[Evaluation of electrocardiogram's interpretation in the emergency department]

The aim of this study was to determine the concordance of emergency physicians' and cardiologists' interpretations of emergency department [ED] electrocardiograms [ECG] and to evaluate the impact of ECG misinterpretation on patient management. From December 1993 to April 1994 one hundred ninety five ECG interpretations [3.3% of all consultants] were registered prospectively using a programmed-response data sheet. A second blinded interpretation by a cardiologist was performed and compared with the emergency physicians' interpretations. The overall concordance between emergency physicians' and cardiologist ECG interpretations was observed in 149 [76%] cases [kappa= 0.41]. The concordance rate was lower in abnormal ECGs [kappa=0.19]

Conclusion: in our study, the quality of ECG interpretation by ED physicians is satisfactory and the rare misinterpretations have minimal clinical impact

[Correlation of clinical and angiographic morphology in unstable angina]

The goal of this study was to compare the clinical presentation and angiographic morphology of patients having an unstable angina pectoris. A total of 321 patients were consecutively studied and underwent cardiac catheterization, mean age 59 + 6 years. According to Braunwald classification, class III was predominant [58%] On coronary angiography, 148 patients had single vessel disease, double-vessel in 92 and triple-vessel in 64. Morphology of coronary artery lesions was classified according to Ambrose's classification, 100 patients had simple lesions [type I or IIA], 204 patients had complex lesions [type IIB, Ill, intracoronary thrombus or total occlusion]. Thoracic rest pain [class III] or postinfarction angina [class C], were associated with the presence of complex lesions. This subgroup of high risk patients would benefit from either Glycoprotein IIb/IIIa blockers with an early revascularisation strategy

Valvuloplastia percutânea mitral por baläo: resultados imediatos de 80 casos / Percutaneous mitral valvuloplasty by ballon catheterization: immediate results of 80 cases

Setenta e sete valvotomias foram realizadas nas primeiras 80 tentativas de tratamento da estenose mitral por valvuloplastia percutânea por duplo baläo (BMV). No grupo de 80 pacientes, 16 eram homens, a média de idade era de 44 ñ 17 anos, 12 tinham sido submetidos anteriormente a comissurotomia mitral cirúrgica, 26 apresentavam pequena insuficiência mitral. Havia importante alteraçäo valvar (imobilidade, espessamento ou calcificaçäo) ou do aparelho subvalvar em 29 pacientes. A média da pressäo "capilar" pulmonar variou de 22 ñ 6 a 12 ñ 5 mmHg (p < 0,001), o gradiente transvalvar mitral médio de 15 ñ 6 a 5 ñ 4 mmHg (p < 0,001). O índice cardíaco näo variou, a área valvar mitral (Gorlin) aumentou de 1,09 ñ 0,29 a 2,19 ñ 0,72 cm**2 (p < 0,001). Variaçöes similares foram medidas pela ecodopplercardiografia. Houve 3 tamponamentos: o primeiro num paciente no qual a BMV näo foi concluída; nos outros casos, as pressöes intracavitárias foram medidas depois da drenagem cirúrgica do pericárdio. A BMV näo foi eficaz num dos pacientes, que faleceu 3 dias após a toracotomia. Os três tamponamentos ocorreram por perfuraçäo do ventrículo esquerdo por baläo terminando em ponta. Näo houve mais tamponamento depois que foram adotados balöes terminando em "pigtail". Näo houve aumento de insuficiência mitral de mais de 1 +. Foi constatada comunicaçäo interatrial com relaçäo de fluxos pulmonar/sistêmico >= 1,5 e < 2 em 5 pacientes, e nenhum deles necessitou correçäo cirúrgica. A BMV é alternativa ao...