Echocardiographic diagnosis of supravalvular aortic stenosis

The echocardiographic features of supravalvular aortic stenosis seen in a patient with valvular aortic and multiple pulmonary branch stenosis are described. Since patterns of valvular, discrete subvalvular, and supravalvular aortic stenosis can be recognized by echocardiography, it is now possible to screen close relatives of patients having supravalvular aortic stenosis and pulmonary branch stenosis by this non-invasive technic.

Infective endocarditis as a complication of heroin use

Infective endocarditis in heroin addicts has been reported to have a mortality as high as 85% and reports have varied widely regarding predominant valvular involvement and infecting microorganisms. A retrspective study was done and 61 cases of heroin-associated infective endocarditis were identified at Freedmen's Hospital and the District of Columbia General Hospital, Washington, DC between January 1969 and January 1973. Our results indicate that staphylococcal infection of the tricuspid valve has a much higher incidence in this population than has generally been believed and that it is the predominant presentation of infective endocarditis in these patients. The outcome of patients in our series compares favorably with previous reports and suggests that early diagnosis and prompt institution of appropriate antimicrobial therapy are important and may lead to improved survival in addicts with tricuspid endocarditis.

Loud first heart sound with long P-R intervals

A case of partial atrioventricular block with Wenckebach periods and a loud first heart sound (S1) associated with the longest P-R interval of the cardiac cycles is described. Although the surface electrocardiogram provided no clues to this paradoxical behavior, the intraatrial electrogram revealed that the long P-R interval with the loud S1 was accompanied by atrial echoes (reciprocal atrial beats). The loud S1 with a very long P-R interval was always caused by an atrial contraction synchronous with the QRS complex.

The abrupt withdrawal of antiparkinsonian drugs in schizophrenic patients

Phenothiazines and other neuroleptic drugs are known to cause extrapyramidal side-effects. Consequently antiparkinsonian (AP) drugs are commonly prescribed at the same time as antipsychotic medication in order to prevent these complications. Once this medication has been started it may be continued for prolonged periods.