bluuebunny/crossref_metadata_2025 huggingface dataset:
Radiological Findings in Endomyocardial Fibrosis
Authors: COCKSHOTT W. PETER , ŠARIĆ SUZANNA , IKEME A. C.
Published: June 2012

The radiological findings in 102 cases of endomyocardial fibrosis occurring in Equatorial Africa are presented. Postmortem studies confirmed the diagnosis in 39 cases. Angiocardiography was done in 78. The right side of the heart was primarily involved in 48 patients and the cardiac silhouette was characteristically globular suggesting a pericardial effusion, the large heart having a conspicuous background of oligemic pulmonary fields. Angiocardiography usually revealed a dilated right atrium and ventricle, extremely slow transit of the contrast material, and tricuspid incompetence. Occasionally, a filling defect in the right atrium, interpreted as thrombus, was seen.

The left side of the heart was established as being primarily involved in 13 cases and the picture of rheumatic mitral disease was simulated. Angiocardiography revealed a rather small left ventricle and mitral regurgitation. Biventricular disease was present in 42 patients, the main differentiating point in routine films from right endomyocardial fibrosis being the size of the superior pulmonary veins. The complete diagnosis is difficult to detect without angiographic studies.
Vectorcardiographic Changes During Intracoronary Injections
Authors: SMITH RAPHAEL F. , HARTHORNE J. WARREN , SANDERS CHARLES A.
Published: June 2012

To determine mechanisms of myocardial toxicity of radiopaque media and to correlate specifically induced changes in the composition of coronary artery blood with changes in the surface electrocardiogram, simultaneous recordings were made from Frank leads X, Y, and Z during intracoronary injections of radiopaque media and special test solutions. The study group consisted of 19 patients, 29 to 64 years of age, with either abnormal or normal-appearing coronary vessels on cineangiography. Recordings were analyzed with an electronic integrator, an oscilloscope, and directly from photographic tracings.

With injections of sodium-containing radiopaque media into the right coronary system, the spatial mean T vector increased in magnitude and deviated to the left and superiorly. With injections into the left coronary system, the T vector increased in magnitude and shifted to the right, downward, and anteriorly. Changes in the QRS complex were less constant but, when present, consisted of slight prolongation of the QRS duration and shift of the QRS vector toward the area of myocardium perfused by the coronary system injected.

Similar T-vector changes could be produced by intracoronary injections of saline solutions, but minimal or no changes were observed with injections of hypertonic mannitol, Ringer's solution, hypoxic blood, plasma, and 5% dextrose in water.

It is concluded that the T-wave changes are caused by regional prolongation of the repolarization process, presumably due to extracellular sodium excess or sodium-calcium antagonism. Delay of the repolarization process and the resulting potential difference may be responsible for re-entrant excitation and the ventricular arrhythmias observed during coronary angiography.
The Ultra Low Frequency Force Ballistocardiograph in Acute Cardiomyopathy
Authors: PHIBBS BRENDAN , LOWE CHARLES R. , HOLMES ROY W.
Published: June 2012

In this study, ultra low frequency force ballistocardiograms were recorded throughout the course of various types of acute cardiomyopathy. Conditions studied included rheumatic carditis, lupus myocarditis, sarcoid carditis, viral myocarditis, acute glomerulonephritis, idiopathic myocarditis, and familial fibrous disease of the myocardium. The instrument used was characterized by an unusually light platform and a very high performance accelerometer. In 14 of the 15 cases studied, tracings were abnormal initially; the recorded force pattern subsequently manifested progressive change which appeared to parallel the clinical course of the disease. Changes included appearance of abnormal forces in early ventricular systole, progressive change in amplitude of acceleration and deceleration forces, appearance of abnormal high frequency components in various portions of the complex, and appearance of abnormal footward forces in late systole.

The alterations thus recorded appear to offer a useful means of diagnosing and following the course of such disease entities. In some cases, this type of recording appears to provide information not available through any other conventional means.
Influence of Age on the Hemodynamic Response to Exercise
Authors: JULIUS STEVO , AMERY ANTOON , WHITLOCK LEIGH S. , CONWAY JAMES
Published: June 2012

Respiratory and hemodynamic measurements were made on 54 sedentary subjects during progressive exercise on a bicycle ergometer up to the point of maximal voluntary effort. The age range of the group was from 18 to 68 years.

The maximum tolerated exercise, as indicated by the highest achieved level of oxygen consumption (V

o
o2

), diminished with age. Older subjects had a lower resting cardiac output (Q) than normal subjects, but an identical increase in Q with V

o
o2

. There was no evidence of flattening of this curve as the older subjects approached highest exercise loads. Consequently, the arteriovenous oxygen difference did not increase abnormally on high loads, and the cardiac response to exercise in older subjects appeared to be adequate. The relationship between inspired air volume and heart rate with V

o
o2

at submaximal loads was not influenced by age.

Systolic pressure increased progressively with exercise and showed a greater change in older subjects. Total peripheral resistance at rest increased with age; but with increasing exercise, this difference progressively diminished.
Absence of Pulmonic Valve Associated with Double-Outlet Right Ventricle
Authors: BAKER WILLIAM P. , KELMINSON LESLIE L. , TURNER W. MARSHALL , BLOUNT S. GILBERT
Published: June 2012

The case of double-outlet right ventricle with absence of the pulmonic valve described illustrates well the problems inherent in the differentiation of this condition from Fallot's tetralogy.
Plasma Volume Expansion Resulting from Interference with Adrenergic Function in Normal Man
Authors: WEIL JOHN V. , CHIDSEY CHARLES A.
Published: June 2012

Guanethidine was administered to 10 normal subjects in order to examine the effects of reduced adrenergic function on plasma volume. An increase in the plasma volume was observed averaging 21.4% after 1 week, and 12.1% and 13.1% after 2 and 3 weeks of drug administration. A similar change in plasma volume resulted when alphaadrenergic blockade was produced with phenoxybenzamine. These changes occurred in the absence of sodium retention and were associated with attenuation of forearm venous sympathetic reflexes and a rise in forearm venous compliance. The increase in venous compliance which was observed was proportional to the changes in plasma volume in these subjects. Thus, the sympathetic nervous system through its control of venous resistance may provide a means whereby the blood volume can be regulated.
Thromboembolic Complications of Prosthetic Cardiac Valves
Authors: AKBARIAN MOHAMMED , AUSTEN W. GERALD , YURCHAK PETER M. , SCANNELL J. GORDON
Published: June 2012

Our experience with thromboembolism in 283 patients surviving at least 1 week following insertion of Starr-Edwards valves is reported here. Of these patients, 155 underwent aortic valve replacement, 21 had aortic valve replacement with mitral commissurotomy, 80 had mitral replacement, and 27 had both aortic and mitral valve replacement. Complete follow-up data were obtained on all patients, from 3 to 49 months following surgery (mean, 20 months).

Thromboembolic episodes developed in 68 of the 283 patients (24%). Seventeen of these 68 patients died (25%), three had serious neurological residual (4%), but the majority of survivors recovered completely.

Use of long-term anticoagulant therapy appeared to reduce incidence of embolic episodes only in patients with aortic valve replacement. Control of anticoagulant therapy (good, fair, or poor) bore no relationship to incidence of embolism within this group. Anticoagulant therapy in untreated patients with emboli reduced the incidence of subsequent thromboembolism. Hemorrhagic complications occurred in 23 patients (8%); one died.

Thromboembolism is a serious complication of prosthetic valves. Its incidence in some patients is reduced but not eliminated by anticoagulant therapy.
An Enquiry into the Role of Cobalt in the Heart Disease of Chronic Beer Drinkers
Authors: KESTELOOT H. , ROELANDT J. , WILLEMS J. , CLAES J. H. , JOOSSENS J. V.
Published: June 2012

The natural history of a new disease entity in chronic beer drinkers consisting of pericardial effusion, a low cardiac output, and in about half of the cases of polycythemia is presented. Normalization of the heart volume, the hemoglobin value, and the hemodynamic state was obtained in patients who stopped drinking. Further evidence of the importance of cobalt in the development of the disease is presented. All patients drank beer to which cobalt was added and the disease was not seen in chronic alcoholics drinking wine or other alcoholic beverages. In view of the rather small quantity of cobalt consumed, an hypothesis is formulated which attributes the cobalt toxicity in chronic alcoholics, to a dietary deficiency of sulfhydryl-groups containing amino acids and a dietary deficiency of protein.
Prognosis of Men with Coronary Heart Disease as Related to Blood Pressure
Authors: FRANK CHARLES W. , WEINBLATT EVE , SHAPIRO SAM , SAGER ROBERT V.
Published: June 2012

Hypertension prior to the onset of the initial myocardial infarction in men is associated with an excess early mortality rate: among men with elevated blood pressure the proportion dead within 1 month is more than twice that found among normotensive men with a first infarction. Hypertensives who survive the acute attack show twice the risk of recurrence and more than five times the risk of cardiac death over the next several years in comparison with men with normal blood pressure prior to infarction.

Among men whose first clinical evidence of coronary disease is angina pectoris, those with an elevated blood pressure have two and one half times the likelihood of experiencing a first myocardial infarction and cardiac death within a follow-up period of 30 months.

These findings are from the HIP (Health Insurance Plan of Greater New York) study of the incidence and prognosis of coronary heart disease, an ongoing prospective study of a general population of 110,000 men and women aged 25 to 64 years.
Hemodynamic Effects of Glucagon in Patients with Heart Disease
Authors: WILLIAMS JOHN F. , CHILDRESS RICHARD H. , CHIP JEROLD N. , BORDER JOHN F.
Published: June 2012

The intravenous administration of 3 or 5 mg of glucagon to 13 patients with heart disease resulted in a statistically significant increase in heart rate, cardiac index, stroke power index, mean rate of left ventricular ejection, and maximum rate of rise of left ventricular pressure, whereas systemic vascular resistance declined. A moderate increase in mean stroke volume index and stroke work index and a slight fall in left ventricular end-diastolic pressure also occurred, although these changes were not statistically significant. The increase in cardiac index averaged 19%, with nine of the patients demonstrating an increase exceeding 10% of their respective control value. These effects of glucagon generally reached a maximum within 15 min after drug administration and also were of short duration.

Positive inotropic and chronotropic effects of glucagon were observed in most but not all of these patients. In addition, the magnitude of these effects varied considerably among patients; the variation, however, did not appear to be related to the severity or duration of the heart disease.

In eight patients, the infusion of isoproterenol produced greater increases in cardiac index and decreases in left ventricular end-diastolic pressure than glucagon did.

Although the effect of glucagon was short, the frequent improvement in hemodynamics which occurred in the absence of significant side effects, notably arrhythmias, indicates that the inotropic actions of this agent may be useful under certain clinical conditions.
Long-Term Effects of Clofibrate (Atromid-S) on Serum Lipids in Man
Authors: HUNNINGHAKE DONALD B. , TUCKER DONALD R. , AZARNOFF DANIEL L.
Published: June 2012

Clofibrate was administered to 45 patients for varying periods of time up to 4 years with no evidence of chronic toxicity. Clofibrate was more effective in lowering serum triglycerides than serum cholesterol, with more than 75% of all patients with elevated triglycerides having at least a 25% reduction in triglycerides, the absolute reduction in triglycerides being directly correlated with pretreatment values. A reduction in serum cholesterol of 15% or more was obtained in 50% of all patients, those individuals with elevations of triglycerides having the greatest reduction in serum cholesterol as well as being most likely to respond.
Reversible Cardiac Failure During Angina Pectoris
Authors: PARKER JOHN O. , LEDWICH J. RODNEY , WEST ROXROY O. , CASE ROBERT B.
Published: June 2012

Left ventricular end-diastolic pressure and left ventricular stroke work were measured during a 10-min period of atrial pacing in 10 normal subjects and 30 patients with coronary artery disease. The normal subjects and the patients with coronary artery disease who did not experience angina during pacing reacted similarly with a fall in left ventricular end-diastolic pressure from 8 to 2 mm Hg returning to control values on cessation of pacing. The average left ventricular end-diastolic pressure during pacing in the 21 patients who developed angina was similar to control values although this pressure rose to abnormal levels in four patients. On cessation of pacing the left ventricular end-diastolic pressure rose abruptly to an average value of 22 mm Hg. This lack of elevation of filling pressure during pacing and the rise to abnormal levels on termination of pacing can best be explained by relating left ventricular end-diastolic pressure to left ventricular stroke work. Analyzed in this fashion it is evident that the ischemic ventricle is operating on a depressed ventricle function curve. This depression of function is reversible following cessation of pacing and can be prevented by the prior administration of nitroglycerin.
Blood Lipids and Human Atherosclerosis
Authors: GRAHAM DEAN M. , LYON THOMAS P. , GOFMAN JOHN W. , JONES HARDIN B. , YANKLEY ALEXANDER , SIMONTON JOHN , WHITE SIDNEY
Published: June 2012

Heparin administered to humans and rabbits causes profound reorientation in the distribution of low density lipoproteins, characterized by a shift of lipoproteins of high S
f
rates to those of successively lower S
f
rates. The observations appear to indicate that this agent has actually caused a transformation of the former group into the latter. Heparin administered to the rabbit prevents the usual buildup of high concentration of the S
f
10-50 lipoproteins during cholesterol feeding and retards the development of atherosclerosis. In man, accompanying the redistribution of lipoproteins, there was observed a marked reduction in angina pectoris in 55 of 59 patients studied who presented this symptom. The relation between the heparin effect upon lipoproteins and its effect upon angina cannot be assessed at present.
Critical Assessment of Use of Central Venous Oxygen Saturation as a Mirror of Mixed Venous Oxygen in Severely Ill Cardiac Patients
Authors: SCHEINMAN MELVIN M. , BROWN MURRAY A. , RAPAPORT ELLIOT
Published: June 2012

Bedside catheterization of the right heart with a percutaneously introduced flowdirected catheter was carried out in 24 critically ill patients; 71 determinations of mixed venous oxygen saturation (MVo
2
) were obtained. A second catheter was inserted either into a central intrathoracic vein or the right atrium for simultaneous sampling of central venous (CVo
2
) or right atrial (RAo
2
) oxygen saturation.

For the group as a whole, mean CVo
2
(57.9% ± 15.25) was significantly greater than mean MVo
2
(53.3% ± 14.84) (
P
<0.001), but there was no significant difference and correlation was good between changes in central venous compared to changes in mixed venous oxygen saturation. On the other hand, there was no significant mean difference as well as an excellent correlation between individual values of RAo
2
and MVo
2
(r=+0.95).

Patients with heart failure or shock showed poor correlation between CVo
2
and simultaneously determined MVo
2
. Furthermore, subjects with shock showed a mean CVo
2
(58.0%±13.05) that was significantly greater than mean MVo
2
(47.5% ± 15.11). In contrast, there was no significant difference between mean RAo
2
and mean MVo
2
and excellent correlation of individual values in patients with either heart failure or shock. Although CVo
2
is a poor reflection of MVo
2
in subjects with severe heart failure or shock, there was a better correlation between changes in CVo
2
with corresponding changes in MVo
2
. In addition, RAo
2
correlated closely with corresponding values of MVo
2
. The reversal of the normal relationship between CVo
2
and MVo
2
under these circumstances is compatible with the thesis that low output states are attended by redistribution of blood flow away from femoral, splanchnic, and renal circulation with preferential preservation of cerebral blood flow.
Circulatory Effects of Electrical Stimulation of the Carotid Sinus Nerves in Man
Authors: EPSTEIN STEPHEN E. , BEISER G. DAVID , GOLDSTEIN ROBERT E. , STAMPFER MORRIS , WECHSLER ANDREW S. , GLICK GERALD , BRAUNWALD EUGENE
Published: June 2012

The effects of carotid sinus nerve (CSN) stimulation were studied at rest and during a mild level of supine bicycle exercise in seven patients in whom CSN stimulators had been implanted for the treatment of angina pectoris. At rest, CSN stimulation produced a fall in mean arterial pressure (MAP) averaging 23% and an 8% decrease in cardiac output (CO). Total peripheral resistance (TPR) fell by 14% and forearm vascular resistance (FVR) by 16%. During exercise, MAP fell 16%, but no significant change occurred in CO. Thus, the fall in MAP could be attributed to a reflexly induced decrease in peripheral vascular resistance. Only small decreases occurred in heart rate. No changes in venous tone, central venous pressure, or the maximum transverse end-diastolic diameter of the heart were produced by stimulation either at rest or during exercise. Thus, at rest, CSN stimulation reduces MAP by reflexly decreasing both vascular resistance and CO; during exercise, the diminution in CO no longer occurs. Finally, the venous system does not appear to participate in reflexes activated by CSN stimulation.
Visual Assessment of Regional Myocardial Perfusion Utilizing Radioactive Xenon and Scintillation Photography
Authors: CANNON P. J. , HAFT J. I. , JOHNSON P. M.
Published: June 2012

A method was devised to visualize the areas of left ventricle supplied by various coronary arterial branches utilizing scintillation photography and an inert radioactive gas which distributes instantaneously between coronary blood and perfused myocardial cells. From 1 to 5 millicuries of
133
Xe dissolved in saline solution was injected through a catheter into the anterior descending or posterior circumflex branch of the left coronary artery of 15 dogs. Scintillation images produced during arrival and washout of
133
Xe in the various regions of the heart were recorded by an image intensifier scintillation camera and high speed television monitor and were reproduced on Polaroid film during replay of the videotape on an oscilloscope. The resulting scintiphotographs defined the region of the left ventricle supplied by the coronary arterial branch. In nine of the dogs acute myocardial infarctions were produced by occluding one or the other branch of the left coronary artery. When
133
Xe was injected again into the coronary artery proximal to the occlusion, that area of the left ventricle that was deprived of nutrient blood flow was no longer visualized on the gamma-ray scintiphotograph. The results indicate that regional myocardial perfusion may be dynamically visualized in the intact animal.
Relation of Extracellular Fluid Volume to Arterial Pressure during Drug-Induced Saluresis
Authors: DAVIDOV MICHAEL , GAVRILOVICH LILLIAN , MROCZEK WILLIAM , FINNERTY FRANK A.
Published: June 2012

The immediate fall in arterial pressure following furosemide in the 17 hypertensive patients studied was asociated with a decrease in plasma volume, cardiac output, and extracellular fluid volume, and an increase in urinary sodium excretion. A glucose infusion administered at the trough of hypotension in an amount exceeding the urinary output resulted in the return of arterial pressure to control levels in each patient. Although an increase in plasma volume was noted in each patient, it was significantly below control levels. The central venous pressure, cardiac output, and state of negative sodium balance following the glucose infusion remained unchanged, but the extracellular fluid volume had re-expanded. It would seem that the changes in arterial pressure either after furosemide or during the glucose infusion were related to changes in extracellular fluid. The fact that a decreased pressor response to norepinephrine following furosemide was associated with a decrease in extracellular fluid and the fact that expansion of extracellular fluid with glucose restored the pressor response to normal further document the importance of the extracellular fluid in the regulation of arterial pressure.
Cardiovascular Pharmacology of Propranolol in Man
Authors: WOLFSON STEVEN , GORLIN RICHARD
Published: June 2012

The success of propranolol in treating the symptoms of angina pectoris has raised questions about the effects of beta-adrenergic blockade on the hemodynamic functions, myocardial mechanics, energetics, and metabolic functions. Five milligrams of propranolol was given intravenously to 27 human subjects, 18 with and nine without angiographically proven coronary atherosclerosis. The drug produced a decrease in externally measured indices of myocardial mechanical effort and consequently a fall in myocardial oxygen demands. The hemodynamic changes and resultant increases in myocardial oxygen consumption and coronary flow during supine leg exercise were also attenuated. Propranolol produced different changes in myocardial arteriovenous oxygen extraction depending upon whether the coronary circulation was normal or diseased. Although the data suggest that coronary vasoconstriction occurred in patients with atherosclerotic lesions, no significant change in myocardial lactate exchange was noted after administration of propranolol. Beta-adrenergic blockade caused a decline in cardiac filling pressures and volumes at the dose level used in this study, presumably by decreasing venous return.
Effects of Atrial Pacing on Left Ventricular Performance in Patients with Heart Disease
Authors: LEIGHTON RICHARD F. , ZARON STEPHEN J. , ROBINSON JOHN L. , WEISSLER ARNOLD M.
Published: June 2012

Hemodynamic data and systolic time intervals were obtained at resting heart rate and during atrial pacing in 10 patients with heart disease, eight with left ventricular dysfunction, and two with mitral stenosis. The mean increase in heart rate was 44 beats/min. During atrial pacing there was no significant alteration in cardiac output, minute work, left atrial or pulmonary wedge mean pressure, or duration of left ventricular pre-ejection period.

When the pressure events which determine the duration of the isovolumic time and the left ventricular pre-ejection period were examined, aortic diastolic pressure rose while left ventricular end-diastolic pressure fell. The rate of pressure rise (dp/dt) determined from high-fidelity left ventricular pressure pulses in three patients increased out of proportion to the increased pressure developed throughout isovolumic contraction. The augmentation in dp/dt from lower end-diastolic pressure indicates improved mechanical performance of the left ventricle, which is not necessarily translated into hemodynamic improvement.
Etiology and Pathogenesis of Acute Myocardial Infarction
Authors: Killip Thomas , EDWARDS JESSE E.
Published: June 2012

From the pathological viewpoint, myocardial infarction is but one major consequence of coronary atherosclerosis. Among subjects with chronic occlusive coronary atherosclerosis, more common than death from acute myocardial infarction is death occurring acutely in the absence of infarction or acute coronary occlusion.

Such negative anatomical evidence is supportive of the concept that myocardial ischemia commonly causes serious failure of the circulation through certain ventricular arrhythmias.
Contribution of the Circle of Willis to the Subclavian Steal Syndrome
Authors: LORD REGINALD S. A. , ADAR RAFAEL , STEIN ROBERT L.
Published: June 2012

The arteriograms and other findings in 42 patients with the subclavian steal syndrome were statistically evaluated to determine which factors predisposed to vertebrobasilar ischemia. Evidence of disconnection of the circle of Willis between the territories of the carotid and vertebral arteries was found in a significantly higher proportion of the patients with vertebrobasilar insufficiency. This finding was interpreted to mean that in these patients one of the major routes normally available for compensating for the basilar ischemia produced by the steal was not present.

It is suggested that this or similar mechanisms may be necessary before the subclavian steal produces symptoms in individual patients.
On-line Analysis of the Exercise Electrocardiogram
Authors: SHEFFIELD L. T. , HOLT J. H. , LESTER F. M. , CONROY D. V. , REEVES T. J.
Published: June 2012

A computer program has been developed which clarifies the distorted exercise ECG and performs desired measurements of it which are reported in the laboratory almost immediately, so that the program can be used as an aid to exercise test monitoring. We have introduced a new measurement of the ECG, the negative ST (—ST) integral, which while unfamiliar to the eye is readily performed by computer. A —ST integral value of 7.5 µv-sec during exercise served to separate a normal group from a group with angina pectoris. Strenuous exercise was often necessary to elicit positive responses in diseased subjects, and the graded exercise test was found well-suited for this purpose.

Use of a computer program as an investigative instrument in its own right, rather than as a means of duplicating classical human measurements, shows promise for improving the diagnosis of ischemic heart disease.
Effects of a Quantitated Physical Training Program on Middle-Aged Sedentary Men
Authors: SIEGEL WAYNE , BLOMQVIST GUNNAR , MITCHELL JERE H.
Published: June 2012

The effects of a 15-week quantitated training program were evaluated in nine men, 32 to 59 years old. All had been blind for 10 years or more but were otherwise in good health. They were sedentary with a stable activity pattern. Training sessions were held three times per week and consisted of four 3-minute exercise periods on a bicycle ergometer, each followed by a rest period of equal duration. Heart rates at the end of the fourth exercise period averaged 27 beats below individual maximal heart rates.

Maximal oxygen uptake increased from 24.0 to 28.5 ml/kg x min or by 19%. Total heart volume and mean serum cholesterol decreased significantly, and psychological tests showed improvement.

Five subjects continued exercising at the same intensity but only once weekly for another 14-week period. Mean maximal oxygen uptake decreased to 6% above the control level. Four subjects who discontinued training after 15 weeks were retested at the same time and had a mean value 5% below control maximal oxygen uptake.
Fluttering of the Mitral Valve in Aortic Insufficiency
Authors: WINSBERG FRED , GABOR GEORGE E. , HERNBERG JOSEPH G. , WEISS BARRY
Published: June 2012

Thirty-five patients with clinical evidence of aortic insufficiency were studied by echocardiography. Eleven patients had characteristic diastolic fluttering of the mitral valve (30 to 40 Hz, maximal amplitude 4 mm). In five others the fluttering was classified as equivocal.

In a control group of 500 echocardiograms in patients without evidence of aortic insufficiency, there were three examples of equivocal fluttering. Atrial fibrillation also produces diastolic fluttering but of slower frequency.
Electrocardiographic Findings Among the Total Adult Population of a Large Religious Isolate
Authors: GOLDBARG ALBERTO N. , KURCZYNSKI THADDEUS W. , HELLERSTEIN HERMAN K. , STEINBERG ARTHUR G.
Published: June 2012

Electrocardiograms were recorded as part of a survey of 1,303 men and 1,348 women past 15 years of age belonging to a large religious isolate inhabiting regions of northwestern U.S.A. and southwestern Canada. The ECGs were classified according to the Minnesota Code and the abnormalities were related to constitutional characteristics, blood pressure, and serum cholesterol.

Major codable ECG items included abnormal Q waves (54 cases), abnormal left axis deviation (44 cases), bundle-branch block (left 10, right 10), T-wave abnormalities (257 cases), prolonged P-R interval (80 cases), and occasional premature beats (143 cases) and showed no significant sex differences. ST-segment depressions were more common among females (
P
< 0.005). The males showed a significantly higher frequency of increased R-wave amplitude (
P
< 0.005) and more qualitative T-wave changes (
P
< 0.005).

In general, abnormal ECG features were associated with age, sex, and blood pressure, but not with serum cholesterol, body weight and height, skin-fold thickness, or arm girth. A notable exception was the negative relationship of body weight to high amplitude R waves in young males.

In clinical practice, age and sex stratifications will improve the diagnostic power of the ECG.
Functional Correlates of Plasma Renin Activity in Hypertensive Patients
Authors: DUSTAN HARRIET P. , TARAZI ROBERT C. , FROHLICH EDWARD D.
Published: June 2012

Correlates of peripheral plasma renin activity were studied in 31 normotensive subjects and 93 untreated hypertensive patients. The latter were grouped according to apparent type of hypertension: essential (58), renovascular (21), renal parenchymal disease (11), and primary aldosteronism (3). Plasma renin activity was inversely correlated with total blood and plasma volumes in normal men, men with essential hypertension, and patients with renal arterial stenosis; no correlations were found in normal and essential hypertensive women and patients with renal parenchymal disease. Serum sodium and potassium concentrations were significantly and inversely related to renin activity only in renovascular hypertension and not in the other hypertensive or normal groups. Relationships of plasma renin activity to arterial pressure and other hemodynamic functions were studied in hypertensive patients. Only in the renovascular group did diastolic pressure correlate positively and significantly, indicating participaton of the renal pressor system in this form of hypertension throughout a wide range of pressures. Cardiac index and left ventricular ejection rate were directly related to renin activity in essential hypertensive men and patients with renal arterial and parenchymal diseases. The data show that plasma renin activity in hypertensive patients should not be judged alone but along with factors modifying it.
The Mechanism of Arterial Hypoxemia in Acute Myocardial Infarction
Authors: SUKUMALCHANTRA YOSVI , DANZIG RONALD , LEVY STEVEN E. , SWAN H. J. C.
Published: June 2012

Arterial blood gases were measured before and during oxygen breathing in 34 patients with acute myocardial infarction of whom 12 exhibited the shock syndrome, 14 showed evidence of left ventricular failure, and eight had no complications. Initial mean values for Po
2
of 58, 60, and 72 mm Hg, respectively, were found for the three groups. When the same patients breathed oxygen via a nasal cannula or face mask at flow rates of 8 to 12 L/min, values were 106, 128, and 160 mm Hg, respectively. In all instances hemoglobin saturation values in excess of 95% were obtained when the patient breathed oxygen.

In 15 patients measurements of the oxygen saturation of right atrial blood permitted calculation of the degree of venous admixture. Saturation of mixed venous blood was found to be 34, 56, and 73% for the groups of patients, while the degree of venous admixture was calculated at 18, 27, and 23%, respectively. Furthermore, from the data obtained while the patients breathed oxygen, the magnitude of true right-to-left shunt was identical for all three groups at 11%. It was concluded that the
initial
pulmonary defect is similar for all patients with acute myocardial infarction, and possibly is due to elevated pulmonary venous pressure in all patients. As time progresses, however, the pulmonary defect changes according to the general progress and circulatory response of the subject. Thus, in those patients in whom general deterioration occurred, pulmonary function also deteriorated; whereas, in those who demonstrated clinical and hemodynamic improvement, pulmonary function improved progressively.
Statistical Investigation of Correlations Between Serum Potassium Levels and Electrocardiographic Findings in Patients on Intermittent Hemodialysis Therapy
Authors: FROHNERT PETER P. , GLULIANI EMILIO R. , FRIEDBERG MORDECAI , JOHNSON WILLIAM J. , TAUXE W. NEWLON
Published: June 2012

Simultaneous determinations of serum potassium and sodium, blood pH, blood pressure, and 12-lead electrocardiograms were obtained in hyperkalemic patients with chronic renal failure. Statistical investigation of the data showed a high correlation between serum potassium levels and ventricular repolarization abnormalities. "Mean intracellular potassium concentration" derived from total body potassium and total body water values was not accurate enough to show significant correlations to ECG changes and did not improve on the already significant correlations with serum potassium levels. Equations are presented which would permit the estimation of serum potassium levels (in a narrow range) from electrocardiographic findings in patients with chronic renal failure and suspected hyperkalemia.
Rapidly Recurring Supraventricular Tachycardia
Authors: GETTES LEONARD S. , YOSHONIS KARL F.
Published: June 2012

Reciprocating tachycardias were diagnosed on the basis of previously established ECG criteria in seven patients with recurrent tachycardia but without WPW. In each patient we could record the onset of arrhythmia because tachycardia recurred within minutes of its termination. Treatment with propranolol alone or with digitalis, or digitalis and quinidine, prevented tachycardia in five patients and slowed it in one. Our cases suggest the following: (1) Recurrent supraventricular tachycardia in patients without the WPW syndrome may frequently be caused by a reciprocal mechanism. (2) The diagnosis of reciprocating tachycardia should be suspected when (a) the tachycardia recurs within minutes of its termination, (b) the onset follows prolongation of the P-R or R-P interval, (c) the P wave during the tachycardia is superiorly directed and different from the P wave which initiates the tachycardia, and (d) at least one other criterion for the diagnosis is met. (3) Propranolol is the drug of choice for the treatment of recurrent supraventricular tachycardias which satisfy the criteria for reciprocating tachycardia.
Embolectomy for Chronic Pulmonary Embolism and Hypertension
Authors: MOOR GORDON F. , SABISTON DAVID C.
Published: June 2012

The case of a 31-year-old Negro who had had two admissions to the hospital at which pulmonary emboli were diagnosed is reported. On his third admission with chest pain, hemoptysis, and dyspnea, chest roentgenograms revealed increased pulmonary vascular markings on the right and a prominent pulmonary artery which was sharply cut off. ECG changes were typical of pulmonary artery obstruction and pulmonary scan revealed a small perfusion defect in the lower lobe of the right lung and complete absence of perfusion in the left lung. The left pulmonary artery was occluded. An organized thrombus was removed from the left pulmonary artery and from most of its distal branches. Good back flow ensued, and 10 months after operation the patient was well except for some edema of the leg.

A discussion of the problems and indications for pulmonary embolectomy is offered.
Pulmonary Artery Agenesis
Authors: GLUCK MORTON C. , MOSER KENNETH M.
Published: June 2012

Pulmonary artery agenesis is one of several diagnostic possibilities which may present with similar chest roentgenographic features, including unilateral pulmonary hypoperfusion and nonvisualization of a pulmonary artery. We have applied ventilation and perfusion scintiphotography as an aid in differentiating agenesis from the other conditions with which it may be confused.

Four patients presenting with the chest roentgenographic features suggestive of pulmonary artery agenesis were evaluated, when possible, with complete pulmonary function studies, bronchography, cardiac catheterization, and pulmonary and aortic angiography. In all patients, the distribution of ventilation and perfusion were evaluated with the Anger scintillation camera,
133
xenon being used for the ventilation study and
131
I-MAA for the perfusion study. In each patient, perfusion scintiphotography showed no blood flow to the affected lung, while ventilation scintiphotography disclosed preservation of homogeneous ventilation to that lung.

Absence of pulmonary artery flow to one lung with maintenance of relatively normal ventilation limits the broad range of diagnostic possibilities to three entities: pulmonary artery agenesis, thrombotic occlusion, and branch stenosis. The history and physical findings should give clues to the latter two diagnoses.
Sublingual Isosorbide Dinitrate Therapy Versus Sublingual Placebo in Angina Pectoris
Authors: ARONOW WILBERT S. , CHESLUK HERMAN M.
Published: June 2012

A double-blind crossover study comparing the effects of 5 mg of isosorbide dinitrate given sublingually four times daily for 4 weeks to those of a placebo also administered sublingually four times daily for 4 weeks was performed on 20 male patients with classical exertional angina pectoris due to coronary artery disease. Isosorbide dinitrate, compared to placebo, significantly reduced the number of anginal episodes requiring nitroglycerin in only one of 17 patients (6%), did not significantly improve exercise tolerance in any of 17 patients, and did not improve the resting or exercise electrocardiograms in any of 17 patients. Isosorbide dinitrate produced headaches in 12 of 19 patients (63%), and two of these patients (11%) were unable to tolerate the drug. Isosorbide dinitrate administered sublingually is no more effective than placebo in treating angina pectoris.
Interpretation of Isopotential Surface Maps in Patients with Ostium Primum and Secundum Atrial Defects
Authors: KARSH RICHARD B. , SPACH MADISON S. , BARR ROGER C.
Published: June 2012

The purpose of this study was to determine if there were consistent differentiating patterns in body surface potential maps in children with normal hearts and in those with ostium primum versus ostium secundum atrial septal defects. A second purpose was to interpret the isopotential surface maps in terms of the position of intracardiac electrical wave fronts.

Body surface activity throughout QRS demonstrated three major intervals: developing, transitional, and declining potentials. Patients with both types of atrial septal defects demonstrated complex distributions (multiple maxima) during the transitional interval which were not encountered in normal subjects. In the primum group, the distribution of positive and negative potentials sequentially changed in an inverted pattern as compared to the pattern in those patients with secundum defects. Furthermore, during the transitional interval the potential distribution was considerably more complex in the primum group. In two additional patients, body surface maps were helpful in clarifying misleading and atypical conventional electrocardiograms.

The presence of simultaneous multiple maxima could only be accounted for by the existence of multiple wave fronts simultaneously present within the heart. In particular the emergence of two widely separated anterior chest maxima in patients with secundum atrial defect indicated the simultaneous presence of prominent left and right ventricular wave fronts. Also, the marked differences in the relative positions of the major body surface maximum and minimum could be accounted for only by considerable differences in the position and extent of intracardiac wave fronts. For example, the target distribution, consisting of an isolated minimum surrounded by multiple maxima and positive potentials over the upper body, in the ostium primum patients, indicated epicardial breakthrough in a wave front positioned in the anterosuperior portion of the heart. In contrast, normal subjects and patients with secundum defect had distributions indicating antero-inferior wave front position at the time of right ventricular epicardial breakthrough.
Multifocal Atrial Tachycardia (Chaotic Atrial Tachycardia)
Authors: LIPSON MANUEL J. , NAIMI SHAPUR
Published: June 2012

Multifocal atrial tachycardia, also designated "chaotic atrial tachycardia," was identified in the records of 31 patients. It was particularly noted that the arrhythmia progressed to atrial fibrillation or flutter in 17 cases (55%). Unifocal or multifocal premature atrial contractions preceded the arrhythmia in 20 cases (64%). The arrhythmia developed during an acute illness in 18 cases (58%). However, it occasionally occurred in paroxysms without an apparent cause in patients with chronic disease. Significant acute or chronic pulmonary disease was present in 12 cases (39%). The arrhythmia was not associated with digitalis toxicity or with rhythm disturbances known to occur in digitalis intoxication such as paroxysmal atrial tachycardia with block. In general, digitalis therapy seemed to have little effect on the course of the arrhythmia, but in some cases it appeared to be beneficial, especially if atrial fibrillation supervened. In several patients there seemed to be a transition from multifocal premature atrial contractions through chaotic atrial tachycardia to atrial fibrillation. These observations suggested that chaotic atrial tachycardia might be a forewarning of atrial fibrillation and that the two arrhythmias may have a similar mechanism.
Acute Effects of Ethanol Ingestion on the Response to Submaximal and Maximal Exercise in Man
Authors: BLOMQVIST GUNNAR , SALTIN BENGT , MITCHELL JERE H. , Vastagh George F.
Published: June 2012

The acute effects of ingestion of ethanol on the response to submaximal and maximal exercise were studied by noninvasive technics in a group of eight healthy men, ages 21 to 33 (series I). Cardiac output (dye-dilution technic) and intra-arterial pressures were measured in a separate series of experiments in a subgroup of four subjects (series II). Mean concentration of ethanol in the blood at the end of the experiment was 156 mg/100 ml in series I and 125 mg/100 ml in series II. Heart rates at rest and during submaximal exercise were higher after ingestion of ethanol, but there was no effect on stroke volume. After ingestion of ethanol cardiac output at rest and during submaximal exercise increased, and total A-V difference and total peripheral resistance decreased. The circulatory response to maximal work was not affected by ethanol. Maximal oxygen uptake did not change. Pulmonary ventilation was not altered during submaximal exercise but was reduced during maximal work.

These findings are in agreement with data from animal experiments suggesting that ethanol in blood concentrations below 200 mg/100 ml has no significant depressive effect on performance of the normal heart.
Management of Arterial Injuries Related to Cardiac Catheterization in Children and Young Adults
Authors: MANSFIELD PETER B. , GAZZANIGA ALAN B. , LITWIN S. BERT
Published: June 2012

Retrograde arterial catheterization in children and young adults carries a risk of vessel damage and occlusion. The management of 29 such injuries is presented. The first patient in this series died after amputation of his lower extremity for gangrene. In all patients in whom distal pulses were absent 8 hours after catheterization arterial obstruction was complete. Claudication developed in the two patients who were not operated upon. Twenty-seven patients had arterial exploration and repair. The indications for exploration and the surgical technics evolved during the series are presented. In 24 patients pulses and perfusion returned to normal after operation, and two patients had residual arterial obstruction without symptoms.
Hemodynamic Findings in 123 Patients with Acute Myocardial Infarction on Admission
Authors: RAMO BARRY W. , MYERS NELSON , WALLACE ANDREW G. , STARMER FRANK , CLARK DAVID O. , WHALEN ROBERT E.
Published: June 2012

Hemodynamic and clinical evaluations of 123 patients with acute myocardial infarction were performed during the first hour of admission to the hospital. In the 123 patients, the right atrial pressure was less than 10 mm Hg in 49 patients, the right atrial oxygen saturation was less than 70% in 97 patients, the arteriovenous oxygen difference was greater than 5.0 vol% in 78 patients. The arterial Po
2
was less than 90 mm Hg in 101 of 107 patients who could be evaluated while breathing room air. The cardiac index was depressed below 3.0 L/min/m
2
in 65 of 98 patients.

The hemodynamic findings generally correlated with the clinical status of the patient; however, within each clinical class of patients there was a wide spectrum of values for each measurement evaluated. There was also considerable overlap of the values found within each clinical classification. It is concluded that hemodynamic evaluation of patients with acute myocardial infarction presents a profile of the patient which is frequently different from the profile that clinical evaluation presents. An objective hemodynamic classification of patients with acute myocardial infarction may provide a more useful index for the evaluation of the patient's prognosis and for the assessment of preventative therapy.
Coronary Heart Disease
Authors: HELFANT RICHARD H. , FORRESTER JAMES S. , HAMPTON JOHN R. , HAFT JACOB I. , KEMP HARVEY G. , GORLIN RICHARD
Published: June 2012

Right atrial pacing was performed in 41 subjects with coronary heart disease. Twenty developed angina pectoris during pacing, while 21 did not. The extent of coronary artery disease, as judged by selective cinearteriography, was similar in the two groups. Both had significant increases in heart rate and pressure-time per minute, but there was no significant difference in either of these parameters between groups. Among the hemodynamic parameters measured, the only statistically significant change was in the cardiac index which fell slightly but significantly in the angina group.

There were no differences in myocardial oxygen extraction either within each group or between groups. In the angina group, however, 14 of 20 subjects exhibited abnormal myocardial lactate metabolism during pacing. The mean change was highly significant (
P
< 0.01). In the nonangina group, eight of 21 subjects had abnormal lactate metabolism during pacing and the mean change was significant (
P
< 0.05). There was no correlation between abnormal lactate metabolism and electrocardiographic evidence of myocardial ischemia in either group. Sublingual nitroglycerin, given to five subjects with angina while pacing was continued, resulted in prompt relief of symptoms, but abnormal lactate metabolism and ST-segment depression were unaffected after 10 min. By contrast, when anginal symptoms were relieved in five subjects by cessation of pacing, symptomatic improvement was accompanied by marked improvement in lactate metabolism after 10 min. Although angina pectoris appears to be related statistically to subnormal left ventricular function and abnormal lactate metabolism, there is significant individual variation.