bluuebunny/crossref_metadata_2025 huggingface dataset:
Cyanotic Malformations of the Heart with Pheochromocytoma
Authors: FOLGER GORDON M. , ROBERTS WILLIAM C. , MEHRIZI ALI , SHAH K. D. , GLANCY D. L. , CARPENTER CHARLES C. J. , ESTERLY JOHN R.
Published: June 2012

The clinical and pathologic features of five patients with pheochromocytoma associated with congenital cyanotic cardiac malformations have been described. This association appears to be more than mere coincidence. Chronic hypoxemia may be a significant factor in the development of this rare endocrine tumor in such patients. The finding of systemic hypertension combined with episodes of nervousness and sweating or repeated severe headaches initially aroused suspicion of a pheochromocytoma in the three patients in which this tumor was diagnosed clinically.
Cardiac Myopathy, Probably of Congenital Origin
Authors: RUTTENBERG HERBERT D. , JUE KENNETH L. , ELLIOTT LARRY P. , ANDERSON RAY C. , EDWARDS JESSE E.
Published: June 2012

The clinical and pathologic findings are presented in a 1-year-old child with an unusual cardiac myopathy of the left ventricle. [see figure in the PDF file] [see figure in the PDF file] The clinical findings suggested the diagnosis of anomalous origin of the left coronary artery from the pulmonary trunk. These features included insidious onset of cardiac failure in the first year of life, massive cardiomegaly with nearly normal pulmonary vasculature, absence of cyanosis and of a cardiac murmur, and electrocardiographic and vectorcardiographic findings of left ventricular hypertrophy with severe myocardial ischemia or infarction.

[see figure in the PDF file]

Angiocardiograph studies, which did not support this diagnosis, revealed an aneurysmally dilated left ventricle with unusual internal septations and loculations.

The necropsy showed concentric semicircular muscular ridges and grooves in the apical portion of the left ventricle and a peculiar fibrous endocardial network of the same chamber. It is suggested that this process may be congenital in origin.
Cyanosis, Cardiomegaly, and Weak Pulses
Authors: WALKER WELDON J. , MULLINS CHARLES E. , KNOVICK GEORGE C.
Published: June 2012

An infant was seen at 2 days of age with cardiomegaly, congestive failure, cyanosis, and weak pulses. The primary cardiovascular lesion was a massive arteriovenous fistula between the left subclavian artery and innominate vein.

Review of the literature indicates that most newborn infants with large systemic arteriovenous fistulas leading to congestive failure have been cyanotic. The hemodynamic alterations incident to large experimental systemic arteriovenous fistulas affords an explanation for this cyanosis.

It is suggested that massive systemic arteriovenous fistula in the newborn lowers systemic resistance to a fraction of the high pulmonic resistance present at this age. The right ventricle bears the brunt of the increased cardiac work. Right ventricular failure associated with a marked increase in systemic venous return to the right atrium elevates right atrial pressure above that in the left atrium and almost inevitably leads to cyanosis with right-to-left shunting of blood through the foramen ovale.

Failure to realize that massive systemic arteriovenous fistula in the newborn may present as cyanotic heart disease can cause fatal delay in recognizing this correctable form of heart failure.
Painless Dissecting Aneurysm of the Aorta
Authors: O'DONOVAN T. P. B. , OSMUNDSON PHILIP J. , PAYNE W. SPENCER
Published: June 2012

A case is reported of a man who had an acute painless dissecting hematoma of the aorta, which was diagnosed clinically in the absence of hypertension or known precipitating cause. The successful surgical treatment is described and illustrated.

The following diagnostic features were stressed in the absence of pain: sudden onset of symptoms, syncope, acute peripheral arterial occlusion, appearance of aortic insufficiency, and finding of bruits over the course of the aorta. The significance of the symptom of pain in the torso and the possible modes of its production in this condition are considered, and it is suggested that pain in dissecting aneurysm may imply a poor prognosis.
Glucose Blockage of the Increase in Stroke Volume Produced by Smoking
Authors: MOSES DAVID C. , POWERS DONALD , SOLOFF LOUIS A.
Published: June 2012

The percentage changes in the cardiac output, stroke volume, and heart rate were determined in seven healthy habitual smokers after smoking, after glucose, and after smoking preceded by glucose. No significant changes occur after glucose. There is a significant increase in cardiac output, stroke volume, and heart rate after smoking. Pretreatment with glucose did not change the heart-rate response to smoking. Nevertheless, the cardiac-output response was diminished. This decrease is due to a block in the increase in stroke volume induced by smoking.
Ventricular Septal Defect with Aortic Regurgitation
Authors: NADAS ALEXANDER S. , THILENIUS OTTO G. , LAFARGE C. GRANT , HAUCK ANNA J.
Published: June 2012

Thirty-four patients with ventricular septal defect and aortic regurgitation, representing less than 5 per cent of our patients with ventricular septal defect, are discussed.

A loud, systolic murmur, characteristic of ventricular septal defect, is noted during infancy, whereas evidences of aortic regurgitation (protodiastolic murmur and wide pulse pressure) does not usually appear until sometime between 2 and 10 years of age.

Clinical and catheterization data indicate that the principal hemodynamic load is aortic regurgitation, whereas the ventricular septal defect does not usually result in a large pulmonary blood flow or high pulmonary arterial pressure. In about 50 per cent of the patients, a significant pressure gradient across the right ventricular outflow tract exists.

Detailed pathologic studies indicate that the ventricular septal defects are high and anterior and encroach to a greater or lesser degree on the membranous bulbar septum. The right coronary cusp is the one most severely involved, and, by its prolapse, causes aortic regurgitation; the noncoronary cusp is always less severely affected. The anatomic basis of the pressure gradient observed across the right ventricular outflow tract is not always clear.
A New Clip Electrode for Clinical Electrocardiography
Authors: HERRMANN GEORGE R.
Published: June 2012

Solid copper no.-27C weak-spring batter-clip electrodes have been found quite suitable for rapid application to patients. These electrodes should be especially useful to electrocardiographers and technicians under emergency situations as well as in routine heart-station work.
Relationship of the Azygos Venous System to Normal Atrial Situs in Levocardia
Authors: LEACHMAN ROBERT D. , SLOVIS ARNOLD J.
Published: June 2012

Levocardia with abdominal visceral situs inversus is associated with complex intracardiac malformation and most often with inversion of the atria.

In patients with levocardia, if the azygos venous system replaces the inferior vena cava as the principal or only avenue of venous return from below the diaphragm, the position of the right and left atria may be normal.

Patients with levocardia associated with simple ostium secundum atrial septal defects that were surgically corrected are briefly presented.
Circulatory Dynamics in the Presence of Carotid-Jugular Fistula
Authors: HOLMES THOMAS W.
Published: June 2012

Two patients are presented, in whom right common carotid artery-internal jugular vein fistula had been patent for 12 years. These cases provide the longest reported follow-up of patients with surgically created carotid-jugular fistulas.

Marked cardiac hypertrophy, a systolic murmur in one patient, and arterial hypertension in the other, proved reversible following repair of the fistulas.

Alterations in circulatory dynamics before and after repair are correlated with established phenomena associated with arteriovenous fistulas of various size, duration, and anatomic location.
The Natural History of Ventricular Septal Defect in Patients Surviving Infancy
Authors: BLOOMFIELD DANIEL K.
Published: June 2012

It is now possible to synthesize the natural history of ventricular septal defect. Size is fundamental, and stemming from it, the smaller defects (groups 1 and 2) separate from the larger (groups 3, 4, and 5) immediately at birth. Apparent size may differ from real size, for defects may become partially closed by tricuspid valve leaflets, or be gradually obstructed by an enlarging aneurysm of the sinus of Valsalva. One instance has been observed in which a muscular defect was obstructed by a large papillary muscle. The reverse may also occur, i.e., a partially obstructed defect may enlarge as a blocking tricuspid leaflet detaches or tears.
The Effect of Posture and of Compression of the Neck on Excretion of Electrolytes and Glomerular Filtration: Furthur Studies
Authors: VIAR W. N. , OLIVER B. B. , EISENBERG SEYMOUR , LOMBARDO T. A. , WILLIS KATHRYN , HARRISON T. R.
Published: June 2012

Compression of the neck of the sitting subject caused increase in urinary sodium output without change in glomerular filtration (creatinine clearance) or apparent cardiac output (electrokymograph). The possible existence of an intracranial mechanism sensitive to alterations in volume of extracellular fluid and regulating the volume of extracellular fluid is suggested.
Early Relief of Chest Pain by Ethyl Chloride Spray in Acute Coronary Thrombosis
Authors: TRAVELL JANET
Published: June 2012

Within a few minutes after its onset, intense pain of acute myocardial infarction was abolished by briefly spraying the precordium with ethyl chloride. Prompt relief of pain did not prevent tissue necrosis, but may have ameliorated the clinical course. We infer that the stimulus for pain in acute infarction is of extremely short duration but gives rise to a secondary, self-sustaining pain cycle which may be terminated by altering the flow of nerve impulses from the skin. The case also illustrates the increased susceptibility to digitalis which develops some days after myocardial infarction.
The Patent Ductus Arteriosus
Authors: GROSS ROBERT E. , LONGINO LUTHER A.
Published: June 2012

A patent ductus arteriosus can be recognized with a high degree of accuracy by auscultation and simple office examination. Electrocardiographic and fluoroscopic studies are helpful, but it is rarely necessary to employ more elaborate and expensive forms of investigation. While the condition seldom causes serious incapacitation in early life, it is apt to be accompanied by a very high percentage of serious complications in later life. These facts give strong backing to the conviction that it is desirable to operate upon all children possessing a patent ductus—even though they are asymptomatic at the time—because it is technically much easier to perform a surgical closure of the vessel in this period. Ligation or suture-ligation is successful in a high proportion of cases, but a complete division of the vessel is the ideal method of therapy. In a consecutive series of 369 cases of division there have been no deaths from hemorrhage. The total mortality rate has been 2.1 per cent. For patients who had no complications prior to surgery, the mortality rate was under one-half of one per cent.
Hepatorenal Factors in Circulatory Homeostasis
Authors: SHORR EPHRAIM , ZWEIFACH BENJAMIN W. , FURCHGOTT ROBERT F. , BAEZ SILVIO
Published: June 2012

Studies were carried out in dogs and rabbits subjected to hemorrhagic and tourniquet shock to determine the tissue origins of two newly described vasotropic principles, VEM and VDM. The vasoexcitor principle, VEM, predominates in the blood during the initial compensatory stage and was traced to the kidney. The vasodepressor principle, VDM, prevails during the decompensatory phase and was found to originate in the liver, skeletal muscle and spleen. During the decompensatory phase, there was a progressive deterioration of the hepatic mechanisms for inactivating VDM. Sequential tissue hypoxia during shock is probably responsible for the formation of these vasotropic principles and for the deterioration of the hepatic VDM inactivation system. Special emphasis is placed on the effects of local concentrations of VDM within the liver and on the resultant diversion of blood from the general circulation into the splanchnic viscera.
Pathology of the Pulmonary Vascular Tree
Authors: BECKER DONALD L. , BURCHELL HOWARD B. , EDWARDS JESSE E.
Published: June 2012

Two cases of mitral insufficiency are reported. In 1 case the lesion was produced by rupture of the chordae tendineae of the posterior leaflet of the mitral valve. In the other case it was produced by fibrous adhesion of the posterior leaflet of the mitral valve to the underlying left ventricular wall, which occurred during healing of subacute bacterial endocarditis. Changes occurred in the pulmonary vascular bed which are essentially identical with those found in mitral stenosis.
The Effect of "Sympatholytic Drugs on the Cardiovascular Responses to Epinephrine and Norepinephrine in Man
Authors: FREIS EDWARD D. , MACKAY J. CALVIN , OLIVER WILLIAM F.
Published: June 2012

Under controlled conditions the effects of various "sympatholytic" agents on the cardiovascular responses to epinephrine and norepinephrine were compared in man. The dosages of the sympatholytic drugs administered approximated those usually employed clinically. Such basic data are given for the following agents: Dibenamine, the imidazoline derivatives [Priscoline and Regitine (C-7337)], the dihydrogenated alkaloids of ergot (D.H.K. and C.C.K.), L-hydrazinophthalazine (C-5968), tetraethylammonium, and hexamethonium (C6).
An Intracardiac Manometer: Its Evaluation and Application
Authors: ELLIS EUGENE J. , GAUER OTTO H. , WOOD EARL H.
Published: June 2012

The miniature intracardiac manometer supplied a method for recording artefact-free pressure tracings from the heart and great vessels of man and the intact animal. This instrument has been applied to the procedure of cardiac catheterization. It has also been used to demonstrate that if motion artefacts can be minimized, the central pulse can be recorded with reasonable accuracy by means of manometric systems with relatively poor dynamic response. Illustrations of pulse waves within the heart and great vessels of man and dogs and the effects of varying the dynamic response of the recording system are included.
The Effect of Digitoxin on Sodium Excretion, Creatinine Clearance and Apparent Cardiac Output
Authors: GREVE M. J. , EDDLEMAN E. E. , WILLIS K. , EISENBERG S. , HARRISON T. R.
Published: June 2012

During the initial phase of decline in cardiac output following the administration of digitoxin to normal subjects, sodium excretion did not decline. Several days later, as cardiac output rose toward the normal level, sodium output decreased in most subjects. The possible implication of these re sults in relation to the regulation of sodium excretion is discussed.
Studies of Tissue Response to Injections of Enzymes
Authors: SCHLAMOWITZ SAMUEL T. , DEGRAFF ARTHUR C.
Published: June 2012

The presence of proteolytic enzymes in blood has been known for a long time. A variety of methods and agents have been employed to activate these enzymes. Among these, is streptokinase, a bacterial kinase obtained from the hemolytic streptococcus. The subcutaneous "nodules" and significant hexosamine alterations which occurred following the single subcutaneous inoculation of crude streptokinase, resembled those obtained with partially purified streptokinase and with trypsin-(crude and crystalline). Although it is possible that the results obtained with streptokinase were due to the direct conversion of the proteolytic enzyme to its active form, and that changes noted with trypsin were due to the nullification of the inhibitor with the concomitant liberation of the free and active enzyme, it is also very possible that both trypsin and streptokinase give rise to the liberation of a tissue activator, which in turn catalyzes the transformation of the proteolytic enzyme to its active form.
Polyarteritis Nodosa
Authors: GRIFFITH GEORGE C. , VURAL I. LUTFI
Published: June 2012

The correlation of the clinical and postmortem findings shows that there is no close relationship between the syndrome of polyarteritis nodosa and the allergic states, that pain is the most common symptom, that congestive heart failure is the common cause of death. There is no consistent relationship of the symptomatology referable to the gastrointestinal, central nervous, and pulmonary systems to the pathologic lesions found. Above all, it is to be noted that although hypertension is one of the most frequent signs of polyarteritis, it may develop very late. Therefore, the rejection of this diagnosis because of the absence of hypertension will lead to error, as may the absence of eosinophilia and subcutaneous nodules.
Acute and Subacute Disseminated Lupus Erythematosus
Authors: GRIFFITH GEORGE C. , VURAL I. LUTFI
Published: June 2012

Eighteen cases of disseminated lupus erythematosus were verified by postmortem study in a series of 19,242 autopsies. Shortness of breath was the most common complaint and occurred in 16. Fourteen of this number had definite cardiac pathology. All 16 had definite pulmonary pathology. Fourteen cases had abnormal urinalysis. Of these cases, 7 had elevated blood nonprotein nitrogen values of over 40 mg., and only 4 had hypertension. However, 14 cases had abnormal pathologic renal findings. Fifteen of the 18 cases had a skin lesion; 11 of the 15 were definitely of the lupus type. Hypochromic anemia was present in 17, leukopenia in 14, elevated sedimentation rate in all cases recorded and an elevated serum globulin in 9. The diagnosis is made by summation of the clinical findings; namely, shortness of breath, joint pains, skin rash, fever, pulmonary, cardiac, and renal abnormalities, and by the laboratory findings of hypochromic anemia, albuminuria, increased sedimentation rate, elevated serum albumin, presence of lupus erythematosus cells, and by a positive skin biopsy.
Physiologic Studies in Mitral Valvular Disease
Authors: DRAPER A. , HEIMBECKER R. , DALEY R. , CARROLL D. , MUDD G. , WELLS R. , FALHOLT W. , ANDRUS E. C. , BING R. J.
Published: June 2012

Physiologic findings obtained by cardiac catheterization on 29 patients with mitral valvular disease are discussed. Cardiac outputs, intracardiac pulmonary arterial and pulmonary pressures are determined during rest and exercise. It is shown that the resting cardiac output is reduced in all patients with mitral disease and that exercise results either in a fall or a small increase in the minute volume of circulation. The pulmonary artery and capillary pressures are elevated with rest and rise further with exercise. A clear differentiation by physiologic means between mitral stenosis and mitral insufficiency is difficult. However, in patients with mitral insufficiency the resting cardiac output is lower, the arterial venous oxygen difference is higher and exercise causes a greater fall in the cardiac output. A comparison is made between the physiologic manifestations of mitral disease and myocardial failure: the residual volume of blood of the right ventricle is usually increased in patients with mitral disease and failure and in myocardial failure alone. However, the right ventricular residual volume is normal in mitral disease without evidence of myocardial failure. The pulmonary vascular resistance in mitral disease is usually elevated. It is demonstrated that in a number of patients the pulmonary vascular resistance is not fixed since it decreases during exercise or following valvulotomy of the mitral valve.
The Electrocardiogram in Congenital Heart Disease
Authors: PAUL OGLESBY , MYERS GORDON S. , CAMPBELL JAMES A.
Published: June 2012

Adequate unipolar electrocardiograms have been recorded on 101 patients with congenital heart disease and the findings analyzed. It has been found that the chief value of such tracings rests in the determination of ventricular preponderance, the evidence being obtained from study of the QRS complexes in unipolar limb and multiple precordial leads, with relatively little help from the RS-T segments and T waves. Auricular hypertrophy, encountered chiefly in association with pulmonic stenosis and tricuspid valve disease, could be best detected by analysis of P waves seen in the right precordial leads rather than in the limb leads. Intraventricular block was observed both with auricular and with ventricular septal defects, and was also found in Ebstein's disease and with coarctation of the aorta. Auriculoventricular block and arrhythmias were rare.
Vibrations of Low Frequency over the Precordium
Authors: JOHNSTON FRANKLIN D. , OVERY DONALD C.
Published: June 2012

A method for taking tracings which represent actual movements of the precordium (displacement curves) or records which show waves proportional to the velocity of movement of the chest wall (velocity curves) is described. The equipment employed is readily available, and the method is easy to use. The displacement curves are nearly identical with cardiograms taken with a good optical setup, and they may have diagnostic value. The velocity curves are more closely related to the functional status of the myocardium. The clinical significance of these tracings, especially the former, is pointed out.
Ventricular Fibrillation Due to Digitalis Preparations
Authors: ENSELBERG CHARLES D. , CROCE JAMES P. , LOWN BERNARD
Published: June 2012

Contrary to expectations, there are very few substantiated clinical case reports of ventricular fibrillation attributable to digitalis preparations. Two cases, one of them fatal, are here described. The nature of ventricular fibrillation due to digitalis is different from that due to other agents. Hence it may not respond to present methods of treatment in the rare cases when opportunity for treatment exists. It is vital therefore to prevent ventricular fibrillation by the avoidance of digitalis when certain premonitory signs are present.
The Effect of Angiocardiography on the Heart as Measured by Electrocardiographic Alterations
Authors: ZINN WILLARD J. , LEVINSON DAVID C. , JOHNS VARNER , GRIFFITH GEORGE C.
Published: June 2012

Six consecutive patients studied by angiocardiography or aortography ranging in age from 1½ to 68 years were checked by a direct-writer type of electrocardiograph during the procedure. The clinical entities consisted of pulmonary stenosis, coarctation of the aorta, aneurysm of the ascending aorta, ventricular septal defect (2 cases), and atrial septal defect associated with complete transposition of the great vessels. Following angiocardiography immediate T-wave depression was noted. This was followed within three minutes by the development of short bursts of ventricular tachycardia lasting up to 27 minutes after dye injection. A different and much less spectacular picture followed aortography. None of these cases showed visible distress.
Studies Utilizing the Portable Electromagnetic Ballistocardiograph
Authors: MANDELBAUM HARRY , MANDELBAUM ROBERT A.
Published: June 2012

A practical method of ballistocardiography, easily adaptable to routine office use, is described. The instrument utilized is a portable electromagnetic ballistocardiograph which records the body movements directly. One hundred normal subjects of all ages were first studied by this method. Observations upon the ballistocardiographic findings in patients with hypertensive and coronary artery heart disease are recorded; particular emphasis is placed upon a specific abnormality in the HIJK complex in the ballistocardiograms of many of these subjects.
Normal Blood Pressure in the Superficial Venous System of Man at Rest in the Supine Position
Authors: OCHSNER ALTON , COLP RALPH , BURCH G. E.
Published: June 2012

The mean and range of venous pressure values in the various body surface areas is presented. Attention is directed to the variability of these values, the constantly decreasing pressure gradient towards the heart, and the essentially equal pressures in corresponding veins on opposite sides of the body. The importance of accurately identifying the vein is emphasized. The relation of venous pressure to age, sex, race and other physiologic factors is commented upon.
Extensive Calcification of the Myocardium
Authors: ERNSTENE A. CARLTON , HAZARD JOHN B.
Published: June 2012

An unusual case of extensive calcification of the myocardium in a 25 year old woman is presented. Presumably it was the result of an earlier severe toxic or septic myocarditis.
Retrograde Conduction from Premature Ventricular Contractions, a Common Occurrence in the Human Heart
Authors: KISTIN ALBERT D. , LANDOWNE MILTON
Published: June 2012

On the basis of studies of esophageal electrocardiograms the authors conclude that retrograde conduction to the atria from premature ventricular beats is common and that the theory of normal unidirectional block in the A-V node is not tenable. In most of the cases with retrograde conduction, the latter is not discernible in simultaneously recorded lead II, which explains why the phenomenon has previously been considered rare. Observations on the ventriculoatrial conduction time and the compensatory pause are presented. In two of the cases there are two orders of magnitude of ventriculoatrial conduction time, which, the authors postulate, may be due to two separate pathways of retrograde conduction.
The Influence of Respiratory Gas Mixtures on Arterial Pressure and Vascular Reactivity in "Normal" and Hypertensive Dogs
Authors: PAGE IRVINE H. , OLMSTED FREDERICK
Published: June 2012

The reactivity of the vascular tree to chemical stimuli is of fundamental importance in both hypertension and shock. Refractoriness and hypotension can be elicited by stimuli arising in the sympathetic ganglions as a result of their stimulation by carbon dioxide. "Total" autonomic ganglionectomy thus prevents the appearance of refractoriness and aids in production of the supernormal hypotensive response to carbon dioxide.

Dogs with renal experimental hypertension differ from those with neurogenic hypertension in that they react normally to carbon dioxide and several other vasoactive substances. The neurogenic hypertensives exhibit greatly heightened depressor responses and hence vasomotor activity. The mechanism for refractoriness is intact in both groups of animals and does not appear overactive in either. The neurogenic mechanism for the production of refractoriness is lost in the sympathectomized animal.
Simplified Determination of Arterial Insufficiency
Authors: WINSOR TRAVIS
Published: June 2012

Reactive hyperemia following 15 minute arterial occlusion at the ankle was studied in plethysmographic tracings using the venous occlusion technic. The resulting curves present an essentially different pattern in normal subjects and patients with various types of peripheral arterial disease. Several characteristic features can be distinguished, notably the level of highest blood flow after release of arterial occlusion, the time required until the highest blood flow is reached, and the degree of secondary vasoconstriction. Evaluation of these factors permits an estimate of the therapeutic value of lumbar sympathectomy.
Ammoniun Chloride Acidosis
Authors: SLEISENGER MARVIN H. , FREEDBERG A. STONE
Published: June 2012

The administration of 6 to 8 Gm. of enteric coated ammonium chloride daily for 7 to 45 days to 6 patients resulted in severe, and in 2 instances nearly fatal, acidosis. Five of the 6 patients had congestive heart failure and one, subacute glomerulonephritis; each of the 5 patients with congestive failure had organic renal disease. The clinical manifestations, differentiation from the low salt syrndrome and the therapy are discussed.
Glossopharyngeal Neuralgia Associated with Bradycardia, Syncope, and Seizures
Authors: KONG YIHONG , HEYMAN ALBERT , ENTMAN MARK L. , MCINTOSH HENRY D.
Published: June 2012

An unusual case of glossopharyngeal neuralgia associated with bradycardia, hypotension, syncope, and seizure is described. Our observations indicate that the cardiovascular components of this syndrome are probably due to stimulation of vagal centers by pain impulses arising from the glossopharyngeal area. Diphenylhydantoin therapy produced satisfactory relief of symptoms in this patient, probably by modification of the intensity of the neuralgic pain and thereby reducing the central vagal response.
Accuracy of the Phonocardiogram in Assessing Severity of Aortic and Pulmonic Stenosis
Authors: GAMBOA RAUL , HUGENHOLTZ PAUL G. , NADAS ALEXANDER S.
Published: June 2012

A critical evaluation was made of the reliability of three easily obtainable phonocardiographic criteria in the estimation of ventricular peak pressure in congenital pulmonic and aortic valvular stenosis.

In 50 patients with pulmonic stenosis the Q-ejection click interval showed a significant inverse relationship to peak pressure (r=–0.77,
p
<0.001), while no significant relationship existed in aortic stenosis (r = 0.40,
p
<0.5). The timing of the peak magnitude of the murmur again related significantly to the right ventricular pressure (r = 0.72,
p
< 0.001) and with the log of pulmonary valve area (r=–0.72,
p
<0.001). In contrast no significant relationships existed in aortic stenosis. The degree of splitting also reflected the severity of right ventricular hypertension (r = 0.84,
p
<0.001), while this measurement in aortic stenosis proved quite variable and did not reflect ventricular peak pressure.

The significance of a combination of these criteria in predicting the severity of right ventricular hypertension and in obviating the need for cardiac catheterization is stressed.

An explanation for the mechanism underlying the observed changes is given. Q-ejection click interval in particular constitutes an indirect but sensitive way (r =–0.90,
p
< 0.001) of estimating the rate of pressure development (dp/dt) in the hypertrophied right ventricle.
Mitral Ball-Valve Prosthesis
Authors: KEZDI PAUL , HEAD LOUIS R. , BUCK BRUCE A.
Published: June 2012

Flow dynamic studies were performed in a mechanical pulse duplicator with Starr-Edwards ball valves. It was shown that the "effective orifice" of the ball valve is less than the measured orifice of the cage of the valve. The orifice is decreased to 83 per cent of the measured orifice in the smaller and to 89 per cent in the larger valves. These measurements corresponded well with the measurements of the "effective orifice" of the valve implanted in patients who were examined by left and right heart catheterization and left ventricular angiocardiograms several months after placement of the valve.

The closing regurgitation found in early systole in the mechanical system appears to be negligible in patients. Left ventricular angiograms did not show reflux of dye into the left atrium through the valve cage.

The size of the mitral annulus in patients was measured from left ventricular angiograms. The size of the mitral ball valve prosthesis which the mitral annulus will accommodate could be predicted with good accuracy from these measurements.
Arrhythmias Related to Cardioversion
Authors: LEMBERG L. , CASTELLANOS A. , SWENSON J. , GOSSELIN A.
Published: June 2012

DC countershock abolished 92 of 101 episodes of atrial fibrillation in 86 patients, an incidence of 91 per cent. Supraventricular arrhythmias were not infrequent immediately after countershock. These were transient and did not complicate the procedure nor were they hazardous to the patient. On two occasions a slow atrioventricular nodal rhythm appeared followed by recurrence of atrial fibrillation a few hours later. Sinus node activity did not return in these patients. Ventricular tachycardia, fibrillation, or standstill did not occur in this series.

The following arrhythmias were observed immediately after countershock but prior to the establishment of a regular sinus rhythm: atrioventricular dissociation, 12 times; passive atrioventricular nodal rhythm, five times; atrioventricular nodal tachycardia, five times; atrial flutter or tachycardia, four times.

The conversion of fibrillation to flutter by countershock implies that the effect of the electric current was merely to shorten the length of the circulating wave, a phenomenon that can also be observed in the treatment of atrial fibrillation with quinidine.

Disorders of rhythm, probably having a different mechanism, were also observed after countershock had established a regular sinus pacemaker. In the group not treated with quinidine prior to countershock (74 episodes) atrial extrasystoles were seen 26 times (35 per cent); atrioventricular nodal extrasystoles or escapes, 18 times (24.3 per cent); atrial flutter or tachycardia, six times (8.1 per cent); atrial fibrillation, eight times (18 per cent); atrioventricular nodal tachycardias, twice (2.6 per cent); and a bizarre, multifocal atrial arrhythmia, once (1.3 per cent). The arrhythmias considered to be responsible for the recurrence of atrial fibrillation and also the possible mechanisms involved were discussed.

Pretreatment with quinidine was effective in reducing the incidence of arrhythmias occurring after conversion (27 episodes), atrial extrasystoles six times (22 per cent), atrioventricular nodal extrasystoles or escapes six times (22 per cent); atrial flutter or tachycardia three times (11 per cent); atrial fibrillation once (3.7 per cent); and atrioventricular nodal tachycardia once (3.7 per cent).
Effect of Transseptal Left Atrial Puncture upon Cardiac Output
Authors: SAMET PHILIP , BERNSTEIN WILLIAM H. , MEDOW AARON
Published: June 2012

Comparisons of cardiac index, mean transit time, and "pulmonary" blood volume were made with indocyanine green dilution curves before and after transseptal left atrial puncture in 105 patients in sinus rhythm and 52 with atrial fibrillation. The results demonstrated that the steady state was not disturbed by transseptal left heart catheterization.
A Simplified Basic Classification of Spatial Alignments of the Heart, Its Chambers, and the Great Vessels
Authors: ROSENBAUM HAROLD D.
Published: June 2012

The problems resulting from a lack of accepted terminology and a basic classification system for the various spatial alignments of the heart, its chambers and great vessels are reviewed. A basic simplified classification system founded on fundamental embryologic, clinical, and roentgenologic considerations is proposed. Terminology employed is precisely defined. The clinical studies needed to place patients in their category are enumerated and discussed. It is recognized that some forms of spatial derangement defy classification within this system. Nevertheless, this classification system with the suggested terminology, however inadequate, is offered as a means to promote clinical definition of these entities and to encourage clear discussion and a better understanding of these conditions. It is hoped that future study will add to our knowledge of the embryologic mechanisms involved and eventually lead to a more comprehensive classification embracing a larger number of congenital cardiac anomalies.
Effect of Chronic Pressure and Volume Overload on Left Heart Volumes in Subjects with Congenital Heart Disease
Authors: MILLER GRAHAM A. H. , SWAN H. J. C.
Published: June 2012

Left heart volumes were determined angiographically in 50 subjects of whom 18 had no abnormality of the left heart, 12 had lesions causing pressure overload of the left ventricle, and 20 had lesions causing volume overload of the left ventricle. The left heart volumes were in the normal range in the presence of pressure overload, but, with volume overload, end-diastolic, end-systolic, and atrial volumes were in excess of normal. A linear relationship was demonstrated between end-diastolic and end-systolic volumes, regardless of the pressure load on the ventricle. Thus, for all but one of the cases studied, total left ventricular ejection volume formed a nearly constant proportion of end-diastolic volume.
Traumatic Tricuspid Insufficiency
Authors: OSBORN JAMES R. , JONES ROBERT C. , JAHNKE EDWARD J.
Published: June 2012

A patient with isolated traumatic rupture of the anterior papillary muscle of the tricuspid valve is described. This is the second such case in the literature.

Clinical observations, hemodynamic data, and details of surgical treatment are discussed.

The diagnosis should be suspected in any patient who initially develops clinical evidence of tricuspid insufficiency following mechanical trauma to the chest or during the course of endocarditis.

Treatment is directed at the associated primary condition, i.e., severe trauma elsewhere in the body or endocarditis. The indications for open-heart surgery will be a matter for decision in individual cases.
The Actions of Cardiac Glycosides on Heart Muscle Cells
Authors: PAGE ERNEST
Published: June 2012

In experimental heart muscle preparations cardiac glycosides specifically inhibit the active transport of Na ions out of heart muscle cells. By this action they bring about a net cellular accumulation of Na and, secondarily, a net cellular loss of K and uptake of Cl, cell swelling, and a fall in the electrical potential difference across the resting cell membrane. The site of inhibition appears to be the external surface of the cell membrane and to involve a displacement of K ions from a critical site at this surface. Inhibition of active transport by cardiac glycosides in intact cells has a counterpart in cell membrane fragments, in which the drugs inhibit the Na- and K-activated enzymatic splitting of adenosinetriphosphate.

The contraction-promoting effect of these drugs is not understood, principally because the sequence of events in cellular contraction and its alterations in heart failure have been only incompletely identified. Cellular contraction has been divided for descriptive purposes into three stages, including depolarization, excitation-contraction coupling, and shortening and relaxation of the myofibrils containing the contractile proteins. Neither the inhibition of active ion transport nor the experimental observations on the three stages of the contractile sequence explain the therapeutic effects of cardiac glycosides. Experimental approaches to the question of cardiac glycoside action at the cellular level and to the related problem of heart muscle cell failure are suggested.
Precordial Vibrations Clinical Clues from Palpation
Authors: DIMOND E. GREY
Published: June 2012

The low-frequency precordial vibrations originating at the point of the apex beat, and especially those in the subaudible range, seem to offer considerable clinical usefulness. In this paper I have briefly outlined some of the physiologic, pathologic, and pharmacologic evidence to support this impression. The instrumentation we have used is crude and undoubtedly we have been misled on occasion by artifacts. However, there is sufficient validity in the technic, reproducibility of result, and correlation with intracardiac events to warrant intensive study.
Renal Biopsy and Its Clinical Correlation in Toxemia of Pregnancy
Authors: ALTCHEK ALBERT
Published: June 2012

Through the combination of a renal biopsy technique modified for pregnant women, electron microscopy, and knowledge of fine (ultramicroscopic) glomerular anatomy, the pathology of the renal glomerular lesion of toxemia of pregnancy (preeclampsia-eclampsia) has been defined. The lesion is pathognomonic and consists of swelling of the cytoplasm of the endothelial cell, deposits underneath the basement membrane and within the swollen endothelial cytoplasm, and an increase of intercapillary cells. The lesion reduces the glomerular capillary lumen. It is the most sensitive pathological lesion of toxemia in the body, and is present in all cases of toxemia. Once formed, the lesion persists until evacuation of the uterus, in spite of apparent clinical improvement with therapy.

The lesion accounts for the characteristically decreased glomerular filtration rate in toxemia, and this may be a factor in the formation of edema. Demonstration of the lesion is the only laboratory method that can reliably differentiate toxemia from uncomplicated essential hypertension (preeclampsia may be superimposed on essential hypertension): the presence of the glomerular lesion indicates toxemia, while absence of the lesion indicates that the illness is not due to toxemia. A severe glomerular lesion indicates impending fetal death.

Although renal biopsy is mainly of investigative use in obstetrics, it is a valid diagnostic tool for discovering or dismissing the possibility of chronic renal disease.
Left Ventricular Performance Following Digitalization in Patients with and without Heart Failure
Authors: MURPHY GERALD W. , SCHREINER BERNARD F. , BLEAKLEY PAUL L. , YU PAUL N.
Published: June 2012

Nine patients, three with left ventricular failure and six with compensated heart disease, were studied by means of right and transseptal left heart catheterization during acute digitalization with acetyl strophanthidin. One of the patients with heart failure and a compensated subject with the Wolff-Parkinson-White syndrome were also studied during supine left leg exercise.

In the decompensated group, digitalization produced a decrease in heart rate and increases in stroke index, stroke work, mean stroke power, mean systolic ejection rate, and the rate of pressure rise in the left ventricle. Left ventricular end-diastolic pressures were markedly lowered after digitalization.

In the compensated group, no significant changes in cardiac index, stroke index, or mean systolic ejection rate were observed. Although there were small increases in stroke work and power and moderate decreases in left ventricular diastolic pressures, the most striking finding was an increase in the rate of rise of left ventricular systolic pressure.

Digitalization produced considerable improvement in the circulatory response to light exercise in a patient with left ventricular failure. Less marked improvement in the exercise response was observed in a patient with normal hemodynamics. After digitalization, left ventricular function points plotted on the stroke work end-diastolic pressure diagram tended to shift upward and to the left in both decompensated and compensated patients. The shift of function points was most prominent in the decompensated group.

This study demonstrates that, in the presence of myocardial failure, acetyl strophanthidin markedly augments left ventricular performance. Furthermore, the data suggest that digitalization also improves left ventricular performance in patients with left ventricular enlargement but no clinical manifestations of heart failure.
The Susceptibility of Dogs with Chronic Impairment of Cardiac Lymph Flow to Staphylococcal Valvular Endocarditis
Authors: MILLER ALBERT J. , PICK RUTH , KLINE IRWIN K. , KATZ LOUIS N.
Published: June 2012

Nine of 16 dogs (56 per cent) with surgically produced chronic impairment of cardiac lymph flow developed acute endocarditis of the mitral valve or acute myocarditis, or both, after intravenous injections of staphylococci, while none of 10 unoperated control dogs did. The results show that chronic impairment of cardiac lymph flow predisposes to staphylococcal endocarditis and myocarditis.

Impairment of cardiac lymph drainage may be important in explaining certain poorly understood pathologic processes in man. Thus, impaired lymph flow may predispose to bacterial endocarditis, recurrent rheumatic carditis, and myocarditis. It may be one of the alterations which perpetuates chronic inflammatory processes in the heart valves and in the myocardium. Inflammation and fibrosis in turn may predispose to impairment of lymph flow, and the latter in its turn will predispose to further inflammation, infection, and fibrosis. Thus a vicious cycle is established. A hypothesis concerning the role of cardiac lymphatics in infection, inflammation, and fibrosis is outlined. There is great need for careful and detailed observations of disease involvement of the cardiac lymphatic system in man.
The Effect of Beta-Sympathetic Blockade on Arterial Oxygen Saturation in Fallot's Tetralogy
Authors: HONEY MICHAEL , CHAMBERLAIN DOUGLAS A. , HOWARD JANE
Published: June 2012

In many patients with Fallot's tetralogy, the fall in arterial oxygen saturation that occurs during exercise can be reduced by prior administration of the beta-sympathetic blocking drug, pronethalol. In a few patients there is also a rise in arterial oxygen saturation at rest.

During exercise, increased stimulation of beta-sympathetic receptors in the heart enhances myocardial contractility; this leads to more complete systolic emptying of the right ventricle, and increased systolic obstruction to ejection of blood into the pulmonary circulation by hypertrophied infundibular muscle. It is this dynamic component of the right ventricular outflow tract obstruction that is abolished or reduced by beta-sympathetic blockade. The phenomenon occurs most readily when valve or high infundibular stenosis is associated with infundibular muscle hypertrophy proximal to the organic obstruction, and can sometimes be demonstrated by angiocardiography.

Beta-sympathetic blocking drugs may have a place in the treatment of cyanotic attacks in Fallot's tetralogy, and possibly in the long-term management of the patients in whom total correction has not yet been undertaken.
The Fate of the Patient with Pulmonic Stenosis
Authors: ENGLE MARY ALLEN , ITO TOMIKO , GOLDBERG HENRY P.
Published: June 2012

The prognosis for the patient with pulmonic stenosis was analyzed from a study of 100 current patients, with long-term observations on 58 of them. Congestive heart failure occurred in seven, all of whom had severe stenosis. Subacute bacterial endocarditis developed in another seven, even when the stenosis was less marked. With appropriate medical supervision of those with mild stenosis who have no cardiac disability, and open-heart surgery for those with more severe obstruction, the outlook for the patient with pulmonary stenosis should be a full and active life.
The Development of Outflow Tract Obstruction of the Left Ventricle in Idiopathic Myocardial Hypertrophy
Authors: TAFUR EMILIO , GUNTHEROTH WARREN G. , BAUM DAVID , BLACKMON JOHN R.
Published: June 2012

A patient was found to have unexplained left ventricular and septal hypertrophy at age 11, but no pressure gradient across the left ventricular outflow tract. At age 13, there was a mean ejection gradient of 82 mm. Hg. The patient died suddenly 1 month later. This patient demonstrates the development of muscular subaortic stenosis in idiopathic myocardial hypertrophy with obstruction due to increasing muscular hypertrophy.

A second patient with left ventricular hypertrophy secondary to a fixed left ventricular outflow tract obstruction produced by an anomalous insertion of a mitral valve leaflet developed additional obstruction due to septal hypertrophy.

We believe that the cases presented establish that "muscular subaortic stenosis" may be the result of ventricular hypertrophy of different etiologies. A schema is presented to assist classification of muscular subaortic stenosis.
Ebstein's Anomaly Associated with Cardiomyopathy and Pulmonary Hypertension
Authors: SUMNER ROBERT G. , JACOBY WILLIAM J. , TUCKER DONALD H.
Published: June 2012

A patient is described with cardiomyopathy and intracavitary electrocardiographic findings typical of Ebstein's anomaly of the tricuspid valve. The cardiomyopathy was characterized by extreme thickness of the left ventricular wall on angiocardiography, elevated end-diastolic pressures of the ventricles, and prominent "a" waves in the atrial pressure pulses. Moderately severe pulmonary hypertension, which has not previously been described in Ebstein's anomaly, was also attributed to the cardiomyopathy. This case illustrates the increasing number of associations with which Ebstein's anomaly has been reported and emphasizes the importance of considering this diagnosis in planning the cardiac catheterization of patients with congenital heart disease. The necessity of demonstrating coexisting Ebstein's anomaly in patients with congenital heart disease is indicated by the formidable mortality of such patients at surgery.