Betablockers in combination with other antihypertensives.

Betablockers (BB) have been recognized as effective antihypertensive agents. Recent meta analysis of various hypertension trials have brought to light the inferiority of BB compared to other antihypertensives as a first line monotherapy agent. Combination of BB with dihydropyridine Calcium Channel Blocker (CCB) has been especially effective in smooth control of BP. Combination of diuretics with BB should be avoided in patients with dyslipidaemia and in those prone to develop diabetes. BB can be combined with vasodilators and alpha blockers with good therapeutic benefit. BB with angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) is not an ideal combination as both the drugs act in the renin-angiotensin system. However, in hypertension with certain specific clinical situation this combination is useful. BB as a monotherapy agent is being less preferred in the treatment of hypertension based on recent evidence while in suitable combination it is a valuable antihypertensive.

Cardiovascular involvement in leptospirosis.

Cardiovascular involvement was studied in 50 patients with serologically proved leptospirosis. Twelve (24%) patients had dyspnoea and 18 (36%) had transient hypotension during the illness. None of them had cardiac enlargement, development of new murmur or pericardial rub. Various electrocardiographic abnormalities occurred in 70 percent of patients. Atrial fibrillation was the most common major arrhythmia (14%). Conduction system abnormalities were seen in 36 percent of patients. T-wave changes were observed in 30 percent of patients. Left ventricular function as assessed by echocardiography and Doppler examination was normal. Three (6%) patients died due to renal failure. In conclusion, even though ECG abnormalities were frequently seen in leptospirosis, there was no data to support associated left ventricular dysfunction. Dyspnoea and hypotension occurring in patients of leptospirosis must be due to a noncardiac mechanism.

Systolic time intervals in constrictive pericarditis. A study before and after digitalis.

Systolic time intervals were studied in 9 patients with documented constrictive pericarditis before and 15 to 20 minutes after intravenous administration of peruvoside (a quick acting digitalis-like glycoside) to determine underlying myocardial dysfunction. Data were compared with those of similarly studied normal subjects and patients with known myocardial dysfunction. Left ventricular ejection time index (LVETI) decreased in normal subjects (P less than 0.01) and in most patients with constrictive pericarditis, and increased marginally in those with myocardial dysfunction (NS) after peruvoside administration. Pre-ejection period index (PEPI) shortened significantly (P less than 0.01) after peruvoside in normal subjects and in patients with myocardial failure, but not in constrictive pericarditis. Likewise the predicted ejection fraction was insignificantly altered in constrictive pericarditis but significantly so (P less than 0.01) in myocardial failure and normal subjects. The response of one patient with constrictive pericarditis to parenteral peruvoside administration was similar to that seen in patients with myocardial failure. This patient had a delayed recovery after pericardiectomy. PEPI/LVETI ratio and ejection fraction were also abnormal in other patients with constrictive pericarditis when compared to normal subjects. Such abnormalities and the unusual response of some patients to administration of peruvoside may reflect underlying myocardial dysfunction in patients with constrictive pericarditis. However, it is possible that the rigid pericardium also contributes to these abnormalities to a varying extent. Systolic time indices and their response to digitalis appear to be a useful, atraumatic method for detecting underlying myocardial dysfunction in patients with constrictive pericarditis.