RESUMO
We studied 10 patients between the ages of 30 and 69 years, all of whom had suffered myocardial infarction (MI) at least 6 months before they died. Two-dimensional echocardiography (2-D E) and catheterism were done no more than 15 days before death. The location and extension of MI were compared to the segmentary mobility (SM), end diastolic wall thickness (EDWT) and percentage of systolic wall thickening (PSWT) determined by 2-D E, in the 15 segments of the left ventricular wall. We also compared 2-D E and coronariographic findings. There was a good correlation between the location (P less than 0.01) and extension (P less than 0.05) of the necrotic area dyssynergy, specially when the MI was transmural. The postmortem measurement of the wall thickness in each one of the segments had also good correlation with the EDWT as measured with 2-D E (r = 0.926). The EDWT was less in the necrotic segments (8.8 +/- 1.8 mm) than in non affected segments (14.1 +/- 1.9 mm) and this difference was significant (P less than 0.05). The wall was thinnest in segment affected by transmural necrosis. The PSWT was significantly less (P less than 0.01) in necrotic segments (12.1 +/- 3%) than in segments without necrosis (24.1 +/- 4.3%). The alteration of SM correlated with coronary obstructions greater than 75%, specially when it was associated with necrosis. The EDWT was less in necrotic segments with important coronary artery obstruction than in those without necrosis even though vascular narrowing was marked (P less than 0.01). The PSWT was also less in the areas with necrosis when coronary obstruction was severe as well as moderate (11.3 +/- 2.3%) than in segments with coronary obstruction but without necrosis (22.3 +/- 4.2%) and even less than that obtained in cases with neither coronary artery obstruction nor necrotic area (30.1 +/- 2.2%) and the difference is statistically significant (P less than 0.01). The segmentary measurement by 2-D E of the EDWT and the PSWT are useful for recognizing areas with necrosis and differentiating it from ischemic areas of left ventricle in coronary artery disease.
Assuntos
Ecocardiografia , Infarto do Miocárdio/patologia , Adulto , Idoso , Cateterismo Cardíaco , Doença das Coronárias/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/fisiopatologia , NecroseRESUMO
During the last 4 years 2040 patients with myocardial infarction were admitted to the C.C.U. of the National Institute of Cardiology. Thirty five patient under 40 years of age were studied. Three had Rheumatic heart disease and in 32 the etiology of the myocardial infarction was probably coronary atherosclerosis. The 32 cases under 40 years of age were compared to a group of patients with myocardial infarction older than 40 years of age. A great predominance of myocardial infarction was found in young males which were heavy smokers. There were no significant differences with the presence of obesity and arterial hypertension. In the younger group, myocardial infarction were more frequent in those with intellectual activity and in taxi drivers. The early hospital course was better in the young group they did not have cardiac failure, cardiogenic shock and none died. However, in the long term follow up the younger group had more P.V.C. and ventricular tachycardia. The cardiography of the younger showed an important predominance of lesions in the left coronary artery. It is concluded that in young people, myocardial infarctions seems to occur primarily in smokers with stress in their Kind of living. These patients seem to have less complications in the early and long term courses. However, more cardiac rhythm disorders are present.