Ajit V. Adyanthaya

Left atrial enlargement. Echocardiographic assessment of electrocardiographic criteria.

SUMMARY A comparison of electrocardiographic manifestations of left atrial enlargement (LAE) and left atrial size by echocardiography was made in 307 patients in sinus rhythm. Electrocardiographic criteria used were L: P wave duration in lead II equal to or greater than 0.12 sec; Va: the ratio of the duration of negative terminal P in V1 to the P-R segment equal to or greater than 1.0; Vb: a negative P terminal force in V, less than −0.03 mm sec. The echocardiographic diagnosis of left atrial enlargement was based on 1) transverse dimension greater than 4.0 cm, or 2) a ratio of transverse atrial to transverse aortic root dimension greater than 1.17. In the presence of left atrial enlargement, a combination of criteria occurred more often than a single criterion. The overall predictive index of the electrocardiogram for left atrial enlargement was 63% (excluding criterion Vb raised probability to 80%); and that for absence of left atrial enlargement was 78%. The index of coarse versus fine fibrillary waves was unreliable in predicting left atrial enlargement. Changes in P wave morphology may be used as a reasonably specific but less sensitive indicator of left atrial enlargement.

Prinzmetal's Variant Angina: Hemodynamic and Angiographic Observations During Pain

Hemodynamic and angiographic data obtained during pain from four patients with Prinzmetals variant angina are reported. The left ventricular pressure-time index did not increase before or during attacks of angina in three of the four patients; left ventricular systolic performance was impaired during pain in all three. In one of these three patients left ventricular pressure-volume data obtained during angina suggested a reduction in diastolic compliance; in another, pain and S-T segment elevation were present during coronary arterial spasm. The fourth patient had an increase in both arterial blood pressure and heart rate before an attack; in this patient coronary arterial spasm could not be demonstrated during the period of pain and S-T elevation. The data presented suggest that hemodynamic factors that increase the myocardial oxygen requirements are absent and that coronary arterial spasm is present in some, but not all, patients with variant angina.

Value and safety of cardiac catheterization during active infective endocarditis

Abstract Cardiac Catheterization during active infective endocarditis is considered to be hazardous and, consequently, is often delayed. A review was made of experience with 35 patients who underwent Catheterization for severe heart failure (30 patients) and persistent sepsis or recurrent embolization (5 patients) in consideration of surgical intervention. The mean interval from hospital admission to Catheterization was 19 days, and 11 of 35 procedures were performed within 10 days of admission. Precatheterization clinical assessment was incomplete or incorrect in 23 patients. Cardiac Catheterization revealed clinically unsuspected multiple valve involvement in seven patients and documented single valve involvement in six patients with murmurs clinically suggestive of multiple valve endocarditis. In one patient thought to have mitral endocarditis, Catheterization localized the problem to the tricuspid valve. In six patients the study disclosed valve ring abscess and in three it provided anatomic definition of a left to right shunt associated with infection of a ruptured sinus of Valsalva. One additional patient was “cured” of infection by removal of a subclavian catheter fragment. The only complication encountered was transient atrial fibrillation. Catheterization-induced embolization and postcatheterization hemodynamic deterioration did not occur in these 35 patients. It is concluded that cardiac Catheterization yields invaluable hemodynamic and anatomic information and can be performed with minimal risk in patients with infective endocarditis who are being considered for surgery.

Multiple pulmonary artery aneurysms. New use for magnetic resonance imaging

The first patient in whom multiple pulmonary artery aneurysms were detected by magnetic resonance imaging is described. The patient was successfully treated with surgery.