Newly diagnosed arrhythmogenic right ventricular dysplasia in an octogenarian

Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is thought to be a disease of the young, with the majority of newly diagnosed patients under 40 years of age. Establishing this diagnosis in elderly patients may be challenging, and a few reports exist of patients older than 70 years diagnosed with ARVD/C at autopsy. We report the case of an octogenarian with antemortem newly diagnosed ARVD/C. This case report represents the oldest patient to date to have a newly established diagnosis of ARVD/C and highlights the difficulty in making the diagnosis in the elderly.     

Left atrial conduit function for left ventricular filling dynamics in patients with myocardial infarction

This study observed the left atrial function in determining filling dynamics of the left ventricle in patients with myocardial infarction. The study consisted of eight control subjects and ten patients with myocardial infarction. The left ventricular filling volume is considered to be composed of the left atrial passive emptying, active emptying, and conduit volumes. The change of left ventricular filling volume was correlated with that of conduit volume (r = .87, P < .01). However, the change of left ventricular filling volume did not have any correlation to those of left atrial passive emptying and active emptying volumes. These results suggested that the left atrial conduit function was important in determining filling dynamics of the left ventricle.     

尼群地平对高血压患者左室舒张功能和细胞内钙浓度的影响

观察２３例高血压患者尼群地平治疗４周后舒张功能指标，淋巴细胞风下浓度、红细胞Ｃａ＾２＋ －ＡＴＰ酶和血浆钙调素的变化。结果显示，尼群地平可增大Ｅ／Ａ比值、快速充盈分数和１／３充盈分数，减小Ａ峰流速，房综期充盈分数和左房内径。提示尼群地平可改善左室舒张功能，尼群地平降低细胞内钙浓度，并与左房排空指数和１／３充盈分数增大呈正相关。     

Captopril adjuvant therapy to beta-blockers and nitrates improves post-myocardial infarction left ventricular performance

A growing body of data support the beneficial effects of angiotensin-convertingenzyme inhibitors in the prevention of cardiac enlargement andimprovement of left ventricular function in patients with acutemyocardial infarction. However, very little information existsabout the direct effect of increased afterload on cardiac performancein these patients and the possible favourable effects of angiotensin-convertingenzyme inhibitors as adjunctive treatment to thrombolysis, beta-blockersand nitrates. We have, therefore, studied the effects of captoprilas adjuvant therapy to thrombolysis, beta-blockers and nitrates(standard therapy) on left ventricular performance in 77 consecutivepatients with uncomplicated Q-wave acute myocardial infarction,by the measurement of the pre-ejection period/left ventricularejection time ratio before and after (0·25–0·50mg) phenylephrine administration on the 4th and 30th post-infarctiondays. Patients were randomized on day 4 either to continue standardtherapy alone (group 1, 35 patients) or to receive oral captopriltherapy (12·5 mg t.i.d.) in addition to standard therapy(group 2, 42 patients) in a double-blind parallel study. Among the patients of group 1 there was a significant deteriorationof left ventricular function after phenylephrine administration.This was shown by an increase of pre-ejection period/left ventricularejection time ratio only in the subset of patients with ejectionfraction <40%, as measured by contrast ventriculography,on both the 4th and 30th post-infarction days changing from0·435±0·070 to 0·528±0·101,P<0·01 and from 0·404±0·098 to0·515±0·092, P<0·02, respectively.In contrast there were no significant changes in patients withejection fraction 40%. Among patients of group 2, phenylephrineadministration induced a significant increase, only on the 4thday, in pre-ejection period/left ventricular ejection time ratioonly in the subset of patients with ejection fraction <40%changing from 0·410±0·107 to 0·535±0·102,P<0·01. In the remaining patients with ejection fraction>40% there were no significant changes on either the 4thor 30th post-infarction days. Furthermore, a significant improvementwas observed after phenylephrine administration in the pre-ejectionperiod/left ventricular ejection time ratio between the 4thand 30th post-infarction days, which changed from 0·535±0·102on day 4 to 0·368± 0·052 on day 30 (P<0·004).Also, a four-way ANOVA detected a significant reduction of heartrate in patients with ejection fraction <40< from day4 to day 30. The results indicate that: (1) the response of pre-ejectionperiod/left ventricular ejection time ratio after increasingafterload may be a useful non-invasive method for the detectionof left ventricular dysfunction in myocardial infarction patients;and (2) captopril adjuvant therapy as compared to thrombolysis,beta-blockers and nitrates alone, after phenylephrine administration,improves the left ventricular performance response in asymptomaticQ-wave post-infarction patients and beneficially affects heartrate. This effect is most pronounced in patients with ejectionfraction 40% whereas those with ejection fraction 40% do notobtain clear benefit.     

依那普利对老年高血压病病人左室舒张功能改善的临床观察

应用平衡法放射性核素心室造影，观察了依那普利（悦宁啶）对老年高血压病患者左室舒张功能的影响。结果表明：血压治疗后较治疗前明显降低，其中收缩压治疗后（１８．５±１．８ｋＰａ）较治疗前（２２．５±２．７ｋＰａ）明显下降（Ｐ＜０．０１），舒张压治疗后（１０．６±１．１ｋＰａ）较治疗前（１３．７±１．４ｋＰａ）明显下降（Ｐ＜０．０１），左室舒张功能得到不同程度改善。平均充盈率（ＭＦＲ）治疗后（１．５００４±０．３５２３）较治疗前（１．３９１１±０．４０８５）明显提高（Ｐ＜０．０１）；１／３充盈分数（１／３ＦＦ）治疗后（０．３４４５±０．１３０４）较治疗前（０．２７７９±０．１１５）明显提高（Ｐ＜０．０１）。提示依那普利在有效地降低血压的同时，亦能确切地改善左室舒张功能。     

卡托普利减轻心室肌重量远期效果观察

口服卡托普利(Captopril,巯甲丙脯酸)治疗心脏病患者31例,疗程3个月。治疗前后用二维超声心动图测量出室间隔厚度、左心室后盛厚度和左室舒张末期内径,并计算出左室重量(LVM)。发现治疗后LVM较治疗前平均减轻17.2％(233.90±61.36 VS 193.68±33.96,P<0.05),而对照组治疗前后无显著差异(P>0.05)。X线心脏远达摄片测得的心胸比率亦有相应变化(0.60±0.16 VS 0.52±0.08,P<0.01)。故认为卡托普利治疗心脏增大的心脏病是可选用的药物。其作用机理可能是多方面的。     

Radiofrequency Ablation of Idiopathic Left Anterior Fascicular Tachycardia

Left Anterior Fascicular Tachycardia. Introduction: A 45-year-old man with idiopathic ventricular tachycardia (VT) having a right bundle branch block configuration with right-axis deviation underwent au electrophysiologic test.
Methods and Results: Mapping demonstrated a site on the auterobasal wall of the left ventricle where there was an excellent pace map and an endocardial activation time of -20 msec, hut radiofrequency catheter ablation at this site was unsuccessful. At a nearby site, a presumed Purkinje potential preceded the QRS complex by 30 msec during VT and sinus rhythm, and catheter ablation was effective despite a poor pace map and an endocardial ventricular activation time of zero.
Conclusion: Idiopathic VT with a right bundle branch configuration and right-axis deviation may originate in the area of the left anterior fascicle. A potential presumed to represent a Purkinje potential may he more helpful than endocardial ventricular activation mapping or pace mapping in guiding ablation of this type of VT.     

Radiofrequency Catheter Ablation of Idiopathic Left Ventricular Tachycardia:

Idiopathic Left Ventricular Tachycardia. Introduction: Idiopathic left ventricular tachycardia with a QRS pattern of right bundle branch block and left-axis deviation constitutes a rare but electrophysiologically distinct arrhythmia entity. The underlying mechanism of this tachycardia, however, is still a matter of controversy. This report describes findings in a 42-year-old man who underwent successful radiofrequency catheter ablation of idiopathic left ventricular tachycardia.
Methods and Results: On electrophysiologic study, the tachycardia was reproducibly induced and terminated with double ventricular extrastimuli. Intravenous verapamil terminated the tachycardia whereas adenosine did not. Detailed left ventricular catheter mapping during sinus rhythm revealed a fragmented delayed potential at the mid-apical region of the inferior site near the posterior fascicle of the left bundle branch. At the same site, continuous electrical activity throughout the entire cardiac cycle was recorded during ventricular tachycardia. Repeated spontaneous termination of this continuous electrical activity in late diastole was followed immediately by termination of the tachycardia. Single application of radiofrequency current for 20 seconds at this site completely abolished inducibility of the tachycardia. After catheter ablation, at the identical site of preablation recording of the fractionated potential during sinus rhythm, no fragmented delayed activity could be recorded. There was no complication from the ablation procedure.
Conclusion: The preablation recordings of fragmented delayed potentials during sinus rhythm and continuous diastolic electrical activity during tachycardia, together with ablation characteristics and previously reported electrophysiologic properties of this arrhythmia, may further support microreentry as the underlying mechanism in idiopathic left ventricular tachycardia.     

Pattern of left ventricular filling in hypertrophic cardiomyopathy: Assessment by Doppler echocardiography and radionuclide angiography

Aims The left ventricle in hypertrophic cardiomyopathy is anatomicallyand functionally non-uniform. This study was undertaken to verifywhether a heterogeneity in the pattern of diastolic fillingcan be detected along the left ventricular inflow tract in hypertrophiccardiomyopathy. Methods and results Early (E) and late (A) diastolic velocitieswere recorded by Doppler echocardiography at mitral and at mid-ventricularlevel in 16 normal volunteers and 30 patients with hypertrophiccardiomyopathy. Patients with hypertrophic cardiomyopathy alsounderwent radionuclide angiography to assess left ventricularfunction. E wave decreased significantly in normal volunteers(80±15 to 60±14cm.s^–1;P<0·001),but it increased in hypertrophic cardiomyopathy (76±22to 87±28cm.s^–1;P=0·04), whereas the A wavedecreased similarly in both. By multivariate analysis, systolicasynchrony and the ejection fraction of left ventricular lateralwall were directly related to the pattern of early filling progression(r=0·656; F=9·467;P<0·002). Moreover,systolic asynchrony showed a univariate direct correlation withchanges in E velocity (r=0·42;P=0·02). Conclusion Many patients with hypertrophic cardio-myopathy havean acceleration of filling within the left ventricular inflowtract; this phenomenon is directly related to systolic asynchronyand ejection fraction of the left ventricular lateral wall,suggesting increased suction.     

Severe visual loss caused by unrecognized malignant hypertension in a 15‐year‐old girl

A 15‐year‐old girl presented with acute bilateral loss of central visual acuity due to hypertensive retinopathy level IV. She was found to have unrecognized malignant arterial hypertension associated with end‐stage renal failure. At the time of diagnosis she also had severe left ventricular hypertrophy (LVH). Hypertension was successfully treated with combined anti‐hypertensive therapy, but renal function did not recover. The patient underwent successful kidney transplant 4 months later and over a period of 20 months hypertensive retinopathy and LVH gradually resolved. This report emphasizes the importance of routine measurement of blood pressure and describes the possible consequences of unrecognized arterial hypertension in children. Early diagnosis and appropriate treatment are necessary to avoid development and progression of target organ damage and promote better long‐term cardiovascular prognosis.