Conversion of atrial fibrillation into a sinus rhythm by coronary angioplasty in a patient with acute myocardial infarction.

Atrial tachyarrhythmias are important complications occurring in more than 8% of acute myocardial infarctions (AMI). Atrial fibrillation (AFi) during the early phase of AMI is caused by atrial ischaemia, atrial distension due to the left ventricular failure or significant diastolic left ventricular dysfunction. AFi in patients with inferior and posterior AMI indicates at least two vessel coronary diseases, a circumflex coronary artery (CX) occlusion before taking off of the left atrial branches as well as significant stenosis or occlusion of the right coronary artery (RCA). In this article the case of a 67-year-old woman with an acute infero-posterior AMI is described. AMI was complicated with a left heart failure, acute AFi with tachyarrhythmia, transient arterial hypotension and ischaemic mitral regurgitation. Emergency coronary angiography disclosed occlusion of the CX, myocardial infarct related artery, and significant stenoses of the RCA. After opening the occluded CX during the PTCA, AFi with a tachyarrhythmia of 160 beats per minute (bpm) immediately converted into a sinus rhythm with 80 bpm, followed by a normalization of blood pressure and cardiac recompensation. Our case report supports the opinion that AFi in patients with inferior and posterior AMI indicates at least a two-vessel coronary disease. Reopening of the occluded atrial coronary branches during urgent medical treatment was casual and effective treatment of both ischaemic heart disease and consequent AFi.

Beat-to-beat QT interval variability in coronary patients.

Changes in ventricular repolarization have been described in patients after myocardial infarction, whereas data for coronary patients without prior myocardial infarction are lacking. This study was designed to evaluate ventricular repolarization in coronary patients with effort angina pectoris. Beat-to-beat QT interval variability (QTV) using 5-minute resting high-resolution ECG recordings was measured in 26 men (mean age 62.1 years) with effort angina pectoris and without prior myocardial infarction, and in 30 age-matched men without clinically evident coronary heart disease (controls). To evaluate the degree of coronary artery disease in coronary patients, coronary angiography was performed. Coronary patients displayed significantly higher values of QTV compared with the control patients (P < .001). Rate adaptation of QT interval correlated significantly with the degree of coronary artery disease in the study group patients (P < .05). The significant association between QTV and coronary heart disease suggests altered ventricular repolarization in coronary patients without prior myocardial infarction.

Acute myocardial infarction induced by alcohol ingestion in an asymptomatic individual.

This case report deals with a 47-year-old asymptomatic man without risk factors for coronary artery disease. He developed acute myocardial infarction 6 hours after ingestion of 0.5 litre of whisky within 30-60 minutes. The acute myocardial infarction was proved by a typical and prolonged angina pectoris, elevated enzymes typical for myocardial necrosis and ECG signs of acute anteroseptal and anterolateral myocardial infarction. A coronary angiography 3 months later revealed normal coronary arteries but marked hypokinesia of the anteroseptal and anterolateral segments of left ventricular wall. The sequence of events and objective data support our hypothesis that disturbance of coronary flow could be induced by an excessive ingestion of alcohol. The article discusses possible mechanisms of alcohol effects on arteries.

A long history of the left main coronary artery occlusion.

The case of a 70-year-old woman with severe angina pectoris for 12 years and occlusion of the left main coronary artery is presented. The reasons for this long history seemed to be adequate collateral circulation, hibernating myocardium, as well as incredible patience of the patient.

Angiographic evidence of coronary artery ectasia: our experience.

The purpose of this angiographic study was to make a review of patients with coronary artery ectasia (CAE) and to compare the average coronary artery diameters of proximal, middle and distal segments of the following three groups of coronary arteries: Group E (ectatic segments in patients with CAE and ischaemic heart disease), Group E-n (presumably normal segments in the same group of patients) and Group N (normal coronary arteries of control patients). It was found that distal segments of all three coronary arteries and the middle segment of the circumflex artery in Group E-n were significantly narrower than the corresponding segments in Group N (p = 0.001 or less than 0.05 respectively), which suggested the arteriosclerotic origin of both, CAE and distal coronary artery involvement.

Conduction disturbances in the Kearns-Sayre syndrome.

The Kearns-Sayre syndrome is an uncommon disease, characterized by the triad of external ophthalmoplegia, retinitis pigmentosa, and heart block. Cardiac manifestations of this syndrome in a 31-year-old man are presented. Electrocardiogram revealed intermittent left bundle branch block and right bundle branch block with left anterior hemiblock. His bundle recording disclosed a prolonged HV interval. Clinical features of the syndrome are discussed and other published cases reviewed.