ABSTRACT
BACKGROUND: The exact relationship between the coronary flow reserve (CFR) and infarct size remains unknown. In this prospective study the relationship between the CFR both in the infarcted and remote myocardium and infarct size was investigated. Furthermore, the diagnostic value of the CFR to predict the extent of microvascular obstruction (MO) was evaluated. METHODS: In thirty patients the CFR was measured with a Doppler guide wire 6 ± 3 days after a first myocardial infarction (MI) in the infarct related and in a reference coronary artery. MO and infarct size were determined with magnetic resonance imaging. RESULTS: The CFR was inversely related to infarct size in the infarcted and remote myocardium (respectively, r=-0.60, p<0.01 and r=-0.62, p<0.01). In the infarcted myocardium the extent of MO was strongly related to the infarct size and was in a multivariate analysis the single significant determinant of the CFR and the hyperaemic flow. In the remote myocardium no relationship was present between infarct size and hyperaemic flow, but the baseline flow increased as the infarct size became larger (r=0.58, p<0.01). In a receiver operator characteristic (ROC) analysis, a CFR value ≤ 2 in the infarct related coronary artery offered the best sensitivity (65%) and specificity (71%) to detect the presence of MO (p<0.05). CONCLUSIONS: After MI, the CFR both in the infarcted and remote myocardium is inversely related to infarct size. In the infarcted myocardium, a CFR value ≤ 2 predicts the presence of MO with moderate sensitivity and specificity.
Subject(s)
Coronary Circulation/physiology , Coronary Disease/diagnosis , Coronary Disease/physiopathology , Microcirculation/physiology , Myocardial Infarction/diagnosis , Myocardial Infarction/physiopathology , Adult , Aged , Blood Flow Velocity/physiology , Cardiac Catheterization/methods , Coronary Disease/therapy , Female , Humans , Magnetic Resonance Imaging, Cine/methods , Male , Middle Aged , Myocardial Infarction/therapy , Prospective StudiesABSTRACT
OBJECTIVE: To investigate the underlying mechanisms of a decreased coronary flow reserve after myocardial infarction (MI) by analysing the characteristics of the diastolic hyperaemic coronary pressure-flow relationship. DESIGN: Prospective study. SETTING: Tertiary care hospital. PATIENTS: 68 patients with a recent MI and 27 patients with stable angina pectoris (AP; control group). MAIN OUTCOME MEASURES: The intercept with the pressure axis (the zero flow pressure or Pzf) and slope index of the pressure-flow relationship (SIPF) were calculated from the simultaneously recorded hyperaemic intracoronary blood flow velocity and aortic pressure after successful coronary stenting. RESULTS: A stepwise increase in Pzf from AP (14.6 (8.0) mm Hg), over non-Q-wave MI (22.5 (9.1) mm Hg), to Q-wave MI (37.1 (12.9) mm Hg; p<0.001) was observed. Similar changes in Pzf were found in a reference artery perfusing the non-infarcted myocardium. Multivariate analysis showed that in both regions the left ventricular end-diastolic pressure (LVEDP) was the most important determinant of the Pzf. The SIPF was not statistically different in the treated vessel between patients with MI and AP, but was increased in MI patients with a markedly increased LVEDP. CONCLUSIONS: After an MI, the coronary pressure-flow relationship is shifted to the right both in the infarcted and in the non-infarcted remote myocardium, as shown by the increased Pzf. The correlation with Pzf suggests that elevated left ventricular filling pressures contribute to the impediment of myocardial perfusion in patients with infarction.
Subject(s)
Coronary Circulation/physiology , Myocardial Infarction/physiopathology , Ventricular Dysfunction, Left/physiopathology , Blood Flow Velocity/physiology , Blood Pressure , Case-Control Studies , Coronary Artery Disease/physiopathology , Coronary Stenosis/etiology , Coronary Stenosis/physiopathology , Coronary Vessels/physiology , Diastole , Female , Humans , Male , Microcirculation , Middle Aged , Myocardial Infarction/therapy , Prospective Studies , StentsABSTRACT
Mianserin is a drug frequently used to treat depression and sleep disturbances. Despite documented effects on various cardiac tissues in animal studies, mianserin has a very safe clinical profile. Only one case of ventricular arrhythmias in a patient treated with mianserin has been reported. This patient had a severe cardiac history. Our case is to our knowledge the first report on ventricular arrhythmias in a patient treated with mianserin without previous or present cardiac disease. After discontinuation of mianserin the arrhythmias disappeared within days. The literature on mianserin toxicity is reviewed.
Subject(s)
Antidepressive Agents, Second-Generation/adverse effects , Mianserin/adverse effects , Tachycardia, Ventricular/chemically induced , Adult , Electrocardiography , Humans , Male , Tachycardia, Ventricular/diagnosisABSTRACT
We present a patient who had one episode of prepatellar bursitis and subsequently several episodes of arthritis of his right knee. Cultures of several punctures of his knee remained sterile, but the patient had been taking oral antibiotics on each of these occasions against our medical advice. Ultimately a diagnostic puncture revealed growth of Staphylococcus aureus. An X-ray demonstrated an osteolytic lesion of the patella, but no defect in the articular surface of the patella could be visualised. MRI demonstrated a communication between the osteomyelitic focus through the medial retinaculum to the bursa suprapatellaris and the knee joint. Osteomyelitis of the patella is mainly a disease of childhood. This case is, to our knowledge, the first report on the association between bursitis, osteomyelitis of the patella and recurrent septic arthritis of the knee in an adult. The literature is reviewed and discussed briefly.
