Anomalous origin of the right coronary artery from the ascending aorta: case history.

A patient is described with an anomalous right coronary artery arising high above the left sinus of Valsalva. This patient is unique because the other 2 cases with such an anomalous origin of a right coronary artery had bicuspid aortic with such an anomalous origin of a right coronary artery had bicuspid aortic valves; this patient had a normal tricuspid aortic valve.

A new scintigraphic method for determining left ventricular volumes.

A new scintigraphic count-based method for measuring absolute left ventricular volumes is presented. It is a fast and simple technique that allows geometrical assumptions to be avoided and is free of radiation attenuation corrections. This method requires the acquisition of an image of the left ventricle in the right anterior oblique projection and the collection of gated blood pool images in the left anterior oblique projection. To assess the accuracy of the method scintigraphic stroke volumes were compared with those derived from thermodilution measurements during cardiac catheterization in 20 subjects, and to assess its precision the technique was applied to phantom data of known radionuclide volumes. Excellent correlations were found between the scintigraphic and both the thermodilution (r = .98) and phantom data (r = .99). The reproducibility (r = .97) of results was investigated by repeating data acquisition and analysis for 15 subjects on two different days, and the interobserver variability (r = .97) of the method was studied by having two computer operators calculate volumes for the same patient data for 20 randomly selected studies.

Diagnostic uses of intraatrial electrocardiography.

Many tachyarrhythmias present difficult diagnostic problems. In patients with underlying cardiac disease, serious hemodynamic derangements can be the sequelae of uncontrolled or improperly treated arrhythmias. Our experience, illustrated by the case presentations, confirm that intraatrial electrocardiography is a safe and reliable technique for elaborating difficult tachyarrhythmias that are not conclusively diagnosed by noninvasive ECG techniques. Because misinterpretation of tachycardias can lead to incorrect therapeutic decisions, the minimal risk of such a procedure is far surpassed by the information obtained, which allows for correct diagnosis and aids in guiding effective therapy. Although careful, critical analysis of ECG and rhythm strips frequently allows a proper diagnosis, occasions often arise when the rhythm cannot be accurately defined. In such instances an intraatrial lead electrocardiogram can be utilized and is invariably of diagnostic aid in resolving the relationship of the P wave to the QRS complexes, which is usually the important key to a tachyarrhythmia diagnosis.

Massive hemopericardium in a patient with postmyocardial infarction syndrome.

A 44-year-old man sustained a transmural inferolateral myocardial infarction and began to show signs of postmyocardial infarction syndrome (Dressler's syndrome) one week after infarction. Anticoagulant therapy had been initiated for suspected pulmonary thromboembolism. Administration of steroids did not improve the patient's clinical condition or the results of laboratory investigations. A massive pericardial effusion was diagnosed clinically, and this diagnosis was confirmed by a pericardial scan using 99m technetium. Subsequently, 1,800 ml of bloody fluid was removed from the pericardial cavity, and following the pericardiocentesis, the patient became asymptomtic. This case reemphasizes the hazards of anticoagulant therapy in patients with the postmyocardial infarction syndrome.

The syndrome of nonejection click-late systolic murmur and mitral valve prolapse. A case report and review of the subject.

The syndrome of nonejection click-late systolic murmur and mitral valve prolapse is reviewed. A patient with this syndrome is reported. Physical findings, important diagnostic studies, and possible complications are discussed.

Treatment of the bradycardia-tachycardia syndrome with permanent demand pacing.

The bradycardia-tachycardia syndrome (paroxysmal supraventricular tachycardia alternating with sinus bradycardia and episodes of sinus node arrest) has previously presented a complicated therapeutic dilemma when excitatory and suppressive drugs have been utilized. A patient with this syndrome successfully treated with a permanent ventricular transvenous demand pacemaker is presented. Various aspects of this syndrome as well as facets of diagnosis and treatment have been reviewed and discussed. Significant underlying cardiac disease was ruled out in this patient by the usual diagnostic methods including left heart catheterization and coronary angiography. An interesting possibility of the relationship of vagal stimulation secondary to hiatus hernia as an etiologic factor in this syndrome has been discussed. The opinion is expressed that the currently preferred method of treatment is the insertion of a permanent transvenous pacemaker alone or in conjunction with antiarrhythmic drugs, preferably digitalis and propranolol.

The displacement cardiograph. A noninvasive technique for recording myocardial wall motion.

The displacement cardiograph (DCG) is a noninvasive device employing an electromagnetic field to record tissue motion within the body. The sensing coil need not be in contact with the patient since the field penetrates air and stationary tissue without significant distortion. Disturbances in the field with result from ventricular wall motion are electronically converted to an analog output and a pattern inscribed on the paper of a physiological recorder. In an attempt to determine the reliability of the DCG in detecting regional areas of abnormal left ventricular wall motion, displacement cardiograms were obtained from 70 patients who underwent cardiac catheterization and left ventriculography. The DCG interpretations were in agreement with the ventriculographic picture of left ventricular wall motion in 67 of the 70 patients. There were two false positive and one false negative DCG diagnoses. The results indicate that the DCG can be employed as a reliable noninvasive method for repetitive assessment of the pattern of contraction of the anterior, anterolateral and posterior left ventricular wall.

Termination of atrial flutter and atrial tachycardia with rapid atrial stimulation.

The results in this series of fifty-seven patients confirms the safety and reliability of rapid atrial stimulation to terminate atrial flutter and atrial tachycardia. Transthoracic wires implanted at thoracotomy or transvenously placed atrial electrodes can be used for the confident intracardiac electrocardiographic diagnosis of tachyarrhythmias and for atrial stimulation. Our experience represents the second largest reported series of patients to undergo cardioversion by this method. In all but five of fifty-seven patients either the atrial tachyarrhythmia was converted to normal sinus rhythm or the flutter-tachycardia was terminated with resultant atrial fibrillation. In forty-three patients sinus rhythm was eventually re-established after atrial stimulation. Various aspects of rapid atrial stimulation, including it's preference over precordial shock, have been discussed. We feel particular consideration should be given cardioversion by rapid atrial stimulation in patients with possible digitalis toxicity and in all patients who have atrial flutter, atrial tachycardia, or junctional tachycardia after open heart surgery.