RESUMO
Although the existence of the postmyocardial infarction syndrome has now long been questioned, the Dressler symptom complex remains widely accepted as a distinct clinical entity. A patient is described whose twenty-five-year follow-up adds to our argument that there is no late or separate multisystem autoimmune disease following acute myocardial infarction. It is suggested that the Dressler complex is an entity that has neither vanished nor been vanquished but one that may never have existed.
Assuntos
Doenças Autoimunes/etiologia , Infarto do Miocárdio/complicações , Pericardite/etiologia , Idoso , Feminino , Seguimentos , Humanos , Infarto do Miocárdio/epidemiologia , Síndrome , Fatores de TempoRESUMO
Since our initial report in 1984 of six patients with AMI temporally related to cocaine use, we have observed 19 additional patients in whom ischemic chest pain syndromes occurred shortly after intranasal or IV use of cocaine or after smoking the drug. Seventeen patients (89 percent) developed non-Q wave infarction and two had Q-wave infarction. One patient manifested angina with striking ST-segment elevation. None of the patients had diabetes or hypertension, and all but one were cigarette smokers. The serum cholesterol level was 162 +/- 7 mg/dl. Four of the five patients who consented to coronary angiographic studies displayed normal coronary arteries, and one showed proximal stenosis of the right coronary artery. The cold pressor test was performed in seven patients; none had angina or ECG changes induced by cold stimulation. We conclude that T-wave infarction is a common form of an acute cardiac event related to cocaine abuse, and its pathogenesis may involve that of the cocaine-induced coronary vasospasm.
Assuntos
Cocaína/efeitos adversos , Eletrocardiografia , Infarto do Miocárdio/induzido quimicamente , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto , Vasoespasmo Coronário/induzido quimicamente , Feminino , Humanos , Masculino , Infarto do Miocárdio/diagnóstico , FumarRESUMO
Six young cocaine users, median age 35.5 years (range 27 to 44 years) experienced acute myocardial infarction. The close temporal correlation in two cases between cocaine use and clinical infarction and the relative paucity of atherosclerotic blockage of the coronary arteries in the others, as demonstrated by autopsy or angiography, suggest that cocaine, either by a mechanism of coronary artery spasm or by increased myocardial oxygen demand consequent to hypertension and tachycardia, is implicated in the precipitation of these infarctions.
Assuntos
Cocaína , Infarto do Miocárdio/induzido quimicamente , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto , Humanos , MasculinoRESUMO
Thirty-five consecutive patients with acute subendocardial infarction admitted to the coronary care unit during a 15-month period were identified and analyzed for location of infarction, and for the in-hospital course in terms of recurrent chest pain, the occurrence of a second infarction, and the clinical status at the end of hospitalization. Thirteen patients developed a transmural infarction sometime between 3 and 21 days (average, ten days) after the initial subendocardial infarction. The transmural infarction was defined by a separate episode of severe and prolonged chest pain, late development of QRS alteration, and an appropriate elevation of the creatine phosphokinase concentration. Our experience with acute subendocardial infarction, hertofore regarded as a relatively benign event, indicates that the immediate prognosis of the patient who sustains his first episode of subendocardial infarction is not at all benign, and, indeed, subendocardial infarction frequently heralds transmural infarction within the acute phase of the disease.
