[Coronary transluminal angioplasty after the use of thrombolytic therapy in acute myocardial infarction]. / Angioplastia transluminal coronária após o uso de trombolítico no infarto agudo do miocárdio.

PURPOSE: To present the Cardiology Institute of Rio Grande do Sul experience with percutaneous coronary angioplasty (PTCA), after thrombolytic therapy in acute myocardial infarction (AMI). METHODS: Fifty-three patients with transmural AMI in whom early successful intravenous streptokinase recanalization was followed by PTCA. The mean age was 50 years, male patients were more frequent, the predominant area of infarct was anterior wall and more frequently the "culprit" coronary was the left anterior descendent. The main indication of PTCA was uniarterial lesion with less than 20 mm of length. RESULTS: The success comes out in 44 patients (81.5%). Ten patients (18.5%) were considered unsuccessful and were referred to emergency bypass graft surgery. The in-hospital AMI rate after PTCA was 5.5%. In the follow-up the reestenoses rate was 11% and reocclusion was 3.7%. New PTCA was necessary in 3 patients (5.5%) and in one, by-pass graft (1.8%). CONCLUSIONS: PTCA is an important and secure modality of complementary therapy after thrombolytic therapy with low morbidity and mortality.

[Unstable angina: comparison of the effects of diltiazem and propranolol]. / Angina instável: efeito comparativo entre diltiazem e propranolol.

PURPOSE: To evaluate the effects of diltiazem and propranolol in patients with unstable angina. METHODS: Fifty-six patients with unstable angina, mean age of 55.4 +/- 8.5, 41 men and 15 women, were evaluated in a randomized, double-blind study of two groups of patients treated with diltiazem or propranolol at total daily doses of 180 mg and 120 mg respectively during the first 48 hours. After that the total daily doses was adjusted to 240 mg and 160 mg, respectively, until the 7th day. The first 48 hours, four times daily, clinical evaluation, CKMB data, ECG were obtained and two times daily until 7th day. A coronary arteriography was done on study entry. RESULTS: A significative reduction of angina crisis number, duration, intensity and the number of sublingual nitrates doses were observed equally in both groups. The SAP, DAP, HR and RR did not show statistical differences between groups. Individual groups analysis showed significative reductions of SAP, DAP and HR in propranolol group. The CKMB data, ECG alterations and coronary arteriography characteristics were similar. CONCLUSION: Both drugs were effective for the unstable angina treatment.

[Use of implantable pacemaker in the treatment of paroxysmal supraventricular tachycardia refractory to pharmacologic therapy]. / Uso de marcapasso implantável no tratamento da taquicardia supraventricular paroxística refratária à terapêutica farmacológica.

PURPOSE: To evaluate the results with the use of an automatic antitachycardia pacemaker in patients with refractory paroxysmal supraventricular tachycardia. PATIENTS AND METHODS: Nine patients aged 32 to 63 years with symptoms from 2 to more than 40 years and prophylactic treatment with several antiarrhythmic drugs that had failed to control tachycardia. The frequency of attacks in the year before the implant was from 1 per month to 3 daily and 4 of patients required direct counter current cardioversion at least once. The electrophysiologic studies demonstrated atrioventricular (AV) nodal reentry in 6 and AV reentry utilizing an accessory AV connection in 4 patients (in one patient both mechanisms were present). The patients have been followed from 2 to 18 months. RESULTS: All patients experienced new episodes of the arrhythmia that were successfully terminated by the pacemaker. Two patients presented episodes of tachycardia not terminated by the pacemaker. These events were successfully treated by reprogramming the unit. The drug treatment was discontinued in 7 patients. CONCLUSION: The antitachycardia pacemaker proved to be an effective therapeutic tool in reentrant supraventricular tachycardia refractory to pharmacologic therapy.

[Bedside cardiac catheterization. Advantages and disadvantages]. / Cateterismo cardíaco à beira do leito. Vantagens e desvantagens.

Three hundred patients submitted to bedside heart catheterization (BHC) from 1973 to 1985 were studied, in order to assess advantages and risks of the procedure. Two-hundred and sixty seven patients (89%) suffered a myocardial infarction (MI) and 146 of them were in functional class (Killip) II, 36 in FC III and 71 in FC IV. Thirty cases were submitted to BHC due to congestive heart failure. BHC was successful in 288 patients (96%) and the wedge pressure (WP) could be measured in 236 cases (78.7%). The WP was less than 18 mmHg in 47.2% of the patients in FC II, in 44.9% of the patients in FC III and in 35.3% of those in FC IV. Minor complications occurred in 33 cases (11.0%); balloon rupture in 12 (4.0%), transient arrhythmias in 11 (3.7%) and lumen obstruction in another 10 cases (3.3%). Forty five patients (15.0%) presented major complications related to the procedure: pulmonary infarction (PI) in 18 cases (6%), phlebitis in 15 cases (5%), sustained arrhythmias in 10 cases (3.3%), pulmonary artery rupture and endocarditis each in 1 case. The mean age between the group of patients with and without complications was similar the maintenance time as greater in the group of patients with complications: 3.4 +/- 0.2 vs 2.7 +/- 0.1 days (p less than 0.05). We concluded that many patients with clinical evidence of heart failure had WP smaller than 18 mmHg, emphasizing the value of the procedure in patients with complicated MI. The maintenance time was associated with the occurrence of complications, mainly PI and phlebitis.

[Changes in the ST segment in unstable angina pectoris. Its prognostic value]. / Alteraciones del segmento ST en la angina pectoris inestable. Su valor pronóstico.

Out of 145 patients with unstable angina hospitalized at CCU of the Instituto de Cardiologia do Rio Grande do Sul (Brazil) in 1981, 69 were studied: group I = 23 case (33.3%) with transient ST segment depression, group II = 13 cases (18.8%) with transient ST segment elevation, group III (control) = 33 cases (47.8%) without acute EKG changes. Group I showed a higher incidence of double-triple coronary artery involvement: 71.4% VS 53.8 and 63.3% respectively (non significant). This group also showed a higher number of patients with severe angina and who suffered acute myocardial infarction during follow-up, although without statistical significance. There were 8 deaths (34.8%) in group I, 3 (23.1%) in group II and 4 (12.1%) in group III (chi 2 = 4.11, p greater than 0.05). The 36 months survival rate was lower in group I than in groups II and III: 52.9% VS. 75.2% (NS) and 89.7% (P less than 0.02) respectively. We conclude that acute EKG changes, mainly transient ST segment depression, in unstable angina, are markers of high risk patients.

Prime number variant of concealed trigeminy.

A 53-year-old man with myocardial infarction was found to have frequent premature ventricular beats. The predominant pattern was classical concealed trigeminy; i.e., the number of conducted sinus beats, S, between extrasystoles satisfied the equation S = 3n + 2, where "n" is zero or any positive integer. Two other transient patterns also occurred. The first one was characterized by exceptional values of S, which satisfied the equation S = 3n + 3. In the second transient pattern, all values of S fitted the classical equation, but there were singularly absent values; i.e., the "n" in the equation was exclusively an odd number, giving rise to only prime numbers of interectopic conducted sinus beats. It is proposed in this last form that there are two sites of fixed block proximal to a variable distal block in a re-entry loop responsible for the ventricular extrasystoles.