[Cardiac myxoma. A report of 23 cases]. / Mixoma cardiaco. Presentación de 23 caso.

Twenty-three cases of cardiac myxoma are reviewed during a period of 11 years. Seventeen patients were females and 6 males with an average age of 36 years. All patients were symptomatic for an average period of time of 4 months. Dyspnea was the main symptom (91%), congestive heart failure (52%), murmurs (74%), atypical chest pain (65%), palpitations (52%), constitutional manifestation (48%), congestive heart failure (36%), embolic events (23%) and ventricular tachycardia as a first manifestation of a right ventricular myxoma in one case (4.5). In all patients the diagnosis of cardiac tumor was made during life. Among they, in 83%, by echocardiogram, 14%, by cardiac catheterization, and in one case (4.5%) with both methods. Seventy percent were located in the left atrium, 18% in the right atrium, 9% in the right ventricule and 4.5% to both right cavities. Two patients died while waiting surgery, one due to pulmonary emboli and another due to refractory congestive heart failure. In all 21 patients who were sent to surgery a direct correlation was seen with the echocardiographic findings. All 23 patients had a confirmatory histopathological diagnosis. There were no surgical deaths. Excision of the tumor resulted in marked symptomatic improvement. The follow up by echocardiography showed that surgery has been curative with no recurrence up till now. We consider that this entity, that is capable to simulate multiple cardiovascular diseases must be removed surgically once it has been diagnosed in order to avoid fatal complications.

[The heart in various connective tissue diseases]. / El corazón en algunas enfermedades del tejido conectivo.

In this study is presented the experience of 294 patients with different connective tissue diseases such as: a) rheumatoid arthritis, b) systemic lupus erythematosus, c) ankylosing spondylitis, d) progressive systemic sclerosis, e) dermatomyositis-polymyositis and f) mixed connective tissue disease. All these patients were studied prospectively during the last eight years through non-invasive methods to detect cardiovascular complications. The connective tissue diseases can provoke inflammation and fibrosis in any of the diverse cardiac structures, with the consequent complications. These alterations are frequent, with a high degree of morbidity, and have a direct relationship with the severity and chronicity of the primary connective tissue disease. Some of these patients respond favorably to cardiological and anti-inflammatory management, while others are refractory to such treatments. The prognosis of the observed complications in these patients depends in great part on the development of the basic rheumatic disease. This kind of patients should be studied systematically from the cardiological view point, so as to detect these complications as early as possible.

[Bifascicular block: long-term follow-up. Report of 40 cases]. / Bloqueo, bifascicular, seguimiento a largo plazo. Informe de 40 casos.

A total of 14,500 E.C.G. tracings were reviewed to determine the incidence of bifascicular block and those patients were followed up to assess prognosis. Forty patients with bifascicular block (complete right bundle branch block associated with left anterior hemiblock), diagnosed with standard E.C.G., according to Medrano's criteria from January 1978 to September 1980 were studied in our Service. The incidence of this intraventricular conduction defect was 0.0033 (3.3 per thousand). Males predominated over females at a rate of 2.4 to 1. This block was more frequent from the sixth to the ninth decades of life. Thirty five percent of the patients had no evidence of cardiovascular pathology; 32.5 percent had high blood pressure, 2.5 percent had coronary heart disease, 2.5 percent rheumatic heart disease, 5 percent chronic pulmonale, and 37.5 percent had diabetes mellitus as an associated finding. During the follow up which covered 20.2 months/patient, only one patient developed junctional rhythm and periods of asystolia and syncope; this case was treated with a permanent pacemaker with good results. Two patients died, one from digitalis intoxication and the other at home, the cause was not determined. It is necessary to study this conduction defect with longer follow up periods and according to the underlying heart disease, in order to assess properly the prognosis and behavior of this conduction defect.

Sindrome de Wolff-Parkinson-White.Presentacion de 33 casos. / Wolff-Parkinson-White syndrome. Presentation of 33 cases

La finalidad de este trabajo es la de estudiar en forma global a un grupo de 33 pacientes con el sindrome de Wolff-Parkinson-White que en forma consecutiva fueron revisados en el Servicio de Cardiologia del Hospital General del Centro Medico Nacional del Instituto Mexicano del Seguro Social, durante cinco anos y medio. Se analizan el cuadro clinico, los hallazgos electrocardiograficos y el tratamiento medico. Tambien se revisa la literatura correspondiente

[Exercise-induced coronary artery spasm. Angiographic demonstration and results of medical treatment]. / Espasmo arterial coronario inducido por ejercicio. Demostracíon angiográfica y resultados del tratamiento médico.

This report describes a case of a patient with a history of classical angina of effort which developed into an unstable progressive syndrome. A 42-year-old-woman was admitted to the hospital because of resting angina pectoris. Examination revealed signs of septal subepicardial ischemia in the resting electrocardiogram and a positive ergometric test with marked depression of the S-T segment. Hemodynamic studies showed in the ventriculogram a clearly defined area of hypokinesis on the anterolateral segment of the ventricle and the coronariography revealed normal vessels. During exercise the patient developed anginal pain and an elevation of the S-T segment in a lead II electrocardiogram. During the pain episode, selective left and right coronariographies showed the presence of a severe spasm in the first portion of the anterior descending branch. In the course of one of the injections the patient developed ventricular fibrillation, this was reverted with a 400 watts/sec shock. The patient was discharged from the hospital a few days after and has been successfully treated with nitrates and calcium blocking agents. This case represents the first time that a coronary spasm in normal vessels has been adequately documented by us.

Cardiac arrhythmias associated with subarachnoid hemorrhage: prospective study.

This is a prospective study of cardiac arrhythmias in patients with acute subarachnoid hemorrhage (SAH) secondary to ruptured aneurysm. Twenty per cent of the patients had serious, life-threatening arrhythmias. However, 100% of the patients had some kind of cardiac arrhythmia. The arrhythmias occurred during the first 48 hours after SAH. Such arrhythmias occur in patients without overt, pre-existing heart disease, hypoxemia, or electrolyte imbalance. A prolonged Q-T interval is frequently observed in patients with SAH who develop serious ventricular arrhythmias. (Neurosurgery, 5: 675--680, 1979).

[Idiopathic cardiomyopathy of the congestive type. Report of a case]. / Cardiomiopatia idiopática tipo congestivo Comunicación de un caso.

It is presented a clinical case and autopsy findings of a 72 years old male, with an illness of one month duration, which due to his symptoms was considered initially to have coronary heart disease with a myocardial infarction in evolution. During his hospitalization this picture was ruled out; however, the patient presented different cardiac arrhythmias, 3 episodes of cardiorespiratory arrest and finally refractory congestive heart failure. The patient died. Clinically the diagnosis of primary congestive cardiomyopathy was suspected, and later, correlated with the anatomopathological findings. The literature was reviewed upon the clinical and laboratory studies to reach the diagnosis; which clinically and anatomopathologically is made by exclusion. Due that we do not think very often about this entity, we consider useful the present communication.