bluuebunny/crossref_metadata_2025 huggingface dataset:
Rebound Phenomena after Anticoagulant Therapy in Cerebrovascular Disease
Authors: MARSHALL JOHN
Published: June 2012

Anticoagulant therapy did not reduce the incidence of further nonfatal cerebrovascular accidents in 90 patients who had already experienced one or more such accidents as compared with a control group. Following gradual withdrawal of therapy, however, there was a significantly increased incidence of nonfatal cerebrovascular accidents during the first three months after therapy. This suggests that following cessation of anticoagulant therapy there is a period of true "rebound" during which thrombo-embolic incidents are more likely to recur.
Pseudoaneurysm of the Heart
Authors: HURST CLYDE O. , FINE GERALD , KEYES JOHN W.
Published: June 2012

A case is reported of coronary atherosclerosis leading to myocardial infarction of the left ventricle and rupture of the left lateral posterior wall with limitation of the hemorrhage by fibrotic parietal pericardium. Formation of the false aneurysm allowed the patient to survive 5 years and 10 months after it was clinically recognized.
Observations on the Pulmonary Vasculature in a Case of Centrilobular Emphysema with Hemosiderosis
Authors: HEATH DONALD , NORRIS R. M. , DAVISON PAUL
Published: June 2012

A 31-year-old man with centrilobular emphysema complicated by pulmonary hemosiderosis suffered from cor pulmonale for many years and eventually died from congestive cardiac failure. At autopsy the right ventricle was 13 mm. thick and was three times the normal weight. The pulmonary arterioles showed classical hypertensive changes, but the pulmonary arteries showed no abnormality apart from an insignificant increase in medial thickness. These findings support the view that hypertensive pulmonary vascular disease is not a passive phenomenon due to the effect of increased pressure on vessels but is brought about by active response to stimuli, which were apparently not present in this case.
The Antiarrhythmic Properties of Lidocaine and Procaine Amide
Authors: HARRISON DONALD C. , SPROUSE J. HENRY , MORROW ANDREW G.
Published: June 2012

The effects of lidocaine (Xylocaine) and procaine amide on arterial pressure, myocardial contractile force, and ventricular excitability were studied in 12 patients undergoing cardiac operations. Both compounds resulted in an increase in the stimulation threshold of the ventricle during diastole and neither caused a significant change in the duration of the absolute refractory period. Lidocaine, in doses of 1.0 to 2.0 mg./Kg., produced no significant circulatory depression but every patient given procaine amide (2.0 or 4.0 mg./Kg.) evidenced a fall in arterial pressure and a decrease in the contractile force of the right ventricle. These physiologic observations and clinical experiences with the use of lidocaine indicate that it is an effective antiarrhythmic agent and that it is preferable to procaine amide in the management of ventricular arrhythmias that occur during and following cardiac operations.
Perforation of Heart during Cardiac Catheterization and Selective Angiocardiography
Authors: KEATES P. G. , WAGNER G. R.
Published: June 2012

A case is reported in which cardiac catheterization and selective angiocardiography led to perforation of the heart without any further complications.

It is suggested that distortion of the pressure tracing indicates partial obstruction of the catheter holes and that it should serve as a warning sign not to proceed with the injection of contrast medium, but to re-position the catheter first. Furthermore, inspection of the electrocardiogram immediately after the injection may give an early indication of myocardial disturbance in the form of ST-segment depression.
Interatrial Communication and Left Atrial Hypertension
Authors: ROSS JOHN , BRAUNWALD EUGENE , MASON DEAN T. , BRAUNWALD NINA S. , MORROW ANDREW G.
Published: June 2012

The combination of left atrial hypertension and a small atrial septal defect was observed in three patients and was found to be responsible for a continuous heart murmur. Mitral stenosis was present in two patients, and mitral atresia in the third. The continuous murmurs were loudest over the lower sternum, were augmented by inspiration, and were reduced or abolished by the Valsalva maneuver. Cardiac catheterization studies demonstrated the presence of a left-to-right shunt at the atrial level in each instance. The continuous murmurs were localized to the right atrium by intracardiac phonocardiography in two patients, and alterations in the interatrial pressure gradient during respiratory maneuvers were documented.
The Continuous Heart Rate in Men Exhibiting an Overt Behavior Pattern Associated with Increased Incidence of Clinical Coronary Artery Disease
Authors: FRIEDMAN MEYER , ROSENMAN RAY H. , BROWN ALVIN E.
Published: June 2012

The continuous heart rates of a group of subjects exhibiting behavior pattern A (associated with a high incidence of clinical coronary heart disease) were obtained by means of a specially designed instrument at various times of the total day and compared with that obtained from subjects exhibiting a converse pattern (behavior pattern B). In addition, the heart rates of patients suffering from functional cardiovascular disease and from clinical coronary heart disease were measured throughout the day.

The average daily heart rates appeared to be about the same in subjects with pattern A and in subjects with pattern B. Moreover, their average heart rates were approximately the same as those in patients with functional cardiovascular disease.

Patients suffering from coronary heart disease with or without a previous infarction, if essentially asymptomatic, showed about the same average daily heart rate as did the subjects of the other groups. However, the patients who had suffered from a previous infarction and who were experiencing symptoms exhibited a faster heart rate.
Complete Transposition of the Great Vessels: Importance of Septal Defects and Patent Ductus Arteriosus
Authors: BOESEN IB
Published: June 2012

In 1,145 autopsies performed on children with congenital heart disease who died before the age of 4, 180 were found to have a completely transposed aorta and pulmonary artery. Of these, 35 were excluded from the analysis because of other severe congenital cardiac malformations (among which were six with pulmonary stenosis); 11 who died from noncardiac disorders and two mongoloid idiots were also excluded. The remaining 132 were analyzed with reference to the relationship between the time of death and the presence of veno-arterial communications. Fortytwo per cent of the children died within 1 month and 73 per cent within the first 3 months of life. Therefore, diagnostic and therapeutic problems chiefly arise during the first months of life in patients with complete transposition of the great vessels.
Coronary Heart Disease and Hypertension in the White Mountain Apache Tribe
Authors: CLIFFORD NATHAN J. , KELLY JOHN J. , LEO THOMAS F. , EDER HOWARD A.
Published: June 2012

Investigation of the members of the White Mountain Apache Tribe has confirmed our clinical experience that coronary artery disease is extremely rare in these people. The Apaches eat a diet low in saturated fat and have a correspondingly low mean serum cholesterol level. Older Apache males tend to have lower cholesterols than the younger men. A surprisingly high prevalence of high blood pressure was found, particularly in young men. A brief discussion of similar studies is included. Further investigation of this relatively stable socioeconomic and racial group is needed.
Blood Flow in the Human Calf during Tobacco Smoking
Authors: COFFMAN JAY D. , JAVETT STANLEY L.
Published: June 2012

Blood flow in the human calf during cigarette smoking was measured by two methods. One technic, the disappearance rate of a radioisotope injected into a muscle, was used to indicate muscle capillary blood flow, while the other method, plethysmography, was used to measure the total blood flow of the calf including both skin and muscle. The smoking of 2 unfiltered, regular-size cigarettes produced a significant increase in muscle capillary blood flow in 14 of 17 normal subjects while plethysmographic blood flow changes were variable and not significant. Tests were performed to demonstrate that the increased muscle blood flow was not secondary to inhalation, that it was reproducible, and that the sympathetic nervous system probably was not involved. Intravenous nicotine produced significant increases in both muscle capillary and total calf blood flow. Patients with arteriosclerosis obliterans showed no change in muscle capillary blood flow during smoking.
Massive Myocardial Necrosis with Calcification
Authors: LITTMAN MARGARET S. , MEADOWS W. R.
Published: June 2012

The clinical and autopsy observations on two cases with myocardial necrosis and calcification are presented. In each case there also was subacute membranous and proliferative glomerulonephritis.

The myocardial lesions closely resemble those produced experimentally by potassium depletion and differ from those in other myocardial necroses.
Communication of the Coronary Sinus with the Left Atrium
Authors: MACMAHON H. EDWARD
Published: June 2012

A communication of the coronary sinus with the left atrium in the absence of other congenital cardiac anomalies is an uncommon finding. Three cases are recorded, one of which is contributed by the author.
Paroxysmal Atrial Tachycardia with Block Around the Ectopic Pacemaker
Authors: PHIBBS BRENDAN
Published: June 2012

A case is presented in which an ectopic atrial pacemaker manifested "pacemaker block," a phenomenon analogous to sinoatrial block in the sinoatrial node. This is believed to be the first recorded instance of such a phenomenon.
Selective Renal Arteriography in the Diagnosis of Renal Hypertension
Authors: MEANEY THOMAS F. , DUSTAN HARRIET P.
Published: June 2012

Renal arteriography following percutaneous femoral arterial catheterization (Seldinger technic) was performed in 100 selected hypertensive patients. Eighty-four per cent of the renal arteries encountered were individually catheterized. This procedure permitted a more detailed study of arterial branches than previously possible with aortic injection of contrast material. No serious complications occurred.

Fifty-two patients were found to have disease of renal arteries or their branches. Eleven or 21 per cent of these patients, had lesions of main arterial trunks. Thirty (58 per cent) had disease of primary branches either alone or in combination with main renal arterial lesions. Aneurysms of primary arterial branches were found in five patients, and avascular segments of renal parenchyma in four. The frequency of primary branch arterial disease was greater in this group of patients than in others previously reported. This difference may be due to improved visualization of the renal arterial system obtained with selective arteriography.
Modification of the Atrial Sound by the Cold Pressor Test, Carotid Sinus Massage, and the Valsalva Maneuver
Authors: HARRIS WILLARD S. , RODIN PHILIP , TABATZNIK BERNARD
Published: June 2012

Three procedures were investigated for their effect on the atrial sound. The cold pressor test caused the atrial sound to appear in one subject and to become louder in 15 of 28 subjects; it increased the atriosystolic murmur in two subjects with mitral stenosis. These effects were at least partly independent of changes in arterial diastolic pressure and heart rate. Carotid sinus massage decreased the atrial sound in five of 10 subjects and produced an unexplained increase in one. Following release of the strain of the Valsalva maneuver the atrial sound became louder than before the strain; in seven subjects its amplitude increased progressively and the sound also migrated from the first heart sound.

Increase of the atrial sound by the cold pressor test is attributed to sympathetic action upon peripheral veins, arteries, and the left atrium; its decrease by carotid sinus massage, to parasympathetic action upon these structures and the cardiac pacemaker; and its increase following release of the strain of the Valsalva maneuver, to combined increases of venous return and cardiovascular sympathetic activity. The proposed explanations require investigation by more direct methods.

Sympathetic activity may contribute to the increased amplitude of atrial sounds during states of exercise and heightened emotion and, in part, for their frequent occurrence in thyrotoxicosis.
Absence of a Primary Division of the Pulmonary Trunk
Authors: CUCCI CESARE E. , DOYLE EUGENIE F. , LEWIS ELMORE W.
Published: June 2012

An ontogenetic theory is proposed to explain the absence of a primary division of the pulmonary trunk on the basis of an error in the septation of the truncus arteriosus, and the two common varieties of the syndrome are discussed in detail. It is suggested that:

Both lateral pulmonary arteries are present in this syndrome, but one of them arises anomalously from the systemic circulation.

The aberrant origin of one lateral pulmonary artery derives from the dorsal shifting of one of the two ridges responsible for the septation of the truncus arteriosus. The sixth arch on the side of the dorsorotated truncal ridge then becomes incorporated into the newly formed ascending aorta.

The combination of tetralogy of Fallot, right aortic arch, and absent left primary pulmonary division results from a single primordial error: a dorsorotation of the left ridge extending throughout the truncoconus.

The initial portion of the aberrant (systemic) pulmonary artery may obliterate postnatally, thus impairing maturation of the terminal portion. This would explain the frequent failure to demonstrate the artery by angiography and, occasionally, at dissection.
Erythermalgia
Authors: BABB RICHARD R. , ALARCON-SEGOVIA DONATO , FAIRBAIRN JOHN F.
Published: June 2012

The syndrome of erythermalgia is characterized by a burning distress of the extremities that is accompanied by redness and increased temperature of the skin. These symptoms are initiated or exacerbated by an increase in environmental temperature and diminished by measures that cool the skin. Of 51 patients with this clinical syndrome seen at the Mayo Clinic during the years 1951 to 1960 inclusive, 30 were considered as having primary erythermalgia because of the absence of demonstrable associated conditions, and the rest were classified as having secondary erythermalgia because the condition was associated with various diseases. Particularly significant was the relation of erythermalgia to the myeloproliferative disorders as evidenced in 10 cases. In some of these cases, erythermalgia preceded other manifestations of the myeloproliferative disorder by as long as 12 years. The primary type was found to occur in younger individuals and to be more often bilateral, to produce pain of greater intensity, and to involve larger areas of the affected extremities. The pathologic physiology of this syndrome remains unknown.
Anomalous Left Coronary Artery Originating from the Pulmonary Artery
Authors: NADAS ALEXANDER S. , GAMBOA RAUL , HUGENHOLTZ PAUL G.
Published: June 2012

Case histories of two infants with anomalous origin of the left coronary artery from the pulmonary artery are presented.

Both infants underwent ligation of the left coronary artery at its entrance into the pulmonary artery. One survived the operation and is asymptomatic 3 years postoperatively, whereas the second one died at surgery.

A classification of instances of anomalous left coronary artery according to adequacy of the collateral circulation between the left and right coronary systems is proposed.

Surgical ligation of the pulmonary artery orifice of the left coronary artery is indicated only if the presence of a left-to-right shunt into the pulmonary artery is demonstrated.

If the direction of blood flow is from pulmonary artery to left coronary artery, surgical procedures should be aimed toward increasing either pulmonary artery oxygen content or left coronary artery perfusion pressure.
Plasma Vasoconstrictor Activity in Patients with Renal, Malignant, and Primary Hypertension
Authors: FITZ ANNETTE E. , ARMSTRONG MARK L.
Published: June 2012

Polypeptide vasoconstrictor activity was assayed in the peripheral venous blood of 45 hypertensive patients and 20 normal subjects. The average activity was significantly increased in all hypertensive groups, and activity tended to be much higher in patients with renovascular and malignant hypertension than in primary hypertension.

In confirmation of previously reported results by Helmer and Judson, there was no correlation between vasoconstrictor activity and renal excretory function. The plasma level of vasoconstrictor activity did not correlate with mean arterial pressure except when malignant or renovascular hypertension was present.

A significant inverse relationship was found between the serum potassium concentration and vasoconstrictor activity: as activity levels increased, the potassium fell. The data suggest that a renin-like substance may be present in various hypertensive states in amounts sufficient to depress serum potassium, presumably by activation of the renin-angiotensin-aldosterone mechanism.
Atherosclerosis in Europeans and Bantu
Authors: MEYER B. J. , PEPLER W. J. , MEYER A. C. , THERON J. J.
Published: June 2012

The atherosclerotic "profile" of the aorta, coronary, and cerebral arteries was gauged by the atherosclerotic index method of Gore and Tejada
12
in 540 unselected white and Bantu autopsy cases. The atherosclerotic indices were very low in all cases until about the third decade. Thereafter there was a progressive rise, which was most dramatic in the aorta and coronary arteries of white men.

The aorta and coronary arteries of the white subjects were more severely affected than those of the Bantu whereas the cerebral arteries were about equally affected in the two racial groups.

The 540 cases included 87 white men, 58 white women, 111 Bantu men, and 85 Bantu women over the age of 25 years. Of the 87 white men 10 had died from coronary occlusion and five from cerebrovascular accidents. Of the 111 Bantu men none died from coronary occlusive disease and seven of cerebrovascular accidents. Five of the 58 white women died at an advanced age from coronary occlusion; seven died from cerebrovascular accidents. None of the Bantu women died from coronary occlusion and seven from cerebrovascular accidents.

Severe atherosclerosis was almost invariably present in cases that died from coronary occlusion suggesting that at least in white persons, coronary atherosclerosis directly predisposes to coronary occlusion. In patients who died from cerebrovascular accidents, macroscopically discernible atherosclerosis was not invariably present.

It is suggested that the wide difference in the percentage of "coronary deaths" in the two ethnic groups is due to the much greater frequency of severe coronary atherosclerosis in white persons than in the Bantu. The close correlation between the percentage of "cerebral deaths" in white and Bantu subjects, on the other hand, is not merely the result of equal occurrence or equal susceptibility of the cerebral arteries to atherosclerosis in the two racial groups, but is rather the integrated result of one or more of the following factors: (1) the relative weakness of the cerebrovascular walls, (2) the relative common occurrence of cerebral artery aneurysms (congenital aneurysms), (3) such atherosclerosis as may be present, and (4) rise in blood pressure.

Atherosclerosis of the cerebral arteries apparently played a somewhat more important role in white persons than in the Bantu.
Successful Therapy of Prolonged Hypotension with an Adrenergic Beta-Receptor Blocking Agent
Authors: LURIA MYRON H. , MILLER ALBERT J. , KAPLAN BENJAMIN M.
Published: June 2012

Two patients with prolonged hypotension requiring continuous vasopressor therapy are described.

In both patients treatment with nethalide, a beta-receptor blocking agent, appeared clinically effective in allowing the withdrawal of metaraminol therapy and the maintenance of normotension. The results in these patients tend to fortify a hypothesis of peripheral adrenergic beta-receptor dominance in patients with prolonged hypotension.
Pulmonary Artery Stenosis Associated with Ductus Arteriosus Following Maternal Rubella
Authors: EMMANOUILIDES GEORGE C. , LINDE LEONARD M. , CRITTENDEN I. HUNTER
Published: June 2012

Nine patients with pulmonary artery stenosis associated with patent ductus arteriosus following maternal rubella are described.

Five of the patients had bilateral pulmonary artery stenosis and four cases involved only the right pulmonary artery. Mild pulmonary valvular stenosis was present in five and a ventricular septal defect in one.

The persistence of a systolic murmur transmitted to the lateral chest wall, after ligation or division of a patent ductus arteriosus, should arouse suspicion of the presence of pulmonary artery stenosis.

This report supports the recently described implication of maternal rubella as a cause of pulmonary artery stenosis. Careful auscultation in patients with history of maternal rubella may discover the presence of such an arterial anomaly, but cardiac catheterization and angiocardiography are necessary for substantiation of diagnosis.

The natural history of these lesions is not known.
A Comparative Analysis of Several Corrected Vectorcardiographic Leads
Authors: BRODY DANIEL A. , ARZBAECHER ROBERT C. , Phillips Harry A.
Published: June 2012

The sensitivity of several corrected vectorcardiographic leads to dipolar, quadripolar, and octapolar components of the equivalent cardiac generator was determined in an electrically homogeneous torso model of the human body. A new experimental method, which insured that the desired parameters were determined for the entire cardiac region, was employed.

Three complete vector systems were thus studied: McFee's axial, Frank's, and the SVEC-III. Individual leads also studied included the tetrahedron X (lead I), the tetrahedron Y (lead aV
F
), the "symmetrical Y," and two grid types of anteroposterior connections.

Except for poor adjustment of scale factors the axial leads were found to be the best corrected of the three complete systems. With relative X, Y, and Z channel sensitivities of 0.92, 1.00, and 0.66, respectively, the axial lead system can be recommended as the best of the three. Of all the connections studied, we found the X lead of the SVEC-III system to be the most inadequately corrected. We failed to confirm that the inclusion of weighted back electrode potentials, as employed in Frank's Y lead, improves the characteristics of the neck to left leg connection as a vertical lead.

We find the symmetrical Y lead superior to both lead aV
F
and the neck to left leg connection The grid type of anteroposterior connection is superior to the other types of corrected Z leads that we investigated, but could probably be corrected further by improvements in design.

The use of corrected leads is to be encouraged as a means of achieving standardization and approximating the biophysical conditions implicit in the basic concept and purpose of vectorcardiography.
Autopsy Study of Atherosclerosis at Madras, South India
Authors: KULANGARA ABRAHAM C. , SUBRAMANIAM R.
Published: June 2012

A sample of 263 hearts and 259 aortas, ranging in age from 6 to 94 years, has been examined for atherosclerotic lesions. The atherosclerotic index for the aorta and the coronary, iliac, innominate, and common carotid arteries has been computed and the data have been analyzed according to sex and age groups. The arteries may be arranged in the following descending series, beginning with the one most heavily diseased: the aorta in both sexes; the coronary arteries of men; the iliac, innominate, and common carotid arteries of both sexes; the coronary arteries of women. The aorta is also the most frequently affected blood vessel.

The frequency of atherosclerotic involvement of the coronary arteries is the same in both sexes, but the extent and severity of lesions are much greater (two to four times) in men than in women. Consistently large differences between the sexes have been observed only in the coronary arteries.

The mean atherosclerotic indices of the aorta and coronary arteries in men indicate a much greater severity of the disease at Madras than so far reported from any other place in India, the severity being very similar to that reported from the United States.
Chronic Obstruction of the Superior Vena Cava due to Histoplasmosis
Authors: MARSHALL ROBERT J. , EDMUNDOWICZ ALPHONSE C. , ANDREWS CHARLES E.
Published: June 2012

Selective angiography and indicator-dilution curves were employed to illustrate the fuctional anatomy of the collateral circulation in two patients with chronic obstruction of the superior vena cava. In both, clinical and laboratory evidence favored an etiologic diagnosis of histoplasmosis.

In case 1, the transit time via the main collateral venous pathway, which comprised the left superior intercostal, accessory hemiazygos and azygos veins, was found to be a little greater than 25 seconds.

In case 2, the superior vena caval obstruction was incomplete, but there was an associated severe narrowing of the right pulmonary artery. Distortion of the indicator-dilution curves provided evidence for an increased bronchopulmonary anastomotic circulation to the right lung.

These observations illustrate how radiographic and hemodynamic technics may usefully be combined to assess the effects of acquired diseases of the major blood vessels.
Atrial Tachysystole with Block
Authors: ROSNER STUART WARREN
Published: June 2012

Two patients are reported who demonstrated bouts of rapid atrial activity with associated AV block at times unrelated to the administration of digitalis. The criteria of Lown and Levine for the differentiation of PAT with block from atrial flutter are examined. The application of atrial rate in the region of the arbitrary borderline is not a useful criterion. Determination of P-wave direction in leads II and III cannot be made in the presence of an undulating baseline. Identification, when possible, is not sufficient evidence for distinguishing the two arrhythmias. The appearance of the baseline may not warrant the decisive weight commonly given to it. A combination of recording instrument characteristics, the appearance of atrial repolarization at critical rates, as well as subjective factors may explain the undulatory baseline rather than denote a special electrocardiographic entity. Alternation of the P-P cycle length in PAT with block occurs inconstantly and is not an intrinsic property of the arrhythmia. Digitalis, which has a vagal effect, may contribute to the presence of this [see figure in the PDF file] phenomenon. The occurrence of ventricular premature contractions, response to carotid sinus pressure, and the AV ratio are nonspecific findings. The mode of termination of the arrhythmia may also lack specificity. Restoration of sinus rhythm following potassium administration will be, at times, coincidental. Moreover, the successful outcome of such a therapeutic trial is evidence of digitalis intoxication not proof of a specific arrhythmia.

Experimental and clinical evidence has firmly established that digitalis is capable of producing an atrial arrhythmia attended by AV block. This report does not contest the observation. A critical review of the contrasting features of atrial flutter and PAT with block and an analysis of the data in the present cases suggest that the electrocardiogram does not provide a means for the clear-cut separation of atrial tachycardia from flutter in certain cases and questions the existence of such a division. The term atrial tachysystole with block is offered as a designation for such tracings.
Transureteral Phonocatheter Recording of the Renal Arterial Pulse
Authors: TANENBAUM HERBERT L. , KISER WILLIAM S.
Published: June 2012

The renal artery and iliac artery pulses were recorded indirectly during split renal function studies in hypertensive patients suspected of having renal vascular lesions. A phonocatheter was easily passed up each ureter and the pulses were recorded at the level of the crossing of the iliac artery and again in the renal pelvis. In patients with renal vascular occlusion, there was a distinct diminution in the amplitude of the transmitted renal arterial pulse as compared to the unoccluded side. The recording of vascular bruits from each side was helpful in localizing their origin. Selected cases confirmed at surgery were presented.
Heart Disease Screening in School Children
Authors: NAIMAN RICHARD A. , BARROW J. GORDON
Published: June 2012

Fifty-two children with known heart disease were chosen as index subjects among 1,382 school children.

All 1,382 children were screened by two methods; namely, a clinical screening examination and a heart-sound tape recording with use of three independent cardiologists to read each tape.

Both methods yielded nearly identical results, identifying 16 to 18 of 20 children with congenital heart disease and 10 to 11 of 29 children with rheumatic heart disease.

Using published prevalence figures for congenital and rheumatic heart disease, the authors calculate that these methods will identify only 43 to 58 per cent of heart disease existing in school-age children.

There is no appreciable difference in the sensitivity or specificity of the two methods.

Tape recording of heart sounds with high-quality portable equipment is found to be more cumbersome, expensive, and time consuming, and of no greater sensitivity than clinical screening by available community physicians.
Transient Compression of the Left Innominate Vein
Authors: FRED HERBERT L. , WUKASCH DON C. , PETRANY ZOLTAN
Published: June 2012

A patient with left-sided cervical venous distention associated with systemic hypertension and congestive heart failure is presented. Angiographic study showed venous return from the left external jugular veins to be impeded by an elongated but otherwise normal thoracic aorta compressing the left innominate vein. Once the hypertension and cardiac failure were controlled, compression of the left innominate vein regressed and the cervical venous engorgement disappeared.
Left Ventricular Volumes in Valvular Heart Disease
Authors: JONES JOHN W. , RACKLEY CHARLES E. , BRUCE ROBERT A. , DODGE HAROLD T. , COBB LEONARD A. , SANDLER HAROLD
Published: June 2012

Left ventricular volumes were determined in 86 patients with aortic and mitral valve disease by use of a biplane angiocardiographic technic in conjunction with cardiac catheterization. Total stroke output of the left ventricle was grossly increased by severe degrees of valvular incompetence. Although both end-systolic and total stroke volume varied directly with the end-diastolic volume, there was no correlation between end-diastolic pressure and either total stroke volume or end-diastolic volume.
Studies on the Relation of Diet, Cholesterol and Atheroma in Chickens
Authors: PETERSON JOHN E. , HIRST ALBERT E.
Published: June 2012

In this study cockerels were fed varying diets supplemented with lard, vegetable oil, and cholesterol. The degree of atherosclerosis was compared in serial autopsies and only the cholesterol-fed group showed a significant difference. During a period of two years there was no apparent change in the degree of atheroma when the diet was supplemented with cottonseed oil or lard. Reversibility of the cholesterol-induced atheroma was also studied in a few chickens, and it appears that the early lesions may undergo considerable regression after cholesterol feeding is stopped. Older lesions, on the other hand, appear to be quite fixed.
The Effects of Arterial and Pulmonary Shunts on the Dynamics of Aortic Coarctation
Authors: GUPTA TRILOK CHAND
Published: June 2012

This communication deals with the manner in which collateral arterial channels and a persistent ductus arteriosus affect the dynamics of an uncomplicated aortic coarctation which was studied experimentally by means of artificial shunts and registration of pressure pulses. The conclusion is reached that effective collaterals or a surgical subclavian-aortic shunt can be effective dynamically in reducing hypertension and left ventricular strain and in providing an adequate flow through tissues despite the fact that the femoral pressure pulse does not revert to a normal form. The presence of an aortic-pulmonary shunt affects aortic pressure both through reduction in aortic resistance and augmentation of systolic discharge until very severe degrees of coarctation exist. The right ventricle of the normal heart can function as a systemic ventricle only when the aorta is almost completely occluded.
Studies on the Effect of Oral and Parenteral Administration of Visammin (Khellin) in Patients with Angina Pectoris
Authors: SCOTT RALPH C. , IGLAUER ARNOLD , GREEN ROBERT S. , KAUFMAN JOSEPH W. , BERMAN BERNARD , MCGUIRE JOHNSON
Published: June 2012

Of 20 carefully studied patients with angina pectoris given oral visammin, 4 had a significant reduction in number of pains. Eleven stated that their pains were less severe and less easily precipitated while taking visammin. There was questionable improvement in the exercise tolerance test in 2 of 9 patients after oral visammin therapy. The daily oral dose ranged from 40 mg. to 240 mg. Undesirable side effects were encountered in 17 of the 20 patients. Parenteral administration of visammin was evaluated by means of the ballistocardiograph, the exercise tolerance test, and by tilting.
A Comparison of Coronary Flow Determined by the Nitrous Oxide Method and by a Direct Method Using the Rotameter
Authors: GREGG DONALD E. , LONGINO FRANK H. , GREEN PAUL A. , CZERWONKA LAWRENCE J.
Published: June 2012

Coronary flow per minute per 100 Gm. of heart with venous drainage into the coronary sinus as measured by the nitrous oxide procedure was compared in the dog with left coronary artery inflow per 100 Gm. of heart perfused by this artery as measured by the rotameter. The error arising from epicardial leak of nitrous oxide was prevented or quantitated by appropriate coverage of the heart. Extremes of the comparisons were +21 and -22 per cent, with an average variation of ±12.4 per cent. The nitrous oxide method is regarded as giving semiquantitative coronary flow values per 100 Gm. of left heart in the dog.
Tromexan—3,3'-Carboxymethylenebis (4-Hydroxycoumarin) Ethyl Ester
Authors: BURKE GRAFTON E. , WRIGHT IRVING S.
Published: June 2012

The use of heparin and dicumarol has provided important information regarding the effectiveness and the difficulties of anticoagulant therapy. Neither, however, is an ideal anticoagulant; therefore a search for new substances with advantages over them must be continued. Tromexan, which is administered orally, appears to have the advantages of more rapid utilization and more rapid cessation of action than dicumarol, although the mode of action is similar in that it produces a hypoprothrombinemia. It does require accurate prothrombin tests for satisfactory clinical use. It appears to be less prone to producing hemorrhagic complications. Animal and clinical experiences with Tromexan are herewith presented.
Clinical Evaluation of Dicumarinyl Derivatives with a Metabolic Study of the Radioactively Labeled Anticoagulants in Animals
Authors: HAUSNER ERIC P. , SHAFER CHARLES L. , CORSON MARION , JOHNSON OGDEN , TRUJILLO THEODORE , LANGHAM WRIGHT
Published: June 2012

The common use of dicumarinyl derivatives for the treatment of thromboembolic diseases justifies further clinical evaluation of dicumarol and 4,4'-dihydroxydicumarinyl ethyl acetate [Pelentan, Tromexan, 3,3'-carboxymethylenebis (4-hydroxycoumarin) ethyl ester.]

The need for a more thorough understanding of the pharmacodynamic action of dicumarinyl anticoagulants has prompted a study of their gross metabolism in animals, using C
14
-labeled materials.
Catheterization of the Left Ventricle in Man
Authors: STEINBERG MORRIS F. , SELIGMANN ARTHUR , KROOP IRVING G. , GRISHMAN ARTHUR
Published: June 2012

Simultaneous catheterization of the left and right ventricles was performed in a case of right bundle branch block. It was thought that in right bundle branch block the polarity of the initial deflection of the potentials obtained in the left ventricular cavity could be studied without interference of those contributed by the right ventricular cavity. A description of the technic employed is given. The results confirm those obtained in dogs. There is initial negativity of the potentials obtained within the left ventricular cavity.
Situs Inversus of the Abdominal Viscera with Levocardia
Authors: YOUNG MAURICE D. , GRISWOLD HERBERT E.
Published: June 2012

A search of the literature has revealed the reports of only 14 cases of situs inversus of the abdominal viscera with levocardia. Eight additional cases are presented in this paper. Angiocardiography and/or heart catheterization was carried out on 6 of these and a Blalock-Taussig operation was performed subsequently on each patient. The autopsy findings in 2 instances, together with the results of special investigations in surviving patients, indicate that the malformations are of a bizarre nature. Anomalies of the venous return to the heart are particularly common and variable degrees of transposition of the great vessels are postulated.
Effect of Ascending an Ordinary Flight of Stairs on the Work of the Heart
Authors: MATHERS JAMES A. L. , GRIFFEATH HAROLD I. , LEVY ROBERT L. , NICKERSON JOHN L.
Published: June 2012

Observations of cardiac work were made in normal persons and in patients with coronary heart disease after ascending an ordinary staircase at various rates of speed. Cardiac output was calculated from records obtained with the low frequency, critically-damped ballistocardiograph. The results were compared, for statistical significance, with those noted following descent and after walking for an equivalent distance on the level. It appears that the compensated coronary patient can mount a flight of stairs leisurely without imposing a greatly increased burden of work on the heart. The optimal rate of ascent usually is the one chosen by the individual.
Effects of Bleeding on Electrolyte Excretion and on Glomerular Filtration
Authors: LOMBARDO T. A. , EISENBERG SEYMOUR , OLIVER B. B. , VIAR W. N. , EDDLEMAN E. E. , HARRISON T. R.
Published: June 2012

Removal of small amounts of blood from sitting subjects caused reduction of sodium excretion without alterations in creatinine clearance, or in apparent cardiac output (electrokymographic method). This reduction could be prevented by compression of the neck. The experiments support the concept of an homeostatic central mechanism which regulates the volume of extracellular fluid by altering sodium excretion. If such a mechanism exists it is apparently activated by changes in the volume of body fluids rather than by changes in cardiac output.
Visualization of the Coronary Arteries during Life
Authors: HELMSWORTH JAMES A. , MCGUIRE JOHNSON , FELSON BENJAMIN , SCOTT RALPH C.
Published: June 2012

By retrograde catheterization of the carotid or the brachial arteries small polyethylene or woven catheters have been inserted into the ascending aorta in 10 individuals. Diodrast or Neo-Iopax solution was forcibly injected and serial roentgenograms were rapidly taken. The coronary arteries or branches were demonstrated in 5 of the subjects. Similar studies were made in 5 dogs with normal hearts, and also in 10 dogs in whom a coronary artery had previously been obstructed. In certain of the normal animals not only the larger, but also smaller branches were clearly shown and the absence of filling in obstructed vessels was demonstrated.
White Thromboembolism in the Hamster Cheek Pouch after Trauma, Infection and Neoplasia
Authors: LUTZ BRENTON R. , FULTON GEORGE P. , AKERS ROBERT P.
Published: June 2012

White thrombosis and embolism were investigated by cinephotomicroscopy in the transillumined cheek pouch of the hamster in an experimental study of factors which may be involved in the febrile hemolytic syndrome in man, characterized by a finding of generalized platelet thrombosis of arterioles, capillaries and veins at autopsy. Endothelial trauma resulting from vascular occlusion produced platelet thrombosis and embolism. Dicumarol prevented the formation of platelet thrombosis and embolism after trauma. Heparin produced spontaneous platelet emboli and both heparin and dicumarol resulted in a leukocytic thrombosis. Platelet and leukocytic coatings and embolization were photographed during staphylococcus infection and malignant neoplasia. Sludged blood was not found in trauma, infection or malignant neoplasia.
Beriberi Heart in Iowa Veterans
Authors: GUTENKAUF CHARLES H.
Published: June 2012

Beriberi heart disease does not constitute a rigid syndrome because the severity of cardiac failure, associated peripheral neuritis, other concomitant signs and symptoms, and response to treatment are variable. Five patients with peripheral neuritis, edema and evidence of cardiac failure are presented. All improved after treatment, and, in two instances, there was marked reduction in cardiac size. Beriberi was thought to be the most likely diagnosis in each case, since there was no evidence of other etiology.
Variations in Electrocardiographic Responses during Exercise
Authors: YU PAUL N. G. , BRUCE ROBERT A. , LOVEJOY FRANK W. , MCDOWELL MARION E.
Published: June 2012

Precordial electrocardiograms were taken before, during, and after exercise in 20 normal subjects and in 48 patients with cardiopulmonary diseases. Analysis of the findings was based on changes in Q-T interval, alterations in QRS, RS-T and T waves and on presence or absence of premature beats. Whereas in performing standard tests, normal subjects showed no evidence of coronary insufficiency, in about two-thirds of the patients abnormal changes were demonstrable. Definite RS-T depression and changes in Q-T interval were also observed in normal subjects under unusual stresses. The electrocardiographic changes during exertion were discussed and emphasized.
Determinants of Impairment of Cardiac Filling During Progressive Pericardial Effusion
Authors: NERLICH WILLIAM E.
Published: June 2012

The progressive reduction in cardiac output—and later in arterial pressures—that develops during advancing degrees of pericardial effusion is usually attributed to a steady decrease in the venoatrial pressure gradient. Evaluation of changes in instantaneous pressures in the right and left atria at the end of ventricular diastole (Z pressure) and systole (V pressure) indicates that as pericardial pressure rises other determinants enter in the following order: (1) reduction in diastolic capacities of the atriums and ventricles; (2) decrease in venoatrial pressure gradient and preponderant rise of left atrial pressures due to the higher elasticity coefficient of this chamber; (3) blockage of atrial inflow during ventricular diastole; (4) impairment of atrial inflow during ventricular systole as its stroke volume diminishes to an extreme degree; and (5) inauguration of a vicious cycle in which a diminishing venopressure gradient decreases ventricular filling, while the consequent reduction in stroke volume attenuates the facilitating effect of ventricular ejection on the venoatrial gradient.
The Isolation of Hypertensin from the Circulating Blood of Normal Dogs with Experimental Renal Hypertension by Dialysis in an Artificial Kidney
Authors: SKEGGS LEONARD T. , KAHN JOSEPH R. , SHUMWAY NORMAN P.
Published: June 2012

Hypertensin has been dialyzed out of the circulating blood of dogs by means of an artificial kidney and a new method has been devised for its recovery from the dialyzate. More hypertensin was recovered from the dialyzate obtained from dogs with experimental renal hypertension than from normal animals.
The Lack of Effect of Oral Doses of Cinchona Alkaloids on the Circulation of Dogs with Renal Hypertension
Authors: GREENE INEZ , HIATT EDWIN P.
Published: June 2012

The effect of repeated oral doses of quinine and quinidine on the circulation of dogs with renal hypertension was studied with measurements of arterial blood pressure and renal hemodynamics. Alkaloid concentrations up to the toxic range had little effect on the blood pressure or renal blood flow. It is pointed out that this lack of effect is in contrast to the vasodilator action of these agents in normal and neurogenic hypertensive dogs. These experiments are interpreted as constituting support for the thesis that the cinchona alkaloids have their vasodepressor effect by virtue of a blockade of sympathetic neuromuscular vasomotor junctions.
Studies on the Spread of Excitation through the Ventricular Myocardium
Authors: PRUITT RAYMOND D. , ESSEX HIRAM E. , BURCHELL HOWARD B.
Published: June 2012

The speed at which the excitatory process spreads through a certain segment of the myocardial syncytium depends upon the orientation of the fibers in that segment to each other and to the point of origin of excitation. Spread down a strip of fibers of which the long axis is parallel to the long axis of the strip is rapid as compared with spread down a strip in which the fibers run at a right angle to the long axis of the strip. Endocardial activation is rapid, not because of the presence of Purkinje fibers, but because the subendocardial bands of myocardium form a network through which excitation can move rapidly along the long axis of the fibers. Spread across the septum in bundle-branch block and across the free wall of the left ventricle in the normally activated heart is slow because excitation is moving through fibers the long axis of which is prependicular to the advancing wave of excitation.
Hepatic Abnormalities in Congestive Heart Failure
Authors: WHITE THOMAS J. , WALLACE ROBERT B. , GNASSI ANGELO M. , KEMP NORVAL F. , PRICE H. PRESTON , LEEVY CARROLL M.
Published: June 2012

Needle biopsies of the liver were performed on 30 patients with heart failure and correlated with clinical features and biochemical liver function studies. Hepatic biopsy served as a useful adjunct to other methods in deciding the status of the liver in this group. Type of heart disease, degree of heart failure and length of heart failure could not be correlated with the observed histology. Neither history, physical examination, nor biochemical functional studies provided sufficient information to predict anatomy with certainty. A histologic diagnosis improved both therapeutic and prognostic perspective.
Anatomic Variations of the Orifice of the Human Coronary Sinus
Authors: HELLERSTEIN HERMAN K. , ORBISON J. LOWELL
Published: June 2012

Anatomic variations of the orifice of the human coronary sinus now have practical significance since the advent of catheterization of the coronary sinus. Six main types of variation of the valve of the coronary sinus of 150 hearts are described. The difficulties encountered in catheterization of the human coronary sinus are probably due to obstruction offered by large membranes, bars and networks, and less frequently due to the presence of a large eustachian ridge. On the basis of this study, catheterization of the human coronary sinus should be possible in a maximum of 75 per cent of the cases.
Circulatory and Respiratory Effects of Adenosine Triphosphate in Man
Authors: DAVIES DEAN F. , GROPPER ARTHUR L. , SCHROEDER HENRY A.
Published: June 2012

The authors have studied the acute effects of the intravenous and intra-arterial injection of the sodium salt of adenosine triphosphate (ATP) in man. Rapid injection causes a frightening sensation in the chest and hyperpnea. The changes found agree with those reported in cats and are consistent with the concept that adenosine triphosphate is a vasodilator in somatic structures but causes an increase in pulmonary vascular and possibly in splanchnic resistance. Its principal action seems to be pharmacologic rather than in its role as an intracellular metabolite.