SYSTOLIC MURMURS IN APPARENTLY HEALTHY INDIVIDUALS.

Presence of a systolic murmur is not always indicative of organic heart disease or abnormality, especially so in asymptomatic individuals. We studied 210 young adults (192 males, 18 females) of the age group 16 to 23 years with systolic murmurs to evaluate the utility of noninvasive tests in ascertaining the presence or absence of heart disease. Each case was categorized after clinical evaluation and again after noninvasive investigations (chest radiogram, 12 lead ECG, and echocardiography) into 3 groups. Based on clinical evaluation alone, 190 (90.5%) cases had no evidence of heart disease (group A), 16 (7.6%) cases had definite heart disease (group C) and in 4 (1.9%) cases the presence of heart disease could not be ruled out definitely (group B). The recategorization after investigations did not alter the initial diagnosis in any of the subjects from groups A and C (98.1%). Two cases from group B (0.95%) changed groups whereas in the remaining 2 cases (0.95%) from group B no definite conclusions could be reached even after echocardiography.

ANEURYSM OF SINUS OF VALSALVA DISSECTING INTO THE INTERVENTRICULAR SEPTUM - ECHOCARDIOGRAPHIC DIAGNOSIS (A Case Report).

Aneurysm of sinus of Valsalva dissecting into interventricular septum is a rare entity. We report one such case who was incidentally diagnosed by echocardiography to have this abnormality during evaluation of a clinically suspected isolated aortic regurgitation.

Complications in 1000 consecutive treadmill tests.

Complication in 1000 consecutive Tread Mill Tests (TMT) done at the Cardiology Centre of Command Hospital (SC) Pune are reported. The tests were done following Bruce Protocol and analysed based on Selzer's criteria. Complications were noted in 18 cases (1.8%) which included ventricular fibrillation, ventricular tachycardia, atrial fibrillation, malignant VPBs, conduction disturbances, asystole following hyperventilation (HV), complete SA block following HV, atrial flutter following HV, hypotension and severe angina requiring ICCU care. No acute myocardial infarctions or deaths were noted. Coronary arteriography (CART) was done in 50 (5.0%) selected cases including 10 with complications. It is concluded that TMT is a safe procedure if carried out after proper patient selection and under supervision of an experienced and efficient team.

Excessive polycythaemia of high altitude. Pulmonary function studies including carbon monoxide diffusion capacity.

Pulmonary function studies were done in 21 soldiers (low landers) posted at high altitude (average height 4773 metres) for prolonged periods (average 77.09 months), who had developed excessive polycythaemia, mean haemoglobin concentration being 23.06 g/dl. Studies revealed significant reduction in diffusion capacity of lungs which gradually returned to normal on sojourn at low altitudes for 70 days. Both the degree of polycythaemia and reduction in lung diffusion capacity were much more pronounced in smokers than in non-smokers. Vital capacity did not show any difference in these subjects while forced expiratory volume in 1 sec and ratio of forced expiratory volume to vital capacity (FEV1/VC) revealed only obstructive features in smokers.

Angiographic recognition of coronary ostial stenosis in nonspecific aorto-arteritis.

A 17-year-old girl was seen with acute anterior myocardial infarction resulting in congestive heart failure. Clinical examination followed by detailed investigation revealed diffuse nonspecific aorto-arteritis, with left coronary ostial stenosis, which is a very rare association. The relevant literature is reviewed.

Ajmaline-induced torsade de pointes.

A patient with primary myocardial disease and left bundle-branch block who developed marked QT prolongation and torsade de pointes following an intravenous injection of ajmaline during an electrophysiologic study is reported. The patient could be resuscitated successfully 1 h after the onset of tachycardia.