Subject(s)
Diuretics/therapeutic use , Hypertension/complications , Hypertrophy, Left Ventricular/complications , Hypertrophy, Left Ventricular/drug therapy , Indapamide/therapeutic use , Aged , Aged, 80 and over , Delayed-Action Preparations , Diuretics/administration & dosage , Electrocardiography/instrumentation , Female , Humans , Indapamide/administration & dosage , Male , Middle AgedABSTRACT
Myocardial perfusion was studied in 12 patients with mitral valve prolapse concurrent with cardiac arrhythmias by using two-dimensional 201Tl myocardial scintigraphy at rest and during exercise test. Signs of myocardial ischemia were revealed only in one case. Five patients were found to have steady-state perfusion defects whose extent correlated with the depth of mitral valve prolapse. There was an irregular distribution of myocardial blood flow, which ceased on exercise in 10 out of 12 patients. Patients with ventricular premature contraction displayed a decreased reserve of myocardial blood flow as compared to those with supraventricular premature contraction, presumably by enhancing myocardial perfusion at rest.
Subject(s)
Coronary Circulation/physiology , Mitral Valve Prolapse/physiopathology , Tachycardia/physiopathology , Adult , Exercise Test , Female , Humans , Male , Mitral Valve Prolapse/complications , Mitral Valve Prolapse/diagnostic imaging , Radionuclide Imaging , Syndrome , Tachycardia/complications , Tachycardia/diagnostic imaging , Tachycardia, Supraventricular/physiopathology , Tachycardia, Ventricular/physiopathology , Thallium RadioisotopesABSTRACT
A contribution of specific features of myocardial hypertrophy and hypercontractility left ventricular diastolic dysfunction to decreased exercise tolerance and developed coronary failure is discussed on the basis of results obtained from a bicycle ergometric test performed in 40 patients with hypertrophic cardiomyopathy. Thallium-201 myocardial scintigraphy conducted at the maximum exercise in 17 patients revealed a reduction in coronary reserve with increased myocardial mass index that was higher than the critical value. An implication of severe myocardial hypertrophy in the presence with coexisting left ventricular posterior wall hypertrophy and impaired perfusion/mass ratios is considered as a risk factor for death of patients with hypertrophic cardiomyopathy.
Subject(s)
Cardiomyopathy, Hypertrophic/physiopathology , Heart Rate/physiology , Myocardial Contraction/physiology , Physical Endurance/physiology , Physical Exertion/physiology , Ventricular Function, Left/physiology , Adult , Aged , Cardiomyopathy, Hypertrophic/diagnostic imaging , Echocardiography , Exercise Test , Humans , Middle Aged , Radionuclide Imaging , Thallium RadioisotopesABSTRACT
The authors describe a case of sudden death (SD) of a patient with unaltered coronary arteries, myxomatous degeneration and mitral valve prolapse (MVP). The case was marked by an isolated prolapse of the anterior cusp of the mitral valve because of its congenital structural abnormalities, which was not encountered previously in MVP patients who died suddenly. Microscopic examination showed large-focal cardiosclerosis at the basis of the papillary muscles determined by dysfunction of the mitral apparatus which might be related to the pathogenesis of lethal arrhythmia. It is believed that MVP patients should constitute a separate group with high risk of SD.