The purpose of the study was to assess the clinical value of echocardiography in a coronary care unit. 133 patients admitted for an acute cardiovascular disorder were examined by a mobile echocardiograph. 83 patients had an acute myocardial infarction, 8 extracardiac chest pain, 6 unstable angina pectoris, 6 acute pulmonary embolism and 16 other acute cardiovascular diseases. 14 patients were excluded from the study because of poor image quality. Echocardiography was found most advantageous in solving the following clinical problems: 1) early diagnosis of acute myocardial infarction (probably the earliest of all available methods); 2) immediate and precise diagnosis of complications in myocardial infarction; 3) differential diagnosis of chest pain; 4) detection of left ventricular thrombi (the most useful method for this purpose); 5) differential diagnosis of other acute cardiovascular diseases (pulmonary embolism, aortic root dissection etc.).
Pericarditis is a common complication of acute myocardial infarction (MI). Its incidence during the first few days after acute MI is 24%-43% when echocardiographic criteria are used, whereas the frequency of clinical pericarditis is much less (from 5% for all acute MIs to 21% for anterior Q wave MIs). Clinical, electrocardiographic findings are discussed. Effusions are mostly small, and the resolution is frequently slow, lasting 1-18 months. Tamponade is extremely rare in the absence of cardiac rupture. Q wave MIs (especially anterior) are more frequently accompanied by pericardial effusion. The prognostic significance of echocardiographically proved pericarditis is questionable.
21 HLA-A, B-antigens were typed in 82 patients with hypertrophic cardiomyopathy and their 17 diseased relatives in 15 families, and their frequency was statistically compared with 300 healthy persons. A statistically significant lower frequency of the HLA-antigen B35 could bei stated (3.66% in contrast to 19.33%). An insignificant occurrence of HLA-B40 and a more frequent occurrence of HLA-Bw22 were statistically significant only before the p-correction. A statistic evaluation was done also in the groups of patients who were subdivided according to the age, the breadth of the ventricular septum and the presence of the obstruction. The importance of the results for the pathogenesis and prognosis of the disease was discussed.
Two-dimensional echocardiography was performed in 75 patients with extensive myocardial infarctions to prove why cardiogenic shock develops only in a minority of such patients. 23 patients with clinical signs of shock formed group A, and 52 patients without signs of shock group B. The extent of akinesis and/or dyskinesis was the same in both groups. The "Asynergy Index"--involving also hypokinesis--was more favourable in group B (126 +/- 28, compared with 158 +/- 23 in group A, p less than 0.05). The ejection fraction was significantly higher in group B (33 +/- 12%, compared with 17 +/- 6% in group A, p less than 0.01). The cause of these differences was severe diffuse hypokinesis of the remote myocardium, which was present in all 23 patients with cardiogenic shock and only in 2 patients without shock (p less than 0.001). All 23 patients with shock had multi-vessel disease, which was present only in 19% of patients without shock (p less than 0.01). The study shows that in addition to two known conditions necessary for the development of cardiogenic shock (multi-vessel disease and infarct size at least 40% of the left ventricle), there exists a third condition of equal importance: severe diffuse hypokinesis of the remote myocardium.
Can intracoronary thrombolytic therapy (ITT) reduce the infarct size and improve regional and global left ventricular function and if so how long after recanalization does this improvement develop? 42 patients were treated with ITT, of whom 25 showed successful recanalization (group A) and 17 had persistent occlusion or reocclusion (group B). Both groups were examined five times during the first month after infarction with two-dimensional echocardiography. The 'asynergy index' improved in group A by 45% of initial pretreatment values, compared with no significant change in group B (P less than 0.005). The 'asynergy extent' improved in group A by 35%, while in group B again no change was observed (P less than 0.01). This improvement occurred slowly, significant differences being achieved by the 10th day. Entire normalization of left ventricular wall motion was observed in 5 patients (20%) from group A and in no patient from group B. We conclude that successful recanalization of the occluded coronary artery by ITT improves left ventricular wall motion in 80% of patients, with entire normalization of local function in 20% of cases. The improvement occurs slowly during the first 10 days.
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