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[ST segment alternams in myocardial infarct: apropos of a case].

Alternans of the ST segment is frequent in Prinzmetal's angina and is referred to a dyshomogeneity of myocardial refractoriness during ischemia. Reports of this phenomenon in myocardial infarction are, on the contrary, extremely rare. A case of alternans of the ST segment in a man with myocardial infarction is described. Based on the previous experimental reports, the hypothesis is advanced that delayed and blocked electrical activity of the ischemic area may be responsible for the event observed. This phenomenon is probably not infrequent in myocardial infarction.

Angina Pectoris, Variant↗

Rebound of vasospastic angina after cessation of long-term treatment with nifedipine.

The beneficial effect of calcium antagonists in the treatment of vasospastic angina is now well recognized. Although withdrawal symptoms have been reported following abrupt cessation of therapy with some cardiovascular drugs, there is no detailed report on similar complications of the cessation of therapy with calcium antagonists. In a 4-month period eight patients with well documented and well controlled vasospastic angina experienced a marked increase in the frequency and duration of anginal episodes at rest following the involuntary cessation of treatment with nifedipine, 10 to 20 mg four times a day. The increase began within 2 to 5 days after the cessation of treatment. Substitute therapy with isosorbide dinitrate, 30 mg, and verapamil, 80 to 120 mg, each four times a day, was effective in all cases. Although the mechanism responsible for this rebound phenomenon is not known, awareness of its existence is essential considering the widespread use of calcium antagonists.

Adult↗

[Cardiological aspects of chest pain (author's transl)].

Of all chest pains, the differential diagnosis of angina pectoris is without doubt prominent. The later life of a person is permanently affected by it. Angina pectoris is a complex of complaints which can only be recognized with great reliability through specific questioning of the patient, whereas practically all objective findings such as direct examination of the patient, radiographic and laboratory findings, even the resting ECG are usually negative. Pointers to the presence of a coronary heart disease can only be found after effort in the ECG or cardioscintigram. In the matter of chest pain particularly, the great importance of medical discussion which is, in fact, able to differentiate the clinical picture with great reliability is underlined here.

Angina Pectoris↗