[Myocardial infarction caused by cold beverage drinking after strenuous physical exercise]. / Infarto del miocardio provocado por ingesta de bebida fría inmediatamente después de ejercicio físico intenso.

A case of acute myocardial infarction in a 36 years old patient is presented. Maleness was male, as the only mayor coronary risk factor. He had myocardial infarction associated with ingestion of cold beverage after strenuous physical exercise. A coronariographic study was done postmyocardial infarction, which showed a mild obstruction of the LAD. The most likely cause of the coronary event in this case is coronary spasm and atherosclerosis. A review of the literature on this subject is made.

[The heart and ankylosing spondylitis]. / El corazón y la espondilitis anquilosante.

UNLABELLED: We studied 40 consecutive patients with Ankylosing Spondylitis from the cardiological point of view through non-invasive methods. Fourteen (35%) patients had some kind of cardiovascular complication as shown by any of the used methods. a) SYMPTOMS: fifteen (37.5%) refered nonspecific chest pain, five (12.5%) dyspnea on exertion and four (10%) frecuent palpitations. b) PHYSICAL EXAMINATION: two patients (5%) had aortic regurgitation and two (5%) mitral valve disease. c) Electrocardiogram: in seven (17.5%), left ventricular hypertrophy was detected, in two (5%) left atrial hypertrophy and in seven (17.5%) some type of conduction disturbance. d) Chest X Ray: six (15%) had left ventricular hypertrophy, one (2.5%) left atrial hypertrophy and two (5%) dilated ascending aorta. e) Echocardiogram: two cases (5%) had aortic dilatation and other two (5%), mitral valve disease. In three patients (7.5%) pericardial effusion was found, which in our series, it is more frecuent than has been reported up until now in the literature.

[Bifascicular block: long-term follow-up. Report of 40 cases]. / Bloqueo, bifascicular, seguimiento a largo plazo. Informe de 40 casos.

A total of 14,500 E.C.G. tracings were reviewed to determine the incidence of bifascicular block and those patients were followed up to assess prognosis. Forty patients with bifascicular block (complete right bundle branch block associated with left anterior hemiblock), diagnosed with standard E.C.G., according to Medrano's criteria from January 1978 to September 1980 were studied in our Service. The incidence of this intraventricular conduction defect was 0.0033 (3.3 per thousand). Males predominated over females at a rate of 2.4 to 1. This block was more frequent from the sixth to the ninth decades of life. Thirty five percent of the patients had no evidence of cardiovascular pathology; 32.5 percent had high blood pressure, 2.5 percent had coronary heart disease, 2.5 percent rheumatic heart disease, 5 percent chronic pulmonale, and 37.5 percent had diabetes mellitus as an associated finding. During the follow up which covered 20.2 months/patient, only one patient developed junctional rhythm and periods of asystolia and syncope; this case was treated with a permanent pacemaker with good results. Two patients died, one from digitalis intoxication and the other at home, the cause was not determined. It is necessary to study this conduction defect with longer follow up periods and according to the underlying heart disease, in order to assess properly the prognosis and behavior of this conduction defect.

[Exercise-induced coronary artery spasm. Angiographic demonstration and results of medical treatment]. / Espasmo arterial coronario inducido por ejercicio. Demostracíon angiográfica y resultados del tratamiento médico.

This report describes a case of a patient with a history of classical angina of effort which developed into an unstable progressive syndrome. A 42-year-old-woman was admitted to the hospital because of resting angina pectoris. Examination revealed signs of septal subepicardial ischemia in the resting electrocardiogram and a positive ergometric test with marked depression of the S-T segment. Hemodynamic studies showed in the ventriculogram a clearly defined area of hypokinesis on the anterolateral segment of the ventricle and the coronariography revealed normal vessels. During exercise the patient developed anginal pain and an elevation of the S-T segment in a lead II electrocardiogram. During the pain episode, selective left and right coronariographies showed the presence of a severe spasm in the first portion of the anterior descending branch. In the course of one of the injections the patient developed ventricular fibrillation, this was reverted with a 400 watts/sec shock. The patient was discharged from the hospital a few days after and has been successfully treated with nitrates and calcium blocking agents. This case represents the first time that a coronary spasm in normal vessels has been adequately documented by us.

[Angina pectoris with normal coronary arteries]. / Angor pectoris con coronarias normales.

Twelve patients 8 females and 4 males, whose ages varied from 33 to 60 years (median 50.6 years), were seen at the Hospital for Cardiology and Neurology of the Mexican Institute for Social Security. All were diagnosed as having angor pectoris, through the clinical history and physical exam. Three patients had stable angor and in nine it was of an unstable type. The resting ECG showed signs of subepicardial ischemia in five cases. In eight the stress ECG according to the Bruce technic showed depression of the ST segment over 1 mm. In one patient atrial stimulation was performed with a pacemaker and ischemic changes of the ST segment were normal in all cases; in two however, coronary spasm that reversed with nitroglycerin appeared. The left ventriculogram was normal in all but one that revealed diaphragmatic hypokinesia associated with right coronary spasm. All patients were followed from two to fifty six months (median 19.4), and only in one case the angor pectoris remained unchanged. In all others it decreased or disappeared. During this time there were no deaths, myocardial infarctions or severe arrhythmias.