Unusual echocardiographic manifestation of pericardial effusion.

Echocardiographic and sector scanning examinations were performed in a patient with pericardial effusion. In addition to the demonstration of fluid posterior to the left ventricle and anterior to the right ventricle, as in most significant pericardial effusions, there was an echo-free space representing fluid recorded posterior to the left atrium. Several possible explanations of this finding are offered.

Systolic time intervals in the syndrome of midsystolic click and late systolic murmur.

Left ventricular function, as measured by systolic time intervals, was studied in 30 subjects with the syndrome of midsystolic click and late systolic murmur (ages, 20 to 53 years; mean, 34 +/- 9 years). Twenty-one were asymptomatic, six had chest pain, two had palpitations, one had shortness of breath, and one had hypotensive episodes. Each patient had the typical auscultatory and echocardiographic findings of the syndrome of midsystolic click and late systolic murmur. In the study the values for the interval between the onset of the QRS complex (Q) and the aortic component of the second heart sound (A2) (377 +/- 42 msec), the Q-A2 index (532 +/- 39 msec), the preejection period (PEP) (97 +/- 17 MSEC), THE PEP index (127 +/- 16 msec), the left ventricular ejection time index (403 +/- 26 msec) and the ratio of PEP to left ventricular ejection time (0.35 +/- 0.01) were not significantly different from the values in 17 controls matched for age. Out study, then, supports the contention that left ventricular function remains well preserved in most patients with the syndrome of midsystolic click and late systolic murmur.

Echocardiographic findings in a patient with Candida endocarditis of the aortic valve.

The echocardiographic appearance of fungal endocarditis of the aortic valve is described in a patient who subsequently died from this disease. In addition, the progressive growth of the vegetation on serial echocardiograms was recorded, and premature closure of the mitral valve was absent, notwithstanding perforation of two aortic cusps.

Sudden death and the floppy mitral valve syndrome.

A 38-year-old female with a history of palpitations, premature ventricular contractions, and a systolic murmur collapsed suddenly and died. Post-mortem studies showed shortened chordae tendinae and myxomatous transformation of both mitral leaflets. As this syndrome becomes more clinically recognizable it appears that its benignancy is diminishing. Thus, it is felt that patients with findings of ventricular extrasystoles and a systolic murmur should have a careful cardiac evaluation to determine the presence of the floppy mitral valve or ballooning mitral leaflet syndrome and that appropriate measures for treatment be taken when necessary.

Jugular venous pulse recording in a patient without a tricuspid valve.

The unusual contour of the jugular venous pulse tracing (JVPT) in a patient whose tricuspid valve was excised is described. The appearance of an early positive systolic wave (SW) followed by a prominent "V" wave and a delayed deep "Y" descent were noted.

Abnormal mitral valve motion associated with ventricular septal defect following acute myocardial infarction.

It is often difficult to make the clinical distinction between acute mitral regurgitation caused by papillary muscle dysfunction or rupture and ventricular septal defect complicating an acute myocardial infarction. A case of a patient with rapidly progressive congestive heart failure and a loud murmur is presented. Echocardiography strongly suggested the presence of a flail posterior mitral leaflet. However, the patient was subsequently found to have rupture of the interventricular septum. This diagnosis was made with bedside right heart catheterization and was later confirmed by left ventriculography and direct inspection at the time of surgery. The mitral valve apparatus was completely normal. Thus this case demonstrates the apparent lack of specificity of the accepted echocardiographic criteria for flail mitral leaflet and acutely ruptured interventricular septum, and the potential necessity of cardiac catheterization to distinguish between these entities.

Neural basis for the genesis and control of digitalis arrhythmias.

The pharmacokinetics of ouabain associated with toxicity were studied in the cat and the guinea pig both in vivo and in vitro using ouabain-H3. After spinal cord transection a higher dose of ouabain was required to reach the lethal endpoint. This intervention also increased the myocardial and serum levels associated with toxicity were studied in the cat and the guinea pig both in vivo and in vitro using ouabain-H3. After spinal cord transection a higher dose of ouabain was required to reach the lethal endpoint. This intervention also increased the myocardial and serum levels associated with death. These findings were corroborated in experiments using digitoxin H3. In vitro, substantially higher ouabain tissue contents were associated with a lethal event. In addition, in cats and guinea pigs, the lethal myocardial ouabain content did not change when the infusion rate of ouabain was varied in vivo or the perfusate ouabain concentration was changed in vitro. In vivo, propranolol increases the myocardial ouabain content associated with death to in vitro levels. In vitro, the drugs prolongs the time to death by retarding the myocardial uptake of ouabain. These data suggest that the toxic effects of ouabain in the whole animal are largely neural and in the isolated heart, substantially myocardial.