than 0.0001) and ventricular gallop at the time of discharge (p less than 0.0001) were the top two predictors of 1 year mortality by both univariate and multivariate analysis in inferior infarction. Age (p less than 0.0001) and peripheral edema (p less than 0.0001) were the strongest predictors of mortality in anterior infarction. Previous infarction, although just as common in the group with anterior infarction, was present at 1 year in 48% of nonsurvivors of the group with inferior infarction compared with only 19% of survivors (p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Survival after hospital discharge in matched populations with inferior or anterior myocardial infarction. 403 Dec 86

We investigated the clinical course of 57 patients with acute inferior myocardial infarction as regards anterior S-T segment depression. Thirty of them showed S-T segment depression greater than or equal to 0.15 mV in at least 2 precordial leads, and 27 did not exhibit such changes. Twenty-seven patients underwent post-infarction exercise stress test. Furthermore, coronary arteriographic findings and left ventricular performance were evaluated in 8 of these patients with and in 8 without anterior S-T segment depression. Patients with anterior S-T segment depression showed greater inferior S-T segment elevation on admission ECG and deeper Q wave in lead aVF in ECG tracings recorded 1 month later. Higher incidences of in-hospital angina (10/30 vs 2/27, P = 0.01) and of late development of cardiac failure (5/21 vs 0/19, P = 0.03) were found among patients with anterior S-T segment depression. They showed a higher overall coronary score (82.4 +/- 31.0 vs 32.5 +/- 28.9, P = 0.002) and left anterior descending artery score (44.1 +/- 20.7 vs 8.5 +/- 16.1, P = 0.0009) and a reduced ventricular performance, evaluated by ventriculography score (49.5 +/- 2.7 vs 51.8 +/- 2.4, P = 0.05). A higher incidence of mitral regurgitation, secondary to papillary muscle dysfunction, was also found among patients with anterior S-T segment depression (4/8 vs 0/8, P = 0.04). Furthermore, the degree of anterior S-T segment depression in each of these subjects was closely correlated with the corresponding difference from normal ventricular score (r = 0.86, P less than 0.01). Finally, no difference between the two groups of patients was found as to incidence of positive exercise stress tests.
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PMID:Anterior S-T changes during acute inferior myocardial infarction. 664 77


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