Analbuminuric proteinuria: a true finding?
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Biomedical subjects
Publications and source records attributed to G Righetti.
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A case of isolated alternans of the ST segment and T wave in a man with myocardial infarction is reported. Based on the previous experimental reports, the hypothesis is advanced that delayed and blocked (2:I) activity of the ischemic area may be responsible for the phenomenon observed.
In four patients, ectopic supraventricular rhythm (or beats) with cephalad anomalous atrial activation and, generally, a short PR, were always associated with an ST elevation in the leads with a negative P wave. An inverted Ta wave appears to be responsible for the ST elevation.
Following a brief outline on problems concerning methodology, the cause of death is analysed in 110 patients dying from acute myocardial infarction during hospitalization. Autopsy studied were carried out in 78 cases. Of the various causes, the most frequent were forms of contractile insufficiency (EPA, shock, shock + EPA, biventricular congestive heart failure) which were responsible for 50.90% of cases; followed by cardiac rupture (considered in a single group with electromechanic dissociations of the patients not submitted to autopsy studies since in the experience of the Authors cardiac rupture almost always presents with this pattern) with a frequency of 29%. The frequency of arrhythmias, on the other hand, is very low, particularly in the coronary care unit where it is practically a negligible causa mortis 2.72%): even if sudden death, in patients who were not monitored, is included amongst the arrhythmias, the percentage is still only about 10%. Embolism (usually pulmonary, but systemic in one case) was the cause of death in 5 patients (4.54%). Three patients over 80 years of age died from ischemic cerebral episodes. Age, sex, and site of infarction, do not appear, in the present series, to have a determinant effect in the cause of death; a higher frequency of rupture in the female sex was not, for example, confirmed. On the basis of the observations in the present series, any relationship between cardiac rupture and anticoagulating therapy, steroid treatment, application of endocavitary stimulators, or early ambulation is excluded. It is also excluded that reanimation, as hypothesized by some Authors, may be responsible for rupture.
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