Cardiac involvement in severe leptospirosis

Eleven patients with severe leptospirosis and myocarditis are described. Widespread ST-T wave changes on the electrocardiogram were found in nine patients. Three had atrial arrhythmias, two had frequent premature ventricular contractions and two had conduction disturbances. In two patients, there were generalized low voltage. Pathological examination revealed interstitial myocarditis in five patients and perivascular infiltrates in two. It is important to recognize that myocarditis may occur in leptospirosis. Serial electrocardiograms should be performed in severe cases to detect this complication (AU)

Large calcified right atrial myxoma in a newborn: rare cause of neonatal death

A newborn baby girl presented at birth with severe cyanosis, congestive cardiac failure, and an ischaemic leg ulcer, and died within 10 hours of birth. Necropsy disclosed a large haemorrhagic, calcified right atrial myxoma obstructing the tricuspid valve (AU)

Open mitral valve commissurotomy, 1968-1978

Twenty-one patients were subjected to open mitral valve commissurotomy between 1968 and 1978. The clinical and investigative data, operative findings and procedure, operative morbidity, and mortality (early and late) along with post-operative follow-up in the survivors have been presented. A low operative mortality (4.7 percent) and an improved clinical and functional status in the majority of survivors indicate that this is a satisfactory operation in those patients who fulfil the criteria for an open mitral valve commissurotomy (AU)

The development of cardiac catheterization at the University Hospital

Cardiac catheterisation at the University Hospital from 1967 to 1978 has been described, with an outline of its development over the years, the techniques used, the results obtained and the complications encountered. Six hundred and six patients were subjected to cardiac catheterisation. Morbidity was low and there was one death due to malignant hyperthermia complicating general anaesthesia (AU)

The prevalence of mitral valve prolapse syndrome in Jamaica - abstract

Click-murmur or mitral valve prolapse (Barlow) syndrome has been recently described as an epidemic in North America. It is the purpose of this survey to explore the prevalence of this syndrome at the University Hospital of the West Indies (UHWI). From August, 1978 to December, 1979, 2,280 patients (ages 10 - 83) were seen in the Cardiac Clinic (UHWI) and 115 (5 percent) had mitral valve prolapse syndrome. This diagnosis was made by history and the findings of typical ausculatory phenomena of mid to late systolic click and murmur in the absence of underlying cardiomyopathy or rheumatic heart disease. Confirmation was obtained in two patients by angiocardiography surgery, and in four additional patients at postmortem examination. One of those patients suffered a bout of infective endocarditis resulting in severe mitral incompetence. Association with atrial septal defect was found in 11 patients. Rhythm and conduction disturbances were analyzed on routine electrocardiograms in 62 patients. Pre-excitation syndrome was detected in 8 patients, sick sinus syndrome in 5 patients, supraventricular and ventricular arrhythmias in 10 patients. Of these, 8 patients had combined pre-excitation and supraventricular or ventricular arrhythmias. Two (2/10 or 20 per cent) of the patients in this group died of refractory ventricular arrhythmias. It is therefore apparent that mitral valve prolapse is a common entity in Jamaica. These patients should be screened for associated pre-excitation, since patients with this association in the older age group seem to be at a higher risk for supraventricular and ventricular arrhythmias and sudden death. Carefully tailored drug regimen for control of arrhythmias in this latter group of patients is advisable. Frequent monitoring to assess the efficacy of the drug therapy is mandatory. In the absence of arrhythmias, pre-excitation or disabling chest pain however, the majority of patients follow a benign course and the only precaution is antibiotic prophylaxis against infective endocarditis (AU)

Pre-excitation at the University Hospital of the West Indies - abstract

The aim of this study was to assess the overall prevalence of pre-excitation syndromes and correlate their clinical association with refractory and life-threatening arrhythmias. All electrocardiograms (ECGs) taken at the University Hospital of the West Indies (UWHI) between January and December, 1979 were analyzed for pre-excitation syndromes. Pertinent clinical data were extracted from hospital records. A total of 6,332 ECGs were reviewed. Fifty-two patients (ages 5 to 83 years) with pre-excitation were detected (8 per 1,000). Of these, 43 had the typical delta waves with variable PR intervals and QRS complexes, while 9 had short PR with normal QRS. These syndromes were associated with a broad spectrum of clinical entities, both cardiac and non-cardiac. The majority of patients were free of dysrhythmias (62 per cent), with pre-excitation being an incidental electrocardiographic (ECG) finding. Twenty patients (38 per cent) had significant arrhythmias, the majority of which were supraventricular. In some, these arrhythmias required frequent hospitalizations or clinic visits. At times, the arrhythmias were refractory to drug therapy and responded only to electrical cardioversion. Two of these patients (4 per cent of the series) died in refractory ventricular tachycardia and fibrillation. Both patients had associated Barlow Syndrome. Pre-excitation is not a rare entity in Jamaica. It appears to be a benign incidental ECG finding in the majority of patients seen at UHWI. However, when it is found in patients with the Barlow Syndrome, rheumatic fever and rheumatic heart disease, sickle cell disease with cardiomegaly and infection or renal failure, congestive cardiomyopathy, congenital heart disease and thyrotoxicosis, it can lead to potentially life-threatening arrhythmias. We recommend therefore that careful cardiac assessment be performed in all patients with ECG diagnosis of pre-excitation to detect those patients at high risk of dying suddenly (AU)

On the role of tortuous coronary arteries in billowing mitral leaflet syndrome: a hypothesis

Sixty three male patients with billowing mitral leaflet syndrome (BML) and forty one age and sex match controls were studied with emphasis on the cineangiographic features of coronary arteries. In the BML group, the coronary arteries were considered normal in five and abnormal in fifty eight. In fifty eight with abnormal coronary arteries, twelve showed atherosclerotic occlusive lesion, fifteen showed combined occlusive lesions and nonocclusive abnormalities and thirty one showed nonocclusive abnormalities alone. The non-atherosclerotic abnormalities consisted of redundancy of the coronary arteries manifested by bizarre changes in configruation and motion. These abnormalities were present in only five patients in the control group. On the basis of our observations and corroborative evidence in the literature, a hypothesis is presented; the salient features of which are that: (1) the spectrum of BML may be considerably more complex than hitherto suspected, (2) a combination of BML and tortuous coronary arteries may form a distinct subset of this spectrum and (3) the increased tortuousity may result in impaired coronary perfusion causing myocardial ischemia thus offering a possible explanation for some of the symptoms- such as chest pain, arrhythmias and even sudden death seen in this syndrome. (AU)