SummaryForty patients, aged , who had had an acute myocardial infarct in the preceding 24 hr, and who were seriously ill, were treated in a hyperbaric oxygen bed at 2 atm (atmospheres) absolute for sessions of 2 hr in and 1 hr out for an average period of 4 days.There were thirty-seven survivors after the treatment, giving an immediate mortality of 7 5 %, but three ofthose died later before leaving hospital, giving a total mortality of 15% in seriously ill patients.Pain and dyspnoea were usually improved in the first hyperbaric session, relapsed in air and progressively improved in successive sessions.Arrhythmias, including heart block, showed similar benefit. No case of cardiac arrest occurred while the patients were actually receiving hyperbaric o xygen.There was, in the opinion of the authors, during a period of over 2 years' experience, a consistent pattern of improvement over and above that expected as spontaneous improvement.The hyperbaric oxygen bed is a promising method of treatment for the acute phase of myocardial infarction, and it is simple to use. There will of course always be an irreducible minimum of patients who will die from obstruction of both coronary arteries or other structural lesions such as rupture or emboli.
IntroductionAcute myocardial infarction is still one of the commonest lethal diseases remaining unchecked. Even of the patients who reach hospital, approximately 25 % die within the next 6 weeks. The circulatory crisis following infarction presents in several ways, and is sometimes remarkably delayed, but
Rupture of the false sac in dissecting aortic aneurysm commonly occurs into the pericardial sac with an immediately fatal outcome (Hirst, Johns, and Kime, 1958). It is well known that should re-entry be established the immediate prognosis is not so grave as used to be thought, though death occurs later from heart failure due to aortic incompetence or hypertensive heart disease (Shennan, 1934). Dissection of the false sac back to the aortic root itself is common and rupture most frequently occurs into the pericardium (Gore and Seiwert, 1952). More rarely rupture into a cardiac chamber occurs. The right ventricle may be entered, a left-to-right shunt being established and, theoretically at least, this is amenable to surgical repair. This is more common with rupture of a sinus of Valsalva rather than a true dissection (Oram and East, 1955). An aortic diastolic murmur is commonly found in true dissection. Various mechanisms for the murmur are described, such as aortic incompetence due to distortion of the valve ring, eddy currents in the distorted aorta, or ebb and flow into the false sac (Hirst et al., 1958). In our case the false sac entered the right atrium. The signs of apparently florid aortic incompetence, however, obscured the signs of the left-to-right shunt though there was clinical evidence of this at least seven months before death. We can find no previously reported case where the sac has
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