[Significance of reciprocal ST-segment depression in the acute stage of transmural myocardial infarct]. / Zur Bedeutung reziproker ST-Senkungen im Akutstadium des transmuralen Myokardinfarktes.

19 patients with transitory ST-segment depression in the wall opposite the infarcted territory during acute transmural myocardial infarction (AMI) were studied. We investigated the reproducibility of this reciprocal ST depression induced by stress testing and correlated the ECG changes with coronary angiographic evaluation of arteries supplying the remote area. We tried to derive criteria for detection of simple mirror image. 3 different groups were defined according to ECG evolution: Group 1 consisted of 7 anterior and 3 inferior AMI where reciprocal ECG changes disappeared appeared within 24 to 48 hours independently of the ECG changes in the infarcted area. These ST depressions were reproduced by stress testing one to two months later, and correlated angiographically with an anatomic lesion. 7 out of 10 patients later had bypass graft surgery. Group 2 consisted of 7 patients in whom posterior wall extension of an inferior AMI made the diagnosis of anterior ischemia impossible. In another two patients (one anterior and one inferior AMI) reciprocal ST depression and infarcted area ECG changes showed a simultaneous evolution. The reciprocal ST depression could not be reproduced during stress testing and did not correlate with any angiographic lesion. It is concluded that reciprocal ST depression during the acute phase of transmural anterior or purely inferior myocardial infarction is correlated with multivessel coronary disease if their regression is not strictly simultaneous to the infarction-related ECG changes. Further investigations are indicated in these patients.

[Risk factors and psycho-social factors in myocardial infarct of the young man]. / Facteurs de risque et facteurs psycho-sociaux dans l'infarctus myocardique de l'homme jeune.

Psychosocial and standard risk factors were assessed in 21 young males aged 32--45 admitted for acute myocardial infarction. All patients underwent extensive clinical, dietary and psychosocial investigation by a team of cardiologists, psychiatrists, dieticians, social workers and physiotherapists both during hospitalization and later at home. Most standard risk factors were found infrequently and the estimated risk of coronary disease would have been low. Heavy smokers (1--4 packs of cigarettes per day) totalled 20/21 patients. In every case the patients, before myocardial infarction, had sustained severe long-term stress in their professional, social and/or familial environments. With rigid and obsessive personality patterns, they appeared to be the prisoners of their problem situations and totally unable to relax. Severe psychosocial stress and heavy smoking appear to be almost constant findings in young males admitted with acute myocardial infarction.

[Early mobilization in the acute stage of myocardial infarction long term results]. / La mobilisation précoce au stade aigu de l'infarctus du myocarde: résultats à long terme

A report is presented on the continuation of a controlled study on early mobilization after acute myocardial infarction performed at the Cantonal Hospital of Geneva. Detailed follow-up studies were made in the patients from the original study 4 years on average after the myocardial infarction. It is well known that early mobilization offers many advantages over prolonged bed rest. The present study demonstrates that early mobilization after acute myocardial infarction involves no longterm risks.