Pravastatin therapy significantly decreased thrombus formation and improved the fibrinolytic profile in patients with and without CAD. These early effects may, in part, explain the benefit rendered in primary and secondary prevention of CAD.
IN 1950 Harris and Kokernot1 reported that sodium diphenylhydantoin (Dilantin Sodium) is effective in the treatment of cardiac arrhythmias in the experimental animal. Since then, several reports have been published which demonstrate the efficacy of diphenylhydantoin given intravenously in abolishing arrhythmias in dogs and humans.2-7 See also page 337.There have been no reported fatalities due to intravenous use of diphenylhydantoin in treating cardiac arrhythmias in humans. The purpose of this report is to present two cases of patients who died following intravenous administration of diphenylhydantoin.Report of Cases Case 1.\p=m-\A 67-year-old white woman with a 30-year history of diabetes mellitus and a ten-year history of angina pectoris was admitted to the Mount Sinai Hospital on Feb 8, 1966, with an acute myocardial infarction (inferior wall) complicated by pulmonary edema. The pulmonary edema responded to treatment including administration of digitalis. Anticoagulants were also administered. The hospital course was then uncomplicated except for occasional episodes of angina pectoris. Six weeks after ad¬ mission the patient had crushing, substernal chest pain, ECG tracings during administration of diphenylhydan¬ toin. Atrial flutter with 2:1 atrioventricular block (top strip); next four strips (two minutes after drug was ad¬ ministered) show sinus rhythm, sinus arrhythmia, ven¬ tricular escape beat, idioventricular rhythm, and cardiac arrest.which lasted several hours and was again followed by frank pulmonary edema. An electrocardiogram revealed more marked ST segment depression in leads Vi through V4« One hour later the pulse rate increased and an ECG then re¬ vealed atrial flutter with a ventricular response of 150. The patient had been on a maintenance dose of digoxin and an additional 0.4 mg of lanatoáide C was given intravenously but no ventricular slowing occurred over the next two hours. The patient's clinical condition deteriorated as substanti¬ ated by increasing pulmonary edema and gradually falling blood pressure. Diphenylhydantoin, 250 mg, was given in¬ travenously for two minutes with electrocardiographic mon¬ itoring. Within one minute after the completion of the administration of the diphenylhydantoin, sinus rhythm was restored but was soor\ followed by sinus arrhythmia, ven¬ tricular escape, idioventricular rhythm, and cardiac arrest (Figure). The patient could not be resuscitated.Case 2.-A 70-year-old white man with chronic lung dis¬ ease for many years and angina pectoris for six months was admitted to the Mount Sinai Hospital on Feb 1, 1966, because of increasing congestive heart failure despite dig¬ oxin and diuretic therapy.On admission the patient manifested evidence of some left-sided and marked right-sided congestive heart failure with tricuspid régurgitation. The ECG revealed regular sinus rhythm with an SiSuSm pattern.The patient responded well to bed rest, oxygen, antibi¬ otics, bronchodilators, and expectorants. A maintenance dose of digoxin was continued. Two days after admissio...
The indication for coronary bypass surgery in the elderly has been dramatically expanded in recent years. The results, however, are often contradictory. 1,538 consecutive patients undergoing cardiac surgery were divided into two groups by their age at the time of operation: younger than 75 years (n = 1,480) and 75 years and older (n = 58). These groups were compared with regard to influencing factors of early and late mortality, morbidity, and quality of life. Preoperatively, the clinical condition of the group greater than or equal to 75 years was significantly worse than the condition of the group less than 75 years (NYHA IV: greater than or equal to 75 years: 63.8%; less than 75 years: 31.9%). Cerebrovascular diseases occurred more often in the patients greater than or equal to 75 years (stroke or transient ischemic attack: greater than or equal to 75 years: 8.6%; less than 75 years: 2.3%). The necessity of carotid reconstruction prior to coronary surgery was significantly higher in the patients greater than or equal to 75 years: (greater than or equal to 75 years: 5.2%; less than 75 years: 1.5%). Diabetes mellitus could be observed in 19.0% of the patients greater than or equal to 75 years and in 10.1% of the patients less than 75 years. The preoperative ejection fraction was similar in both groups. Cardiopulmonary bypass time and crossclamping time of the aorta did not differ significantly. Both groups received approximately the same number of distal coronary anastomoses. Rethoracotomy due to hemorrhage had been observed more often in the older group (greater than or equal to 75 years: 8.6%; less than 75 years: 4.5%).(ABSTRACT TRUNCATED AT 250 WORDS)
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