Search PubMed⌕ Search

Biomedical subjects

I D'Cruz

Publications and source records attributed to I D'Cruz.

13 recordsLinked to original sources
PubMed1986

Atrial size, atrial fibrillation, and stroke.

M-mode and two-dimensional echocardiographic images were reviewed retrospectively in 20 patients with atrial fibrillation and ischemic stroke with no known valvular disease and in 20 patients with atrial fibrillation without known stroke. Left atrial size was measured and analyzed without knowledge of patient grouping. Two-dimensional echocardiography showed that 90% of the stroke patients had left atrial enlargement compared with only 20% in the nonstroke group. This finding suggests that left atrial enlargement may convey additional stroke risk in patients with atrial fibrillation.

Aged↗
PubMed1983

Submitral atheromatous lesions in monkey and man.

Posterior submitral recess (PSMR) calcification is a common autopsy finding in elderly people, but its pathogenesis is undetermined. In this communication we show that, in part at least, the PSMR changes at autopsy are atheroma-like with lipid around the sclerosis and calcific deposits. These changes in the PSMR showed a statistically significant correlation with the presence of hypertension and with an autopsy finding of severe coronary atherosclerosis. We showed, for the first time, that similar fibrosis and lipid deposition in the PSMR can be produced in high-fat, high-cholesterol fed macaque monkeys (Macaca arctoides) with or without concomitant experimentally produced hypertension. It is concluded that changes in the PSMR in monkeys and man are strongly related to atherosclerosis and hypertension.

Adult↗
PubMed1982

Abnormalities in the mitral valve apparatus in patients undergoing long-term hemodialysis. Autopsy and echocardiographic correlation.

Examination of the heart at autopsy in patients who received long-term hemodialysis revealed the following two changes in the mitral valve apparatus previously almost completely overlooked: (1) fibrosis and thickening affecting chordae tendineae in four cases: in one, severe mitral regurgitation was documented by hemodynamic studies; (2) extensive calcification in the mitral anulus region in two cases, with calcification in the base of the mitral leaflets in one and in the papillary muscle and chordae tendineae in the other. The causes of these abnormalities is unclear. Rheumatic and other known causes all seem unlikely origins of the extensive fibrosis. Secondary hyperparathyroidism is probably responsible for the calcification. In all six patients, these abnormalities in the mitral valve apparatus, which may be associated with functional impairment, were diagnosed during life by M-mode and two-dimensional echocardiography.

Adult↗
PubMed1980

Echocardiographic practice in a large metropolitan area.

A survey performed concerning echocardiography in a metropolitan area. Of 110 hospitals in the area, 62 reported having echocardiographic facilities. Echocardiographic physicians and/or technicians from 41 of these hospitals responded to questionnaires designed to determine the following: (1) educational background and credentials of technicians, (2) average salaries of technicians, (3) role of the physician and technician in the performance and reporting of echocardiograms, (4) volume, cost, and method of storage of echocardiograms, and (5) number and type of echocardiographic units in use. Our data suggest various trends, including a lack of formal training among technicians, the prevalence of cardiologists-internists as directors of echocardiographic facilities, the performance of echocardiograms by cardiology fellows in only 46% of institutions with cardiology training programs, and the widespread projected availability of cross-sectional echocardiographic capability within the next two years.

Allied Health Personnel↗
PubMed1979

Submitral calcification or sclerosis in elderly patients: M mode and two dimensional echocardiography in "mitral anulus calcification".

Submitral calcification or sclerosis was visualized with M mode echocardiography in 84 elderly patients, 35 of whom were also studied with two dimensional echocardiography. Posterior submitral calcification, commonly referred to as "mitral anulus calcification," was present in 82 patients and was located in the angle between the posterior mitral leaflet and left ventricular posterior wall, rather than in the mitral anulus proper. M mode scans from the left ventricle to the left atrium showed that posterior submitral calcification ended abruptly in 66 cases, and in these it became contiguous with the posterior atrioventricular junction (true mitral anulus) in only 14 instances, in 16 patients the posterior submitral calcification sloped anteriorly to merge with the posterior aortic root. Anterior submitral calcification was visualized in 12 patients, 10 of whom also had posterior submitral calcification. Anterior submitral calcification was usually located immediately anterior to the base of the anterior mitral cusp. In two cases, if appeared to arise in the region between the aortic and mitral rings; in one instance, it was located in the mid left ventricle, in the mitral chordal region. We suggest that the terms anterior and posterior submitral calcification are more appropriate than "mitral anulus calcification" because in most cases such calcific deposits do not appear to be located in or to arise from the true mitral anulus.

Age Factors↗
PubMed1977

Potential pitfalls in quantification of pericardial effusions by echocardiography.

In the echocardiographic assessment of patients with pericardial effusions, the apparent width of the echo-free space between the left ventricular posterior wall and the parietal pericardium is commonly used to estimate the amount of pericardial fluid present. In 4 patients with pericardial effusions, we showed a distinct disparity between the widths of the posterior pericardial space at different levels of the left ventricular posterior wall. In 2 of them, a 'swinging heart' appearance was recorded when the ultrasoound beam was directed caudally, but not when its direction was cephalad or less caudad. It is suggested that the left ventricle should be scanned at all possible sites to minimise potential errors in estimating the amount of a pericardial effusion.

Adult↗
PubMed1977

Tachycardia and bradycardia-dependent bundle branch block alternans: clinical observations.

Eleven patients with tachycardia-dependent, bradycardia-dependent, or "pseudobradycardia-dependent" bundle branch block (BBB) alternans were studied. This classification is based on the following criteria: 1) When alternans is initiated by a sudden acceleration in ventricular rate, or it appears with aberration of the second beat after a pause, the alternans is tachycardia-dependent and results from a 2:1 bidirectional block in the affected bundle branch. 2) When alternans begins with the aberrant complex terminating a pause it is bradycardia-dependent; such an alternans results from alternating bundle branch cycle lengths and refractoriness, possibly produced by alternating transseptal retrograde penetration of the affected bundle branch. 3) In cases referred to as "pseudobradycardia-dependent BBB" alternans, a change from alternans to persiscardia-dependent BBB" alternans, a change from alternans to persistent BBB occurs as the cycle lengthens; however, the disappearance of BBB with further increase of the cycle length proves the tachycardia-dependence of the conduction defect.

Aged↗
PubMed1976

Flutter of left ventricular structures in patients with aortic regurgitation, with special reference to patients with associated mitral stenosis.

Echocardiography was performed in 45 patients with aortic regurgitation. Forty showed a high frequency diastolic flutter of the mitral valve, which was holodiastolic in all but the patients with associated mitral stenosis. Of four patients with coexisting mitral stenosis, mitral flutter was absent in two; in the other two, in atrial fibrillation, mitral flutter occurred, but only during a fixed interval after mitral valve opening, irrespective of cycle length. A fine flutter of similar frequency was observed on the left ventricular aspect of the ventricular septum in 12 patients. In six of these it was of slight degree and restricted to early diastole and the high septum; in four others (three of whom had associated mitral stenosis), the septal flutter was more marked, holodiastolic, and present over all parts of the septum scanned; in two, it was holodiastolic over the high septum but early diastolic at lower septal levels. Aortography performed in 19 patients showed that septal flutter was present in seven of 12 patients in whom the regurgitant aortic jet was directed forward to the ventricular septum, whereas in the other seven patients with no septal flutter, the jet was directed away from the septum. Septal flutter is useful as an echocardiographic sign of aortic regurgitation, especially in the presence of mitral stenosis when mitral flutter may be absent or exceeded by septal flutter in both amplitude and duration, and when the mitral valve has been replaced by a prosthetic valve. Vibration of the septum appears to be attributable to the regurgitant aortic jet impinging on it and may contribute to the production and radiation of the characteristic diastolic murmur of aortic regurgitation.

Adolescent↗
PubMed1976

Concealed intraventricular conduction in the His bundle electrogram.

Multiple areas of concealed intraventricular conduction are deduced on the basis of aftereffects observed in His bundle recordings. Electrocardiograms and His bundle recordings are presented from two patients with unstable bilateral bundle branch block, the instability of which depended on the interval at which ventricular depolarization was initiated by sinus or paced impulses. This circumstance allows postulation of 1) concealed transseptal retrograde penetration of the left bundle branch system; 2) concealed transseptal retrograde penetration of the right bundle branch system; 3) alternate beat Wenckebach phenomenon with two areas of block in the bundle branch system with concealed penetration of the proximal area; 4) concealed re-entry in the right bundle branch system during an H-V Wenckebach cycle with resetting of the sequence of 2:1 H-V block and return of the re-entry wave to the A-V node causing subsequent A-H block; 5) proximal 2:1 block and distal Wenckebach block producing only two consecutively blocked beats; and 6) infrahisian Wenckebach block with changes both in A-V conduction and QRS contour.

Aged↗
PubMed1976

Echocardiography in mechanical alternans. With a note on the findings in discordant alternans within the left ventricle.

We described the echocardiographic manifestations of mechanical alternation of left ventricular (LV) contraction during regular sinus rhythm. Chronic LV dilatation and failure existed in all our four cases. Alternation was observed with respect to the following echocardiographic variables: amplitude and rate of increase of amplitude of systolic excursions of the LV posterior wall and ventricular septum (VS); reciprocal changes in the duration of LV ejection and pre-ejection periods (on the aortic valve echo) such that the total duration of LV electromechanical systole remained constant; reciprocal changes in the duration of RV ejection and pre-ejection periods (on the pulmonic valve echo) such that the total duration of RV electromechanical systole remained constant; systolic anterior excursion of the aortic root as a whole; steepness of the mitral EF slope; septal and LV posterior wall diastolic position; and end-systolic LV diameter. In two patients, discordant alternans of the motion of the LV posterior wall and the VS was observed.

Adult↗
PubMedDate not supplied

Cerebral embolism in the Michael Reese Stroke Registry.

Infarction secondary to cerebral embolism was diagnosed in 127 (23.5%) of 540 patients in the Michael Reese Stroke Registry. Coronary artery disease, atrial fibrillation, valvular heart disease, mitral annulus calcification, and cardiomyopathy were the commonest etiologies. Echocardiography documented a potential embolic source in 7 patients without previously known heart disease, and clarified the cardiac pathology in many of the patients with known heart disease. The left anterior circulation was affected in 48%, right anterior in 37%, and posterior circulation in 15% of patients. CT was abnormal in 71% of the patients, and was approximately equally helpful in all locations. Nineteen percent of emboli presented with a deficit that was other than maximal at onset. Concurrent systemic embolism was unusual (2.3%). Prognosis was somewhat worse than in thrombotic stroke. Grouping of patients according to embolic source (intra-arterial, cardiac, and uncertain source) showed no differences in activity at onset, early course, or in subsequent course of the illness.

Aged↗