Ricardo J. Esper

Detection of mild aortic regurgitation by range-gated pulsed doppler echocardiography

In order to assess the sensitivity and specificity of the range-gated pulsed Doppler echocardiogram for the detection of aortic regurgitation, a study with use of this technique was carried out in 46 patients. They were classified into 3 groups: Group I was composed of 19 patients with a variety of heart diseases but with a competent aortic valve. Cardiac catheterization revealed no aortic regurgitation in any of the 19 patients, and the Doppler echocardiogram detected no turbulent diastolic flow in the left ventricular outflow tract. Group II was composed of 17 patients who clinically and by auscultation had aortic regurgitation, which was confirmed by cardiac catheterization in 6. In all 17 patients the Doppler echocardiogram detected several grades of turbulent diastolic flow compatible with aortic regurgitation in the left ventricular outflow tract. Group III was composed of 10 patients with aortic regurgitation but without the expected clinical or auscultatory evidence. The echocardiogram detected mitral valve flutter in only 1 patient. Cardiac catheterization revealed aortic regurgitation graded 1/4 and 2/4 in 9 patients, and the patient who did not undergo catheterization had a murmur of aortic insufficiency 6 months later. In all 10 patients the Doppler echocardiogram detected a regurgitating turbulent flow compatible with aortic regurgitation in the left ventricular outflow tract. It is concluded that the Doppler echocardiogram was more useful than auscultation and echocardiography for the detection of mild aortic regurgitation. In this study the range-gated pulsed Doppler echocardiogram proved 100% sensitive and specific. However, it will be necessary to study larger groups in order to assess its utility in more complicated conditions (obesity, emphysema, and heart failure) and the differential diagnosis with other diastolic murmurs.

QT prolongation and torsade de pointes ventricular tachycardia produced by Ketanserin.

A 65‐year‐old man with arterial hypertension received oral treatment with Ketanserin, a new drug, during a period of five months. He developed marked QT interval prolongation and have several Stokes‐Adams attacks. A Holter recording obtained during one of these episodes showed torsade de pointes ventricular tachycardia. The arrhythmias occurred during maximum QT interval prolongation, The correlation between Ketanserin and QT interval prolongation was evaluated by using several Holter studies during administration and withdrawal of the drug. The effect of Ketanserin on the QTc interval was analyzed retrospectively in six patients who had been taking the drug orally. Following a period of four to eight months, the QTc interval was prolonged by the drug (5 to 31%, mean 17%) in five patients. We conclude that torsade de pointes is a potential hazard of long‐term treatment with Ketanserin.

Intra-Hisian blocks of several degrees induced by the Ajmaline test

Although the effect of ajmaline on intra-Hisian bundle conduction in humans has been reported in part, ~,2 splitting of the His (H) potential induced by this drug has not been reported. We report herein the electrophysiologic studies of 2 patients with intermittent atrioventricular (AV) conduction defects; in both patients, splitting of the H potentials was caused by the ajmaline test. 3 Ajmaline aspartate was administered intravenously in a dose of 1 mg/kg body weight over 90 seconds.