Present status of diuretics in the management of hypertension.
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Biomedical subjects
Publications and source records attributed to S R Mittal.
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Surface electrocardiograph of twelve cases of isolated left ventricular inferior infarction and 24 cases of biventricular inferior infarction confirmed by two-dimensional echocardiography were analysed. ST segment elevation in lead III more than in lead II and ST segment depression in leads I and aVL were highly sensitive in diagnosing right ventricular involvement. ST segment depression in lead V3 equal to or greater than ST segment elevation in lead III was highly specific but had low sensitivity. These findings can be helpful in cases where right sided chest leads have not been recorded or are inconclusive.
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Right ventricular enlargement on left anterior oblique view at 60 degrees had low sensitivity (58.8%) but very high specificity (100 %) for diagnosing right ventricular infarction. Right ventricular and right atrial enlargement on other views had very low sensitivity (16.7-26.7%) but high specificity (80-90%). Thus chest X-ray in left anterior oblique view at 60% is useful in detecting right ventricular infarction when clinical examination and electrocardiogram are inconclusive.
Four cases of congenital heart disease with right ventricular overload and echocardiographic evidence of persistent right ventricular regional wall motion abnormalities are presented. Right ventricular infarction could be a possibility. Such regional wall motion abnormalities could add to overall right ventricular dysfunction in these cases. Echocardiography is useful in diagnosis. Right ventricular wall motion abnormalities should be studied in detail in all cases of congenital heart disease with right ventricular overload.
Jugular venous pressure (measured clinically) and pulse wave form (recorded at 100 mm/s) were analysed in 44 cases of first acute myocardial infarction and 10 age-matched controls. Patients were divided into different groups according to site of infarction decided by detailed 2-D echocardiography. Raised jugular venous pressure had high specificity (96.8%) but low sensitivity (39%) in diagnosing right ventricular infarction. Positive Kussmaul's sign had equal specificity but lower sensitivity (26.1%). Rapid 'y' descent had high specificity (100%) but low sensitivity (17.3%) in diagnosing right ventricular infarction. Jugular venous pressure and pulse wave form are significantly affected by the magnitude of damage to interventricular septum and left ventricular free wall.
Fifty cases of acute myocardial infarction manifesting in anterior chest leads were studied. The site of infarction was determined by detailed two-dimensional echocardiography. Isolated left ventricular anteroseptal infarction was found in 32 patients, infarction of the anterior wall of the left as well as the right ventricle in 12, and infarction localized to the right ventricular anterior wall in 6. ST-segment depression followed by deep symmetrical T wave inversion, increasing in depth from lead V1 to lead V3 without loss of the R wave in these leads, was highly sensitive and specific in detecting isolated right ventricular anterior wall infarction. ST-segment elevation in right-sided chest leads was not useful. Concomitant ST-segment depression in inferior leads was highly specific and sensitive in diagnosing infarction of the right ventricular anterior wall in the presence of left ventricular anterior infarction.
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Mortality due to hypertrophic cardiomyopathy is only around one percent per annum in unselected patients [1]. Therefore, the incidence of sudden cardiac death is still lower. However, identification of this small subgroup is important because prophylactic intervention may reduce mortality [2-5]. Unfortunately, we still do not have an accurate method of identifying this high risk subgroup.
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A case of isolated right ventricular infarction in a young female with hypertrophic cardiomyopathy is reported. This case highlights the importance of detailed evaluation of right ventricle in cases with hypertrophic cardiomyopathy.
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