PubMed Health⌕ Search

Biomedical subjects

M L Bhatia

Publications and source records attributed to M L Bhatia.

At least 73 records · Page 4Linked to original sources
PubMed1985

Ajmaline-induced torsade de pointes.

A patient with primary myocardial disease and left bundle-branch block who developed marked QT prolongation and torsade de pointes following an intravenous injection of ajmaline during an electrophysiologic study is reported. The patient could be resuscitated successfully 1 h after the onset of tachycardia.

Ajmaline↗
PubMed1984

Effects of labetalol on left ventricular mass and function in hypertension--an assessment by serial echocardiography.

We determined echocardiographic (M-mode) indices of left ventricular mass and function serially at 1-month intervals in 10 patients with uncomplicated mild or moderate essential hypertension, before and after adequate control of blood pressure with labetalol, a combined alpha- and beta-receptor blocking agent. Seven patients had pretreatment echocardiographic evidence of left ventricular hypertrophy with disproportionate septal thickness in 4. Systolic blood pressure in the untreated state correlated well (r = 0.96) with left ventricular mass but poorly (r = 0.30) with diastolic pressure. Following a satisfactory blood pressure reduction, achieved in all patients, left ventricular mass decreased from 240.5 +/- 71.1 g to 159.5 +/- 40.7 g (P less than 0.01), interventricular septal thickness from 1.33 +/- 0.3 cm to 0.92 +/- 0.25 cm (P less than 0.01) and posterior wall thickness from 1.03 +/- 0.23 cm to 0.93 +/- 0.23 cm (P less than 0.05). While the maximum changes in left ventricular mass were noted by the end of first month (P less than 0.01) with insignificant changes thereafter, the correlation of fall in blood pressure with change in left ventricular mass was significant only after 2 months of treatment (P less than 0.05). Indices of left ventricular function (end-diastolic volume, ejection fraction, fractional diameter shortening, left atrial dimension and posterior aortic wall motion) were normal before treatment and remained unchanged during 3 months of treatment. In this short-term study, labetalol reduced left ventricular hypertrophy (expressed as left ventricular mass and wall thickness) without altering left ventricular function indices in patients with uncomplicated essential hypertension. This has important implications in the treatment of hypertensive patients.

Adult↗
PubMed1984

Thrombotic obstruction of Bjork-Shiley valves--diagnostic and surgical considerations.

We have evaluated 12 patients with thrombotic obstruction of the Bjork-Shiley valve since 1975, 11 in the mitral and 1 in the aortic position. During this period 442 patients with 303 mitral (181 plano-convex and 122 convexo-concave) and 205 aortic (112 plano-convex and 93 convexo-concave) Bjork-Shiley valves were available for follow-up. The incidence of thrombosis for the plano-convex model was 1.06% per patient year for the mitral position and 0.19% per patient year for the aortic position. The new convexo-concave model has brought down the incidence to 0.78% per patient year for the mitral (P less than 0.01) and 0% per patient year for the aortic valve. The onset of symptoms was acute (less than 15 days) in 41.7% and subacute (greater than 15 days) in 58.3% patients. All patients presented with pulmonary edema. Evidence of inadequate anticoagulation was present in only 3 (25%) patients. Reduction of prosthetic sounds and appearance of a new murmur was highly suggestive of valve thrombosis. Echocardiography and cinefluoroscopy was very useful for the instant recognition of this condition and had obviated the need for cardiac catheterisation in the last 6 patients. Emergency surgery was obligatory in all. Thrombectomy alone was successful in 9 patients. Three patients required replacement of the prosthesis. There was one operative death (mortality 8.3%). The long-term follow-up of these patients (3-82 months, mean 34 months) is excellent. We conclude that thrombotic obstruction of the Bjork-Shiley valve is often not related to inadequate anticoagulation, and more than half of the patients do not present with abrupt onset of symptoms. The convexo-concave model has significantly reduced this problem. Emergency surgery with thrombectomy is the procedure of choice for clotted prostheses.

Adult↗
PubMed1984

Acute effects of anti-arrhythmic drugs on cardiac pacing threshold.

Forty cardiac pacing threshold studies were conducted in 20 patients during temporary pacing prior to permanent pacemaker implantation using the following intravenously administered anti-arrhythmic drugs: Lignocaine 2 mg/kg (10 patients), mexiletine 5 mg/kg (5 patients), ajmaline 1 mg/kg (5 patients), verapamil 0.15 mg/kg (10 patients) and propranolol 0.1 mg/kg (10 patients). Changes in voltage (volts), current (mA), energy (micro-joules) and resistance (ohms), were measured using a pacemaker system analyzer at a constant pulse width (0.6 msec) and pacing rate (70/minute). Lignocaine increased the voltage threshold significantly (p less than 0.05) with insignificant (p greater than 0.05) change in current, energy and resistance. Mexiletine and ajmaline significantly (p less than 0.01 and p less than 0.02) increased the voltage and current thresholds but did not change the energy level and resistance (p greater less 0.05). Verapamil caused a significant increase in the current and energy threshold (p less than 0.05), without changing the voltage threshold significantly (p greater than 0.05). The resistance values showed a consistently decreasing trend. Propranolol on the other hand did not affect any parameter significantly (p greater than 0.05). Anti-arrhythmic drugs appear to produce variable effects on different pacing threshold parameters. This has important clinical implications.

Adult↗
PubMed1984

Valve replacement in children under twenty years of age. Experience with the Björk-Shiley prosthesis.

Prosthetic valve replacement in young patients has been reported to be associated with a high mortality and morbidity because of valve-related problems. Of 549 patients undergoing valve replacement with the Björk-Shiley valve prosthesis, 136 were under the age of 20 years. Sixty-four patients were under 16 years of age, the youngest being 6 years old. Of the 136 patients, 61 underwent mitral valve replacement, 50 received an aortic valve, and 25 received both aortic and mitral valves. Overall operative mortality was 10.3%. Late mortality over a follow-up period of 6 months to 8 years was 4.4%. Actuarial survival curves up to 8 years of follow-up are presented. Results obtained in this group are compared with those obtained in 413 patients over 20 years of age operated during the same period. Valve thrombosis was not seen in any patient under 20 years of age, but it occurred in 4.13% of the patients over 20 years of age. The incidence of thromboembolism and anticoagulant-related hemorrhage was very low. There has been no instance of structural failure of the valve. Long-term results are excellent, with 90% of the survivors returning to New York Heart Association Functional Class I. The Björk-Shiley valve gives excellent and durable long-term palliation in young patients requiring valve replacement.

Actuarial Analysis↗