Stress echo for evaluation of valvular heart disease.

Resting echocardiography is the most important tool for diagnosing valvular heart disease. However, treatment planning in valvular heart diseases may require additional information in some patients, particularly asymptomatic patients with severe valve disease or symptomatic patients with moderate disease. Stress echocardiography provides invaluable information in these situations and aids decision making. Stress echocardiography is performed using either physical stress or dobutamine stress and various valve parameters are monitored during the stress. Further, the ventricular performance, which is an important determinant of outcome in valve disease is also closely monitored during stress which helps immensely in planning the intervention. Lastly, possibility of associated coronary artery disease can also be evaluated, especially in the elderly. This article discusses the role of stress evaluation in assessment of valve disease in the commonly encountered clinical situations.

Role of echocardiography in assessing the mechanism and effect of ramipril on functional mitral regurgitation in dilated cardiomyopathy.

The objectives of this article are to determine the possible mechanism of functional mitral regurgitation in patients with dilated cardiomyopathy (DCM) and to know the effect of ramipril on left ventricle (LV) and mitral regurgitation by ECHO. Several postulates are put forth for functional mitral regurgitation in DCM, and mitral annular dilatation is said to be the primary mechanism in the past, but the exact mechanism is not clear. Though angiotensin converting enzyme (ACE) inhibitors are known to remodel the LV, their beneficial effect in patients with DCM with functional mitral regurgitation is not known. Various cardiac dimensions and degree of mitral regurgitation were measured by echocardiography in 30 normal control group and in 30 patients with DCM of various etiologies except ischemic, before and after ramipril therapy. There was a significant difference in all parameters especially sphericity of left ventricle and position of papillary muscles (P < 0.0003) in DCM patients, but mitral valve annulus did not show significant change (P < 0.3) compared to control group. In 50% of the patients, the functional mitral regurgitation totally disappeared. In 30% of patients, it came down from grade II to I or became trivial. In 20% of patients, it remained unchanged. There was remarkable improvement in sphericity, LV dimension, volumes, and EF%, which increased from 31 +/- 9.81 to 39.3 +/- 8.3% (P < 0.0003). It is concluded that echocardiography clearly demonstrates the increased sphericity of LV in DCM. The lateral migration of papillary muscles possibly plays a major role in functional mitral regurgitation. Ramipril significantly reduces not only sphericity but also functional mitral regurgitation.

Electrocardiographic localization of the occlusion site in left anterior descending coronary artery in acute anterior myocardial infarction.

BACKGROUND: The site of occlusion of left anterior descending coronary artery is important in acute anterior myocardial infarction because, proximal occlusion is associated with less favorable outcome and prognosis. The present study attempted to evaluate the electrocardiographic correlate of the location of the site of the left anterior descending coronary artery occlusion with respect to first septal perforator and/or the first diagonal branch. METHODS AND RESULTS: The study included 50 patients with a first acute anterior myocardial infarction. The electrocardiogram with the most pronounced ST segment deviation before the start of reperfusion therapy was evaluated and correlated with the left anterior descending occlusion site as determined by coronary angiography. ST segment elevation in lead aVR, ST segment depression in lead V5 and ST segment elevation in V1>2.5 mm strongly predicted left anterior descending occlusion proximal to first septal, whereas abnormal Q wave in V4-6 was associated with occlusion distal to first septal. Abnormal Q wave in lead aVL was associated with occlusion proximal to first diagonal, whereas ST depression in lead aVL was suggestive of occlusion distal to first diagonal branch. For both first septal and first diagonal, ST segment depression > or =1 mm in inferior leads strongly predicted proximal left anterior descending artery occlusion, whereas absence of ST segment depression in inferior leads predicted occlusion distal to first septal and first diagonal. All the patients were followed during their in-hospital stay (median of 7 days), during which four patients in the proximal to first septal and first diagonal group and one patient in the distal to first septal and first diagonal group died (p < or = 0.001). CONCLUSIONS: In acute myocardial infarction electrocardiogram is useful to predict the left anterior descending occlusion site in relation to its major side branches and such localization has prognostic significance.

Frequency of various congenital heart diseases: analysis of 3790 consecutively catheterised patients.

A retrospective analysis of 3790 consecutive patients with congenital heart disease (CHD) who underwent haemodynamic and angiographic studies at Sri Jayadeva Institute of Cardiology, Bangalore, from April 1981 to April 1994 has been done. The incidence of various CHD has been compared with that in other series from Asian and Western countries. Out of 6985 patients who underwent haemodynamic studies, 3790 had CHD (54.3%). Approximately 63 percent (2386) of these cases had shunt lesions like atrial septal defect (ASD), ventricular septal defect (VSD) and patent ductus arteriosus (PDA). Among them, 15 percent (367) had pulmonary arterial hypertension of various grades. The overall incidence of pulmonary arterial hypertension is higher than that reported in the Western literature. Corrective surgery was done in approximately 63 percent of cases. Ethnic differences in the incidence of CHD were found in this study when compared to the Eastern and Western literature. Congenital aortic stenosis and coarctation of aorta were less common compared to Western countries and Tetralogy of Fallot was less common compared to Eastern countries.

Clinical profile of acute myocardial infarction in women.

Three hundred fifty women with acute myocardial infarction who formed 17% of total myocardial infarction cases admitted were studied. Only 7.7% were below 40 years. Infarction occurred mostly (80%) in postmenopausal period. History of previous illness was present in 73% cases. Risk factors were present in majority (75%) of the cases. Common risk factors in Indian women were hypertension in 49% cases and diabetes mellitus in 34% cases. None were using oral contraceptives and it occurred mostly (77%) in multiparous women. Majority (94%) presented with typical chest pain. Premonitory symptoms occurred in only a few patients (14%). Complications occurred more frequently in 40% cases. Mortality rate appears to be high (18%); the commonest cause being cardiogenic shock.