Prognostic Factors in Right Bundle-Branch Block Complicating Acute Myocardial Infarction

Summary: Seventy patients with right bundle-branch block (RBBB), comprising 6% of 1083 patients with acute myocardial infarction, were admitted to our coronary care unit (CCU) over a five-year period. Thirty-eight of them died in hospital. Their prognosis was not altered significantly by the presence of complete heart block (CHB), bilateral bundle-branch block or the site of infarction and serum enzyme levels. Hospital mortality was lower ( p <0.015) among eight patients with transient RBBB of whom one died. The high mortality appeared to be due mainly to extensive infarction.
All 32 survivors were followed from two to 50 months and 15 have died. Four patients who had had bilateral bundle-branch block or CHB died suddenly. Although no sudden deaths occurred in those with RBBB alone the mortality at six, 12 and 18 months did not differ significantly from patients with bilateral bundle-branch block.
Of the 17 patients still alive eleven have persistent RBBB, one has bilateral bundle-branch block, one has required permanent pacing for Stokes-Adams attacks and four have a QRS complex of normal duration.
The late sudden deaths suggest that permanent pacing may have a place in the management of patients with bilateral bundle-branch block surviving infarction.     

Rate Related Atrioventricular Block Complicating Acute Myocardial Infarction

Summary: Three patients who developed advanced or complete atrioventricular (AV) block as a complication of acute inferior myocardial infarction are presented. Block occurred when the sinus rate exceeded 110 to 130 per minute and 1:1 AV conduction was established below this rate. There was no associated ventricular bradycardia and thus no indication for temporary transvenous pacing. Complicating ventricular arrhythmias occurred and their management in the presence of impaired AV conduction is discussed; one such arrhythmia developed late in in the patient's hospital course, after he had left the coronary care unit. Late arrhythmias now, account for approximately one third of the deaths from acute myocardial infarction in this hospital and the provision of a subacute monitoring area following intensive coronary care is discussed.     

急性下壁心肌梗死合并完全性房室阻滞患者冠状动脉病变的特点及临床预后

目的:探讨急性下壁心肌梗死合并完全性房室阻滞(CAVB)患者的冠状动脉病变特点及早期预后.方法:对发病12小时内急诊直接经皮冠状动脉腔内成形术且梗塞相关血管为右冠状动脉的急性下壁心肌梗死患者139例,按经皮冠状动脉腔内成形术前是否出现CAVB分为CAVB组(n=35)和无完全性房室阻滞(NAVB)组(n=104),进行临床、冠状动脉造影、心功能及早期预后分析.结果:经皮冠状动脉腔内成形术前梗塞相关血管闭塞(TIMl 0～1级)率CAVB组高于NAVB组,有显著性差异(P＜0.05);CAVB组多支病变、无有效侧支循环、严重心律失常(室性心动过速、心室颤动)发生率均高于NAVB组,有极显著性差异(P＜0.01);肌酸激酶峰值、合并右心室梗死及院内病死率CAVB组高于NAVB组,均有显著性差异(P＜0.05).多因素分析完全性房室阻滞不是院内死亡的独立危险因素.结论:急性下壁心肌梗死发生的完全性房室阻滞,与梗死区域的残余血流(前向血流与侧支血流)减少及多支冠状动脉病变有关,合并完全性房室阻滞者即使介入治疗成功仍有较高的病死率,应给予更积极的治疗和严密监测.     

急性下壁心肌梗塞伴房室传导阻滞发生与冠状动脉病变的关系

目的 :研究急性下壁心肌梗塞伴房室传导阻滞 (AVB)发生与冠状动脉病变之间的关系。　　方法 :40例急性下壁心肌梗塞患者分为房室传导阻滞组 (AVB组 ,n=16 )和无房室传导阻滞组 (NAVB组 ,n=2 4) ,分析两组间肌酸激酶峰值、冠状动脉病变支数、多支冠状动脉严重病变及优势型冠状动脉狭窄程度对 AVB发生的影响。　　结果 :AVB发生与优势型冠状动脉狭窄严重程度有关 ,狭窄程度越高 ,则 AVB发生率越高 ,L ogistic多元回归分析显示优势型冠状动脉狭窄程度是唯一有意义的危险因素 (P=0 .0 0 2 9,OR=8.86 0 1)。　　结论 :优势型冠状动脉的严重阻塞是 AVB发生的一个独立因素。     

急性心肌梗死早期室性心律失常相关因素分析

目的探讨急性心肌梗死(AMI)早期各类室性心律失常(VA)的相关因素和对近期预后的影响.方法161例确诊为AMI患者.根据心电记录将VA分为5组.单发室性早搏组(单发室早组,10例);成对,二联律的室性早搏组(成对室早组,21例);非持续性室性心动过速组(非持续室速组,31例);室性心动过速,心室颤动组(室速室颤组,11例);对照组88例.每位均接受了冠状动脉造影,超声心动图检查.结果左主干病变在室速室颤组较对照组发生率显著升高,差异具有统计学意义(P＜0.05);右冠状动脉病变发生率在非持续室速组较对照组显著增高,差异具有统计学意义(P＜0.05);梗死相关血管再通未达到心肌梗死溶栓治疗临床试验(TIMI)Ⅲ级发生率在室速室颤组较对照组显著增高,差异具有统计学意义(P＜0.05);三支血管存在大于70%冠状动脉狭窄病变发生率在室速室颤组较对照组显著增高,差异具有统计学意义(P＜0.05);左心室射血分数在室速室颤组较对照组明显降低,差异具有统计学意义(P＜0.01).30天病死率室速室颤组与对照组比较,差异具有统计学意义(P＜0.05).结论AMI早期发生的各类VA中,室速室颤的发生影响患者近期预后.持续性室速室颤发生的相关因素为梗死相关血管为左主干病变,再通血流未达到TIMIⅢ级,多支血管病变和左心室射血分数明显降低.     

Left Bundle Branch Block and Complete Heart Block Complicating Inferior Myocardial Infarction

Left bundle branch block following inferior myocardial infarction remains uncommon and scarcely reported in the literature. We describe a rare presentation of a 58‐year‐old male patient who developed left bundle branch block and third degree atrioventricular block after inferior myocardial infarction requiring permanent pacemaker placement. Pathophysiology, impact on mortality, and management options are discussed.     

Reference Guide to Cardiogenic Shock Complicating Acute Myocardial Infarction

Journal of Thrombosis and Thrombolysis -     

Diabetes Mellitus and Cardiogenic Shock Complicating Acute Myocardial Infarction

Background

Diabetes mellitus (diabetes) increases the risk of acute myocardial infarction, which can result in cardiogenic shock. Data on the relation of diabetes and the occurrence and prognosis of cardiogenic shock postacute myocardial infarction are scant.

老年糖尿病合并急性心肌梗死的ICU救治

目的研究并探讨老年糖尿病合并急性心肌梗死患者的ICU救治的临床效果。方法选取2012年1月—2014年12月该院收治的50例老年糖尿病合并急性心肌梗死患者作为研究对象,将其设置为观察组,并择取同期在该院进行治疗的50例非糖尿病急性心肌梗死老年患者作为对照组研究对象,对这100例急性心肌梗死患者采取ICU救治措施进行治疗。观察对照组和观察组患者的并发症发生情况和死亡情况。结果观察组患者的并发症发生率较对照组明显更高(P0.05),其死亡率较对照组明显更高(P0.05)。结论与非糖尿病急性心肌梗死患者相比,合并患有糖尿病的急性心肌梗死患者其病情更加危急,在临床上对糖尿病合并急性心肌梗死患者应进行尽早的救治,对其糖尿病症状进行严格的控制,是降低患者死亡率的关键。     

Prognostic Factors in Acute Myocardial Infarction treated in a Coronary Care Unit*

Summary: Prognostic factors in 269 cases of acute myocardial infarction treated in a coronary unit were analysed using a computer. The mortality rate was significantly higher in the elderly (≤60 years) and those with extensive infarction, shown by prolonged cardiac pain (>4 hours) or high serum enzyme levels (SGOT> 200 Sigma-Frankel units/ml; LDH> 2,000 Berger-Broida units/ ml). It was high also with tachycardia (sinus, supraventricular or ventricular), complete heart block, and complete bundle branch block. It increased progressively with severity of myocardial failure. Secondary cardiac arrect had a high mortality. Clinical signs of catecholamine hypersecretion (sinus tachycardia, pallor, sweating), hypoxaemia (central cyanosis), or low cardiac output (peripheral cyanosis, cold extremities, oliguria) greatly increased the mortality rate. Radiological cardiomegaly and pulmonary congestion each doubled it. An insignificant mortality increase accompanied ventricular and supraventricular ectopics, atrial fibrillation, incomplete heart block, and previous myocardial infarction, angina, and hypertension. There was no significant relationship between mortality and admission delay, sex, tobacco consumption, diabetes, or family history of ischaemic disease or diabetes. Only one patient died of primary cardiac arrest. Sinus bradycardia was a good prognostic sign. Analysis of the literature showed its lower mortality rate to be significant. Since intravenous atropine may cause arrhythmias, it should be reserved for sinus bradycardia with hypotension. It was suggested that patients with adverse prognostic signs short of extreme myocardial decompensatiqn should be monitored longer. Younger patients without severe infarction had a low mortality rate. Investigation of these may reveal a group which can be discharged safely from hospital soon after the completion of monitoring.     

Combined Myocardial Free-Wall and Pericardial Rupture with Hemothorax Complicating Acute Myocardial Infarction

Although myocardial rupture is a commonly identified fatal complication of myocardial infarction, the association of myocardial rupture through the pericardium to produce hemothorax without hemopericardium or left ventricular aneurysm has not been reported. We describe this unusual complication of myocardial rupture in a patient 5 days after myocardial infarction.(J Interven Cardiol 2000;13:51–58)     

新活素对急性心肌梗死伴心力衰竭患者炎症因子的影响

目的：探讨新活素对急性心肌梗死（AMI）伴心力衰竭患者炎症因子的影响。方法：AMI合并心力衰竭患者70例,随机分为常规治疗组（n=35）和新活素治疗组（n=35）,分别测定治疗前后血清肿瘤坏死因子（TNF-α）、C反应蛋白（CRP）及白介素-6（IL-6）水平,并记录2组治疗前及治疗后1个月时的左室射血分数（LVEF）、左室舒张末期容积指数（LVEDVI）、左室收缩末期容积指数（LVESDVI）。结果：新活素治疗组治疗后血清TNF-α、CRP及IL-6水平较治疗前均明显下降（P〈0.05）,且明显低于常规治疗组治疗后（P〈0.05）。新活素治疗组治疗后1个月超声心动图相关指标改善优于同期常规治疗组（P〈0.05）。结论：新活素能在一定程度上减轻AMI伴心力衰竭患者心肌的炎症反应,改善心功能。     

急性心肌梗死不同时期发生的房室传导阻滞

目的：探讨急性心肌梗死病人不同时期发生的房室传导阻滞（ＡＶＢ）的临床特点、治疗及预后。方法：采用非创伤性心电监测法监测４６６例Ｑ波型心肌梗死病人ＡＶＢ的发生率和药物治疗反应及演变。其中６５例病人发生ＡＶＢ，按发生的不同时期分为两组：①早发组，１５例为发病８小时内出现ＡＶＢ；②晚发组，５０例为发病８小时后出现ＡＶＢ。结果：４６６例心肌梗死中，发生房室传导阻滞６５例（１４％）。晚发组比早发组死亡率高（Ｐ＜０．０５）；晚发组泵衰竭多于早发组（Ｐ＜０．０５）；用阿托品治疗后早发组比晚发组有效。结论：急性心肌梗死病人ＡＶＢ早发组比ＡＶＢ晚发组病情较轻，部分病人药物治疗有效，预后较好。