Maurice H. Choo

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.

Two-dimensional echocardiography in Lutembacher's syndrome

10. Bissada NK, Finkbeiner AE, Williams GD, Weiss JB. Successful extraction of intracardiac tumor thrombus of renal carcinoma. J Urol 1977;118:474-5. Goldman A, Parmeswaran R, Kotler MN, Hartman J, Parry W. Renal cell carcinoma and right atria1 tumor diagnosed by echocardiography. AM HEART J 1985;110:183-6. Bryant J, Vuckovic G. Metastatic tumors of the endocardium. Arch Path01 Lab Med 1978;102:206-8. Schellhammer PG. El-Mahdi A. Renal cell carcinoma with solitary metastases to pericardium. Urology 1983;21:399401. Hrick H, Demas BE, Williams RD, McNamara MT, Hedgcock MW, Amparo EG, Tanagho EA. Magnetic resonance imaging in the diagnosis and staging of renal and perirenal neoplasms. Radiology 198

The immediate hypotensive effect of oral nifedipine

154:709-X. Choyke PL, Kressel HY, Pollock HM, Arger PM, Axe1 L, Mamourian AC. Focal renal masses: magnetic resonance imaging. Radiology 1984;152:471-7. Freedberg RS, Kronzon I, Rumancik W, Liebeskind D. The contribution of magnetic resonance imaging to the evaluation of intracardiac tumors diagnosed by echocardiography. Circulation 1988;77:96-103.

Stroke masking electrocardiographic abnormalities.

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.

Simultaneous Occurrence of Type A and Type B Wolff-Parkinson-White Conduction Abnormalities: Case Report

Summary Strokes may mimic or mask electrocardiographic abnormalities. An example of the little known masking phenomenon is described.

Spontaneous directional change of F waves in atrial flutter

A 50 year-old woman with recurrent palpitations presented with electrocardiographic changes of simultaneous type A and type B Wolff-Parkinson-White conduction abnormalities suggesting the presence of multiple anomalous pathways.

Two-Dimensional Echocardiographic Abnormalities of Right Atrial Metastatic Tumors in Hepatoma*

Spontaneous change in direction of F waves in atrial flutter is rare. Its analysis may lend some insight to the current uncertainty about mechanisms responsible for atrial flutter.