Isradipine dose-confirmation study in Filipino patients with mild to moderate hypertension.

The effective and well tolerated dose of isradipine was determined in 130 Filipino patients with mild to moderate essential hypertension in a multicentre study with a 2-week placebo pretreatment period followed by an 8-week active treatment period. 37 male and 93 female patients (mean age 51 years, mean weight 59.9kg) participated in the study. Average systolic/diastolic blood pressure on admission was 163.8/103.7mm Hg. Results showed isradipine normalised sitting diastolic blood pressures in 109 of 130 (83.8%) patients. 71 patients (54.6%) were receiving isradipine 1.25mg twice daily while 38 patients (29.2%) required a dose of 2.5mg twice daily. A drop of greater than or equal to 10mm Hg in sitting diastolic blood pressure was achieved in 71 patients (54.6%) administered isradipine 1.25mg twice daily and 44 patients (33.8%) on isradipine 2.5mg twice daily. Heart rate was not significantly changed with either dosage. Drug-related adverse effects were only transient in duration and mild to moderate in severity. No patient discontinued treatment because of these effects. This study provides confirmatory evidence of the clinical efficacy and tolerability of a daily dose of less than or equal to 5mg isradipine in Filipino patients with mild to moderate hypertension.

Hemodynamic correlates of vectorcardiographic QRS loops in pure mitral stenosis.

The hemodynamic correlates of the vectorcardiographic types of right ventricular hypertrophy (RVH) according to Chou and Helm and those with normal QRS loop in the horizontal plane of Frank system were analyzed in 100 patients with pure mitral stenosis. All underwent right and left heart catheterization. Additionally, coronary arteriography was done on 16 whose ages were above 40. Type A RVH was associated with the most severe hemodynamic alterations with markedly elevated total pulmonary vascular resistance (TPVR), mean pulmonary artery pressure (MPAP), peak right ventricular pressure (RRVP) and the smallest mitral valve area (MVA). The severity of these parameters were to a lesser degree obtainable in type C but with no significant difference from type A (p greater than 0.05). However, types A and C were clearly separated from type B and normal QRS loop (p less than 0.05). Type B RVH and normal QRS loop showed milder hemodynamic changes and were not significantly different (p greater than 0.05). Our results indicate that in pure mitral stenosis the development of RVH is from a normal loop into type B, C and A reflecting an increasing severity of hemodynamic changes which affect the right ventricle. This order of development is different from the traditional view.

Two-dimensional echocardiographic diagnosis of left-atrial thrombus in rheumatic heart disease. A clinicopathologic study.

Two-dimensional echocardiographic studies were performed in 293 patients with rheumatic heart disease who underwent open-heart mitral valve surgery during an 18-month period. Diagnostic confirmation of a left atrial thrombus was based on direct inspection of the left atrium during surgery and histopathologic examination. Two-dimensional echocardiographic recordings were reviewed. Of the 293 patients, 33 had left atrial thrombi by two-dimensional echocardiographic criteria. This diagnosis was confirmed at surgery and histopathologic study in 30 (specificity 98.8%). A thrombus was not found in three patients. In 21 other patients, left atrial thrombi were present but were not detected by two-dimensional echocardiography (sensitivity 58.8%). Ten of these 21 had thrombi in the left atrial cavity. In 11 patients, thrombi were located in the left atrial appendage, all of which were missed by two-dimensional echocardiography. Excluding these 11 left atrial appendage thrombi, the sensitivity of two-dimensional echocardiography for detecting left atrial cavity thrombi was 75.0%.

Two dimensional echocardiography in valvular heart disease.

From October 1, 1979 to June 30, 1980, 890 2D echocardiographic examinations were performed. Of these, 221 showed valvular lesions with predominant rheumatic aetiology. The valvular lesions encountered were pure mitral stenosis, pure mitral insufficiency, mixed mitral stenosis and insufficiency, aortic incompetence, aortic stenosis, mitral valve prolapse and left atrial thrombus. It is concluded that 2D echo imaging should in due time provide the "gold standard" for the evaluation of valvular lesions.

Sensitivity of echocardiography in the diagnosis of mitral stenosis and in the assessment of its severity.

The sensitivity of M-mode echocardiography in the diagnosis of mitral stenosis and in the assessment of its severity was determined in 85 patients with pure mitral stenosis. This technique was 100% sensitive in diagnosing mitral stenosis (MS). It is highly sensitive in the assessment of severity in those with severe MS. However, in mild and moderate MS, its sensitivity is low. Other echocardiographic parameters should be considered in the assessment of severity of MS.

Changes in P-R interval immediately before, during, and after acute myocardial infarction.

A 48 years old male developed acute cardiac pain manifested by prolonged P-R interval as the only electrocardiographic sign. Subsequently the electrocardiogram evolved an acute myocardial infarction with a normal P-R interval. Immediately therafter prolonged P-R interval reappeared to become established even after digitalis was long discontinued.