bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship of cardiothoracic ratio and plain film heart volume to late survival.
Authors: Hammermeister K E , Chikos P M , Fisher L , Dodge H T
Published: June 2012

We assessed the prognostic value of cardiothoracic ratio and plain film heart volume in relation to other clinical, exercise, hemodynamic and quantitative angiographic variables. Both cardiothoracic ratio and plain film heart volume are highly sensitive, but nonspecific, indicators of abnormal left ventricular end-diastolic volume and ejection fraction. Both variables are univariately important predictors of survival in cohorts of medically and surgically treated heart disease patients. Plain film heart volume significantly adds to the multivariate prediction of prognosis obtained from groups of clinical, exercise, hemodynamic and quantitative angiographic variables. These measurements from the routine chest roentgenogram are sensitive detectors of abnormal left ventricular function or volume and important predictors of long-term survival. The fact that they contribute prognostic information in addition to left ventricular volume and ejection fraction suggests that other cardiac chamber volumes are of prognostic importance.
A collaborative study of infective endocarditis in the 1970s. Emphasis on infections in patients who have undergone cardiovascular surgery.
Authors: Kaplan E L , Rich H , Gersony W , Manning J
Published: June 2012

Twenty-six major cardiovascular centers participated in a cooperative study of all cases of infective endocarditis occurring during a single calendar year to obtain an overview of infective endocarditis. The study was designed to learn which patients appear to be at highest risk to develop this infection after palliative or reparative cardiovascular surgery. Of 278 patients developing infective endocarditis during the year at these medical centers, 63 (23%) had had previous cardiovascular surgery and 215 had not. Seventy percent of the 278 patients had recognized congenital or acquired heart disease before developing the infection. Rheumatic heart disease accounted for over half of the patients with underlying structural heart disease. A majority (55%) of the 63 patients who had been operated on before developing endocarditis had prosthetic valves inserted. Of those who did not require prosthetic valves, the majority had congenital heart disease with systemic artery-to-pulmonary artery shunts. Although these data were obtained from a selected group of patients, they confirm a significant risk of endocarditis in patients with prosthetic valves and suggest that in postoperative patients with non-valvular congenital heart disease, the highest risk appears to be in cyanotic patients with palliative pulmonary artery-to-systemic artery shunts.
Imaging experimental infective endocarditis with indium-111-labeled blood cellular components.
Authors: Riba A L , Thakur M L , Gottschalk A , Andriole V T , Zaret B L
Published: June 2012

The capability of radionuclide imaging to detect experimental aortic valve infective endocarditis was assessed with indium-111 (111In)-labeled blood cells. Sequential cardiac imaging and tissue distribution studies were obtained in 17 rabbits with infective endocarditis after administration of 111In-platelets and in five after 111In-polymorphonuclear leukocytes. Forty-eight to 72 hours after platelet administration, in vivo imaging demonstrated abnormal 111In uptake in all animals in the region of the aortic valve in an anatomically distinct pattern. Images of the excised heart showed discrete cardiac uptake conforming to the in vivo image and gross pathological examination. 111In platelet uptake in vegetations from the 17 animals averaged 240 +/- 41 times greater than that in normal myocardium and 99 +/- 15 times greater uptake in blood. In contrast, 111In-leukocyte cardiac imaging showed no abnormal aortic valve uptake 24 hours after tracer administration and the lesion myocardium activity ratio was only 5 +/- 2 (3 +/- 1 for lesion/blood activity). Four normal rabbits demonstrated neither positive 111In platelet scintigraphs nor abnormal cardiac tissue uptake. Likewise, noncellular 111In was not concentrated to any significant extent in three animals with infective endocarditis. This study demonstrates that 111In platelet, but not leukocyte cardiac imaging, is a sensitive technique for detecting experimental infective endocarditis. The imaging data conform to the cellular pathology of the infective endocarditis vegetation.
Univentricular heart of right ventricular type with double or common inlet.
Authors: Keeton B R , Macartney F J , Hunter S , Mortera C , Rees P , Shinebourne E A , Tynan M , Wilkinson J L , Anderson R H
Published: June 2012

Seventeen cases are described in which both atria connect directly to a chamber with right ventricular characteristics. The atria connected through separate atrioventricular valves in six hearts and a common valve in 11. All hearts had a posterior rudimentary chamber. The septum which separated it from the main chamber was directed to the crux of the heart. Ten hearts were from patients with atrial situs solitus and seven from patients with atrial situs ambigous. Arterial connections were concordant in three cases, had a double outlet from the main ventricular chamber in nine and single outlet of the heart in five. The patent artery always arose from the main chamber, with pulmonary atresia in three and aortic atresia in two. This and other studies indicate that double inlet atrioventricular connection does not predict the morphology of the main chamber. Although usually associated with a main chamber of left ventricular type, it may also be associated with a main chamber having right ventricular characteristics. Both types should be considered as univentricular hearts; the posterior chamber in hearts of right ventricular type are analogous to the anterior chamber in univentricular hearts of left ventricular type and are a rudimentary chamber rather than a hypoplastic ventricle. In the right ventricular form of univentricular heart, the trabecular zone of the rudimentary chamber is of left ventricular type.
Blood levels after sublingual nitroglycerin.
Authors: Armstrong P W , Armstrong J A , Marks G S
Published: June 2012

Pharmacokinetic analysis of nitroglycerin (GTN) has been hampered by the lack of a sensitive and specific method for measuring GTN in blood. Therefore, we examined the appearance of GTN in blood after administering 0.6 mg sublingually in 10 studies of normal volunteers. We used a gas-liquid chromatographic method with electron-capture detection and isosorbide dinitrate as the internal standard. GTN appeared in blood at 0.5 minutes, reached a peak of 2.3 +/- 0.36 ng/ml at 2 minutes, fell to 50% of peak value at 7.5 minutes and was barely detectable at 20 minutes. These blood levels paralleled the changes in heart rate and systolic blood pressure. These data show rapid appearance and disappearance of GTN from blood after sublingual administration, a large volume of distribution, and a rapid rate of total body clearance that precludes the liver from being the sole elimination site. This method for analysis of GTN and isosorbide dinitrate should be helpful in defining the role of chronic nitrate therapy.
Echocardiographic assessment of cardiac anatomy and function in hypertensive subjects.
Authors: Savage D D , Drayer J I , Henry W L , Mathews E C , Ware J H , Gardin J M , Cohen E R , Epstein S E , Laragh J H
Published: June 2012

Cardiovascular complications are a major source of morbidity and mortality in hypertensive patients. To assess the prevalence of anatomic and functional abnormalities of the heart in such patients, we studied 234 asymptomatic subjects with mild-to-moderate systemic hypertension by echocardiography. After adjusting the echocardiographic values for age and body surface area, we found abnormally increased ventricular septal and/or posterobasal free-wall thickness in 61% of the hypertensive subjects. We found increased left atrial, aortic root, and left ventricular internal dimension (at end-diastole) in 5-7%, and decreased mitral valve closing velocity (E-F slope) and left ventricular ejection fraction were noted in six and 15% of the subjects, respectively. Four percent of the patients had disproportionate septal thickening (i.e., ventricular septal-to-left ventricular free-wall thickness ratio greater than or equal to 1.3). In contrast to the high prevalence of cardiac abnormalities detected by echocardiography, less than 10% of the hypertensive subjects had abnormal 12-lead ECGs or abnormal chest x-rays. These findings demonstrate a high prevalence of cardiac abnormalities in a population of asymptomatic hypertensive subjects. These abnormalities can be detected by echocardiography before they are otherwise apparent.
Effects of volume expansion and contraction in normotensive whites, blacks, and subjects of different ages.
Authors: Luft F C , Grim C E , Fineberg N , Weinberger M C
Published: June 2012

We studied the blood pressure, natriuretic, kaliuretic and humoral responses of 347 normal subjects after volume expansion and volume contraction to examine possible differences among whites, blacks and subjects of different ages. According to outpatient 24-hour urine collections, blacks excreted less sodium and potassium than whites. After similar states of sodium intake were achieved among all subjects, 2 liters normal saline were given i.v. Blacks and subjects greater than or equal to 40 years excreted less sodium than whites or subjects less than 40 years, over a 24-hour period. In addition, blacks excreted less potassium. The delay in sodium excretion occurred during the first 12 hours after the salt load. Blacks had a greater suppression of plasma renin activity than whites 24 hours after saline. Blacks also had higher blood pressures than whites after saline administration; their pressure remained elevated until furosemide was given. Furosemide, 120 mg over 24 hours, evoked greater natriuresis, but less kaliuresis in blacks than in whites. The greater prevalence of hypertension in both blacks and older subjects may be related to relatively blunted natriuretic responses when these groups engage in the high sodium-low potassium intake characteristic of our society.
Cardiovascular response to isometric exercise in normal adolescents.
Authors: Laird W P , Fixler D E , Huffines F D
Published: June 2012

The purpose of this study was to document the cardiovascular response to submaximal isometric handgrip (IHG) exercise in 32 normal adolescents. Left ventricular (LV) dimensions and systolic time intervals were recorded using echocardiography; blood pressure was measured by sphygmomanometry both at rest and during IHG exercise at 25% maximum contraction. This level of isometric exercise produced significant (p less than 0.001) increases in mean heart rate, systolic, diastolic and mean blood pressures. Despite this response LV diastolic and systolic dimensions remained unchanged during exercise; hence, stroke volume remained constant. Cardiac index increased by 22% (p less than 0.001) due to the increase in heart rate. Systemic vascular resistance did not change significantly. LV ejection indices, including shortening fraction, mean Vcf and systolic time intervals also remained unchanged, except for an increase in LV ejection time index (p less than 0.025). These data indicate that the cardiovascular response to submaximal isometric exercise in normal adolescents is similar to that reported in adults. This study demonstrates that sustained isometric stress testing in adolescents is safe and provides normal hemodynamic values.
Thallium-201 myocardial scintigraphy in patients with triple-vessel disease and ischemic exercise stress tests.
Authors: Leppo J , Yipintsoi T , Blankstein R , Bontemps R , Freeman L M , Zohman L , Scheuer J
Published: June 2012

Thirty patients with triple-vessel coronary artery disease proven by angiography, symptomatic angina and a positive ECG stress test were evaluated with thallium-201 (201TI) scintigraphy. Twenty patients also had aortocoronary saphenous vein bypass surgery; 15 of them had repeat noninvasive evaluation. Seventy percent of these patients showed ischemia by 201TI scintigraphy, of which one-half returned to normal after surgery. Postoperative reversion of the ECG stress test together with 201TI stress/reperfusion imaging correlated well with the completeness of surgical revascularization. We could not explain the prevalence (80%) of infarcts detected by 201TI in this group, of which 76% could be anatomically correlated to epicardial scars. The positivity of infarcts by 201TI exceeded that predicted by previous history of infarction, Q waves on resting ECG or ventriculographic akinesis. These observations suggest that 201TI scintigraphy is a useful noninvasive tool in the follow-up and understanding of patients with coronary heart disease. These conclusions also support the concept that 201TI stress imaging need not have the identical connotation as the ECG stress test.
Antiarrhythmic drug therapy in survivors of prehospital cardiac arrest: comparison of effects on chronic ventricular arrhythmias and recurrent cardiac arrest.
Authors: Myerburg R J , Conde C , Sheps D S , Appel R A , Kiem I , Sung R J , Castellanos A
Published: June 2012

We studied the long-term effects of membrane-active antiarrhythmic agents on chronic ventricular arrhythmias in patients who have survived prehospital cardiac arrest. Among 16 patients treated with a dose-adjusted, plasma level-monitored antiarrhythmic regimen, eight have survived for longer than 12 months and eight have had recurrent cardiac arrests (RCAs). Monthly Holter monitor tapes (HM) recorded during the 4 months before the eight RCAs were compared with monthly HM tapes matched for time of entry and duration of follow-up in the eight patients who did not have RCAs. Transient or persistent complex ventricular ectopic depolarizations (VEDs) have been recorded on 47 of the 63 monthly HM tapes (75%). The difference between VEDs in the RCA patients (mean 153 VEDs/hr, median 19 VEDs/hr) and VEDs in the patients who have not had RCA (mean 122 VEDs/hr, median 8 VEDs/hr) was not significant (p less than 0.2); nor was there a predictable relationship between therapeutic plasma levels of antiarrhythmic agents and the frequency and complexity of chronic asymptomatic VEDs (therapeutic levels--mean 104 VEDs/hr, median 6 VEDs/hr; subtherapeutic levels--mean 184 VEDs/hr, median 21 VEDs/hr). Differences were not significant (p greater than 0.1). In contrast, all eight RCA patients had unstable plasma levels (21 of 31 determinations subtherapeutic) while six of the eight patients who have not had RCA had consistently therapeutic levels (p less than 0.01). Thus, adequate plasma levels of antiarrhythmic agents may protect against RCA, despite failure to suppress VEDs predictably. The apparent dissociation between predictable suppression of chronic VEDs and protection against RCA suggests that clinical effectiveness of these agents may not be best measured by their effect on chronic VEDs.
The cardiac conduction system in situs ambiguus.
Authors: Dickinson D F , Wilkinson J L , Anderson K R , Smith A , Ho S Y , Anderson R H
Published: June 2012

The cardiac specialized conduction tissue was studied by serial sectioning in 13 cases of situs ambiguus. In four cases of right isomerism, we found paired sinus nodes in relation to a crista terminalis, and in each case a sling of conduction tissue between two atrioventricular nodes was present regardless of the ventricular morphology or cardiac position. In the cases with left isomerism, the sinus node was hypoplastic and abnormally located. We saw two types of atrioventricular conduction systems. In the three cases in which the morphologically right ventricle lay to the right of the morphologically left ventricle (presumed d-loop), a single atrioventricular bundle arose from a normally located atrioventricular node. In the five cases in which the morphologically right ventricle lay to the left of the morphologically left ventricle (presumed l-loop) and in the one case with a univentricular heart, paired atrioventricular nodes were present, linked or potentially linked by a sling of conduction tissue.
The pathophysiology and diverse etiology of septal perforator compression.
Authors: Kostis J B , Moreyra A E , Natarajan N , Hosler M , Kuo P T , Conn H L
Published: June 2012

Compression of the septal perforator branches of the left anterior descending artery (systolic obliteration and diastolic reopacification during arteriography) has been proposed as a marker of idiopathic hypertrophic subaortic stenosis (IHSS). Among 568 unselected coronary arteriograms this angiographic finding was pronounced in 11 of 17 patients with IHSS; in 12 of 44 with aortic stenosis (AS); in five of 46 patients with severe (95%) proximal stenosis of the left anterior descending coronary artery; in three of 18 with myocardial bridge; in three of 12 with hypertrophic cardiomyopathy; in one of 62 with normal right and left heart catheterization; and in none of the 369 patients with other cardiac diseases. Mild septal perforator compression (SPC) was observed in six other patients with IHSS, one patient with hypertrophic cardiomyopathy, 19 patients with AS, eight patients with severe stenosis of the LAD and one patient with myocardial bridge. SPC was more pronounced in patients with high systolic pressure gradients (Spearmann Rank r = 0.64, p = 0.003 and Pearson r = 0.31, p = 0.159 for IHSS; Spearmann Rank r = 0.47, p = 0.001; Pearson r = 0.51, p = 0.001 for AS) and increased septal thickness (Spearmann Rank r = 0.45, p = 0.05, Pearson r = 0.61, p = 0.011 for IHSS; Spearmann r = 0.44, p = 0.013, Pearson r = 0.42, p = 0.018 for AS). SPC is not specific for IHSS. It may result from a decrease of the intraluminal pressure in the septal perforators resulting from obstruction at the left ventricular, aortic valvular or coronary arterial level and from increased septal thickness which may lead to higher extraluminal pressure.
Effects of nitroglycerin on echocardiographic measurements of left ventricular wall thickness and regional myocardial performance during acute coronary ischemia.
Authors: Komer R R , Edalji A , Hood W B
Published: June 2012

The effects of nitroglycerin on regional left ventricular performance, assessed by echocardiographic techniques, were investigated in anesthetized, open-chest dogs during acute myocardial ischemia. During transient occlusion of the left anterior descending coronary artery, there was end-diastolic thinning and marked reduction in systolic thickening in the central ischemic zone. Similar changes of lesser degree were noted in the border zone. The normal zone was unaffected. Infusion of nitroglycerin during ischemia in dosages of 2.5--50 microgram/kg/min reduced left ventricular end-diastolic pressure without changing the abnormalities of systolic wall thickening. Effects of bolus injections of 20 and 50 microgram/kg of nitroglycerin were similar, although this also lowered aortic pressure. In a subgroup of animals in which nitroglycerin infusion was unaccompanied by tachycardia, there was also no evidence that ischemic dysfunction was altered. We conclude that nitroglycerin does not improve regional myocardial performance in acutely ischemic canine myocardium. The decrease in preload is probably entirely due to the peripheral effects of the agent.
Circadian variation of exercise capacity in patients with Prinzmetal's variant angina: role of exercise-induced coronary arterial spasm.
Authors: Yasue H , Omote S , Takizawa A , Nagao M , Miwa K , Tanaka S
Published: June 2012

Thirteen patients with Prinzmetal's variant angina performed treadmill exercise tests in the early morning and in the afternoon of the same day. The attacks with ST elevation were induced repeatedly in all 13 patients in the early morning, but in only two patients in the afternoon. Propranolol did not suppress the exercise-induced attacks in all 13 patients. Diltiazem suppressed the attacks in all 13 patients and phentolamine in eight of the nine patients. Coronary arteriograms demonstrated that spasm occluding completely or almost completely the large coronary artery supplying the area of myocardium showing ST elevation appeared during the attacks and disappeared along with the attacks after nitroglycerin administration in all four patients in whom the attacks were induced by arm exercise in the catheterization laboratory. We conclude that there is circadian variation of exercise capacity in patients with Prinzmetal's variant angina caused by coronary arterial spasm induced by exercise in the early morning but not in the afternoon.
Coronary arterial spasm as a cause of exercise-induced ST-segment elevation in patients with variant angina.
Authors: Specchia G , de Servi S , Falcone C , Bramucci E , Angoli L , Mussini A , Marinoni G P , Montemartini C , Bobba P
Published: June 2012

Four patients with variant angina pectoris exhibited reproducible exercise-induced chest pain and ST-segment elevation. Coronary arterial spasm was documented with arteriography during exercise-induced ST-segment elevation (three patients) or after intravenous administration of ergonovine maleate (one patient). Our observations show that in patients with variant angina exercise can trigger coronary arterial spasm, thus inducing anginal pain and ST-segment elevation.
Immediate effects of hydralazine-isosorbide dinitrate combination on exercise capacity and exercise hemodynamics in patients with left ventricular failure.
Authors: Franciosa J A , Cohn J N
Published: June 2012

Resting hemodynamics improve during vasodilator administration in patients, with congestive heart failure (CHF), but the effects of these agents on exercise is unknown. Twenty-two patients with class II or III CHF performed bicycle exercise to symptomatic maximum before and 90 minutes after random double-blind administration of oral hydralazine (100 mg) and isosorbide dinitrate (40 mg) (11 patients, group 1) or placebo (11 patients, group 2). Exercise duration was unchanged after treatment in either group. Maximal oxygen consumption changed insignificantly in both groups, from 12.6 +/- 1.2 (SEM) to 13.6 +/- 1.6 ml/kg/min in group 1, and from 11.7 +/- 1.4 to 13.4 +/- 1.7 ml/kg/min in group 2. Maximal cardiac index was unchanged in both group 1 (4.00 +/- 0.33 to 4.41 +/- 0.29 l/min/m2) and group 2 (4.11 +/- 0.43 to 4.14 +/- 0.42 l/min/m2). Systemic vascular resistance at peak exercise was also unchanged in both group 1 (14.1 +/- 1.6 to 11.8 +/- 1.0 units) and group 2 (14.7 +/- 1.6 to 13.5 +/- 1.6 units). at submaximal exercise (300 kilopond-meters/min), however, cardiac index after treatment increased in group 1 (0.51 +/- 0.18 l/min/m2, p less than 0.05) and systemic vascular resistance decreased (-3.3 +/- 1.3 units, p less than 0.05), but were unchanged in group 2. Thus, although vasodilators do not improve maximal exercise capacity acutely, they can improve hemodynamics at lower work loads which may, therefore, be better tolerated in patients with CHF.
The quality of resonance of the first heart sound after myocardial infarction: clinical significance.
Authors: Renner W F , Renner G W
Published: June 2012

Frequency analyses of the first heart sound (S1) were performed in 80 normal subjects and 80 postinfarction patients. A readily recognizable frequency pattern characterized by a quality of resonance greater than or equal to 2, as measured by the Q factor at 3 db down, was noted in 78 of the 80 apparently normal subjects. An aberrant pattern with a Q less than 2, often accompanied by a lowering of the frequency content, was found in 78 of 80 postinfarction patients. We propose that the quality of resonance of S1 is a measure of the degree to which the structural homogeneity of the left ventricle as a compliant contractile unit has been preserved after myocardial infarction.
Effects of amiodarone on cardiac and coronary hemodynamics and on myocardial metabolism in patients with coronary artery disease.
Authors: Côté P , Bourassa M G , Delaye J , Janin A , Froment R , David P
Published: June 2012

While the antiarrhythmic effects of amiodarone are well-documented, its hemodynamic effects are not. We injected 5 mg/kg amiodarone i.v. in 16 patients undergoing coronary arteriography. Heart rate did not change. Aortic (systolic, diastolic and mean) and left ventricular (systolic and end-diastolic) pressures decreased significantly (p less than 0.01) at 5 and 15 minutes; systemic vascular resistance also fell significantly (p less than 0.05), while cardiac index increased slightly but significantly (p less than 0.05). Coronary vascular resistance decreased significantly (p less than 0.01) and coronary sinus blood flow rose in most patients, from a mean of 138 ml/min to 153 ml/min at 5 minutes (p less than 0.02); it then returned toward the control value at 15 minutes (mean 145 ml/min). Myocardial metabolism of O2 was normal and unchanged. Metabolism of lactate improved in five patients, remained unchanged in seven and deteriorated transiently in four. No undesirable hemodynamic and clinical side effects occurred when the drug was administered slowly. We conclude that amiodarone is a powerful systemic and coronary vasodilator. In addition to its present indications in the treatment of angina pectoris and arrhythmias, the drug might be very useful as an afterload-reducing agent.
The mechanism of apparent right bundle branch block after transatrial repair of tetralogy of Fallot.
Authors: Horowitz L N , Simson M B , Spear J F , Josephson M E , Moore E N , Alexander J A , Kastor J A , Edmunds L H
Published: June 2012

The electrocardiographic pattern of right bundle branch block (RBBB) is routinely observed after transatrial repair of tetralogy of Fallot even though no ventriculotomy has been performed. The mechanism of this conduction disturbance was studied in 16 patients with tetralogy of Fallot and one patient with infundibular pulmonic stenosis. Preoperative ECGs and vectorcardiograms showed right ventricular hypertrophy and no RBBB. Epicardial activation maps were obtained before and after total surgical repair in all patients and after infundibular resection but before closure of ventricular septal defect (VSD) in four of these patients. After infundibular resection, RBBB appeared and activation was markedly delayed (greater than 30 msec) over the pulmonary outflow tract, but was unchanged over the body of the right ventricle. No further changes in ventricular activation occurred after closure of the VSD. This study shows that RBBB after transatrial repair of tetralogy of Fallot is usually produced by infundibular resection, but not by VSD closure, and is associated with delayed activation of the pulmonary outflow tract and base of the right ventricle which results from damage to portions of the right ventricular conduction system.
Body surface potential maps in patients with pulmonic valvular and aortic valvular stenosis of mild to moderate severity.
Authors: Sohi G S , Green E W , Flowers N C , McMartin D E , Masden R R
Published: June 2012

Multiple-lead surface potential maps were compared throughout ventricular activation in nine patients with mild-to-moderate pulmonic stenosis and in 12 patients with mild-to-moderate aortic stenosis. Abnormal patterns of potential distribution were found in aortic stenosis, including three patients without electrocardiographic evidence of left ventricular enlargement. When related to the onset of depolarization, abnormal departures started later, peaked later, lasted longer, and were more intense, more uniform and discrete in aortic stenosis. In pulmonic stenosis, abnormal departures started earlier, but were more dispersed in timing and location than in aortic stenosis. The left ventricle appears to be the more remote, though more powerful and compact, generator. The right ventricular shell, however, is nearer to the surface, and is more anatomically extended in surface area, permitting much wider shifts in wavefront location and orientation as a result of small differences in pressure, or volume, or location of the heart in the thorax.
Myocardial fascicle and fiber disarray in 25 mu-thick sections.
Authors: Fujiwara H , Kawai C , Hamashima Y
Published: June 2012

We compared the histologic picture of myocardial fiber disarray in thin (4 mu) and thick (25 mu) sections of tissues obtained at autopsy from 18 adults and eight infants with clinically normal hearts, from 10 hearts with concentric hypertrophy (hypertensive patients), nine with myocardial infarction and four with hypertrophic cardiomyopathy (HCM). In the thick sections, so-called bizarre myocardial fiber disarray in thin sections was seen as a bizarre fascicle disarray. Therefore, the usual fiber disarray reported in cases of HCM is actually a fascicle disarray with a three-dimensional complex network. There was no marked difference in distribution and frequency of fascicle disarray among normal adult and infant hearts, and diseased hearts with hypertension and myocardial infarction. In the four hearts with HCM, diffuse bizarre fascicle disarray in the thick section was detected in the septum and anterior and posterior walls of the left ventricles in all cases, and in the lateral walls in one case. In the portions without the diffuse fascicle disarray, the distribution of disarray was the same as that in hearts with no HCM. Such fascicle disarray, including that of HCM, is probably congenital.
Effects of the Valsalva maneuver on myocardial ischemia in patients with coronary artery disease.
Authors: Pepine C J , Wiener L
Published: June 2012

The influence of the Valsalva maneuver (VM) on myocardial ischemia was evaluated in 24 patients with coronary heart disease. Clinical and hemodynamic responses to the VM were studied during acute ischemia manifested by angina pectoris with transient left ventricular (LV) dysfunction and compared with responses during nonischemic intervals. In the absence of evidence for acute ischemia (angina and increased LV end-diastolic pressure), six patients had abnormal hemodynamic responses to the VM. Five had lack of systolic pressure overshoot and in one, systolic pressure did not decline during straining. When the VM was performed during an ischemic episode, 14 patients had abnormal responses (12 with lack of overshoot in phase IV and two with lack of systolic pressure decline in phase II). In 18 patients a prompt decline in LV end-diastolic pressure occurred with the disappearance of angina during the VM. These changes uniformly occurred during the latter part of straining (VM phase II) as cardiac size and systolic pressure declined. No adverse effects occurred when a VM was performed during acute ischemia. Our observations suggest that the VM abruptly reduces determinants of cardiac oxygen demand, relieving acute ischemia without harmful effects.
Instantaneous blood flow responses to positive end-expiratory pressure with spontaneous ventilation.
Authors: Perschau R A , Pepine C J , Nichols W W , Downs J B
Published: June 2012

Variable hemodynamic responses to positive end-expiratory pressure (PEEP) with spontaneous ventilation have been reported. To clarify these responses, 15 awake patients were studied using a catheter-tip velocity transducer to record phasic aortic root blood flow continuously before, during and after PEEP (10 cm H2O) applied with a face mask. Central blood volume and effective ventricular filling pressures were measured. Phasic pulmonary artery blood flow was also simultaneously recorded in three of these patients. PEEP produced an acute aortic blood flow reduction, detected within one respiratory cycle. Stroke volume decreased 12%, and since heart rate was unchanged, cardiac output also declined (p less than 0.05). Inspiratory-to-expiratory aortic flow changes were less during PEEP. In contrast, inspiratory-to-expiratory pulmonary artery flow alterations were exaggerated due to a marked flow decline during expiration. Central blood volume and effective left ventricular filling pressure decreased 9% and 19%, respectively (p less than 0.05 in all patients). The decrease in pulmonary artery flow was associated with a decrease in central blood volume in the three patients in whom pulmonary flow was measured. PEEP promptly reduces cardiac output during spontaneous ventilation, related to a decrease in pulmonary flow in expiration.
The conduction system in hypoplasia of the aortic tract complex.
Authors: Bharati S , Lev M
Published: June 2012

This is a study of the course of the conduction system in two cases of hypoplasia of the aortic tract complex, one with mitral stenosis and the other with mitral atresia. In both there was a posterior atrioventricular (AV) node which formed the AV bundle. In case 1 the bundle was short and bifurcated early. The branching bundle gave off a large left bundle branch (LBB), many Mahaim fibers to the septum and a small right bundle branch (RBB). In case 2 the AV node was divided into two parts which formed two posterior bundles which joined together to form a short branching bundle. Instead of a LBB there were profuse Mahaim fibers passing from the branching bundle to the depths of the ventricular septum. The RBB was large. The abnormalities seen in the conduction system particularly in the LBB are discussed from the embryologic stand-point.
Sympathectomy for Essential Hypertension
Authors: ALLEN EDGAR V.
Published: June 2012

The successful treatment of essential hypertension remains one of the most difficult problems in medicine. Approximately 18 years have elapsed since extensive sympathectomy was first performed for essential hypertension. Extensive sympathectomy occasionally produces striking decrease in blood pressure of patients with essential hypertension; in many instances it fails to decrease blood pressure or modify the course of the disease. That which is most desired are some standards for preoperative selection of patients so that only patients who will be benefited by sympathectomy will be operated on. Unfortunately this apparently cannot be accomplished. The indications for sympathectomy remain at least partially uncertain and there is no agreement among those most experienced in the field of hypertension relative to the results of operation. There also are differences of opinion about the extensiveness of sympathectomy which is advisable. This paper indicates clearly differences of opinion among those most experienced in this field and emphasizes some of the points of agreement. It seems clear that additional technics of sympathectomy cannot be devised for the treatment of essential hypertension. There seems little doubt that sympathectomy would not be performed were adequate medical treatment available. This presentation gives the opinion of internists and surgeons who are particularly interested in hypertension and its treatment.
The Effect of Procaine Amide (Pronestyl) in Clinical Auricular Fibrillation and Flutter
Authors: MILLER G. , WEINBERG S. L. , PICK A.
Published: June 2012

Procaine amide (Pronestyl) was administered to patients with auricular fibrillation and flutter in an attempt to restore sinus rhythm. Thirteen of 20 patients with auricular fibrillation had sinus rhythm re-established. Several of the patients who were not converted with procaine amide were later restored to sinus rhythm with quinidine.
The Distribution of Cardiac Potentials Around the Chest in One Hundred and Three Normal Men
Authors: SIMONSON ERNST
Published: June 2012

Chest leads farther right to V
1
and farther left to V
6
have been suggested, and are increasingly used, for diagnosis of right ventricular or posterior wall lesions. Normal standards are provided for the regional distribution of seven arbitrarily defined patterns and amplitudes of main deflections, in five positional groups, in 15 leads around the chest, resulting in statistical evaluation of 600 electrocardiographic items. In general, the results favor a much more conservative interpretation than has been noted in the past. Some implications to electrocardiographic theory are discussed.
Further Observations on Penicillin-Treated Cardiovascular Syphilis
Authors: EDEIKEN JOSEPH , FORD WILLIAM T. , FALK MORTIMER S. , STOKES JOHN H.
Published: June 2012

One hundred and eleven cases of cardiovascular syphilis were treated with penicillin and, of these, 13 were in congestive heart failure, eight suffered from angina pectoris, and three had a history of coronary occlusion. Except for mild fever in a few instances therapeutic shock was not observed in any of the patients and therapeutic paradox, although sought for, was also not observed. There is evidence to suggest that penicillin has a favorable influence upon cardiovascular syphilis; angina pectoris and congestive heart failure do not contraindicate the use of penicillin in cardiovascular syphilis.
The Pathogenesis of Spontaneous Cardiac Rupture
Authors: WESSLER STANFORD , ZOLL PAUL M. , SCHLESINGER MONROE J.
Published: June 2012

Twenty patients with cardiac rupture were compared with suitable control groups. In each ruptured heart there was an acute coronary artery occlusion and a recent, transmural myocardial infarction which was unprotected at the site of rupture by scar or anastomotic circulation. Clinically, rupture usually occurred during the first two weeks of an acute infarction in a hypertensive patient with no previous history of old infarction or congestive failure; persisting hypertension or excessive effort usually preceded rupture. The role of an increased intraventricular pressure in the pathogenesis of cardiac rupture has therapeutic implications.
Pressor Effects of Epinephrine, Norepinephrine and Desoxycorticosterone Acetate (DCA) Weakened by Sodium Withdrawal
Authors: RAAB W. , HUMPHREYS R. J. , MAKOUS N. , DEGRANDPRÉ R. , GIGEE W.
Published: June 2012

Recent findings suggest an important role of the sodium ion, intracellularly deposited by the adrenal mineralocorticoids, as the physicochemical mediator between the pressor actions of the mineralocorticoids and of the adrenosympathogenic neurohormones. The following observations show that the pressor effectiveness of both the pressor neurohormones and desoxycorticosterone acetate depends on the availability of sodium. This supports the theory that vascular pressor responsiveness and tonus is determined jointly by the sodium-depositing corticoids as sensitizers and the adrenosympathogenic neurohormones as the physiologic stimulators of the vascular contractile elements.
The Ballistocardiogram in Myocardial Infarction: A Study of One Hundred Cases
Authors: MOSER MARVIN , PORDY LEON , CHESKY KENNETH , TAYMOR ROBERT C. , MASTER ARTHUR M.
Published: June 2012

In the presence of previous myocardial infarction, the direct ballistocardiogram is
abnormal
in approximately 80 per cent of the cases. Following the coronary occlusion, a
normal
ballistocardiogram is relatively rare in patients with angina pectoris as compared with those who are asymptomatic. There is no correlation between the ballistocardiographic patterns and the persistence of electrocardiographic evidence of myocardial infarction. The prognostic significance of the ballistic findings reported will be determined by long-term follow-up studies.
Aconitine-Induced Auricular Arrhythmias and Their Relation to Circus-Movement Flutter
Authors: BROWN BARBARA B. , ACHESON GEORGE H.
Published: June 2012

Certain characteristics of aconitine-induced auricular arrhythmias in dogs and the responses of aconitine-induced flutter to various experimental procedures and to drugs are described. In certain experiments there was evidence that a secondary flutter mechanism had developed which, in some instances, resembled flutter of circus-movement origin. When aconitine-induced and circus-movement flutters were induced separately and simultaneously in auricles functionally divided by a crush, they responded to drugs in their characteristic manners. Aconitine-induced flutter slowed progressively and recovered gradually to flutter, whereas circus-movement flutter frequently reverted suddenly and permanently to sinus rhythm.
Measurement of Arterioles in Coarctation of the Aorta
Authors: PAINTER ROBERT C. , HINES EDGAR A. , EDWARDS JESSE E.
Published: June 2012

In cases of aortic coarctation determinations of the wall-to-lumen ratio were made for the arterioles of the thyroid, pancreas, kidney and periadrenal tissue and compared with those for arterioles from the same organs in control cases. As in primary hypertension, there was, on the average, an increase in the wall-to-lumen ratio in each of the regions studied in the cases of coarctation as compared with the same tissues of the control group. This means that for arterioles of the same wall size the lumen was narrower in the cases of coarctation than in the control cases.
The Intestinal Excretion of Digitoxin in the Rat
Authors: ST. GEORGE SHIRLEY , FRIEDMAN MEYER
Published: June 2012

Rats given a parenteral injection of digitoxin (1 µg. per gram of body weight) were found to excrete approximately 15 to 18 per cent of the dose in their feces. This fecal digitoxin however came from the bile, and there was no evidence of any active secretion of the glycoside by the bowel wall itself.
Skin Temperature Response of Normal Human Subjects to Various Conditions
Authors: REDISCH WALTER , SHECKMAN EDWARD , STEELE J. MURRAY
Published: June 2012

Ten healthy volunteers (five males and five females), 25 to 41 years of age, were exposed to several different environmental conditions in a constant temperature room. It was found that at 20 C. and about 55 per cent humidity, about five hours after the last meal, the behavior of the temperature of the toe in contrast to that of the finger was consistent, reliable and reproducible. These conditions, somewhat cooler than those frequently used, were deemed suitable for testing vasodilator drugs or procedures.
The Relation of Water and Sodium Excretion to Blood Pressure in Human Subjects
Authors: GREEN D. M. , WEDELL H. G. , WALD M. H. , LEARNED B.
Published: June 2012

High sodium loads were administered intravenously to a group of subjects whose blood pressures covered a wide range. Despite large individual variations, the water and sodium excretion of the group were found to be significantly and directly correlated with blood pressure.
The combined effect of smoking and coffee drinking on LDL and HDL cholesterol.
Authors: Heyden S , Heiss G , Manegold C , Tyroler H A , Hames C G , Bartel A G , Cooper G
Published: June 2012

Conflicting reports on the effect of smoking and coffee drinking on lipoproteins prompted us to study the combined effect of these two associated, widely prevalent habits in 361 persons randomly sampled from the Evans County cohort. Low-density lipoprotein (LDL) cholesterol levels were significantly higher among persons who smoked cigarettes and consumed five or more cups of coffee per day than among nonsmokers who abstained from coffee. Conversely, high-density lipoprotein (HDL) cholesterol was higher in persons who did not smoke or drink coffee than in coffee-consuming smokers. However, this trend was not statistically significant. Triglycerides and very low-density lipoprotein (VLDL) cholesterol were highest among smokers who drank five or more cups of coffee per day, but these differences did not reach statistical significance. Lipoprotein cholesterol levels were adjusted for age, sex and body mass. Smoking and coffee drinking interact in affecting LDL and total cholesterol, but coffee drinking alone did not appear to affect blood lipids.
Left anterior hemiblock obscuring the diagnosis of right bundle branch block in acute myocardial infarction.
Authors: Sclarovsky S , Lewin R F , Strasberg B , Agmon J
Published: June 2012

Thirty cases in which transient left anterior hemiblock (LAHB) obscured the diagnosis of right bundle branch block (RBBB) appearing during the first days of an acute myocardial infarction (AMI) are presented. Twenty-eight of the patients with AMI had a clear septal wall involvement, while the remaining two had an anterolateral and lateral wall AMI, respectively. These intraventricular conduction defects developed 2-120 hours (mean 64.9 +/- 26 hours) after the acute event, and persisted for 24 hours to 7 days (mean 63.1 +/- 35 hours). The ECG was characterized by a pure LAHB with wide QRS complexes and the presence of RBBB was shown by recording high V1 and right-sided chest leads. The vectorcardiogram was also useful in several cases. The clinical course of this type of bifascicular block was transient and benign, with an in-hospital mortality of 6.7%. No patient developed trifascicular or complete atrioventricular block and, therefore, we conclude that prophylactic installation of a temporary pacemaker is not indicated in this type of bifascicular block. The possible role of extracellular potassium released during acute myocardial necrosis in the pathophysiological mechanism of these blocks is discussed.
Significance of chronic bifascicular block without apparent organic heart disease.
Authors: Dhingra R C , Wyndham C , Bauernfeind R , Denes P , Wu D , Swiryn S , Rosen K M
Published: June 2012

Eighty-six of 452 patients (19%) with chronic bifascicular block were found to have no clinically apparent associated organic heart disease (OHD) and were defined as having primary conduction disease (PCD). Comparison of patients with PCD and OHD revealed a significantly lower incidence of the following clinical variables in the PCD patients (p less than 0.001): exertional angina, dyspnea, congestive heart failure, cardiomegaly, functional class I (all by study design), left bundle branch block and premature ventricular contractions. Both mean AH and HV intervals were significantly shorter in patients with PCD (p less than 0.01). The incidence of HV prolongation was 21% in PCD and 41% in OHD patients (p less than 0.001). All patients were prospectively followed for 21-2998 days with a mean +/- SEM of 1209 +/- 66 days for PCD and 1172 +/- 36 days for OHD. Atrioventricular (AV) block developed in three patients from the PCD group and 26 from the OHD group (NS), with spontaneous block occurring in one (1%) PCD patient and 19 (5%) OHD patients (p less than 0.05). Annual mortality due to sudden death as well as total cardiovascular mortality (including sudden death) for the 5-year follow-up was significantly lower in patients with PCD. Patients with PCD have significantly lower incidence of electrophysiologic abnormalities and subsequent spontaneous AV block as well as cardiovascular and sudden death mortality. The diagnosis of PCD based on clinical criteria probably underestimates the presence of underlying OHD, as suggested by a small but definite risk of cardiovascular mortality.
Modified Shumacker repair of transposition of the great arteries.
Authors: Waldhausen J A , Pierce W S , Berman W , Whitman V
Published: June 2012

Seven infants weighing from 6.4 to 10.3 kg underwent correction of transposition of the great arteries by the venous transposition operation as described by Shumacker. In this operation, a new atrial septum is constructed using a bipedicled right atrial flap, and the lateral atrial wall is constructed using a viable pericardial flap. Three of the patients had an associated ventricular septal defect. Six of the seven patients survived and have had an excellent clinical result. Although atrial arrhythmias were common in the early postoperative period, all patients are now in sinus rhythm. Two patients have had postoperative cardiac catheterization and cineangiography, which showed excellent hemodynamic results. The modified Shumacker operation preserves two of the three internodal pathways, provides a compliant, viable atrial septum, and permits fabrication of a generous-size physiological left atrium. This appears to offer advantages not present in the Mustard procedure.