ABSTRACT
The use and current limitations of early exercise testing of the patient with a postmyocardial infarction (MI) is reviewed. The test provides useful information in identifying patients at high risk of a second coronary event, thereby helping direct possible interventional therapy. It also furnishes information regarding the patient's capacity for physical exertion, detection of ventricular arrhythmias, and extent of coronary artery disease. Angina, ST segment responses, BP, and ventricular arrhythmias during early exercise testing are evaluated for their importance in determining prognosis. The concomitant use of thallium scintigraphy and radionuclide ventriculography seems to augment detection of multivessel disease and left-ventricular dysfunction. A practical strategy for the use of early exercise testing in the evaluation of post-Mis is provided.
Subject(s)
Myocardial Infarction/rehabilitation , Angina Pectoris/etiology , Electrocardiography , Exercise Test , Heart/diagnostic imaging , Humans , Prognosis , Radionuclide Imaging , Risk , ThalliumABSTRACT
Thrombolytic dissolution of coronary artery thrombus has added new dimensions to early myocardial infarction treatment. Reperfusion via streptokinase infusion has been shown to be beneficial; however, adverse effects are being noted. We present the case of a patient so treated who subsequently developed left ventricular free wall rupture.
Subject(s)
Heart Rupture/chemically induced , Myocardial Infarction/drug therapy , Streptokinase/adverse effects , Coronary Disease/complications , Coronary Disease/drug therapy , Humans , Infusions, Intra-Arterial , Male , Middle Aged , Myocardial Infarction/etiology , Streptokinase/administration & dosageABSTRACT
A 29-year-old obese man had marked tonsillar hypertrophy, somnolence, hypoxemia, and hypercapnia. Endotracheal intubation followed by tracheostomy relieved the hypoventilation. Weight loss improved the arterial blood gas levels. Sequential upright and supine flow-volume loops were compatible with a fixed upper-airway obstruction (such as would occur) with enlarged tonsils) prior to tonsillectomy. Following surgery, the expiratory flow-volume curve was abnormal in the supine position, consistent with the additional diagnosis of posterior pharyngeal hypotonia. Thus, in this patient the unique combination of tonsillar hypertrophy, posterior pharyngeal hypotonia, obesity, and a depressed respiratory center led to retention of carbon dioxide.
