Pulmonary hypertension in aortic regurgitation: early surgical outcome.

A review of the haemodynamic data of 139 patients with isolated, severe, chronic aortic regurgitation revealed severe pulmonary hypertension (pulmonary artery systolic pressure of greater than or equal to 60 mmHg) in 34 (24 per cent). The left ventricular end-diastolic pressure was high in all patients, suggesting that pulmonary hypertension was a consequence of severe long-standing regurgitation with ventricular dysfunction. Aortic valve replacement was performed in 69 patients, 33 of whom had normal or mildly elevated pulmonary artery systolic pressure (less than 39 mmHg; group I) and 36 of whom had moderate or markedly elevated pulmonary artery systolic pressures (less than 40 mmHg; group II).

Coronary risk factors in newly diagnosed and previously diagnosed type 2 diabetic men with myocardial infarction.

Risk factors for coronary artery disease in 131 known non-insulin-dependent (type 2) diabetic patients is compared to that in 115 newly diagnosed type 2 diabetic subjects and in 316 non-diabetic patients. The subjects, all Indian men aged 21-60 years, represent consecutive survivors of myocardial infarction and were investigated 3-4 months after their acute episode. A group of 524 healthy Indian men aged 21-60 years were included as controls.

Serum lipoproteins and apolipoproteins in young normocholesterolaemic, non-diabetic Indian men with myocardial infarction.

Serum total cholesterol, triglycerides, high density lipoprotein cholesterol, low density lipoprotein cholesterol, apolipoprotein A-I and apolipoprotein B were evaluated as potential indicators of the risk of coronary artery disease in young (less than 46 years) normocholesterolaemic, non-diabetic men who had previously sustained a myocardial infarction (n = 50) and in healthy age and sex matched controls (n = 122) with a similar socioeconomic background. Significant differences were observed between patients and controls in the mean concentrations of serum total cholesterol, triglycerides, low density lipoprotein cholesterol, high density lipoprotein cholesterol and apolipoprotein B, as well as in the ratios of total cholesterol to high density lipoprotein cholesterol and apolipoprotein A-I to apolipoprotein B. No significant difference was demonstrated in the concentration of apolipoprotein A-I between the two groups.

Lipid and lipoprotein abnormalities in South African Indian men with myocardial infarction.

The Indian (Asian) population in South Africa has a high rate of coronary artery disease. Fasting serum lipid and lipoprotein levels were measured in 620 consecutive male survivors of myocardial infarction and compared with those of 524 healthy male volunteer controls, and the presence of hypercholesterolaemia and hypertriglyceridaemia in the patient group was related to other non-lipid coronary risk factors. All survivors and controls were below age 61 years.

Balloon dilatation of the mitral valve by a single bifoil (2 x 19 mm) or trefoil (3 x 15 mm) catheter.

The efficacy of balloon dilatation of the mitral valve by a bifoil (2 x 19 mm) or trefoil (3 x 15 mm) catheter (single catheter technique) was assessed in 53 patients (mean age 28) with mitral stenosis, most of whom were women. The procedure was unsuccessful in three patients. After balloon dilatation the left atrial pressure decreased from 22 mm Hg to 13 mm Hg and the mitral valve gradient from 12 mm Hg to 4 mm Hg.

Abnormalities in sex hormones are a risk factor for premature manifestation of coronary artery disease in South African Indian men.

The relation between sex hormone levels and myocardial infarction was studied in a case-control study among 117 Indian men with myocardial infarction aged 30-60 years and in 107 healthy Indian male controls. The patients and controls were further divided into subsets defined by age in decades. In the total patient population, testosterone concentration was significantly lower than in the controls (P less than 0.

Prognostic importance of admission plasma glucose in diabetic and non-diabetic patients with acute myocardial infarction.

We assessed the relationship of plasma glucose concentrations measured on admission to mortality during the acute phase of myocardial infarction in 143 diabetic patients and 277 patients without a previous history of diabetes. Mortality in hospital in patients not known to have diabetes increased significantly from 4 per cent in patients with admission plasma glucose below 8 mmol/l to 35 per cent in patients with admission plasma glucose above 11 mmol/l. In diabetic patients the mortality increased with increasing admission plasma glucose but the difference was not significant.

Isolated endocarditis of the pulmonary valve with fragmentation haemolysis.

An unusual case of isolated endocarditis of the pulmonary valve complicated by fragmentation haemolysis resolved on antibiotic treatment.

Anomalous origin of the right coronary artery from the left sinus of Valsalva. A report of 2 cases.

Two cases of inferior myocardial infarction associated with anomalous origin of the right coronary artery from the left sinus of Valsalva are described.

Plasma lipids can be reliably assessed within 24 hours after acute myocardial infarction.

Total serum cholesterol and triglycerides were measured in 159 Indian patients (134 males) with acute myocardial infarction during their stay in hospital (days 1 and 2) and 3 months later in order to assess whether lipid levels measured soon after acute myocardial infarction represent basal values. Early and 3 month lipid levels were also compared according to the sex and glucose tolerance of the patients. The mean total cholesterol levels on admission (day 1) were comparable to the 3 month values in both men (6.

Incidence and bedside diagnosis of haemodynamically significant right ventricular infarction.

The incidence, diagnosis and clinical course of haemodynamically significant right ventricular infarction (RVI) were assessed prospectively in 90 patients with their first acute inferior myocardial infarction. The haemodynamic criteria for RVI were defined as a mean right atrial pressure of 10 mmHg or more and a mean right atrial pressure equal to or greater than the mean pulmonary capillary wedge pressure. Twenty-six patients (29%) had haemodynamic evidence of RVI (group A) whereas 64 (71%) did not meet the criteria (group B).

Abnormal glucose tolerance is the dominant risk factor in South African Indian women with myocardial infarction.

Risk factors for coronary artery disease were determined at least 3 months following myocardial infarction in 90 Indian women between the ages of 26 and 60 years. The risk factors were analysed according to age (greater than 45 vs. less than or equal to 45 years) and also their prevalence was compared to that of 76 healthy age- and sex-matched Indian controls.

Stress hyperglycaemia is a predictor of abnormal glucose tolerance in Indian patients with acute myocardial infarction.

66 non-diabetic Indian patients with acute myocardial infarction were assessed prospectively for the presence of hyperglycaemia and the value of this admission hyperglycaemia and glycosylated haemoglobin (HbA1) levels in reflecting the glucose tolerance status of the patients was studied. Hyperglycaemia, defined as admission plasma glucose greater than or equal to 8 mmol/l was detected in 49% of the patients, whilst raised HbA1 values were seen in 11%. The admission plasma glucose (APG) correlated significantly with both the HbA1 levels and with the 2 hour glucose value in the oral glucose tolerance test (p less than 0.

Risk factors in young Indian males with myocardial infarction.

Risk factors were assessed in 108 young Indian males with myocardial infarction. The mean age was 36 years (range 21-40 years). Cigarette smoking was the most common risk factor (79% of patients).

Histocompatibility antigens in Indian patients with myocardial infarction.

The frequency of HLA-A, B, C and DR tissue antigens in 103 Indian men aged 40 years or under who had experienced a myocardial infarction was compared with the frequency in 760 healthy Indian controls. No significant differences in antigen frequencies were found. The findings in this study provide no support for either a genetic or an immunological basis for myocardial infarction in young Indian men.

Sex hormone levels in young Indian patients with myocardial infarction.

The finding of abnormal levels of sex hormones in men with coronary artery disease has led to the hypothesis that alterations in sex hormones may represent an important risk factor for myocardial infarction. In this study, the sex hormone profile of 28 young men (aged less than 40 years) with myocardial infarction was compared with 28 age- and weight-matched normal men. Although the mean total serum estradiol levels and the free estradiol index of the patients and controls were similar, the mean serum total testosterone level and the free testosterone index were significantly lowered in the patients with myocardial infarction (p less than 0.

Insulin response to oral glucose in young, non-obese Indian males with myocardial infarction.

Plasma glucose and insulin concentrations were estimated during an oral glucose tolerance test (OGTT) in a group of 25 young (less than 40 years), non-obese Indian males 6-12 months after an episode of acute myocardial infarction and in 25 age- and sex-matched controls. All the subjects in both groups had a normal response to the OGTT according to the 1980 World Health Organization criteria. Glucose values during the OGTT and the mean plasma insulin response were significantly higher in the patients who had had a myocardial infarction.

Pulsatile hepatomegaly in constrictive pericarditis.

In a study of 30 consecutive patients with constrictive pericarditis diagnosed by clinical, radiological, and echocardiographic criteria 21 (70%) were found to have pulsatile hepatomegaly. The pulsations were felt clinically and confirmed by external hepatic recordings. These pulsations conformed almost identically to the jugular venous pulsations in the neck.

Unstable angina precipitated by nifedipine. A case report.

A case of unstable angina pectoris precipitated by the administration of nifedipine, a complication which has not been well documented, is reported.

Abnormal glucose tolerance and lipid abnormalities in Indian myocardial infarct survivors.

Glucose tolerance and lipid levels in a random sample of 103 Indian patients (96 males and 7 females) with coronary artery disease (CAD) aged between 20 and 55 years were compared with those in a healthy Indian control group matched as regards age and sex. Previous episodes of myocardial infarction were taken as evidence of CAD. Of the patients 44% were overweight.

Valve replacement in active infective endocarditis.

To assess the role of emergency valve replacement in patients with active infective endocarditis (IE), we reviewed 30 patients who underwent valve replacement within 3 months of the diagnosis of IE. Eighteen patients fulfilling the criteria for active IE underwent emergency surgery. The aortic valve was involved in all cases and was previously thought to be normal in 12 (67%).

Problems encountered during insertion of permanent endocardial pacing electrode.

Case reports of two potential problems arising during permanent endocardial pacemaker electrode insertion are described. They are cannulation of a persistent left-sided superior vena cava, and unsuspected subclavian vein thrombosis. A left-sided superior vena cava may be recognized clinically and avoided; but, if necessary, it can be employed as a route to the right ventricular endocardium.

Insertion of permanent endocardial pacing electrodes via the infraclavicular subclavian vein.

A technique of insertion of permanent endocardial pacing electrodes via the infraclavicular subclavian vein is described. Twenty-eight electrodes have been inserted without a displacement or any of the recognized complications occurring. The method is quicker and more reliable than more conventional approaches.