Right ventricular infarction mimicking extensive anterior infarction

Two patients with inferior infarction complicated by right ventricular infarction are presented. Both manifested electrocardiographic changes involving the anterior chest leads with initial S-T segment elevation followed by loss of R waves and the development of QS complexes mimicking anterior infarction. Cardiac catheterization showed right coronary artery occlusion with normal left coronary system and anterior wall motion in each case. Radionuclide angiocardiography showed dilated poorly contracting right ventricles. The ECG changes of "anterior infarction" in these patients were therefore due solely to right ventricular injury.     

Esophageal infarction

Opinion statement Esophageal infarction or acute necrotizing esophagitis is a rare condition that has a dramatic endoscopic appearance of a “black esophagus.” The esophageal involvement can vary from the distal third to the total esophagus. Excluding corrosive injury and other well-known rare causes of black esophagus, the etiology of this condition is unknown. Ischemia due to hypoperfusion state is thought to play a central role in the pathogenesis. The treatment is supportive with acid suppression and gastrointestinal rest. Mortality is high due to comorbid conditions.     

Renal infarction

A 43-year-old woman complaining of left flank pain was found to have renal infarction. New-onset atrial fibrillation suggested thromboembolism, which was confirmed by retrograde urogram and intravenous pyelogram. The patient was treated with heparin and was discharged on coumadin after evaluation of her cardiac disease.     

Auricular infarction

Three cases of distinct auricular infarction, without ventricular involvement, are presented. A fourth case in which the electrocardiograms showed changes apparently typical of auricular damage proved to be one of ruptured, false aneurysm, with hemorrhagic infiltration of the auricles.The first case was interesting because of the unfortunate location of the small infarct; it might have been less serious if it had been located in the ventricle.In three of the four cases there were deviations of the P-Ta segments conforming to that described as typical of auricular damage. In one there was also an apparent disturbance of the A-V conduction pathway; this was most likely due to the ulceration through the interventricular wall.All of the infarcts were located in the right auricle.     

胼胝体梗死

胼胝体的血液供应丰富,功能复杂,梗死发生率低.胼胝体梗死的危险因素和病因与其他部位梗死无异.该病的临床表现复杂多样,2个经典的临床表现为胼胝体离断综合征和额叶型步态障碍,但临床上以偏瘫、单瘫、失用和智力障碍等多见.CT平扫阳性率低,MRI对胼胝体梗死具有较高的敏感性和特异性.结合病史和影像学检查,胼胝体梗死的诊断并不困难,但需与其他易累及胼胝体的疾病相鉴别.多数胼胝体梗死患者的预后良好.     

Myocardial infarction

When a diagnosis of infarction or ischemia is considered, the diagnostic value is greatly amplified by comparison of serial ECGs, particularly when at least one is recorded during chest pain and another immediately after a therapeutic maneuver. Daily evaluation of serial ECGs, with a consistent standardization technique and lead placement, is essential to determine the evolution of MI and to evaluate changes indicating that new cardiac regions might be jeopardized by acute ischemia.     

Gastric infarction

This report describes a case of massive gastric hemorrhage, initially controlled by selective arterial vasopressin infusion. Infusion was followed by extensive necrosis of the gastric wall which necessitated subtotal gastrectomy. Gastric necrosis following arterial infusion is rare and in this case appears to be due to migration of the infusion catheter into a peripheral branch of the left gastric artery in a patient whose gastric circulation had been compromised by prior surgery. The complications related to the use of arterial infusion for the control of gastric hemorrhage are discussed and the literature is reviewed.     

Differentiation of aborted myocardial infarction from masquerading myocardial infarction

We read with great interest the article by Verheugt et al.¹dealing with aborted myocardial infarction (MI) as a new targetfor reperfusion     

Anteroseptal myocardial infarction clinically mimicking right ventricular infarction.

Acute transmural anteroseptal myocardial infarction with acute left ventricular failure can also raise systemic venous pressure in the absence of right ventricular infarction. Right ventricular infarction, therefore, should not be diagnosed simply by the presence of systemic venous congestion.     

Acute right ventricular infarction without infero-posterior left ventricular infarction

Two cases of acute right ventricular infarction associated with acute extensive anterior myocardial infarction in the absence of inferior and/or posterior left ventricular infarction are presented. Such a combination is likely to occur from acute occlusion of the left anterior descending artery in the face of severe narrowing of the infundibular (conus) artery rather than from acute occlusion of the right coronary artery.     

脑梗塞后出血与梗塞面积及预后的关系

为探讨脑梗塞后出血与梗塞面积及患者预后的关系，对49例血性脑梗塞（HI）患者进行了CT动态观察（其中大面积脑梗塞出血27例），并与22例大面积非出血性脑梗塞（NHI）患者作对照，两组患者均在病初及病程第四周各进行临床神经功能缺损程度评分一次，以第二次的评分减少值作为判断脑功能恢复的指标。结果表明，脑梗塞面积越大，出血的可能性越大；HI患者的预后明显差于NHI患者。说明预防脑梗塞后出血对改善患者预后具有重要意义。