Right ventricular cardiomyopathy: a rare and underdiagnosed cause of sudden death in young adults

We present an example of right ventricular cardiomyopathy, a very uncommon condition which caused sudden death in an adolescent boy. This case report is used to highlight the pathological features of this rare and poorly understood condition, which is often undiagnosed (AU)

Reconstruction filter choice and lesion detectability in myocardial single-photon emission computed tomography (Spect) imaging

Traditionally, T1-201 has been used in conjunction with planar scintigraphy or SPECT to indicate abnormalities in the heart muscle perfusion. Recently, however, different myocardial perfusion agents labelled with Tc-99m have come into use. The choice of filter to be used in the image reconstruction process may be a significant factor in efficient SPECT imaging using these new agents. In the present study, the detectability of simulated mycocardial lesions has been investigated, in SPECT imaging using a rotating Siemans OrbiterII gamma camera and a cardiac phantom. Tissue equivalent inserts placed in a solution of Tc-99m in the phantom simulated lesions. Seven standard filters were used in the reconstruction program to obtain images which were qualitatively assessed for best lesion detectability. Three of these filters were chosen for further quantitative investigation using circumferential profiles. The results indicated that a Band Limited Ramp and a Shepp-Logan filter, each with a cut-off frequency of 0.5 Nyquist, were the most effective filters in terms of lesion detectability (AU).

Pathology of idiopathic cardiomegaly in Jamaica

Twenty-one cases of idiopathic cardiomegaly which came to necropsy have been reviewed. Investigations included injection and x-ray studies, careful microscopical examination and skip serial sectioning of the conduction systems. The obvious feature was gross cardiomegaly in the absence of atheroma of the large coronary vessels and an associated fibrosis of the right and left bundle-branches. Three hearts showed thickening of the intramural vessels of 80æ to 400æ diameter. We suggest that such changes may be one of the causes of the ischaemic electrocardiographic findings reported in previous epidemiological surveys.(AU)

Prognosis of idiopathic cardiomegaly in Jamaica with reference to the coronary arteries and other factors

Clinical and epidemiological features of idiopathic cardiomegaly in Jamaica are reviewed, and the high community prevalence of the disorder is shown. The frequency occurrence of sudden or unexpected death in patients whose earlier electrocardiograms had shown repeated ventricular ectopic beats has been noted. Common electrocardiographic findings included a high rate of abnormalities usually regarded as indicative of coronary artery disease: cardiac arrhythmias, particularly multiple ventricular extrasystoles; and high voltage complexes characteristic of left ventricular hypertrophy. The differences and similarities between idiopathic cardiomegaly and coronary heart disease are shown. A possible role for intramuscular lignocaine in the control of the chronic ventricular ectopic rhythms is demonstrated. There is a statistically significant association between idiopathic cardiomegaly and positive serological tests for treponemal infection. The hearts are invariably hypertrophied at necropsy. In some hearts the smaller intramuscular coronary arteries show occlusive changes. Their possible nature and significance are discussed.(AU)

Idiopathic cardiomegaly

Cardiomyopathies are certain heart diseases of unknown etiology and pathogenesis, occurring mostly in tropical and subtropical areas, where they constitute a major clinical problem and sometimes a public health problem. The need for international co-operation in the study of such forms of heart diseases has long been recognized and WHO convened informal meetings of investigators on various aspects of the subject in 1964, 1965 and 1966. Out of these have arisen co-operative studies co-ordinated by WHO. In November 1967 a fourth informal meeting was held in Kingston, Jamaica, to review the following topics: the progress reports from all co-operating laboratories; the diferent types of cardiomyopathies; past experience with cardiac registries, and the diagnostic importance of coronary angiography. Steps were taken towards the formulation of a standard terminology, since too many confusing names are currently employed to mean "cardiomegaly of unknown origin". A common name, "idiopathic cardiomegaly", was therefore suggested for further use. The account presented here was prepared by Dr. Z. Fejfar, Chief Medical Officer, Cardiovascular Diseases, World Health Organization, Geneva, on behalf of the other participants and is a precis of some of the information that was exchanged, some of the views that were expressed and of the suggestions that were made.(AU)

Jamaican cardiomyopathy

Eight cases of cardiomyopathy found in Jamaica are described. The ages ranged from 19 to 60 years. There were six men and two women. All the hearts were enlarged, the weights ranging from 480-370 g, except for one patient in whom the heart weighed 275 g. The principal pathological finding was fibrous thickning of the endocardium confined to the left side in seven patients and most evident in the ventricles. Four hearts showed mural thrombi which in two instances had given rise to systemic emboli. Valvular involvement -slight-was seen in only three patients. The endocardial thickenings contained deposits of fibrin and originated from them. This cardiomyopathy resembles most closely "heart muscle" disease found in Nigeria (Summary)

Becker type cardiomyopathy in a West Indian woman

A case of cardiomyopathy in a West Indian Negro woman is reported in which the lesions correspond closely to those described in one form of South African cardiomyopathy, Becker's disease. The lesions are described and it appears that they are specific to this disease and dis-similar to those seen in endomyocardial fibrosis (AU)

Cardio-respiratory response to submaximal work as a function of protein-calorie intake

As a result of experimental studies performed in student volunteers it was postulated that the combination of strenous work and limited protein intake impairs myocardial efficiency. The resemblance of the cardiac rhythm changes to those noted in nutritional cardiomyopathy in Africa was noted (AU)

Myocardial disease in a rural population in Jamaica

This survey has revealed an unexpectedly high prevalence of angina pectoris and of electrocardiographic abnormalities usually interpreted as due to myocardial ischaemia or focal myocardial damage. The rarity of myocardial infarction caused by coronary artery occlusion in Jamaicans, as well as the lack of any clear relationship between myocardial damage and age, the association with high serum globulin levels, and the apparently increased prevalence in those with haemoglobinopathies suggest that its etiology is different from that of ischaemic heart disease due to atheroma of the coronary arteries. This study has raised a number of questions of which the most important concern the pathogenesis of the condition and its importance in terms of prognosis; it forms the base line for longitudinal investigation that may resolve some of the outstanding questions (AU)