A 75-yeai^old man was admitted to the hospital on January 21, 1990, with 1 hour of severe anterior chest pain, nausea, and diaphoresis. He showed QRS and T wave changes indicative of an acute inferior MI and was soon in third-degree heart block. His blood pressure was 130/70 mm Hg, there was no jugular venous distention (JVD), the lungs were clear, and no S3 gallop or significant murmur was heard. A temporary pacemaker was inserted without difficulty with resultant 100 percent capture. The admission chest roentgenogram was within normal limits. The patient was started on a regimen of a nitroglycerine drip. Thrombolytic therapy was believed contraindicated because of the pacemaker insertion. buy ventolin inhalers
The patient had had an inferior MI 13 years ago, and coronary artery bypass grafts to the left anterior descending artery with sequential grafts to the first obtuse marginal and posterior descending arteries 11 years ago. Four years ago the patient had unstable angina and a successful percutaneous transluminal coronary angioplasty (PTCA) was performed on the first obtuse marginal. A cardiac catheterization 18 months ago showed a normal ejection fraction with normal wall motion.
Postpericardiotomy and Postmyocardial Infarction Syndrome (2)