[The appearance of giant negative T waves in anterior acute myocardial infarct with a Q wave is associated with minor myocardial damage and a minor extension of coronary disease]. / La aparición de ondas T negativas gigantes en un infarto agudo de miocardio anterior con onda Q se asocia a un menor daño miocárdico y una menor extensión de la enfermedad coronaria.

INTRODUCTION AND OBJECTIVE: The early inversion of T waves in patients with acute myocardial infarction has recently been related to a better left ventricular function and a more favourable evolution, contrary to what happens in the unstable angina. On the other hand, the significance of the appearance of deep negative T waves in the early phase of some acute myocardial infarction is not known. The aim of this study is to evaluate its relation with the existing myocardial damage and the underlying coronary artery disease extension in anterior some with Q wave. METHODS: 48 patients with a first anterior Q-wave acute myocardial infarction, thrombolized or not, admitted to hospital with an evolution of less than 24 hours, and with a coronariography performed before discharge were analyzed. Giant negative T waves were defined as those which were 8 mm or more from baseline. RESULTS: 17 of the 48 patients presented giant negative T waves (T-group) and 31 did not (N-group). In the T-group patients, the size of the negative T wave was 11.29 +/- 2.86 mm and the number of precordial leads with negative T waves was 4.35 +/- 1.57. There were no differences between both groups in variables such as sex, coronary risk factors, and other basal characteristics. The T-group patients were younger, had lower peak-CK, CK-MB and LDH levels and presented greater recovery of R waves during the follow-up, the differences being significant with the N-group patients. The left ventricular ejection fraction was higher (56.3 +/- 13.4 vs 42 +/- 12%; p < 0.001) and the number of affected coronary vessels was lower in the T-group (1.12 vs 1.64; p < 0.01); there were no differences in the localization or severity of coronary lesions, nor in the frequency of postinfarction myocardial angina. None of the patients in the T-group were Killip > I, while this situation occurred in 38.7% of the N-group patients. CONCLUSIONS: The appearance of giant negative T waves in the acute or early phase of Q-wave anterior acute myocardial infarction is associated with a smaller infarct size, lower functional deterioration and less extension of the underlying coronary disease.

[Poisoning by delayed-release verapamil in an uremic patient]. / Intoxicación por verapamilo de liberación lenta en un enfermo urémico.

The appearance of toxic effects upon consumption of delayed release verapamil at therapeutic doses (120 mg/12 h) in a 64 year old patient with renal failure is described. The patient presented hypotension, bradycardia due to auriculoventricular block, hepatotoxicity, slight hyperglycemia, hyperpotassemia and metabolic acidosis with increased anionic gap. The picture remitted spontaneously with support treatment following discontinuation of the medication. The pathogenesis of the syndrome and the possibility that the hepatotoxicity was the triggering factor are discussed. Extreme precaution is recommended when this type of drugs is used in severe uremic or diabetic patients.

[Pulmonary thromboembolism with mobile thrombus in the right atrium. Presentation of a case diagnosed with bidimensional echocardiography and review of the literature]. / Tromboembolismo pulmonar con trombo móvil en aurícula derecha. Presentación de un caso diagnosticado por ecocardiografía bidimensional y revisión de la literatura.

A case is presented of a pulmonary thromboembolism secondary to detachment of an elongated and mobile thrombus in right atrium, identified by bidimensional echocardiography in a patient without previously identified cardiac pathology. The presence of pulmonary thromboembolism in this patient was confirmed by lung angiography. In-spite of anticoagulant treatment, the patient died four days later due to massive pulmonary embolism, before a surgery could be carried out, coinciding with the disappearance of the right atrium thrombus by bidimensional echocardiography. The echocardiographic characteristics of right atrium thromboembolisms are described as well as their differential diagnosis and the most appropriate therapeutic attitude in these cases based in a literature review.