Coronary arteriographic findings in cocaine abuse-induced myocardial infarction.

A 31-year-old black man was admitted with an acute anterior myocardial infarction 20 minutes after IV cocaine abuse. Cardiac catheterization showed a totally occluded left anterior descending artery. Intracoronary and intravenous streptokinase resulted in thrombolysis: repeat angiography showed a normal anterior descending.

Right ventricular function: methodologic and clinical considerations in noninvasive scintigraphic assessment.

Right ventricular function plays an important role in many cardiac disorders. Changes in left ventricular function, right ventricular afterload and preload, cardiac medications and ischemia may affect right ventricular function. Radionuclide ventriculography permits quantitative assessment of regional and global function of the right ventricle. This assessment can be made at rest, during exercise or after pharmacologic interventions. The overlap between right ventricle and right atrium is a major limitation for gated scintigraphic techniques. The use of imaging with newer short-lived radionuclides may permit more accurate and reproducible assessment of right ventricular function by means of the first pass method. Further work in areas related to improvement of techniques and the impact of right ventricular function on prognosis is needed.

Biventricular function in sickle-cell anemia: radionuclide angiographic and thallium-201 scintigraphic evaluation.

Left ventricular (LV) and right ventricular (RV) function were evaluated at rest and during exercise using radionuclide ventriculography in 10 patients, aged 19-53 years, with sickle-cell anemia (SCA). Seven patients were in New York Heart Association functional class I and 3 were in class II. The resting LV ejection fraction (EF) was normal in 9 patients and the resting RVEF was normal in 4. LV dilation and high cardiac output were observed in 6 patients at rest. The LVEF during exercise was normal in all 10 patients, whereas only 2 patients had normal RVEF at rest and during exercise. The LVEF was lower in patients with SCA at rest (54 +/- 4% versus 61 +/- 6%, p less than 0.001) and exercise (66 +/- 4% versus 74 +/- 6%, p less than 0.001) than in 42 age-matched normal subjects. Rest thallium-201 images from 9 patients showed abnormal RV uptake in 8 and normal LV uptake in 8. Thus, in adult patients with SCA, LV function was normal during exercise in all patients and at rest in all but 1 patient. The LVEF, however, was lower than that in age-matched normal subjects. RV function was abnormal in most patients at rest and during exercise. RV thallium-201 uptake suggested pressure or volume overload (or both), most likely due to pulmonary vaso-occlusive complications of the disease.

Left ventricular function at rest and during exercise in congenital complete heart block: a radionuclide angiographic evaluation.

This study evaluates intrinsic cardiac performance during upright exercise in patients with congenital complete heart block. Left ventricular ejection fraction and volume were measured at rest and peak upright exercise with radionuclide angiography in 5 patients aged 11 to 39 years with congenital complete heart block: 4 were in New York Heart Association class I and 1 was in class II. The resting cardiac output was maintained at a normal level by an increase in end-diastolic volume rather than by a decrease in end-systolic volume. The left ventricular ejection fraction was normal at rest in all patients, but an abnormal response to exercise was noted in 3 patients. There was no appreciable change in the end-diastolic volume during exercise. Thus, patients with congenital complete heart block utilize the Starling mechanism to maintain normal resting cardiac output, but the response to exercise is usually abnormal even in the absence of symptoms.

Significance of the upright T wave in precordial lead V1 in adults with coronary artery disease.

To determine the prevalence and evaluate the significance of an upright T wave in precordial lead V1, the 12 lead electrocardiograms of 218 patients undergoing diagnostic catheterization for the evaluation of chest pain were reviewed. Of this total, 184 patients had severe coronary artery disease (greater than or equal to 75% luminal narrowing) and 34 patients had minimal or no coronary artery disease. An upright T wave in lead V1 (greater than or equal to 0.15 mV) was present in 3 subjects (9%) without coronary artery disease; in 19 (20%) of 96 patients with one vessel disease; in 14 (27%) of 51 patients with two vessel disease and in 13 (35%) of 37 patients with three vessel disease. Among the patients with one vessel disease, an upright T wave was more frequent in patients with left circumflex artery disease than in patients with left anterior descending or right coronary artery disease (probability [p] less than 0.001). Among patients with two vessel disease, an upright T wave was more frequent in patients with disease of the right coronary and left circumflex coronary arteries than in the remaining patients (p less than 0.005). It is concluded that an upright T wave in precordial lead V1 is common in patients with isolated left circumflex artery disease but is rare in those with isolated left anterior descending artery disease. Similarly, in patients with multivessel disease, an upright T wave is common when the left circumflex artery is diseased. This finding, along with other noninvasive tests, may prove useful in patient evaluation.

Choledochocele: radiologic diagnosis and endoscopic management.

A case of choledochocele, missed during exploratory laparotomy but managed by endoscopic biliary surgery, is presented.