Læknablaðið - 01.12.1969, Page 41

LÆKNABLAÐIÐ
217
með öllu óviðunanlegt fyrir lækna að takast á hendur meðferð
þessara sjúklinga án þess að eiga kost á því að beita þeirri tækni,
sem þykir bezt hverju sinni.
SUMMARY
Myocardial infarction
This retrospective analysis relates a thirteen year experience in
diagnosis, treatment and prognosis of 394 unselected patients with 414
episodes of acute myocardial infarction which were seen in a depart-
ment of internal medicine serving predominantly a city population.
The incidence of myocardial infarction per 100 general admisssions
rose from 3.2% during 1956—60 to 4.9% during 1965—68. This rise
in incidence, which is statistically significant, p=0.00033, was
both absolute and relative, and was limited to males. There was
no rise in incidence among males under 45 years of age. The over-
all ratio of males to females was 2:1. The mean age for males
was 62 years and for females 67 years. Of the 261 males, 115 were
manual workers. The total number of myocardial infarctions in males
was 274 and in females 140, in persons seventy years and over the
total number of infarctions was 70 and 61 respectively. No seasonal in-
fluence was noted.
One third of the patients were in hospital within six hours after
beginning of the acute attack and two thirds within 24 hours. Serial
electrocardiograms were obtained in 400 instances, 14 patients died be-
fore ecg’s could be taken. The ecg was diagnostic in 374 instances,
showing different anterior affections in 43%, inferior in 38% and
subendocardial in 18%. The incidence of conduction defects, ar-
rhythmias and the lethality rate was almost equal in anterior and
inferior infarctions.
One hundred and nineteen patients died during treatment for an
initial or recurrent infarction at this hospital, and one hundred and
four were examined post mortem, i. e. 87.0%. The over-all lethality
rate was 29%, for males 26% and for females 35%. One hundred
patients died within four weeks, i. e. 85%, of those 40% were dead
within 24 hours after admission and 70% within one week. Risk factors,
i. e. age, hypertension and diabetes were more frequent among females
and the relative incidence of shock and left ventricularfailurewasmuch
higher in females than in males. The immediate causes of death were
as follows: cardiogen shock 38 ptt’s, sudden death 33, left ventricular
failure 27, heart rupture 12, pulmonary embolism 9.
Attempts to evaluate the efficacy of treatment are inconclusive
due to lack of control study. Early ambulation was practiced as a
routine during the whole observation period without harmful effects.
The efficacy of anticoagulant therapy was not possible to assess. No
deaths or life-threatening hemorrhages attributable to it were observed.
Höf. þakka hr. Jóni E. Þorlákssyni cand. act. fyrir tölfræðilega aðstoð.