Presentation of CaseA 62-year-old man was admitted to the hospital because of bradycardia.On the morning of admission, while eating breakfast, he had the onset of a mild ache in the neck, profuse sweating and weakness. A physician found bradycardia and sent him to the hospital via ambulance. As the patient arrived in the Emergency Ward cardiac arrest developed. With external cardiac massage and electric countershock cardiac activity was restored. A few minutes later effective cardiac action again ceased, and a cardiac monitor disclosed ventricular fibrillation. External countershock was again applied successfully, although the blood pressure remained low. Isoproterenol . . .
Dual-chamber pacemakers, more sophisticated and costly than single-chamber pacemakers, are being used with increasing frequency, often with unclear indications. Proponents of dual-chamber devices have focused on initial differences in cost without considering additional induced costs. We examined the incremental cost of dual versus single-chamber pacemakers over the expected lifetime of a pacemaker recipient. In addition to initial costs, we included the costs of pacemaker malfunction, reimplantation, generator replacement, and follow-up. Expected differences in cumulative costs per patient were calculated over a 12-year period. Dual-chamber pacing is $2500 more costly at implantation. The difference in cumulative cost increases to $5100 by year 12, reflecting shorter functional life for dual-chamber pacemaker generators and increased cost of follow-up. The incremental cost of dual-chamber pacemaking is neither short-term nor trivial. Dual-chamber pacemakers should be reserved for those who clearly benefit from its advanced technology.
Case Studies1 February 1967Traumatic Myocardial InfarctionReport of a Case with Normal Coronary AngiogramJ. WARREN HARTHORNE, M.D., F.A.C.P., PAUL A. KANTROWITZ, M.D., ROBERT E. DINSMORE, M.D., CHARLES A. SANDERS, M.D.J. WARREN HARTHORNE, M.D., F.A.C.P.Search for more papers by this author, PAUL A. KANTROWITZ, M.D.Search for more papers by this author, ROBERT E. DINSMORE, M.D.Search for more papers by this author, CHARLES A. SANDERS, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-66-2-341 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptMyocardial damage after nonpenetrating chest trauma has been reported to occur after 16 to 76% of traumatic injuries (1). The number of cardiac injuries due to automobile accidents alone has been estimated at 150,000 annually (2). Such traumatic damage to the heart has generally been manifested by nonspecific ST-T-wave changes and has usually constituted a minor aspect of the clinical situation. Frank myocardial infarction is uncommon and has usually been considered to reflect underlying coronary disease. Parmley, Manion, and Mattingly (2) in a review of 546 cases of nonpenetrating myocardial trauma found 105 cases of contusion with or without laceration...References1. WATSONBARTHOLOMAE JHWM: Cardiac injury due to nonpenetrating chest trauma. Ann. Intern. Med. 52: 871, 1960. LinkGoogle Scholar2. PARMLEYMANIONMATTINGLY LFWCTW: Non-penetrating traumatic injury to the heart. Circulation 18: 371, 1958. CrossrefMedlineGoogle Scholar3. SKLARINSEEGERSHIRSCHHORN BSWKK: Hyperlipemia. Geriatrics 16: 374, 1961. Google Scholar4. LEESHATCH RSFT: Sharper separation of lipoprotein species by paper electrophoresis in albumin-containing buffer. J. Lab. Clin. Med. 61: 518, 1963. MedlineGoogle Scholar5. AKENSIDE M: Account of a blow upon the heart. Philos. Trans. LIII: 353, 1763. Google Scholar6. CHAPMANMCEACHERN MGJA: Cardiac contusion caused by the use of a jackhammer. Amer. Heart J. 54: 625, 1957. CrossrefMedlineGoogle Scholar7. FRIEDBERG CK: Diseases of the Heart. W. B. Saunders Co., Philadelphia, 1956, p. 1061. Google Scholar8. FREDRICKSONONODAVIS DSKLL: Lipolytic activity of post-heparin plasma in hyperglyceridemia. J. Lipid Res. 4: 24, 1963. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Boston, MassachusettsFrom the Department of Medicine, Harvard Medical School, and the General Medical Service of The Massachusetts General Hospital, Boston, Mass.This study was supported in part by grant HE 08898-02, the U. S. Public Health Service, Washington, D. C.Requests for reprints should be addressed to J. Warren Harthorne, M.D., Cardiac Catheterization Laboratory, The Massachusetts General Hospital, Boston, Mass. 02114. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByMyocardial infarction and concurrent chest injuries: Two case reportsDissection coronaire et traumatisme thoracique ferméPrior blunt chest trauma may be a cause of single vessel coronary disease; hypothesis and reviewTrauma associated with acute myocardial infarction in a multi-state hospitalized populationPosteromedial papillary muscle rupture as a result of right coronary artery occlusion after blunt chest injuryA Case of Post-Traumatic Coronary OcclusionContusions myocardiques dans les traumatismes thoraciques fermés : étude prospectiveCoronary arteriography in dogs following blunt cardiac trauma: A longitudinal assessmentCoronary artery dissection secondary to blunt chest traumaECG findings in nonpenetrating chest trauma: A reviewChildhood traumatic infarction causing left ventricular aneurysm: Diagnosis by two-dimensional echocardiographyAcute Anterior Wall Myocardial Infarction Secondary to Blunt Chest TraumaMyokardinfarkt nach stumpfem ThoraxtraumaImmediate diagnosis of acute myocardial contusion by two-dimensional echocardiography: Studies in a canine model of blunt chest traumaObstruction of aortocoronary bypass due to blunt chest traumaNon-iatrogenic trauma of the coronary arteries and myocardium: Contribution of angiography—Report of six cases and literature reviewMultiple peripheral emboli after cardiac trauma.Nonpenetrating traumatic complete heart block and myocardial infarction with normal coronaries: A case report with review of the literatureCoronary artery obstruction due to blunt chest trauma with residual angina pectorisAcute coronary artery occlusion secondary to blunt chest traumaElectrocardiographic Diagnostic Dilemmas in Myocardial Ischemia and InfarctionDelayed acute myocardial infarction after blunt chest trauma in a young womanEarly Occlusion and Late Stricture of Normal Coronary Arteries Following Blunt Chest TraumaElectrophysiological manifestations of non-penetrating cardiac trauma.Obstruction of the Proximal Right Coronary Artery with Acute Inferior Infarction Due to Blunt Chest TraumaPHILIP B. OLIVA, M.D., ALAN HILGENBERG, M.D., DONALD MCELROY, M.D.Post-traumatic coronary occlusion and early left ventricular aneurysmStumpftraumatische Schäden des Herzens und der großen herznahen GefäßeCOXSACKIE INFECTION AND MYOCARDIAL INFARCTIONAcute coronary occlusion following blunt injury to the chest in the absence of coronary atherosclerosisCardiac traumaCase 3-1976An Electrocardiographic Pattern of Acute Myocardial Infarction Associated with Excessive Use of Aerosolized IsoproterenolRapid Resolution of Coronary Arterial Emboli Myocardial Infarction and Subsequent Normal Coronary ArteriogramsRONALD J. O'REILLY, M.D., RICHARD D. SPELLBERG, M.D., F.A.C.P.Rupture of the Right Coronary Artery Due to Nonpenetrating Chest TraumaCoronary angiographyNonpenetrating cardiac injuries: A collective reviewNormal coronary arteriogram following myocardial infarction in a 17 year old boyTransient post-traumatic right bundle branch blockBeurteilung und Behandlung von Verletzungen des Brustkorbes und der Brustorgane im Rahmen der MehrfachverletzungenMedico-Legal Aspects of Coronary Heart Disease 1 February 1967Volume 66, Issue 2Page: 341-344KeywordsAngiographyAntsHospital medicineLeft anterior descending coronary arteryLeft coronary arteryMedical servicesMyocardial infarctionRight coronary arteryThoraxTraumatic injury Issue Published: 1 February 1967 PDF DownloadLoading ...
