Bernard K. Ee

Anomalous chordae tendinae. A source of echocardiographic confusion

A unique instance of an anomalous chorda tendinae visualized in the left ventricular outflow tract during M-Mode and two-dimensional echocardiog raphy, and subsequently confirmed during surgery for concomitant severe rheumatic valvular disease, is described. The M-Mode appearance can be confused with more serious forms of heart disease manifesting extraneous echoes in the outflow tract, and an approach to these echoes is described, based on a review of the literature.

U wave inversion in unstable angina due to left main coronary artery stenosis.

A 50-year-old male was admitted to hospital for repeated episodes of chest pain due to unstable angina. Serial electrocardiograms were all normal except for one electrocardiogram, recorded during chest pain, which showed isolated U wave inversion in leads I, V4 and V5. Subsequently, selective coronary arteriography showed isolated 99% stenosis of his left main coronary artery.

The immediate hypotensive effect of oral nifedipine

The immediate hypotensive effect of oral nifedipine was assessed in 15 patients with moderate to severe hypertension. Supine and erect blood pressure and heart rates were measured before and 30 minutes after 10 mg nifedipine. The results showed that there was a significant (p less than 0.001) reduction in both systolic and diastolic pressures. There was a slight increase in heart rate and mild postural hypotension but neither appeared to be significant. It is concluded that nifedipine given by the oral route is an effective agent for the rapid lowering of elevated blood pressure and deserves further evaluation as an agent for the management of hypertensive emergencies.

Diffuse Conduction Abnormalities in an Adolescent with Familial Sinus Node Disease

We report a case of familial sinus node disease with associated conduction abnormalities in the atrioventricular node and distal conducting system. Spontaneous atrial pacemaker activity was absent though the atrium could be depolarized. The pacemaker activity of the heart resided in the atrioventricular junction. The AV node showed impaired automaticity and abnormal conduction properties which partially improved after vagal blockade. (PACE, Vol. 4, November‐December, 1981)

Echocardiographic abnormalities in acute rupture of the aortic valve due to infective endocarditis.

The M-mode echocardiographic findings seen in 5 patients with acute rupture of the aortic valve leaflets due to infective endocarditis are described. These findings embrace a wide spectrum of abnormalities seen in the aortic root in diastole and they are (1) fine, high frequency oscillating echoes, (2) thick oscillating bands of echoes, and (3) dense shaggy echoes loosely attached to the aortic valve leaflets. Three patients showed persistence of these aortic root echoes right up to the level of the left ventricular outflow tract. All 5 patients demonstrated early closure of the mitral valve and exaggerated motion of the interventricular septum and the posterior wall of the left ventricle. Two patients died from the illness and the remaining 3 had successful aortic valve replacement after appropriate antibiotic therapy. The aortic valve and the aortic root were carefully examined in all 5 patients either at necropsy or at operation. Two patients had leaflet perforation alone, whereas the remaining 3 had both leaflet perforations as well as vegetations. An attempt was made to correlate morphologic findings with the echocar diographic abnormalities. It is concluded that it is frequently difficult from abnormal echoes in the aortic root alone to differentiate between ruptured leaflets and vegetations. However, the presence of the combination of early closure of the mitral valve, exaggerated motion of the interventricular septum and the posterior wall of the left ventricle, together with abnormal aortic root echoes as described above should strongly suggest acute rupture of the aortic valve leaflets due to infective endocarditis, or in rare cases myxomatous degeneration of the aortic valve.