Supernumerary nipple as a cutaneous marker of mitral valve prolapse in Asian Indians.

We studied 68 Asian Indians from South India with supernumerary nipple (SN) and 49 age- and sex- matched controls without SN for evidence of mitral valve prolapse (MVP) and associated features. We found that MVP and its forme fruste were more common in the SN group (odds ratio 6.0, 95% confidence intervals 2.16 to 16.63), indicating an association of SN with MVP.

Circadian variation in the onset of pain of acute myocardial infarction in Indian patients.

Two hundred patients admitted with acute myocardial infarction (AMI) to the coronary care unit of a tertiary-care-teaching hospital over a period of 1.5 years were studied prospectively, with regard to the time of onset of pain of infarction. The maximum number of infarctions (i.e. 71) (35.6%) occurred between 4.00 AM and 10.00 AM, significantly higher than other 6 hour periods of the day (P < 0.01). Various possible mechanisms leading to this early morning increase in the incidence of AMI and its therapeutic implications are discussed.

Mitral valve prolapse syndrome and associated thoracic skeletal abnormalities.

Clinical characteristics of 60 (41 males, 19 females) patients with echocardiographically proven mitral valve prolapse were analysed, with special interest in the associated thoracic skeletal abnormalities. There was a male preponderance (2.2:1) and 91.7% of patients were symptomatic--atypical chest pain, palpitations, exertional dyspnoea and easy fatiguability being the major symptoms. Sixty seven percent had an asthenic body habitus, and 55% had high-arched palate. Thoracic scoliosis (55%), straight back syndrome (50%), flat chest (46.7%), and pectus excavatum (20%) were seen in association with the condition, with 81.7% having any one or combination of these features. Lateral chest radiography showed pancaking of heart shadow in 48.3%. Isolated non-ejection systolic click(s) was the major cardiac auscultatory finding (61.7%), while 60% showed pansystolic prolapse on echocardiography. Electrocardiographic ST-T-U changes in the inferior and/or lateral chest leads were seen in 46.7%, while 16.7% had cardiac arrhythmias. None had infective endocarditis, heart failure or cerebral embolic events. The findings corroborate the view that thoracic skeletal anomalies may be regarded as non-auscultatory features of this syndrome.

Early onset Dressler's syndrome--a study of fifteen cases.

Fifteen out of 612 acute myocardial infarction patients who had onset of features of post-myocardial infarction (Dressler's) syndrome between the 3rd and 21st post-infarction days were studied. All had pericardial rub and raised ESR, 86.6% had fever, 73.3% had arthralgia and 66.7% had pleuro-pericardial pain. Early onset Dressler's syndrome (EODS) was found to be more common in anterior wall myocardial infarction, to occur earlier in second infarctions and in diabetics, and to occur most commonly between the 6th and 10th post-infarction days. It was concluded that EODS is an occasional cause for recurrent chest pain after acute myocardial infarction.

Anhidrosis with anisocoria: clinical and autonomic evaluation.

Four patients with anhidrosis associated with normal sweat glands at skin biopsy are reported. One patient had a positive family history. All of them had pupillary asymmetry. Pharmacologic tests evinced evidence of parasympathetic denervation of the pupil in three and sympathetic denervation in the other patient. Autonomic function tests revealed intact cardiovascular reflexes. Restricted involvement of functionally and geographically distant population of autonomic neurons suggests their possible ontogenetic or biochemical similarities.