Ashvin K. Patel

Detection and estimation of rheumatic mitral regurgitation in the presence of mitral stenosis by pulsed doppler echocardiography

The sensitivity and specificity of pulsed Doppler echocardiography (PDE) in diagnosis and estimation of the severity of mitral regurgitation in the presence of rheumatic mitral stenosis was studied in 34 patients (18 women and 16 men) ranging in age from 33 to 70 years (mean 55). Definitive diagnosis of mitral regurgitation was confirmed in all patients by angiography and in 20 patients also by indicator dilution technique. Mitral regurgitation was detected by PDE in all patients with angiographically proven severe mitral regurgitation and in 7 of 8 patients with moderate mitral regurgitation. In patients with trace to mild mitral regurgitation, PDE was positive in only 7 of 13 patients. When subdivided for mild, moderate and severe mitral regurgitation, PDE sensitivity for diagnosis was 54, 88, and 100%, respectively; overall accuracy was 79% and specificity was 100%. Average systolic dispersion on time-interval histogram was 59% for mild, 89% for moderate, and 100% for severe mitral regurgitation. Groups of patients with mild mitral regurgitation could be differentiated from those with moderate (p less than 0.05) and severe (p less than 0.01) mitral regurgitation. A significant overlap of individual values, however, occurred. In 7 of 11 patients with moderate to severe mitral regurgitation, systolic turbulence also was detected in the left atrium. PDE was sensitive and specific in diagnosing moderate to severe mitral regurgitation in the presence of mitral stenosis. Assessment of precise severity of mitral regurgitation is still a problem in individual patients.

Fungal Purulent Constrictive Pericarditis in a Heart Transplant Patient

Purulent pericarditis caused by Candida species is rare and is associated with very high mortality. Immunosuppressed transplant patients are particularly susceptible to fungal infections. We report a case of Candida purulent constrictive pericarditis in an immunocompromised heart transplant patient who was treated successfully with antifungal agents, surgical drainage, and pericardiectomy.

Hyperkalemia With Cardiac Arrhythmia: Induction by Salt Substitutes, Spironolactone, and Azotemia

In two patients, severe hyperkalemia and serious cardiac arrhythmia developed after excessive use of potassium-containing salt substitutes. Both had impaired ability to handle and excrete additional potassium load due to chronic congestive heart failure, azotemia, and administration of spironolactone. Prompt recognition of the arrhythmia and immediate restoration of the cardiac rate and rhythm by pacemaker support followed by intensive regimen to lower the serum potassium prevented a potentially fatal outcome. These cases emphasize the potential danger of salt substitutes when used by patients who are predisposed to retain potassium.

Multiple calcified thrombi (rocks) in the right ventricle.

Large, organized right ventricular thrombi are rare. This report describes a 51 year old man with a history of recurrent pulmonary emboli treated with inferior vena cava ligation who subsequently developed multiple mobile calcified thrombi in the right ventricle. He was treated successfully by surgical resection. Unusual clinical presentation on admission consisted of a two component friction rub secondary to calcified masses rubbing against each other in systole and diastole. Cardiac catheterization showed a constrictive-restrictive pattern that persisted after surgery. The role of noninvasive studies in the diagnosis and long-term follow-up of the patient is emphasized.

Tocainide pharmacokinetics during continuous ambulatory peritoneal dialysis

Abstract Tocainide hydrochloride is a class IB antiarrhythmic agent that has a long duration of action and a narrow therapeutic to toxic ratio. Although tocainide resembles lidocaine structurally, it differs in potency, lipophilicity, metabolism and pharmacokinetic profile. Tocainide is almost completely absorbed after oral administration and has a bioavailability approaching 100%. 1 It is both metabolized and excreted unchanged by the kidney. The metabolites do not exert cardioprotective or cardiotoxic effects. 2 In patients with normal renal function, the biologic half-life of tocainide is about 15 hours. 1 However, in patients with end-stage renal disease, the half-life is prolonged to approximately 23 hours. 3 Hemodialysis removes about 25% of tocainide from the body, decreasing the half-life to about 5 hours. 3 Nonrenal elimination of tocainide in end-stage renal disease appears unaffected. 3 The effect of continuous ambulatory peritoneal dialysis (CAPD) on the elimination of tocainide is unknown. This study examined selected tocainide pharmacokinetic variables in patients undergoing routine CAPD.

Efficacy of propranolol in IHSS and cardiogenic shock

Efficacy of propranolol in IHSS and cardiogenic shock Ashvin K. Patel MD, William G. Muller MD, Vicente U. Yap MD & James H. Thomsen MD To cite this article: Ashvin K. Patel MD, William G. Muller MD, Vicente U. Yap MD & James H. Thomsen MD (1980) Efficacy of propranolol in IHSS and cardiogenic shock, Postgraduate Medicine, 68:3, 167-170, DOI: 10.1080/00325481.1980.11715540 To link to this article: http://dx.doi.org/10.1080/00325481.1980.11715540