The Bussola study. Final results, conclusions and proposals.

OBJECTIVE: To evaluate the use of thrombolytic and acetylsalicylic acid therapies in acute myocardial infarct patients as well as the availability of technical and human resources for the care of these patients in the emergency units of the city of Rio de Janeiro. Additional objectives were the evaluation of the use of primary angioplasty and the level of acceptance of SBC /RJ as an entity responsible for programs of continued medical education. METHODS: Interviews with physicians at 46 emergency units in the city of Rio de Janeiro. RESULTS: Of the 46 emergency units inspected, a policy of encouragement to use thrombolytic therapy was only prescribed in 6.5%. In 1/3 of the public wards no thrombolytic agents were available, and in none of them was access to primary angioplasty regularly available; 45.9% did not offer the minimal conditions required for the handling of cases of acute myocardial infarction; 60% of the physicians on-call (at both public and private emergency units), appeared not to know the importance of the use of acetylsalicylic acid in acute myocardial infarct patients; all physicians interviewed would participate in programs of continued medical education organized by the SBC/RJ. CONCLUSION: The study suggests there was: 1) the low probability of the use of thrombolytic therapy in the majority of the emergency units in of the city of Rio de Janeiro due to the inadequate policy of waiting for the transfer of the patient to coronary or intensive care unit; 2) a low awareness to the importance of early use of acetylsalic acid in acute myocardial infarct; 3) half of the emergency units of the public net do not have the minimal conditions required for the handling of cases of acute myocardial infarction; 4) a high level of credibility exists that would enable the SBC/RJ to set up programs for continued medical education to change the mentality regarding the use of thrombolytic therapy and of acetylsalicylic acid.

[Multiple fistulae in coronary artery of left ventricle]. / Múltiplas fístulas das artérias coronárias ao ventrículo esquerdo.

A 51 year-old man was admitted to the coronary care unit due an episode of retroestenal pain with ischaemic alterations in electrocardiogram. It was made the diagnosis of unstable angina. Cinecoronariography showed dilated coronary arteries without obstructions and multiples coronary fistulas draining into left ventricular cavity. Transesophagic echocardiogram with microbubbles injection into coronary arteries showed an important coronary steal phenomena. It is discussed the diagnosis and the treatment. This is one of the rare cases of coronary fistulas draining into the left ventricular cavity and the first one with alterations in the rest ECG.