A congenital adrenal hyperplasia patientpresented with myocardial infarction due to inadequate glucocorticoid therapy
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Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)Cardiac Rupture
Heart Rupture
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Abstract Most studies have suggested that patients with anterior myocardial infarction have an adverse prognosis compared with patients with inferior infarction. The objective of this study was to compare the mortality and morbidity in anterior versus inferior acute myocardial infarction (AMI) during 1 year in a consecutive series of patients hospitalized with AMI. All patients fulfilling the criteria for AMI who were admitted to a single hospital during 21 months (n = 921) participated in the study. Patients with anterior infarction (n = 312) had a 1‐year mortality rate of 26% versus a rate of 24% for patients with inferior infarction (n = 269) (p > 0.2). The corresponding figures for patients with no previous infarction who developed Q waves were 27 and 21%, respectively (p > 0.2). Reinfarction, thromboembolic events, and other aspects of morbidity during longterm follow‐up appeared with similar frequency in the two groups. Thus, in a nonselected group of patients admitted to a single hospital because of AMI, the prognosis was found to be similar among patients with inferior and those with anterior infarction. In the subset of patients with a first myocardial infarction who developed Q waves, there was a trend indicating higher mortality in anterior infarction.
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To determine the prognosis after hospitalization of patients hospitalized with acute chest pain in a coronary-care unit, we undertook a prospective study of 211 consecutive admissions to the Stanford Coronary Care Unit. On the basis of predetermined criteria, 16 patients were found to have noncardiac chest pain, and myocardial infarction was ruled out in 89, one of whom died in the hospital. Infarction was documented in 84 others, six of whom died in the hospital. Prospective follow-up after hospitalization was carried out in the 88 patients in whom infarction was ruled out and in the 78 patients who survived infarction. The rate of myocardial infarction or death was 8.0 per cent at six months and 21.6 per cent at a mean of 27.8 months of follow-up for patients who had infarction ruled out, as compared with 7.7 per cent at six months and 21.8 per cent at a mean of 27.8 months of follow-up for those who had a documented infarction during the initial hospitalization. Cardiomegaly, congestive heart failure, and angina after discharge from the hospital tended to increase the risk of morbidity and mortality in both groups. The patient hospitalized with acute ischemic chest pain without evolution of a myocardial infarction has a six to 24-month prognosis similar to that of the patient hospitalized with an acute infarction, and therefore requires similar diagnostic and therapeutic assessment. (N Engl J Med. 1980; 303:1–5.)
Coronary care unit
Unstable angina
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This study assesses the impact of infarct location on immediate (in-hospital) and 1- and 5-year mortality among patients with reinfarction during the year following discharge from the initial episode of myocardial infarction. The analysis included 192 patients with a second myocardial infarction who were compared in four infarction location groups. The in-hospital mortality associated with reinfarction was higher in patients with a second anterior (32%) than with a second inferior (18%) location, irrespective of the first infarction location (p = 0.03). At 5 years of follow-up, the mortality (65%) tended to be higher in patients with a first anterior-second anterior infarction as compared with patients with all other combinations of location.
Anterior wall
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Objective To investigate the characteristics of acute infarction in different locations.Methods A retrospective study was carried out in the patients with acute myocardial infarction. The patients were divided into different groups according to the infarction walls.Results There were 1 827 patients who matched the diagnosis criterion of acute myocardial infarction. The patients with infarction of the anterior wall accounted for 45.8 %, while 26.7 % were infarction of the inferior wall. Among all the groups, the incidences in male patients ranging from 64.0% to 88.3% were higher than those of the female patients with 11.7% to 36.0%. There was significant difference between males and females (P0.05).The group of acute myocardial infarction with both anterior and inferior walls had a significant higher mortality than the average mortality (P0.05).Conclusion Anterior or inferior wall of the ventricle were the two most common of myocardial infarction.Male had the higher risk of acute myocaridial infarctions. Patients with acute infarction of both anterior and inferior walls have a markedly increased mortality.
Anterior wall
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To evaluate the 10-year incidence of later infarction and subsequent mortality, as well as predictors of later infarction, in patients with suspected myocardial infarction and alive on day 15 after admission.5993 patients admitted with suspected myocardial infarction and alive on day 15 after admission were registered in The First Danish Verapamil Infarction Trial database in 1979-81. 2586 had definite infarction, 402 probable infarction and 3005 no infarction as they fulfilled 3, 2 and 1 criteria for infarction. They were followed for 10 years with respect to later infarction and death, i.e., including death after later infarction. The 10 year infarction rate after index admission was 48.8% in definite, 47.3% in probable and 24.6% in no infarction patients (P < 0.0001). The subsequent 10-year mortality was 82.3% in primary definite, 74.7% in primary probable, and 77.9% in primary no infarction patients (ns), Cox regression analysis with sex, age group, and definite, probable or no infarction as independent variables showed that females aged < 50 years without a primary infarction had the lowest hazard ratio (0.13 relative to males, aged 50-65 years with definite/probable infarction at index admission) for a later infarction, in contrast to the highest hazard ratio (1.17) for males aged > 65 years with definite or probable infarction.The 10-year infarction rate in patients with suspected myocardial infarction in whom the diagnosis is ruled out is lower than in those with definite or probable infarction, but the mortality after a later infarction is similar in all three groups.
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In 50 patients with acute myocardial infarction (16 patients with previous infarction and 34 patients without), total creatine phosphokinase (CPK) released which represents infarct size was calculated from the serial change of serum CPK activity by the method of Sobel improved by Norris, and related it to the presence or absence of heart failure, the ejection fraction and one-year-mortality. If the patients with previous myocardial infarction were excluded, mean total CPK released in 10 patients with heart failure (1428 ± 200.4 IU/ml in Group II) was significantly larger (P<0.01) than that in 24 patients without heart failure (735.3 ± 83.6 IU/ml in Group I). However, in patients with previous myocardial infarction there was no significant difference in infarct size between these two groups (Groups I and II) indicating that the complication of heart failure does not directly relate to the size of the recent infarction but in large extent to the presence of prior infarction. The ejection fraction was obtained in 15 patients who had left ventriculography. Both of two patients with prior myocardial infarction in these 15 patients showed smaller ejection fraction than the predicted values myocardial infarction could contribute to impaired cardiac function as well as the recently occured infarction. One-year-mortality in Group II (37.5%) was higher than that of Group I (7.4%). In four patients with prior infarction who died within one year after the onset, mean total CPK released (275.3 IU/ml) was significantly smaller than that in three patients without prior infarction (899.0 IU/ml). These results strongly suggest that the patients with previous myocardial infarction are often complicated with heart failure and have poor prognosis even with comparatively small infarction and also demonstrate the substantially large contribution of the reduced contractility resulting from the previous myocardial infarction to the impaired cardiac function.
Creatine kinase
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PATIENTS who have a first myocardial infarction deserve consideration as a special group. For the most part, the early mortality rate from a first infarction is roughly half the rate found in patients with a second or third infarction,1 , 2 and the long-term survival is considerably better than in patients who have had previous infarctions.3 , 4 The published studies on risk stratification4 5 6 and treatment7 8 9 after an infarction have paid remarkably little attention to patients having their first myocardial infarction. Such patients constitute a majority (60 to 80 percent) of those with acute infarction, yet they are rarely viewed as a special group. . . .
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Acutely damaged myocardium was shown in 103 patients with suspected acute myocardial infarction using 99Tcm pyp. A significant incidence of false positive and false negative results occurred, 9true9 results being defined by standard clinical, electrocardiographic, and enzyme criteria. Localisation of infarction compared reasonably well with standard electrocardiographic criteria but more frequently suggested true posterior involvement. Serial estimates of infarct size may be of value in the recognition of infarct extension during the acute phase. Viable perfused myocardium was shown in 63 patients with a variety of cardiac disorders using 129Cs. The technique gives a reliable indication of anterior infarction but tends to underestimate inferior infarction. There was good correlation with the electrocardiogram with regard to localisation and extent of infarction. Nineteen patients received both isotopes and were included in each of the above groups. The combination permits further assessment of equivocal results Furthermore as 129Cs demonstrates both previous and recent infarction and 99Tcm pyp accumulates only in acutely damaged myocardium it was possible to estimate the extent of previous and recent myocardial damage.
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TIMI
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