Anticoagulant therapy in acute myocardial infarction.

In 265 patients of acute myocardial infarction (AMI) heparin followed by warfarin sodium was used routinely whenever there was no contraindication to the drug. Patients were followed up to 2 years with weekly estimation of prothrombin time. Another 265 patients of AMI having identical clinical profiles were taken as control and neither any anticoagulant nor any antiplatelet agent was used in them. Both groups were also treated with identical coronary dilators whenever needed. 2 years cardiac mortality was 11.6% in the control group and 5.9% in the anticoagulant therapy (ACT) recipient group (P less than 0.05). Incidence of reinfarction (RMI) was 14.4% during the period in the control group whereas it was only 6.7% in the ACT group (P less than 0.05). The incidence of intracranial events were also more frequent in control group (8.4%) compared to ACT group (3.1%) (P less than 0.05). However on further analysis of intracranial events, it was found that haemorrhagic intracranial events were slightly more frequent in ACT (2.3%) than in the control group (2%), but this difference was statistically insignificant (P greater than 0.05); non-haemorrhagic intracranial events were however significantly less in ACT group (1.96%) compared to the control group (6%) (P less than 0.05). There was no major or fatal extracranial haemorrhagic complication in either group. Only minor extracranial haemorrhages were more commonly observed in the ACT group (4.3%) compared to the control group (1.2%) (P less than 0.05).

An echo-cardiographic (M-mode & 2D) analysis of thalassaemia major.

25 cases of thalassaemia major were studied by 2D and M-mode echocardiography. A significantly increased (p less than 0.001) mean value (100.8 +/- 27.37 msec, range 80 to 140 msec) of A2-E (early relaxation period) interval on M-mode was observed in thalassemia in comparison to mean level (82.6 +/- 5.7, range 60 to 100 msec) of control population. No significant differences were noted in FS % (fractional shortening) and EF% (ejection fraction) when compared to corresponding normal values respectively. Mean serum iron concentration (142.2 +/- 29.1 micrograms/dl, range 102 to 192 micrograms/dl) was significantly higher in thalassaemia as compared to normal population (mean 106.3 +/- 11.4 micrograms/dl, range 75 to 120 micrograms/dl). There was also a direct correlation between serum iron concentration and A2-E interval. 11 patients (44%) showed abnormal A2-E interval but only 3 patients (12%) showed abnormal percentage of FS and EF. It is therefore concluded that A2-E interval will help to detect early left ventricular dysfunction much before overt and irreversible heart failure becomes manifest and which will also help to optimise transfusion and chelation therapy.

The surgical treatment of atrial myxomas. Clinical experience and results in eight patients.

Between 1983 and 1988, eight patients underwent excision of left atrial myxomas at the Institute of Postgraduate Medical Education & Research, Calcutta. There were five females and three males. The presenting symptoms and signs often simulated mitral stenosis or insufficiency, and the diagnosis was confirmed by echocardiography and angiocardiography. One patient presented with features of cerebral embolism. The myxomas were successfully removed under cardiopulmonary bypass in all patients, either by shaving them from the atrial septum, or by excising a portion of normal atrial septum with the tumour. Small tumours were removed through left atriotomy, while a biatrial approach was utilised for large tumours. There was one perioperative death, and another patient died one and half years later, probably due to tumour embolisation in brain. Late functional results have been excellent in all the other patients. Two dimensional echocardiography has proved to be extremely accurate in early diagnosis of myxomas and in the late follow up of patients. The pertinent literature is reviewed.