ABSTRACT
Although CPK-MB determinations are useful adjuncts in diagnosing myocardial infarction (MI), the values are frequently elevated in circumstances other than infarction and almost certainly remain normal in some patients who have sustained myocardial necrosis. Elevations in patients with trauma, sustained tachyarrhythmias, and unstable angina can be particularly confusing. As there is still no adequate diagnostic standard for MI, in many cases the clinician can only make a judgment as to the probability of infarction.
Subject(s)
Creatine Kinase/blood , Myocardial Infarction/diagnosis , Clinical Enzyme Tests/standards , Diagnosis, Differential , Humans , Isoenzymes , Myocardial Infarction/bloodSubject(s)
Bundle-Branch Block/etiology , Heart Diseases/complications , Adult , Aged , Bundle-Branch Block/diagnosis , Cardiac Catheterization , Cardiomyopathies/complications , Coronary Disease/complications , Electrocardiography , Heart Block/complications , Heart Conduction System , Humans , Male , Middle Aged , Myocardial Infarction/complications , PrognosisSubject(s)
Myocardial Infarction , Pain/etiology , Palpation , Electrocardiography , Humans , Male , Middle AgedABSTRACT
We compared ejection fraction, left ventricular end-diastolic pressure, cardiac index and the relation of left ventricular stroke work index to left ventricular end-diastolic pressure during rest and exercise in 60 patients with coronary artery disease. Left ventricular end-diastolic pressure was usually normal at rest (48/60) and abnormal during exercise (46/60) and did not correlate with ejection fraction. Cardiac index was insensitive, usually remaining normal until ejection fraction was less than 0.40. Patients with a normal left ventricular stroke work index response to exercise had higher ejection fractions than those with an abnormal response (p is less than 0.05). However, 9 patients with normal ejection fractions had an abnormal exercise response. This may reflect loss of left ventricular reserve, abnormal compliance or clinically silent ischemia during exercise. Different indices of left ventricular performance may be widely disparate in coronary artery disease, and abnormalities are frequently apparent only during exercise.
Subject(s)
Coronary Angiography , Coronary Disease/diagnosis , Hemodynamics , Adult , Aged , Blood Pressure , Cardiac Output , Coronary Disease/physiopathology , Humans , Male , Middle Aged , Myocardial Contraction , Oxygen Consumption , Physical ExertionABSTRACT
A patient with coronary artery disease exhibited reduction in systemic arterial pressure and striking changes in pulmonary artery wedge pressure and pulse contour during an episode of exercise-associated angina pectoris. There is suggestive evidence that these phenomena were secondary to marked but reversible exacerbation of mitral regurgitation.