RESUMEN
A terminal QRS deflection on a 12-lead electrocardiogram (previously described as peri-infarction block) most likely represents slowed conduction in a large area of myocardium near the infarct zone. We have described a patient with peri-infarction block, abnormal findings on signal-averaged electrocardiogram, and reentrant ventricular tachyarrhythmias. Our observation underscores the need to recognize the importance of terminal QRS deflections in the appropriate clinical situation.
Asunto(s)
Electrocardiografía , Taquicardia/fisiopatología , Adulto , Humanos , MasculinoRESUMEN
Coronary artery aneurysms are detected with increasing frequency owing to the advent of coronary angiographies. Although most patients with coronary artery aneurysms are asymptomatic, manifestations of myocardial ischemia may occur. The case described herein serves as a basis for a discussion of the pathogenesis, clinical manifestations, detection, and treatment of coronary artery aneurysms.
Asunto(s)
Aneurisma Coronario/diagnóstico , Adulto , Cateterismo Cardíaco , Angiografía Coronaria , Diagnóstico Diferencial , Electrocardiografía , Prueba de Esfuerzo , Humanos , Masculino , Síndrome Mucocutáneo Linfonodular/diagnósticoRESUMEN
Ninety-three patients with acute anterior myocardial infarction were treated with emergency percutaneous transluminal coronary angioplasty (PTCA). All were found to have a high-grade obstruction in the left anterior descending (LAD) vessel or the bypass graft to this vessel; 64 patients had a total occlusion. A completely successful PTCA, defined as a residual lesion of less than or equal to 50%, was achieved in 73 (78%) patients. A partially successful PTCA, with a residual lesion of 51% to 99%, was achieved in 12 (13%) patients. PTCA was unsuccessful in eight (9%) patients. Hospital mortality was 14%. Three parameters viewed separately each predicted hospital mortality: presence of shock, a proximal location of the LAD vessel occlusion, and the residual stenosis after PTCA. Reocclusion was found in only 11% of patients but 34% had evidence of restenosis on restudy.