Two-dimensional echo Doppler findings in juvenile and adult onset ankylosing spondylitis with long-term disease.

The authors' objective was to determine by 2-dimensional echo Doppler (2DECHO) the cardiac abnormalities in juvenile onset ankylosing spondylitis (JOAS) and adult onset ankylosing spondylitis (AOAS) in male patients with long-term disease. Twenty patients with JOAS, 31 with AOAS, and 20 healthy controls of the same age and gender without cardiopulmonary symptoms were studied. Using 2DECHO, the heart dimensions were determined according to American Society of Echocardiography guidelines. The left ventricle ejection fraction (LVEF) was calculated by Teichholz's formula. Cardiomyopathy was established when 2DECHO had diminished LVEF. Statistics used were the Student t and Fisher test, chi2, and ANOVA. Ninety percent of JOAS and 51% of AOAS patients were B27+ (p=0.005). The disease duration was 19.3 +/- 8.8 years in JOAS and 14.8 +/- 12.8 years in AOAS (p=NS). Age at the time of the study was 30.7 +/- 9.9 years in JOAS vs 40.3 +/- 12.7 in AOAS (p=0.003), and vs 40.2 +/- 17 years in controls (p=NS). There was a higher frequency of cardiomyopathy in AOAS (32.2%) than in JOAS (25%) and the controls (0%) (p=0.01). Patients with JOAS had a higher mitral valve gradient (25%) than AOAS patients (19%, p=NS) and controls (0%, p=0.04). Abnormal aortic ring reflectance was shown in 19% of AOAS vs 0% abnormalities in JOAS and controls (p=0.01). The aortic root diameter was increased in 58% of AOAS, 30% of JOAS, and 0% of controls (p=0.001). The frequency of 2DECHO abnormalities was increased in cardiopulmonary asymptomatic spondylitis patients. Despite the high frequency of B27+, JOAS had a lower frequency of aortic abnormalities than AOAS. Mitral valve gradient was found in JOAS and in AOAS that could contribute to a decreased ejection fraction and to left ventricular dysfunction.

[Myocardial infarction caused by cold beverage drinking after strenuous physical exercise]. / Infarto del miocardio provocado por ingesta de bebida fría inmediatamente después de ejercicio físico intenso.

A case of acute myocardial infarction in a 36 years old patient is presented. Maleness was male, as the only mayor coronary risk factor. He had myocardial infarction associated with ingestion of cold beverage after strenuous physical exercise. A coronariographic study was done postmyocardial infarction, which showed a mild obstruction of the LAD. The most likely cause of the coronary event in this case is coronary spasm and atherosclerosis. A review of the literature on this subject is made.

[Torsade de pointes in myxedema. Report of a case and review of the literature]. / Torsade de pointes en mixedema. Informe de un caso y revisión de la literatura.

A 57 years old female suffered from recurrent attacks of ventricular tachycardia including one episode of torsade de pointes, she had hypothyroidism with myxedema secondary to Sheehan Syndrome, following thyroid replacement therapy the tachyarrhythmia did not relapse and there was no need to give specific antiarrhythmic therapy.

[Arterial embolism. The detection of the central emboligenic source by transthoracic echocardiography. A study of 38 cases]. / Embolia arterial. Detección de fuente embolígena central mediante ecocardiografia transtorácica. Estudio de 38 casos.

38 cases with systemic embolism were studied with transthoracic echocardiography. Patients with previous history of neurologic manifestations or intermittent claudication were excluded. Only patients with good quality echocardiographic studies were included. The goals of the study were: to diagnose intracardiac masses responsible for the embolic episode and to evaluate the study as a guide for medical or surgical therapy in this group of patients in order to prevent new embolic events. In 9 patients an intracardiac mass was identified as responsible for the embolic event, 5 cases located in the left atrium, 2 cases of left ventricular thrombus, 1 case of left atrial myxoma and 1 case of marantic endocarditis. The later two were resected surgically and 3 cases of rheumatic mitral valve disease and 1 case of left ventricular aneurism were corrected surgically. It is concluded that transthoracic echocardiography is a valuable study in this patients not only as a diagnostic tool but as a guide to surgical and medical management.

[Risk of complete auriculoventricular block and cardiological complications in patients with bifascicular block undergoing general surgery]. / Riesgo de bloqueo auriculoventricular completo y complicaciones cardiológicas en pacientes con bloqueo bifascicular sometidos a cirugía general.

26 patients with bifascicular block defined as complete right bundle branch block and left anterior block diagnosed electrocardiographically according to Medrano's criteria, were studied to evaluate the indication for preoperatory pacemaker insertion due to the risk of complete A/V block, other cardiac complications were recorded carefully. 7 patients underwent a prophylactic insertion, due to associated first degree A/V block in 4 cases and in 3 cases due to symptomatic bifascicular block. No instance of complete A/V block was found in the study. The most severe complication recorded was in a patient who presented a myocardial infarction complicated with ventricular Tachycardia. The risk of complete A/V block is low and only a small group of this patients should be considered for a preoperatory pacemaker insertion due to associated risk factors.

Cardiovascular manifestations in systemic lupus erythematosus. Prospective study of 100 patients.

One hundred consecutive female patients with active systemic lupus erythematosus (SLE) were studied from the cardiovascular point of view by means of non invasive methods. Seventy percent of the cases presented some type of cardiovascular anomaly. Seventy four percent of the resting electrocardiograms were abnormal as well as 72% of the M mode echocardiograms and 55% of the cardiac X ray series. The most frequent observed complications were: pericarditis and or pericardial effusion (39%), arterial hypertension (22%), ischemic heart disease (16%), myocarditis (14%), congestive heart failure (10%), pulmonary hypertension (9%), valvular heart disease (9%), pleural effusion (7%) and cerebro vascular accident (3%). We analyzed each one of these complications and found of special interest the high incidence of ischemic heart disease which is more frequent than has been hitherto reported. Ischemic heart disease was observed in two types of patients: a) Those with long term steroid therapy. In these, the mechanism seems to be an atherosclerotic disease probably induced by the chronic use of steroids. The management of these cases do not differ from other types of coronary heart disease due to atherosclerosis. b) Those with frank episodes of vasculitis in whom the basic mechanism is an inflammatory process of the coronary arteries and its treatment is fundamentally that of the vasculitis. We consider necessary to study routinely all patients with SLE through non invasive cardiological methods.

[Cardiovascular manifestations in progressive systemic sclerosis]. / Manifestaciones cardiovasculares en la esclerosis sistémica progresiva.

UNLABELLED: We studied 20 consecutive patients with progressive systemic sclerosis from the cardiological point of view through non invasive methods. Sixteen (80%) patients had some kind of cardiovascular complications as shown by any of the used methods. a) SYMPTOMS: fourteen (70%) referred some type of cardiac symptoms. b) PHYSICAL EXAMINATION: eleven (55%) had an abnormal cardiac examination and 10 (50%) had arterial hypertension. c) Electrocardiogram: sixteen (80%) were abnormal. Among them, three cases (15%) had bifascicular block, complication considered up till now as rare. d) Cardiac X Ray Series: Fourteen (70%) were abnormal mainly due to pulmonary fibrosis (55%). e) Echocardiogram: 45% of them showed some kind of abnormality.

[The heart and ankylosing spondylitis]. / El corazón y la espondilitis anquilosante.

UNLABELLED: We studied 40 consecutive patients with Ankylosing Spondylitis from the cardiological point of view through non-invasive methods. Fourteen (35%) patients had some kind of cardiovascular complication as shown by any of the used methods. a) SYMPTOMS: fifteen (37.5%) refered nonspecific chest pain, five (12.5%) dyspnea on exertion and four (10%) frecuent palpitations. b) PHYSICAL EXAMINATION: two patients (5%) had aortic regurgitation and two (5%) mitral valve disease. c) Electrocardiogram: in seven (17.5%), left ventricular hypertrophy was detected, in two (5%) left atrial hypertrophy and in seven (17.5%) some type of conduction disturbance. d) Chest X Ray: six (15%) had left ventricular hypertrophy, one (2.5%) left atrial hypertrophy and two (5%) dilated ascending aorta. e) Echocardiogram: two cases (5%) had aortic dilatation and other two (5%), mitral valve disease. In three patients (7.5%) pericardial effusion was found, which in our series, it is more frecuent than has been reported up until now in the literature.

[Cardiovascular manifestations in mixed connective tissue disease in adults]. / Manifestaciones cardiovasculares en la enfermedad mixta del tejido conectivo en adultos.

Twenty two patients with mixed connective tissue disease (MCTD) were studied with noninvasive cardiovascular techniques. Fifty percent of the cases presented cardiovascular abnormalities which in order of importance were: pericarditis with effusion (28%), myocarditis (14%) and one case; myocardial infarction. Complications of less importance were: supraventricular and ventricular premature beats, enlargement of left and right cardiac chambers, septal hypertrophy and type A paradoxical septal movement. We consider that patients with MCTD should have a routine cardiological evaluation.

[Cardiovascular changes in acromegaly. Prospective study]. / Alteraciones cardiovasculares en la acromegalia. Estudio prospectivo.

We present 38 acromegalyc patients who were studied by non invasive methods to assess the frequency of cardiovascular complications. Seventy one percent of the cases presented some type of cardiovascular alteration. In 68% we observed left ventricular hypertrophy by echocardiography which was the most sensitive method to detect it. In 71% we obtained abnormal electrocardiograms, mainly because of conduction disturbances, being right bundle branch block the most frequent. Half of the cases had pulmonary fibrosis and chronic bronchitis. Arterial hypertension was present in 32%. Diabetes mellitus in 21%. Only 2 cases had coronary heart disease. In 37% of the patients who underwent hypophisectomy we observed regression up to 90% of the cardiac complications except for left ventricular hypertrophy and pulmonary fibrosis. None of the patients has died.

Coincidence of cerebrovascular accident and silent myocardial infarction.

Although it is well known that a myocardial and a cerebral infarction may be coincident, the nature of this association is not clear. The problem is further complicated because the myocardial infarction may be silent. This is a report of 3 patients with cerebral infarct in whom a silent recent myocardial infarction was found. All patients with cerebrovascular disease should be screened for a possible myocardial lesion.

Diverse clinical manifestations of pheochromocytomas.

Many difficulties are encountered by clinicians in attempting to diagnose pheochromocytomas. We describe several patients with unusual clinical features. These include sudden death, cerebral hemorrhage, refractory congestive heart failure, acute abdominal pain, and hypercalcemia. In 2 patients, the rare association of this tumor and pregnancy was observed. Two subjects had sudden death, 1 during a pneumoencephalogram and another during an epidural block. The clinicians should be aware of these manifestations of pheochromocytomas.

[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.

[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.

[Angina pectoris with normal coronary arteries]. / Angor pectoris con coronarias normales.

Twelve patients 8 females and 4 males, whose ages varied from 33 to 60 years (median 50.6 years), were seen at the Hospital for Cardiology and Neurology of the Mexican Institute for Social Security. All were diagnosed as having angor pectoris, through the clinical history and physical exam. Three patients had stable angor and in nine it was of an unstable type. The resting ECG showed signs of subepicardial ischemia in five cases. In eight the stress ECG according to the Bruce technic showed depression of the ST segment over 1 mm. In one patient atrial stimulation was performed with a pacemaker and ischemic changes of the ST segment were normal in all cases; in two however, coronary spasm that reversed with nitroglycerin appeared. The left ventriculogram was normal in all but one that revealed diaphragmatic hypokinesia associated with right coronary spasm. All patients were followed from two to fifty six months (median 19.4), and only in one case the angor pectoris remained unchanged. In all others it decreased or disappeared. During this time there were no deaths, myocardial infarctions or severe arrhythmias.