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In a sample of 114 patients, 6 patients developed hypertension while taking tricyclic antidepressants. All these patients were diagnosed as having panic disorder, with or without major depression. Half of the 6 patients had a previous diagnosis of hypertension, which had been well controlled by antihypertensive drugs for years. A comparison group of patients with major depression, who had never had panic attacks, had no cases of hypertension induced by these antidepressants. These findings raise the possibility that patients who have panic disorder may experience cardiovascular disregulation that increases their risk for antidepressant-induced hypertension.

Fluttering of the anterior mitral leaflet may be absent in patients with moderate to severe aortic regurgitation (AR), suggesting that the volumetric severity of AR alone does not determine the presence or absence of abnormal diastolic mitral valve motion. Fifteen patients with moderate to severe AR and normal mitral valves, 9 of whom demonstrated anterior mitral leaflet fluttering, were studied to elucidate the determinants of abnormal anterior mitral leaflet motion in these patients. Pulsed Doppler mapping of the flow-velocity disturbance of AR demonstrated its presence in the third of the left ventricular outflow tract adjacent to the anterior mitral leaflet in 8 of 9 patients with anterior mitral leaflet fluttering and none of the 6 patients without anterior mitral leaflet fluttering (p less than 0.02). The impact of this regurgitant jet on early diastolic transmitral inflow was examined with pulsed Doppler in these 2 groups of patients with AR and in age-matched control subjects. Deceleration of early diastolic transmitral filling was slower in patients with AR and anterior mitral leaflet fluttering than in age-matched control subjects (283 +/- 107 vs 457 +/- 176 cm/s2, p less than 0.02), whereas it was not significantly different from controls in AR patients without anterior mitral leaflet fluttering. This resulted in significant prolongation of the duration of early diastolic transmitral filling in patients with AR and anterior mitral leaflet fluttering (297 +/- 93 vs 203 +/- 44 ms for age-matched control subjects, p less than 0.02), which was not observed in patients with AR who did not have anterior mitral leaflet fluttering.(ABSTRACT TRUNCATED AT 250 WORDS)

To characterize the contour and duration of aortic flow-velocity waveforms in the normal human, the ascending aorta of 23 persons without evidence of cardiovascular disease was examined systematically with pulsed Doppler echocardiography. In 16 of the 23 subjects, measurements throughout the ascending aorta showed flow-velocity waveforms of similar contour and duration, characterized by flow-velocity peaking in early to midsystole, with most flow velocity (60 +/- 4%) occurring in the first half of the available systolic ejection period, and then gradually decreasing to 0 baseline coincident with aortic valve closure. In the other 7 subjects, aortic flow-velocity waveforms recorded at most of the sampling sites also revealed a normal flow-velocity pattern; however, in each of these subjects, 1 to 3 sites that displayed a distinct alteration from the normal pattern were also identified. The waveforms recorded from these latter sites were characterized by flow-velocity peaking earlier in systole and decelerating to 0 baseline approximately 100 ms before aortic valve closure; consequently, a particularly large fraction of flow velocity (88 +/- 9%) occurred in the first half of the systolic ejection period. These apparently shortened waveforms were always detected at sites near the medial aortic wall and often at or near the junction of the ascending and transverse aorta. Hence, aortic flow-velocity waveforms with altered contour and duration (resembling those recorded in patients with obstructive hypertrophic cardiomyopathy) were infrequently identified by pulsed Doppler echocardiography in subjects with normal hearts and were not characteristic of the overall aortic flow-velocity pattern in any of these subjects.(ABSTRACT TRUNCATED AT 250 WORDS)