Nayab Ali

Echocardiographic observations in opiate addicts with active infective endocarditis

Echocardiographic observations are described in 25 opiate addicts with active infective endocarditis involving apparently previously normal valves. Infective endocarditis was isolated to the tricuspid valve in 11 patients, involved both right- (tricuspid valve) and left-sided valves in 7 and was isolated to the left-sided valves in 7 (mitral valve in 6). Twenty patients (80%) had tricuspid valve regurgitation, 12 had mitral regurgitation, 3 had aortic regurgitation and none had pulmonary valve regurgitation. Considering the 75 cardiac valves (excluding the pulmonary) in the 25 patients, echocardiographic abnormalities consistent with active infective endocarditis were detected in 26 (74%) of the 35 clinically incompetent valves but in none of the 40 competent valves. Comparison of the 20 incompetent tricuspid valves with the 12 incompetent mitral valves indicated that (1) the echocardiogram was less sensitive in detecting tricuspid valve lesions, (2) rupture of tricuspid valve chordae tendineae was absent or not detectable, and (3) tricuspid valve vegetations tended to be larger.

Cardiovascular effects of dobutamine in severe congestive heart failure

The effects of continuous infusion of dobutamine 5 to 15 microgram/Kg./min. were studied in 17 patients using right heart catheterizations, echocardiography, and/or the Systolic Time Intervals. HR increase was dose-related, but insignificant (p less than 0.05) rate increase was obtained at infusion rates below 15 microgram/Kg.)min. C.O. increased from 2.9 +/- 0.7 to 5.0 +/- 1.2 liters/min. (p less than 0.001), and the stroke volume from 30 +/- 6 to 49 +/- 14 ml./min. (p less than 0.005). The mean BP did not change, P.A.W.P. decreased from 30 +/- 7 to 20 +/- 8 mm. Hg (p less than 0.001) and R.A.P. from 20.0 to 12.0 mm. Hg (p less than 0.005). The P.E.P.I. decreased from 160.93 +/- 54.91 to 133.4 +/- 28.7 msec. (p less than 0.050). Echo-determined mean VCf increased from 0.387 +/- 0.14 to 0.537 +/- 0.13 cm. (p less than 0.010), diastolic diameter did not change significantly, but the end systolic diameter decreased from 6.020 +/- 0.69 to 5.750 +/- 0.70 cm. (p less than 0.025). During a mean infusion period of 75 hours, the only side effects noted were transient nausea and/or vomiting at 15 microgram/Kg./min. dose range in two patients, and multifocal P.V.C.s following 68 hours of infusion in another patient. It is concluded that in the dose range of 5 to 15 microgram/Kg./min., dobutamine is well tolerated and is a very potent inotropic agent with only minor effects on the heart rate and blood pressure.

Transvenous endomyocardial biopsy using the gastrointestinal biopsy (Olympus GFB) catheter.

Abstract The use of a GFB biopsy catheter (Olympus) for endomyocardial biopsy in 23 patients is described. The catheter may be introduced alone or through a Cournand catheter. This technique is simple and safe and has a success rate of 100 per cent. There is little problem with cleaning out the blood. The technique of introducing the biopsy catheter through an already positioned Cournand catheter avoids any damage to the veins or perforation through the vein or right atrium; even in patients with large right atria, the procedure of first manipulating a soft rather than a stiff catheter into the right ventricle, and then introducing the biopsy through the Cournand catheter, becomes technically easy. The biopsy specimens measure 2 by 2.5 mm., which are adequate for microscopic examination and bacterial or viral culture studies. There have been no immediate or late complications.

Loud first heart sound with long P-R intervals

A case of partial atrioventricular block with Wenckebach periods and a loud first heart sound (S1) associated with the longest P-R interval of the cardiac cycles is described. Although the surface electrocardiogram provided no clues to this paradoxical behavior, the intraatrial electrogram revealed that the long P-R interval with the loud S1 was accompanied by atrial echoes (reciprocal atrial beats). The loud S1 with a very long P-R interval was always caused by an atrial contraction synchronous with the QRS complex.

Recording of His bundle electrogram from the arm.

Summary Technique of recording His-bundle electrograms using the arm vein is described in 14 patients. In four patients, the use of the veins of the lower extremity was either contraindicated or not possible. Good quality recordings were obtained and were identical to ones recorded using femoral veins in two patients. The patients in whom only the basilic veins were used felt a little less uncomfortable than those in whom femoral veins were used and the lower trunk almost immobilized.