Biomedical subjects
Publications and source records attributed to S Padmavati.
Thrombosis of a Bjork-Shiley valve in the mitral position was suspected clinically and confirmed by echocardiography and cine fluoroscopy. Streptokinase therapy followed by intravenous heparin infusion was given and the clot lysed successfully. The patient was asymptomatic upto two years of follow-up.
Forty-six malnourished children between 3-48 mo with varying grades of malnutrition (PEM) were evaluated for left ventricular function by echocardiography. None of these children had any pre-existing cardiac disease, chronic illness or significant anemia. Children with Grades III and IV PEM had significantly smaller cardiac chamber size and ventricular wall thickness as compared to normally nourished children. Cardiac output as well as other indices of left ventricular function (percentage fractional shortening, mean rate of circumferential fibre shortening and ejection fraction) were also significantly decreased in severe PEM. The atrophic PEM heart does appear to show left ventricular dysfunction in moderately severe malnutrition.
Forty-two patients with complete heart block were subjected to electrophysiological studies wherein apart from localization of the site of the conduction defect, ventricular pacing was done to assess ventriculo-atrial (VA) conduction and concealed ventriculo-nodal (VN) conduction. There was evidence of retrograde conduction in the presence of orthograde CHB in 22 patients (52.4 per cent). Fifteen patients (35.7 per cent) had VA conduction and seven (16.6 per cent) had concealed VN conduction. In patients with supra-Hisian CHB, three of the nine patients had VA conduction while of the 11 patients with intra-Hisian CHB, six had retrograde conduction (four with VA and two with concealed VN conduction). In the infra-Hisian CHB group, of the 22 patients, eight had VA conduction and five had concealed conduction. Incremental ventricular pacing induced VA Wenckebach periods at VPR from 110 to 133/minute with a VA interval of 110 to 130 msec. In view of the induction of Wenckebach VA periods, the recording of retrograde H potentials in some cases, and relatively long VA conduction time, it is surmised that retrograde conduction in the presence of orthograde CHB takes place through the AV conduction system.
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Ten patients with atrial septal defect of the secondum variety undergoing diagnostic haemodynamic study were subjected to electrical stimulation of the endocardium of the left atrium using a bipolar pacing electrode catheter. The polarity, frontal plane P wave axis and P wave configuration were analysed from ten scalar 12 lead electrocardiogram (ECG), recorded at 25-50 mm/sec during sinus rhythm and left atrial stimulation. While four patients demonstrated the "dome and dart" appearance of P waves in V1, nine out of ten patients revealed upright P waves in V1 during left atrial pacing; one patient showed inverted P waves in V1-V6. Four patients had negative "P" waves in L1 and only five of ten patients had inverted "P" waves in L1 and V6. All the criteria of left atrial rhythm were present in only one patient. It appears that the "P" waves change during left atrial pacing are variable and that the typical findings of left atrial rhythm are not obtained in all cases. This study was planned because trans-septal left atrial stimulation in the genesis of left atrial rhythm has not been widely reported.
Studies on the prevalence and other epidemiological features of rheumatic fever and rheumatic heart disease and pilot prophylactic programmes have been carried out in India for the past 12 years or more. The results of these, together with data from other developing countries, have been taken into account in discussing the problems of these diseases in the developing world. Suggestions for their control, to be modified according to local conditions, are made.
Chronic cor pulmonale is more prevalent in northern India than in the south. It is equally common in men and in women and accounts for 20% of all admissions for heart disorder in Delhi. In a study of 766 patients (239 men and 527 women) carried out over a 15-year period there were some striking sex differences. Some 75% of men and 10% of women smoked. The women came from the poorest class and all of them cooked from an early age over smoky and primitive fireplaces in ill-ventilated huts, while only 7% of the men cooked their own food. Chronic bronchitis and bronchiectasis were the commonest associated lung disorders in both sexes. The women developed heart failure 10-15 years earlier and showed more severe congestive failure with larger hearts and greater derangement of pulmonary function. It is concluded that the cause of chronic cor pulmonale in women in Delhi was damage to the lungs from exposure to smoky cooking fuels from girlhood onwards, followed by repeated chest infections.
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Two elderly women were given a bipolar endocardial ventricular inhibited demand pacing system. They developed total loss of capture on the 16th and 62nd post-operative day and sikagrams of chest revealed pull out of endocardial catheter due to formation of multi-twined loop in the loose and laxed subcutaneous pulse generator pockets. Various mechanisms of this unusual complication with suggestions for prevention have been discussed.
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