Acute Anterior Infarction Research Articles

Successful Immediate Repair of Acquired Ventricular Septal Defect and Survival in Patients with Acute Myocardial Infarction Shock Using a New Double Patch Technique

Despite excessive mortality early following ventricular septal defect (VSD) due to acute myocardial infarction, immediate operation within the initial honrs and early repair within a few days following perforation has generally been too hazardous. Recognizing the need for an improved therapeutic approach, this report describes successful immediate VSD repair within a few hours of rupture and longterm survival using a new double patch technique and infarctectomy in three consecutive patients with cardiogenic shock, in the first day (two patients) and sixth day (third patient) of acute anterior infarction. Closure was achieved in two of the patients six and seven hours after rupture. VSD diagnosis and quantification of left-to-right shunt ratios (6.0, 5.1 and 2.8/1) were carried out at bedside right heart catheterization. In addition, left heart catheterization including ventricular angiography and selective coronary arteriography, was performed preoperatively. Closure of the muscular VSD was achieved by sandwiching both sides of the septum with two large Teflon patches sutured together to completely enclose the infarcted septal area. Catheterization two weeks postoperation demonstrated objectively intact ventricular septum by oxygen series, cardiogreen dye curves, hydrogen electrode and angiography. AD patients recovered fully without difficulty and are living (9 to 14 months). Thus are demonstrated the feasibility and safety of immediate repair of VSD, ie within a few hours of rupture due to acute myocardial infarction, with reversal of refractory pump failure.

Myocardial infarction associated with the use of oral contraceptives.

Two women, ages 27 and 37, experienced an acute myocardial infarction while taking oral contraceptives. Both showed electrocardiographic changes of acute anterior infarction, and on coronary angiography both were found to have occlusion of the anterior descending coronary artery. In one case there were no known predisposing factors present, whereas in the other a family history of heart disease and recent weight loss may have played a role in the illness. Although a cause-and-effect relationship cannot be proved, the possibility of an association between premature coronary occlusion and the use of oral contraceptives is raised.

The diagnosis of posterior myocardial infarction

An anatomico-pathologic basis for the vectorcardiographic diagnosis of high posterior infarct has been demonstrated. Autopsy findings and vectorcardiographic diagnosis indicate that almost one tenth of all infarcts involving the posterior wall of the left ventricle are small and are limited to its upper portion. Even more common are infarcts so situated but extending to other portions of the left ventricle. The importance of these observations lies in the fact that the high posterior infarcts do not, as a rule, produce diagnostic signs in the electrocardiogram. Consequently, many posterior wall infarcts are overlooked, and in an even larger number of cases the extent of the lesion is minimized. Our preliminary studies in vectorcardiography have directly or indirectly confirmed some generally accepted explanations for the diagnostic failure of the electrocardiogram in cases of infarct and have revealed some new ones. The observations herein reported demonstrate some of the limitations of the electrocardiogram in relation to the diagnosis of posterior infarction. Diagnostic failure is witnessed when the electrocardiogram discloses left bundle branch block, when the posterior infarct is small, located high on the posterior wall, is old, or is associated with acute anterior wall infarction. Old anterior wall infarction and left ventricular hypertrophy do not interfere with the development of the electrocardiographic signs of posterior infarction. It is noteworthy that not a single electrocardiogram in this series of cases was interpreted as normal. An abnormal electrocardiogram, then, obtained in a patient with a clinical picture of acute coronary heart disease, should be considered consistent with, but not diagnostic of, acute infarction. The electrocardiogram was interpreted as abnormal in nineteen of the eighty cases, and in twelve of them anterior infarction was also present. Since acute anterior infarction commonly conceals the electrocardiographic signs of posterior infarct, the latter should be suspected in some cases in which the electrocardiogram shows only acute anterior infarction, especially when changes reciprocal to the anterior infarct are poorly developed or absent and when bundle branch block or high-grade auriculoventricular block appears during the course of the illness. The electrocardiographic changes in high posterior infarct may consist solely of S-T segment depression or tall R and T waves in the precordial leads.

III. Correlation of electrocardiographic and pathologic findings in anteroposterior infarction

III. Correlation of electrocardiographic and pathologic findings in anteroposterior infarction

Electrocardiographic studies of gunshot and stab wounds of the heart

The electrocardiographic studies of two patients with cardiac trauma, one with a gunshot wound of the apex of the left ventricle, and the other with a stab wound of the right auricle, are reported. In Case 1, the electrocardiographic picture of acute anterior coronary infarction is in keeping with the preoperative diagnosis of three wounds, one on the anterior surface and two on the posterior surface of the apex of the left ventricle. In Case 2, with a stab wound of the right auricle, the electrocardiographic changes reveal prolongation of P-R intervals to 0.24 second. The other changes in the electrocardiographic pattern may be attributed to acute pericarditis.