Richard H. Childress

Exercise cross-sectional echocardiography in ischemic heart disease.

We performed cross-sectional echocardiograms at rest, during supine bicycle exercise, and after sublingual nitroglycerin administration in 28 patients suspected of having ischemic heart disease. Technically adequate exercise cross-sectional echocardiograms were obtained in 20 patients (71%). Ten patients had new areas of reversible segmental dysynergy, and all 10 had significant stenoses of coronary arteries supplying areas of the heart corresponding to the location of reversible dysynergy. Six of these 10 patients also underwent exercise thallium-201 perfusion scanning, and all six had reversible perfusion defects in the area that demonstrated reversible dysynergy on exercise cross-sectional echocardiography. At least two of the remaining 10 patients who did not have reversible segmental dysynergy on exercise cross-sectional echocardiography probably experienced myocardial ischemia that we did not detect. We conclude that exercise cross-sectional echocardiography is technically difficult but feasible. The mechanical consequences of exercise-induced regional myocardial ischemia can be detected noninvasively by real-time, two-dimensional, cross-sectional echocardiography.

Hemodynamic Effects of Glucagon in Patients with Heart Disease

The intravenous administration of 3 or 5 mg of glucagon to 13 patients with heart disease resulted in a statistically significant increase in heart rate, cardiac index, stroke power index, mean rate of left ventricular ejection, and maximum rate of rise of left ventricular pressure, whereas systemic vascular resistance declined. A moderate increase in mean stroke volume index and stroke work index and a slight fall in left ventricular end-diastolic pressure also occurred, although these changes were not statistically significant. The increase in cardiac index averaged 19%, with nine of the patients demonstrating an increase exceeding 10% of their respective control value. These effects of glucagon generally reached a maximum within 15 min after drug administration and also were of short duration.Positive inotropic and chronotropic effects of glucagon were observed in most but not all of these patients. In addition, the magnitude of these effects varied considerably among patients; the variation, however, did not appear to be related to the severity or duration of the heart disease.In eight patients, the infusion of isoproterenol produced greater increases in cardiac index and decreases in left ventricular end-diastolic pressure than glucagon did.Although the effect of glucagon was short, the frequent improvement in hemodynamics which occurred in the absence of significant side effects, notably arrhythmias, indicates that the inotropic actions of this agent may be useful under certain clinical conditions.

Hemodynamic Effects of Lidocaine in Patients with Heart Disease

The intravenous administration of 50 mg of lidocaine as a single bolus to four patients with heart disease did not result in a significant change in cardiac output or left ventricular end-diastolic pressure (LVEDP). Two patients had moderate decrease in systemic arterial pressure which was not accompanied by symptoms, was of short duration, and did not require therapeutic intervention. Left ventricular function, as assessed by the relationship of changes in stroke volume index (SVI) and stroke work index (SWI) to changes in LVEDP, was not significantly affected nor was the maximum rate of rise of left ventricular pressure (dp/dt). The intravenous injection of 100 mg of lidocaine into eight additional patients with heart disease did not produce a statistically significant change in any of these hemodynamic variables when compared to their respective control values. Examination of individual responses, however, revealed that some depression of left ventricular function occurred in at least three and probabl...

Left ventricular function in patients with chronic obstructive pulmonary disease

Left ventricular function was assessed in six patients with essentially normal cardiopulmonary function, in five patients with primary myocardial disease, and in 16 patients with chronic obstructive pulmonary disease by determining the response of the ventricle to an increased resistance to ejection. Studies were performed at the time of cardiac catheterization and increased resistance to left ventricular ejection was produced by the intravenous infusion of methoxamine. In the control patients, methoxamine produced an increase in stroke volume index (SVI), in stroke work index (SWI), and stroke power index (SPI), whereas left ventricular end-diastolic pressure (LVEDP) increased only moderately. In contrast SVI, SWI, and SPI fell, whereas LVEDP increased inordinately in the patients with myocardiopathy. The patients with chronic obstructive pulmonary disease responded to the infusion with an increase in SVI, SWI, SPI, and LVEDP comparable to the control patients. Furthermore, in this latter group of patients, a quantitatively similar response was observed in those with essentially normal resting hemodynamics, in those with resting pulmonary hypertension, and in those whose disease had progressed to the stage of right ventricular failure. This study provides no evidence that chronic obstructive pulmonary disease results in chronic impairment of left ventricular function, but on the contrary, has demonstrated that the left ventricle responds normally to an increased pressure load in these patients.

Corrected Transposition of the Great Vessels in a 73-Year-Old Man

The case of a 73-year-old white man with corrected transposition of the great vessels and associated mitral and mild aortic regurgitation is reported. The patients survival was the longest of any patient with this defect reported to date. Although the condition is theoretically compatible with a normal life span, few patients with this lesion survive past 40 years of age because of associated congenital defects or the subsequent development of A-V valvular insufficiency or heart block, or both.

Effect of Diphenylhydantoin on Left Ventricular Function in Patients with Heart Disease

The effect of 250 mg of diphenylhydantoin, administered intravenously, on left ventricular function was determined during cardiac catheterization in nine patients with heart disease.Five minutes after drug administration, left ventricular end-diastolic pressure rose in each patient from an average of 6.0 mm Hg to 10.0 mm Hg. Concurrently, stroke work and stroke power indices decreased in each patient by an average of 22.0% and 22.2%, respectively. Stroke volume index decreased in seven patients and maximum left ventricular dp/dt fell in eight patients. Over the next 25 minutes, all parameters returned to control values. Cardiac index was unchanged, whereas generally small and insignificant changes were observed in heart rate and systemic arterial pressure throughout the study.Although this study has demonstrated that diphenylhydantoin depresses myocardial function, the effect may have limited clinical significance since it was relatively short-lived and did not reduce cardiac output or greatly elevate ventricular end-diastolic pressure. Furthermore, the absence of a significant systemic hypotensive effect is of distinct clinical importance.

Mid systolic notching of the pulmonary valve in the absence of pulmonary hypertension

In a patient with idiopathic dilatation of the pulmonary artery the pulmonary valve echogram showed a prominent mid systolic closing motion or notching indistinguishable from that seen in pulmonary hypertension. Normal right ventricular and pulmonary arterial pressures were recorded simultaneously with echocardiograms of the pulmonary valve.

Mitral Insufficiency Secondary to Ruptured Chordae Tendineae

Excerpt Mitral insuffiency due to rupture of the chordae tendineae is a relatively rare entity and, until recently, one primarily of academic interest. Heretofore the diagnosis was rarely considere...

Successful resection of a benign right ventricular mesenchymoma.

Abstract The successful resection of a benign right ventricular mesenchymoma is reported. The clinical features included a history of recurrent paroxysmal tachycardia and a progressive decrease in effort tolerance. Preliminary studies suggested the diagnosis of a chronic recurrent pericardial effusion; however, the conventional roentgenographic studies of the chest and particularly the angiographic studies were atypical for those associated with pericardial effusion. The size and location of the tumor resulted in a mechanical restrictive impairment of right ventricular filling. The reasons for using the term “benign mesenchymoma” were reviewed, and similar reported lesions fitting the criteria are tabulated.