Biomedical subjects
Publications and source records attributed to S S Kothari.
A 32 year old female with systemic lupus erythematosus having circulating lupus anticoagulant developed a thrombus in the left ventricle cavity, an unusual site. She responded to standard anticoagulant regime.
Electromechanical dissociation (EMD) may be primary, due to disease of the heart muscle itself, or secondary to alterations in loading conditions of the heart. Factors such as internal hemorrhage, acute cardiac tamponade, tension pneumothorax, acute pulmonary embolism, and inflow or outflow obstructions of the heart may be responsible for changes in loading. Myocardial ischemia, myocardial depressant overdose, and other conditions may also contribute to secondary EMD. If detected early, these secondary forms of EMD may respond to treatment. Drugs for resuscitation of a patient with EMD include epinephrine, atropine sulfate, and, in selected instances, calcium.
A case of discordant atrioventricular (AV) connection and concordant ventriculoarterial (VA) connection (with aortomitral fibrous continuity and tricuspid pulmonary discontinuity) in situs inversus (I, D, I) is reported because of its rarity. This segmental combination with abnormally related great arteries in the absence of anomalies of venous connections and/or splenic anomalies is extremely rare.
A genetically determined error in the handling of catecholamines by the developing heart has been speculated to cause hypertrophic cardiomyopathy. A critical appraisal of the published literature reveals that there is little actual experimental or clinical evidence favouring the role of catecholamines in the pathogenesis of hypertrophic cardiomyopathy. Other factors seem to be more important. An abnormality of myocardial growth, either induced by excessive growth promoting substance, or a genetically determined abnormality in myocardial responses to normal growth factors during life (but not in the fetal handling of catecholamines) is likely to be responsible for hypertrophic cardiomyopathy.
A patient with severe hypertension, hypokalemia and marked T-U wave alternans on electrocardiogram is reported for its rarity. Relevant literature is reviewed. Recent data indicate that electric alternans is related to changes in action potential configuration, and that it may be a marker of cardiac electrical instability.
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Autonomic neural impulses that accompany discharges during a seizure can cause a variety of cardiac manifestations, including cardiac arrhythmias, sudden death, anginal chest pain, neurogenic pulmonary edema, and symptoms of pheochromocytoma. Either generalized or focal seizures may generate such signs and symptoms. A better appreciation of cardiac problems caused by epilepsy is helpful in preventing misdiagnosis, because the clinical picture in such a patient may be confusing.
Fourteen patients with polymyositis-dermatomyositis (PM-DM) underwent prospective cardiac assessment with non-invasive techniques. One patient had electrocardiographic evidence of Long-Ganong-Levine syndrome with multiple supraventricular premature beats. Echocardiographically one patient had late systolic prolapse of the posterior mitral leaflet and another had paradoxical movements of the interventricular septum. The study suggests that cardiac involvement is infrequent in PM-DM.
To assess the utility of electrocardiogram in identifying left atrial enlargement, electrocardiogram of 600 consecutive patients were correlated with their M-mode echocardiographic findings. Left atrial enlargement, as reflected by P terminal force in V1 had sensitivity of 79%, specificity 91%, predictive value 85% and accuracy of 86%. Patients older than 30 years with large left atrium (greater than 5.0 cm) had atrial fibrillation more frequently than younger patients (P less than 0.001). It is concluded that P terminal force in V1 is a reliable indicator of left atrial enlargement.
A patient with tetralogy of Fallot associated with aortopulmonary window has been documented. The association was found in one case out of 350 consecutive cases of Fallot's tetralogy evaluated cineangiographically. Since tetralogy of Fallot may be completely masked by the aortopulmonary window it is suggested that a right ventricular angiogram should be obtained in all patients with an aortopulmonary window.
We report the finding of complete heart block in two siblings (brother and sister) with hypertrophic cardiomyopathy. Its relationship to the disease is discussed and the relevant literature is reviewed.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
PURPOSE: We studied the relationship of initial angiographic morphology in patients with aortic stenosis due to nonspecific aortitis and its relationship to immediate and later outcome following percutaneous transluminal angioplasty (PTA). METHODS: Correlation was performed in 10 successive patients by retrospective analysis. All had clinically inactive nonspecific aortitis and hemodynamically significant aortic stenosis resulting in hypertension or lower limb claudication. Five patients had discrete concentric stenosis; the other five had eccentric stenosis with diseased aortic segments adjacent to the stenosis. RESULTS: The five patients with concentric stenosis (Group I) had primarily successful and uncomplicated PTA with sustained improvement. The five patients (Group II) with eccentric stenosis had initial success in three patients and two initial treatment failures with one patient showing late improvement. Four of these patients developed large intimal flaps. One of these had an aneurysm during follow-up. Follow-up angiograms in five patients showed remodelling with further angiographic and clinical improvement. CONCLUSION: Eccentricity of the stenosis and diffuse aortic disease correlate unfavorably with immediate outcome of PTA but late improvement may still be seen.
The role of digoxin in the treatment of congestive heart failure is (CHF) being questioned. Digoxin continues to be the drug of choice for patients with atrial fibrillation in CHF. Large randomised trials have shown that digoxin (in addition to ACE inhibitors and diuretic) is beneficial in CHF due to systolic dysfunction, although it does not reduce mortality. Limited data suggest that digoxin benefit some, but not all patients with CHF due to left to right shunts. Digoxin does not benefit CHF due to diastolic dysfunction and it is not routinely recommended for prematures with patent ductus and CHF. The treatment with digoxin should be individualised.
Results of fetal echocardiography in 1062 high risk pregnant patients are described. It was performed before 28 weeks of gestation in 770 cases. These were 38 abnormal scans (3.6%). A fetal arrhythmia was diagnosed in 14 cases and structural abnormality of the heart in 24. Complete atrioventricular block was commonest (n = 12), structural heart disease associated in two of these cases. Other lesions identified were atrioventricular septal defect (n = 5), hypoplastic left heart syndrome (n = 4), ventricular septal defect (n = 4), Ebstein's anomaly (n = 3), coarctation of aorta (n = 2) and others (n = 9). Postnatal confirmatory echocardiography is available in a total of 993 babies including 36 of 38 abnormal cases. There were eleven neonatal deaths amongst babies with abnormal scans. Errors in interpretation were observed in six instances. An anomaly was missed in five cases; in two of these, the main cardiac malformation was picked up but secondary lesions were missed. In one case, a false positive diagnosis of atrial septal defect was made. These errors did not influence the management of the pregnancy. Fetal echocardiography is a very sensitive (91.6%) and specific (99.9%) tool for antenatal diagnosis of congenital heart disease in high risk pregnancies. The information so obtained helps in guiding the optimal obstetric and neonatal management of these cases.