Chaithiraphan S

Randomized double-blind, placebo-controlled trial of oral atenolol in patients with unexplained syncope and positive upright tilt table test results.

The objective of this investigation was the assessment of the response rate of oral atenolol in patients with vasovagal syncope after 1 month of treatment. We randomized into two groups all patients referred to our unit who had had at least one episode of syncope or two episodes of presyncope 1 month before presentation and had a positive isuprel Tilt Table Test (TTT). Group 1 (Gr 1) received oral atenolol, and group 2 (Gr 2) received placebo medication. After a 1-month period patients were reassessed for degree of their symptoms and underwent repeated TTT. Forty-two patients were enrolled in the study. Gr 1 and Gr 2 were comparable in age (38 +/- 13 years vs 43 +/- 14 years, p = 0.216 and sex (male/female = 6:15 vs 10:11, p = 0.204). The severity of attack was similar in both groups. Eight patients in Gr 1 and six patients in Gr 2 had mitral valve prolapse (p = 0.5). No significant differences were seen in systolic blood pressure (122 +/- 17 vs 117 +/- 16 mmHg, p = 0.334), diastolic blood pressure (70 +/- 11 vs 72 +/- 11 mm Hg, p = 0.677), and heart rate (79 +/- 12 vs 79 +/- 13, p = 0.98) between the two groups. The response rates (negative TTT) after 1 month of treatment were 62% versus 5% (p = 0.0004) in the atenolol and control group, respectively. Moreover, patients who received atenolol reported feeling better compared with those who received placebo (71% vs 29%, p = 0.02). In conclusion, atenolol significantly improved symptoms of patients with vasovagal syncope.(ABSTRACT TRUNCATED AT 250 WORDS)

Multivariate analysis in the prediction of death in hospital after acute myocardial infarction.

Prognostic factors in patients with acute myocardial infarction based on clinical and investigative data on admission were evaluated prospectively in 111 consecutive patients. Seventeen patients (15.3%) died during hospital stay. Age, a previous infarct, high Killip class, cardiomegaly, high serum concentrations of cardiac enzymes, a low ejection fraction, and a high wall motion score index correlated significantly with in-hospital mortality; whereas sex, risk factors, and pericardial effusion did not. Multivariate analysis showed that age and the wall motion score index were the best predictors of death in hospital. Wall motion detected by cross sectional echocardiography may reflect the extent of myocardial involvement. Age and wall motion score index predicted in-hospital mortality with a sensitivity of 76.5%, a specificity of 91.5%, and a predictive accuracy of 89.2%. Age and the wall motion score index can be determined on admission and are useful for identifying patients at high risk of cardiac death who might benefit from early intervention.

Echocardiographic diagnosis of a ruptured aneurysm of the sinus of Valsalva: operation without catheterisation in seven patients.

A ruptured aneurysm of the sinus of Valsalva was diagnosed by Doppler, colour, and cross sectional echocardiography in a consecutive series of seven patients. The diagnoses were confirmed at operation without cardiac catheterisation. Examination by pulsed and continuous Doppler echocardiography showed continuous turbulence in six patients with aneurysms rupturing into the right ventricular outflow tract and in the patient with rupture of an aneurysm of the non-coronary sinus into the right atrium. Colour Doppler echocardiography showed turbulent flow across the defects in all seven patients. A ventricular septal defect with aortic regurgitation was detected in one patient and an associated ventricular septal defect in another. Doppler, colour, and cross sectional echocardiography were useful non-invasive techniques for diagnosing a ruptured aneurysm of the sinus of Valsalva without the need for cardiac catheterisation.

Multivariate analysis in the prediction of left atrial thrombi in patients with mitral stenosis

The prediction of left atrial thrombi based on clinical and investigative data was evaluated prospectively in 100 consecutive patients with significant mitral stenosis. Nineteen patients had left atrial thrombi by surgical findings. Age, atrial fibrillation, and mitral valve area were the variables that predicted the presence of left atrial thrombus, whereas sex, dimension of left atrium, history of systemic embolism, history of previous mitral valvuloplasty, and associated significant mitral regurgitation were not. Patients with atrial fibrillation have a sixfold increase in risk of atrial thrombi compared with patients in sinus rhythm. Transthoracic echocardiography detected 11 (58%) of 19 and transesophageal echocardiography detected 17 (89%) of 19 thrombi found by surgical inspection. Multivariate analysis showed that age and atrial fibrillation were the best predictors of left atrial thrombus. In general clinical practice, these variables could be used to predict left atrial thrombi in patients with mitral stenosis. However, in certain situations such as prior percutaneous balloon mitral valvuloplasty or prior electrical cardioversion, transesophageal echocardiographic examination should be used for high accuracy in the detection of extent and location of left atrial thrombi.

Diagnosis of a right coronary artery-left ventricular fistula by cross sectional and Doppler echocardiography.

A case of right coronary to left ventricular fistula was diagnosed by cross sectional and Doppler echocardiography. The origin and site of entry into the left ventricle of the enlarged right coronary artery were shown by cross sectional echocardiography. Diastolic flow was detected in the left ventricle by both pulsed and continuous Doppler echocardiography. The fistula was confirmed by cardiac catheterisation and was successfully closed at operation.