Apical hypertrophic cardiomyopathy in Pakistan: electrocardiographic, echocardiographic and myocardial scintigraphic features

Apical hypertrophic cardiomyopathy is a recently recognized entity, with typical electrocardiographic, echocardiographic and myocardial scintigraphic features. Thallium imaging is more sensitive than echocardiography, but electrocardiogram appears to be an important clue to its diagnosis which shows changes in the mid precordial leads in most of the patients

Real time cross sectional echocardiographic imaging and colour mapping in the human fetus

New high-resolution real-time ultrasound cross-sectional imaging systems have enabled us to demonstrate detailed fetal cardiac anatomy in the second half of pregnancy. We studied fetal cardiac anatomy qualitatively and quantitatively by echocardiography in the second half of the pregnancy in 23 normal pregnancies in healthy mothers. The estimated gestational ages were 20-41 weeks of pregnancy. Nine new horns were also examined within 24 hours of birth. To evaluate fetal cardiac anatomy, we reproduced commonly used cross-sectional views of the heart. The four chamber and short axis great artery views have been most successful for cardiac evaluation in the fetus. Measurements of the right and left ventricle [RV, LV] at the atrioventricular valve level were taken from four chamber plane images of the heart before and after birth and measurements of the aorta and left atrium were taken in the long axis view. Physiologic changes in the circulation at birth affected RV size considerably compared with measurements before birth. The RV/LV dimensional ratio was 1.28 +/- 0.17 before birth and decreased to 0.70 +/- 0.17 within 24 hours of birth. The aorta to left atrial dimensional ratio did not change significantly after birth. Our findings about cardiac growth and the major adjustments of the circulatory system for extrauterine life are similar to those previously reported in humans and animals. One case of single ventricle, atrioventricular canal and transposition of the great arteries was present in the cases examined. It appears from our study that the diagnosis of major congenital heart defects should be possible before birth

Septal Q wave in exercise testing: evaluation by single photon-emission computed tomography before and after coronary bypass grafting

To evaluate changes of septal Q waves in lead V5 by exercise with single-photon emission computed tomography [SPELT], seven patients were studied before and after coronary artery bypass grafting [CABG]. Multivessel coronary artery disease was present in all of them. In rive patients there was regression of Q wave amplitude during exercise [1.4 +/- 0.42 to 0.6 +/- 0.29, P <0.001] and they showed septal perfusion defects by exercise which disappeared in late images. All five had left anterior descending coronary artery [LAD] involvement. Two patients did not show any changes in Q wave amplitude and no septa] ischaemia was seen during stress imaging in them. After CABG, there was no change in the Q wave amplitude during exercise and stress thallium imaging did not show the septal perfusion defects seen preoperatively in the five patients. In all of them, the grafts to LAD were patent. Thus, SPELT before and after CABG during exercise revealed that septal Q waves are valuable in assessing the degree of septal ischaemia

Right-sided endocarditis: role of transthoracic and transesophageal echocardiography

In right sided endocarditis, the tricuspid valve is primarily involved. Pulmonary valve endocarditis is a rare clinical entity. Even though two-dimensional transthoracic echocardiography [TTE] is useful in diagnosing infective endocarditis, improved visualisation of the pulmonary valve on the longitudinal views provided by biplane transesophageal echocardiography [TEE] improves the diagnostic utility of TEE in pulmonary valve endocarditit. We report two cases of pulmonary valve endocarditis, of which one was diagnosed by TEE, and a third case of tricuspid valve endocarditis. All three cases were seen in the setting of pre-existing congenital heart disease Although TTE is useful in the diagnosis of infective endocarditis, it appears to be the preferred method for identifying and evaluating pulmonic valve endocarditis, specially in adults

Updating cardiopulmonary resuscitation

Make a diagnosis of cardiopulmonary arrest, palpate carotid pulse, look for chest movement, and associated air movement. Don't freeze, if in doubt begin CPR. Extend head and remove any foreign body to form adequate airway. Thump and then proceed immediately with CPR. When giving artificial ventilation, watch for sternal motion, correct air leaks around nose and mouth, correct airway obstruction. The patient should be placed on a hard surface. When giving a cardiac compression the heel of the hand should be parallel to sternum and not over xiphoid process. See that the compression is 1.5 to 2 inches in adult; place weight of shoulders and torso over extended arms Compression and relaxing should be timed equally Promptness of the resuscitative efforts and the expertness with which they are delivered may help salvage many a patients who have had cardiac arrest. Smooth and co-operative performance of CPR needs a lot of education, instruction and practice Doctors and paramedics working in hospitals especially in Emergency Wards should realize the paramount importance of CPR As physicians working in different departments it is of utmost importance that we initiate personal training, supervise drills, and conduct review sessions after CPR. With added awareness and consciousness we may not only be able to save the hearts which are too good to die but we may also be able to salvage some of the extensively damaged ones

Rate dependent bundle branch block

Eight cases of intermittent bundle branch block showing rate dependence are presented. Six cases were tachycardia dependent, one bradycardia dependent and one case showed both Right Bundle Branch Block and Left Bundle Branch Block at different rates. Tachycardia - dependent bundle branch block was explained on the basis of cycle-length recovery time relation and revealed a critical rate for normal intraventricular conduction. Bradycardia - dependent bundle branch block was best explained on the basis of enhanced phase-4 depolarisation of the bundle branch block system. Ischemic heart disease and Hypertension appeared to be the most important aetiological factors. The appearance of intermittent bundle branch block in younger age groups could be a marker of ischaemic heart disease developing in the later part of life

Exercise and the heart: a review

From the available epidemiological, clinical and experimental data it appears that one must accept that habitual physical activity plays a protective role in human atherosclerosis, mainly coronary heart disease. Habitual physical activity may be a decelerating factor in atherosclerosis and atherogenesis and would help these people to remain relatively immune to this epidemic disease of our modern civilization. Physical activity should be advised to all as man is athero-sclerotic by nature, and available data is certainly convincing as regards its protective nature. Certainly it would be expected to play a protective role against the development of coronary atherosclerosis. Physical activity also forms an important aspect for better rehabilitation of patients suffering from CD. If we change our way of modern life and among other factors maintain physical fitness by more muscular labour or exercise, we may be able to save our coronary arteries and thus our heart. In the end let us remember an age old advice, you must use more exercise, eat less or be sick