bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effectiveness of Long-Term Treatment of Malignant Hypertension
Authors: DUSTAN HARRIET P. , SCHNECKLOTH ROLAND E. , CORCORAN A. C. , PAGE IRVINE H.
Published: June 2012

A survey is reported of the courses of 84 patients who presented the syndrome of malignant hypertension and who have been under treatment with potent antihypertensive drugs.

Among these, 70 per cent survived 1 year of observation, 50 per cent 3 years, 33 per cent 5 years, and 26 per cent 6 years. These survival rates represent substantial therapeutic gains over survival rates in the untreated series of Keith, Wagener, and Barker.

The reported first-year survival rate is weighted by the untoward complication of hexamethonium pneumonitis, and current survival is greater than in the estimate presented.

Other causes of death are (1) rapidly or (2) delayed or slowly progressive renal failure and (3) complications of atherosclerosis. The first is usually associated with poor control of blood pressure. It seems merely an attenuation of the usual course of malignant hypertension. The syndrome of delayed or slowly progressive renal failure is associated with diffuse occlusive fibrous intimal hyperplasia of major renal arteries. Among the complications of atherosclerosis, cerebral hemorrhage was the most common and was associated with poor control of blood pressure level, while myocardial infarction, the next most common, was not. It may be that the coronary arteries, like the renal, are subject to progressive occlusive disease in some patients with treated malignant hypertension. It is not clear whether this process represents a continuation in vessels larger than arterioles, of a basic vascular disease or a delayed response on the part of the arteries to preexisting severe hypertension.

Survival is improved in patients who undertake treatment before malignant hypertension has caused extensive vascular damage. Patients who present themselves for treatment with evidences of severe renal damage generally do not survive for long periods. However, several such have maintained active lives for many months and years. Hence treatment should be withheld only in the most desperate circumstances.
Mammary Souffle of Pregnancy
Authors: SCOTT JAMES T. , MURPHY EDMOND A.
Published: June 2012

Little attention has been paid to the continuous parasternal murmur that may occur during pregnancy and that disappears after lactation. We have encountered 2 cases of this phenomenon. The murmur probably arises from arteries supplying the breast. The mechanism of its production has not been established, but it may depend on some permanent anatomic anomaly. This benign murmur has special characters by which it may be readily distinguished from significant continuous murmurs.
Ventricular Septal Defect in Infants and Children
Authors: FYLER DONALD C. , RUDOLPH ABRAHAM M. , WITTENBORG MARTIN H. , NADAS ALEXANDER S.
Published: June 2012

Now that ventricular septal defect is amenable to surgical repair it is most important to define the indications for surgical intervention. In this paper the natural history of the disease and its clinical and physiologic characteristics are carefully detailed. These observations permit better recognition and understanding of the condition and offer a basis for comparison with results after surgery.
The Clinical Measurement of Retinal Arterial Pressure
Authors: PERRY RICHARD B. , ROSE JOHN C.
Published: June 2012

The determination of retinal diastolic arterial pressure by ophthalmodynamometry is described. In both normal and hypertensive subjects there was an average difference of 20 mm. Hg between retinal and brachial arterial diastolic pressures. The clinical usefulness of this procedure was demonstrated in patients with obstructive lesions in the internal carotid artery.
Excessive Urinary 5-Hydroxy-3-Indole Acetic Acid in the Absence of a Metastatic Carcinoid
Authors: MCMULLEN FABER F. , HANSON HUGH H.
Published: June 2012

Considerable interest has been aroused in the dianosis of the malignant carcinoid syndrome and the diagnostic reliability of increased urinary excretion of 5-hydroxy-3-indole acetic acid. The authors present observations important to this problem.
Functional Diagnosis of Patent Ductus Arteriosus Studied by Cineangiocardiography in Fifty-three Cases
Authors: CAMPETI FRANK L. , GRAMIAK RAYMOND , WATSON JAMES S. , RAMSEY GEORGE H. , Palladoro Vivian A.
Published: June 2012

The hemodynamic alterations revealed by cineangiocardiography in 53 cases of patent ductus arteriosus made possible the correct angiocardiographic diagnosis in 90 per cent of the cases. The most constant functional sign is "blanching of the pulmonary artery," which is seen during diastole and consists of a decrease in density of the pulmonary artery and its branches. This phenomenon has been analyzed by projecting the cineangiocardiograms frame by frame and measuring angiographic density and diameter at the same points of the pulmonary artery. The curves obtained were correlated with each other and plotted against time. The findings were correlated with clinical, surgical, and pathologic information. The hemodynamics of the shunt in patent ductus arteriosus are discussed and a theoretical explanation is offered.
Cardiac Arrhythmias Associated with the Repair of Atrial and Ventricular Septal Defects
Authors: SASAKI RIKURO , THEILEN E. O. , JANUARY L. E. , EHRENHAFT J. L.
Published: June 2012

This is a report of cardiac arrhythmias associated with the repair of cardiac septal defects. Electrocardiographic studies showed a high incidence of paroxysmal disturbances of rhythm following surgery.
Cardiac Rupture due to Metastases from a Carcinoma of the Antrum
Authors: SINGER DONALD H. , CZERNOBILSKY BERNARD , STEINBERG LESTER A.
Published: June 2012

The case is described of a 70-year-old white man with a primary anaplastic carcinoma of the right maxillary antrum, and with widespread visceral dissemination, including metastases to the heart. Myocardial rupture was noted to have occurred through one of the metastatic lesions. To the best of our knowledge this is the fourth instance of rupture as a sequel to tumorous infiltration of the heart.

Among the metastases were one or more to a clear-cell adenoma of the left kidney. This instance of metastasis of "cancer to cancer" is the second case of this rare condition in the recent autopsy material of the Beth Israel Hospital.
Origin of Heart Sounds as Elucidated by Analysis of the Sequence of Cardiodynamic Events
Authors: BRAUNWALD EUGENE , MORROW ANDREW G.
Published: June 2012

Evidence for the valvular origin of the first heart sound was obtained by simultaneous phonocardiograms and pressure pulses from the left atrium and left ventricle in patients with mitral stenosis. It was consistently observed that the first heart sound begins at the time of mitral valve closure, significantly after the onset of left ventricular contraction. Hemodynamic observations which explain the splitting of heart sounds in the normal and in diseased states were briefly reviewed.
Mechanisms of Fixed Splitting of the Second Heart Sound
Authors: PERLOFF JOSEPH K. , HARVEY W. PROCTOR
Published: June 2012

Forty-four patients with wide splitting of the second heart sound and 25 normal controls were studied with fast speed logarithmic phonocardiograms.

In the control group, inspiratory augmentation of right heart filling increased the right ventricular stroke volume, prolonged the right ventricular stroke time and delayed pulmonic valve closure, thus altering the second sound from expiratory synchrony to inspiratory separation of its 2 components.

In the group with atrial septal defects, the second sound normalized postoperatively, reflecting the ability of the right ventricle to undergo its normal inspiratory increase and expiratory decrease in stroke volume when the defect was closed. Before closure, the right ventricular stroke time neither shortened with expiration nor lengthened with inspiration because of the constant diastolic right ventricular hypervolemia. Hence, preoperatively the interval between aortic and pulmonic valve closures remained characteristically wide and fixed. That the preoperative delay in pulmonic valve closure could not have been a reflection of "incomplete right bundle-branch block" was illustrated by the postoperative normalization of the second sound without change in the QRS pattern of the electrocardiogram. Although the split of the second sound was not altered by respiration, it was altered by change in cycle length, widening after longer cycles and narrowing after shorter cycles.

Wide splitting of the second heart sound was found in mitral insufficiency because of early aortic valve closure, in complete right bundle-branch block because of delayed pulmonic valve closure, and in complete left bundle-branch block because of a reversed sequence of aortic-pulmonic valve closure. When right ventricular failure coexisted with these lesions, the decompensated chamber did not convert its inspiratory augmentation of filling into increased stroke volume. The inspiratory increase in right ventricular stroke time and the inspiratory delay in pulmonic valve closure therefore could not occur so the split of the second sound remained fixed throughout the respiratory cycle.
Relationship of Amount of Cigarette Smoking to Coronary Heart Disease Mortality Rates in Men
Authors: BUECHLEY ROBERT W. , DRAKE ROBERT M. , BRESLOW LESTER
Published: June 2012

Seven out of 8 previous reports indicate a relationship between morbidity or mortality from coronary heart disease and amount of cigarette smoking. Data from 2 California study groups, longshoremen and respondents to a household sample health survey, are presented to show similar relationships. In 4 studies showing mortality, the coronary heart disease death rates for men, in various age groups from 40 to 70 years, who smoked a pack of cigarettes or more per day, generally exceeded the corresponding rates for nonsmokers by from 1 to 7 deaths per thousand per year.
Use of Biplane Cinefluorography for Measurement of Ventricular Volume
Authors: CHAPMAN CARLETON B. , BAKER ORLAND , REYNOLDS JACK , BONTE FREDERICK J.
Published: June 2012

A biplane cinefluorographic technic for measuring ventricular volume is described and its accuracy and limitations are assessed. Although rather complicated and time-consuming at present, the method permits construction of volume curves and estimation of stroke volume of the left ventricle for several successive contractions in the intact animal or man. This method may prove most useful for physiologic research and ultimately for diagnostic purposes.
Pulse Characteristics of Abdominal Aortic Aneurysm and of the Femoral Artery Distal to It
Authors: BLACKARD EMBREE H.
Published: June 2012

The advent of successful surgical treatment of abdominal aneurysm has increased the importance of detection and diagnosis of these lesions. The author has studied the pulse characteristics of abdominal aortic aneurysm and the distal femoral artery, and reports his results.
The Determination of Cardiac Output by the Dilution Method without Arterial Sampling
Authors: MACINTYRE WILLIAM J. , PRITCHARD WALTER H. , MOIR THOMHAS W.
Published: June 2012

The selection of an external site for a radioisotope determination of cardiac output is discussed with respect to satisfying the analytical conditions of the Stewart-Hamilton dilution equation. Examples of both single-chamber and multichamber recording are illustrated, along with a discussion of the difficulties of curve calibration and extrapolation from multiple sites. The development of a method independent of critical placement or patient variability is described.
Graded Pulmonary Vascular Changes and Hemodynamic Findings in Cases of Atrial and Ventricular Septal Defect and Patent Ductus Arteriosus
Authors: HEATH DONALD , HELMHOLZ H. FREDERIC , BURCHELL HOWARD B. , DUSHANE JAMES W. , EDWARDS JESSE E.
Published: June 2012

With use of a previously described system of grading, a study was made of the relation between each of the grades of hypertensive pulmonary vascular disease and the hemodynamic findings in the lesser circulation in 15 cases of atrial septal defect, 19 cases of ventricular septal defect, and 6 cases of patent ductus arteriosus.
Dynamics of the Orifices of the Venae Cavae Studied by Cineangiocardiography
Authors: CAMPETI FRANK L. , RAMSEY GEORGE H. , GRAMIAK RAYMOND , WATSON JAMES S. , Palladoro Vivian A.
Published: June 2012

Closure of the caval orifices of the right atrium and dynamics of the venae cavae have been studied by an analysis of high-speed cineangiocardiographic records. The influence of respirogenic and cardiogenic factors on venae cavae dynamics was demonstrated. Findings indicated that mechanical and hemodynamic factors interact in directing the atrial blood forward and in preventing its reflux into the venae cavae. Relative narrowing of the caval orifices was demonstrated during atrial systole. The degree of narrowing, however, was insufficient to produce a mechanical closure and thus to prevent caval refluxes when the pressure gradients were altered. The findings are illustrated and discussed.
Atrial Flutter as a Manifestation of Digitalis Toxicity
Authors: COFFMAN JAY D. , WHIPPLE GERALD H.
Published: June 2012

Although digitalis overdosage is known to produce a variety of atrial, junctional, and ventricular arrhythmias, atrial flutter due to digitalis intoxication has been rarely reported. The present paper reviews the literature and reports what appears to be the sixteenth case. The available information on the accepted cases of atrial flutter due to digitalis toxicity has been analyzed for clues as to when digitalis can be considered the cause of the flutter.
Atrial Septal Defect: Factors Affecting the Surgical Mortality Rate
Authors: MCGOON DWIGHT C. , SWAN H. J. C. , BRANDENBURG ROBERT O. , CONNOLLY DANIEL C. , KIRKLIN JOHN W.
Published: June 2012

Analysis of accumulated experience with the repair of atrial septal defect in 119 adults has revealed several factors determinable preoperatively that appear to have a strong influence on the operative risk. These factors are related to the presence of pulmonary vascular disease or heart failure and contribute importantly to the selection of patients for operation.
Severe Acidosis and Hyperpotassemia Treated with Sodium Bicarbonate Infusion
Authors: SCHWARZ KUNO C. , COHEN BURTON D. , LUBASH GLENN D. , RUBIN ALBERT L.
Published: June 2012

Four uremic patients with severe acidosis, hyperpotassemia, and electrocardiographic signs of toxicity were treated with intravenous sodium bicarbonate. Serial determinations showed a fall in plasma potassium, a rise in blood pH, and regression of the electrocardiogram toward normal. The mechanisms responsible for these changes are discussed.
Biochemical Alterations in Blood in Obliterative Atherosclerosis
Authors: GIBIŃSKI KORNEL
Published: June 2012

Biochemical alterations in blood due to pathologic changes in the legs are difficult to detect when the blood samples are taken from the cubital vein. In the reported investigations biochemical properties of this blood are compared with those of the venous blood flowing out from a leg affected by obliterative atherosclerosis.
The Pulmonary Diffusing Capacity in Congenital and Rheumatic Heart Disease
Authors: AUCHINCLOSS J. HOWLAND , GILBERT ROBERT , EICH ROBERT H.
Published: June 2012

The pulmonary diffusing capacity was determined both in patients with intracardiac septal defects and in patients with valvular heart disease in an effort to find out whether pulmonary congestion and hyperemia as they occur ill cardiac disease have different effects on the process of gas diffusion and whether these effects vary at different stages of the disease process.
Determinants of the Left Atrial Pressure Pulse in Mitral Valve Disease
Authors: HAMER NEIL A. J. , ROY SUJOY B. , DOW JAMES W.
Published: June 2012

The difficulties of preoperative evaluation of patients with combinations of mitral stenosis and incompetence prompted analysis of the left atrial pressure pulse in a series of patients studied by left atrial puncture. Theoretic considerations indicate that similar pressure pulses may be produced by a variety of mitral valve lesions if the volume-pressure characteristics of the left atrium are appropriate. An explanation is offered for the differences found in the presence of mitral regurgitation.
Beriberi Heart Disease
Authors: JONES REVERDY H.
Published: June 2012

Two cases of beriberi heart disease are presented together with a discussion of the history, diagnosis, and treatment of this condition. Special emphasis is given to the broadened concept of the diagnosis of beriberi heart disease, particularly as it occurs in the Occident.
Disseminated Nodular Pulmonary Ossification in Patients with Mitral Stenosis
Authors: WILSON WILLIAM R. , SASAKI RIKURO , JOHNSON CHARLES A.
Published: June 2012

What seem to be rare complications of common diseases may merely be uncommon because no one accumulates a large number. The unusual combination of disseminated nodular bone formation in the lungs and chronic mitral stenosis is more common in young men. The clinical findings in 4 cases are described and the pathogenesis is discussed.
Effects of Chlorothiazide on Specific Renal Functions in Hypertension
Authors: CORCORAN A. C. , MACLEOD CATHEL , DUSTAN HARRIET P. , PAGE IRVINE H.
Published: June 2012

Oral administration of chlorothiazide depresses glomerular filtration, increases blood urea, maintains sodium output in the face of decreased filtered sodium load, and paradoxically for a diuretic, in these and in tests done shortly after intravenous administration, increases the efficiency of water reabsorption.
Depressive Reactions in Hypertensive Patients
Authors: QUETSCH RICHARD M. , ACHOR RICHARD W. P. , LITIN EDWARD M. , FAUCETT ROBERT L.
Published: June 2012

Because of reports that derivatives of Rauwolfia serpentina may cause severe mental depression when used in the treatment of hypertension, the depressive reactions and possible contributing factors were studied in a group of 387 hypertensive patients. Some of the patients received no specific antihypertensive medication; some were treated with Rauwolfia derivatives alone and some with Rauwolfia and other antihypertensive drugs. Of the patients receiving Rauwolfia, alone or with other drugs, 26 per cent experienced depressive reactions whereas only 5 per cent of the others had them.
The Role of Vessel Tone in Maintaining Pulmonary Vascular Resistance in Patients with Mitral Stenosis
Authors: SEMLER HERBERT J. , SHEPHERD JOHN T. , WOOD EARL H.
Published: June 2012

Changes in pulmonary vascular (arteriolar) resistance were estimated in 58 patients with mitral stenosis following mitral valvotomy and during exercise. Evidence is presented that changes in "resistance" reflect active changes in the caliber of the vessels due to alteration in their smooth muscle tone, valvotomy being followed by a decrease in tone and exercise by an increase.
Electrocardiographic Response to Exercise in Patients with Mitral Stenosis
Authors: RAMSEY LLOYD H. , BEEBLE JOHN
Published: June 2012

On the assumption that a positive Master 2 step exercise test is good evidence for the existence of myocardial ischemia, the coronary circulation of 40 patients with rheumatic heart disease and isolated mitral stenosis has been tested by this means. The findings in patients of classes I to III are discussed regarding factors that might be responsible and the relationship of the findings to symptomatology in patients with mitral stenosis.
Anomalous Drainage of Entire Pulmonary Venous System into Left Innominate Vein
Authors: COOLEY DENTON A. , COLLINS HAROLD A.
Published: June 2012

Total anomalous drainage of pulmonary venous blood produces a severe circulatory disturbance. In the most common type of this category of lesions, the entire venous return from the lungs enters a common venous channel ascending in the left superior mediastinum where it connects with the innominate vein. Seven cases of this type are described. Successful total correction was possible in 4 of these patients in whom a special technic was used, which incorporated the pump oxygenator for temporary cardiopulmonary bypass. This technic provides optimum conditions for complete correction of this complicated anomaly.
Effects of Periodic Mental Stress on Serum Cholesterol Levels
Authors: GRUNDY SCOTT M. , GRIFFIN A. CLARK
Published: June 2012

The effects of academic final examinations on serum cholesterol levels were studied on 2 groups of medical students. A significant increase in the mean total serum cholesterol levels were observed during examination periods as compared to control periods of relaxation. These findings support previous reports of the effects of mental tension on serum cholesterol levels.
The Aortic Arch Syndrome (Pulseless Disease)
Authors: THURLBECK W. M. , CURRENS J. H.
Published: June 2012

Ten patients are presented in whom absent arterial pulsations were noted in 1 or both arms. Six patients also had absent carotid arterial pulsations on 1 or both sides.

The blood pressure was determined satisfactorily by a machine devised to record the Korotkov vibrations. This indicates feeble arterial pulsation in spite of inability to palpate them clinically.

Three autopsied cases showed severe atherosclerosis with superimposed thrombosis.

Long-term anticoagulation used in 2 patients for as long as 3 years seemed to result in some clinical improvement.
Clinical and Physiologic Relationships in Mitral Valve Disease
Authors: SAMET PHILIP , LITWAK ROBERT S. , BERNSTEIN WILLIAM H. , FIERER EUGENE M. , SILVERMAN LEONARD M.
Published: June 2012

Physiologic data obtained during right and combined right and left heart catheterization are presented in a variety of subjects with mitral valve disease. These studies have led to a broader understanding of the pathophysiology of this disease. The clinical value of combined heart catheterization is illustrated.
Kinetocardiographic Findings of Myocardial Infarction
Authors: SUH SOON KYU , EDDLEMAN E. E.
Published: June 2012

A study of the precordial pulsations (kinetocardiograms) in patients with acute myocardial infarctions is presented. A paradoxic pulsation (bulge) over either the precordium or the epigastric area was noted in all patients studied.
Exertional Hypotension in Cardiac Patients
Authors: BRUCE ROBERT A. , COBB LEONARD A. , KATSURA SHIGEAKI , MORLEDGE JOHN H. , ANDRUS W. WYMAN , FULLER THEODORE J.
Published: June 2012

Hemodynamic studies during steady states of sitting and walking on a treadmill have shown a fall in mean arterial pressure in 10 of 16 cardiac patients. This was associated with a greater increase in peripheral resistance during sitting, and a failure to increase stroke index during walking. Cardiac index during exercise increased somewhat, largely because of greater acceleration of heart rate.
Production of Heart Sounds by the Cardiac Catheter
Authors: ELDRIDGE FREDERIC L. , HULTGREN HERBERT N.
Published: June 2012

Extra heart sounds are frequently produced by the cardiac catheter in the human subject during routine cardiac catheterization. They are associated with a characteristic pressure artefact, which suggests that the sound is produced by back-and-forth movement of the catheter tip across the pulmonic valve. Similar sounds, and also murmurs, can be produced by catheter passage across pulmonary or aortic valves in excised canine hearts. The fact that such artificial sounds can be produced by the intracardiac catheter suggests gests that some caution must be used in interpreting phonocardiograms obtained during cardiac catheterization.
A Study of Cases Manifesting Low Voltage in the Frontal Plane Electrocardiographic Leads
Authors: WATTS RICHARD W. , GURSAL KEMAL
Published: June 2012

A study of 20 consecutive examples of frontal plane electrocardiographic low voltage revealed an incidence of 2.1 per cent among 935 patients having electrocardiograms. Arteriosclerotic heart disease was the most common cause and carried a high mortality rate. The striking lack of correlation between low voltage and heart size was pointed out and reasons for it are discussed. The lack of added value that the criteria of low voltage in the precordial leads afforded is also discussed.
Osmole and Water Excretion in Mercurial Diuresis in Congestive Heart Failure
Authors: SPRITZ NORTON , FRIMPTER GEORGE W. , BRAVEMAN WARREN S. , RUBIN ALBERT L.
Published: June 2012

The relationhip between water and total solute excretion following mercurial administration has been previously studied in normal human subjects during superimposed water and solute diureses. It is the purpose of the study to determine the solute/water relationships in the mercurial diuresis produced in water-deprived patients with edema from congestive heart failure. The results indicate that in such patients, the diuresis produced has the relationship of a simple osmotic diuresis. The clinical implications are discussed.
Anatomic Variations of the Auditory Canal Pertaining to the Fit of Stethoscope Earpieces
Authors: GROOM DALE , CHAPMAN WADDY
Published: June 2012

Leaks in the enclosed acoustical system of the stethoscope reduce its efficiency and can greatly impair the physician's ability to detect the faint murmurs of early valvular heart disease. The results of this study demonstrate a high degree of variability in size and configuration of the external auditory meatus among different individuals. It appears probable that both excessive leaks and also partial or complete occlusion of the acoustical pathways commonly result with the use of standard stethoscope earpieces.
Clinical Use of the Percutaneous Renal Biopsy
Authors: ARNOLD JOHN D. , SPARGO BENJAMIN
Published: June 2012

The renal biopsy is undoubtedly a justifiable diagnostic tool though it has not yet reached full maturity in clinical practice.

Risks.
For most patients the risks do not appear to be excessive. An added caution must be exercised in malignant hypertension but even here after careful appraisal of this added risk the biopsy may still be justified. The experience of the operator would appear to modify some of the risk.

Returns.
The biopsy has often added to the confusion surrounding a given case because it may be uninterpretable or because it provides an unfamiliar complex of findings. Thisresult is becoming less common with increasing experience.

Even when the histology of the kidney is not diagnostic, it may suggest something of clinical value about the nature of the disease process, such as the presence of vascular disease, focal nephritis, or tubular disease of unidentified nature. The use of the electron microscope has extended the range of the percutaneous biopsy considerably. It is unfortunate that the cost and complexity of this instrument have confined it to certain centers.

It should be remembered also that a number of technical failures will occur, and the sampling error may be large.

Despite these real problems, the percutaneous renal biopsy is often the only way of establishing a diagnosis and makes its greatest contribution in the appraisal of the asymptomatic patient with proteinuria and an abnormal urinary sediment.
Acute Reversible Heart Failure in Severe Iron-Deficiency Anemia Associated with Hookworm Infestation in Uganda Africans
Authors: SOMERS K.
Published: June 2012

Severe iron deficiency anemia is a common sequel to the heavy hookworm infestations prevalent in Uganda, and in some hypoxia can be so severe that heart failure supervenes. The clinical manifestations in 15 cases are described. Comment is made on reversible electrocardiographic changes.
Effect of Nitroglycerin on the Coronary Circulation in Patients with Coronary Artery Disease or Increased Left Ventricular Work
Authors: GORLIN RICHARD , BRACHFELD NORMAN , MACLEOD COLIN , BOPP PIERRE
Published: June 2012

Except for the electrocardiogram objective evaluation of the functional state of the coronary circulation in man is often difficult. The nature of the coronary circulation in the presence of known coronary insufficiency has not been evaluated. In this report, 17 patients were studied of whom 14 had angina pectoris. Observations were made of coronary blood flow and hemodynamics both at rest and following administration of nitroglycerin. The authors conclude that
resting
coronary flow is normal, but
cannot increase
further with dilators. They consider this phenomenon a consequence of prior exhaustion of the dilator capacity of the arterioles in compensation for the atherosclerotic obstruction of the coronary tree. The "fixed flow" concept is suggested as an objective means of detecting coronary insufficiency. Nitrites probably relieve pain in some manner other than general coronary dilatation.
Electrocardiographic Patterns in Man at High Altitudes
Authors: ROTTA ANDRÉS , LÓPEZ ANDRÉS
Published: June 2012

Electrocardiograms of healthy men both native and long-term residents at 14,900 feet above sea level have been obtained and classified according to their dominant pattern. Most of the tracings showed signs of either right ventricular hypertrophy or right bundle-branch block, incomplete and complete. Some of the mechanisms responsible for these electrocardiographic changes found at high altitudes, such as pulmonary hypertension, positional changes of the heart, and chronic hypoxia, are discussed.
A Clinical Study of 1,000 Consecutive Cases of Mitral Stenosis Two to Nine Years after Mitral Valvuloplasty
Authors: ELLIS LAURENCE B. , HARKEN DWIGHT E. , BLACK HARRISON
Published: June 2012

A study is presented of 1,000 cases of predominant mitral stenosis operated by valvuloplasty between 1949 and 1956. It is shown that the survival of these patients is better than would have been expected under medical management. Sixty-nine per cent of the survivors of the operation in groups II and III improved, and 55 per cent in group IV. Factors influencing the late results are discussed. After substantial improvement lasting a year or more, 228 of this series deteriorated; the factors affecting this deterioration are discussed, of which mitral insufficiency, an inadequate valvuloplasty, and recurrent rheumatic fever are the most striking.
Mitral Incompetence Caused by Disease of the Mural Cusp
Authors: NIXON P. G. F. , WOOLER GEOFFREY H. , RADIGAN LEO R.
Published: June 2012

Mitral regurgitation can be caused by one or a combination of different anatomic lesions. Because of this the authors believe that the surgeon can be aided if the type of defect is known preoperatively. The present study of 240 patients with disease of the mitral valve revealed a significant number whose disease was limited to the mural cusp. Criteria for the bedside diagnosis of this type of mitral regurgitation are presented.
Influence of Some Vasoactive Drugs on Fibrinolytic Activity
Authors: WEINER MURRAY , DE CRINIS KURT , REDISCH WALTER , STEELE J. MURRAY , Weisberg Louis G. , Gilbert Gordon R.
Published: June 2012

The phenomenon of fibrinolysis in thromboembolic disease is of great importance. In this communication the authors present striking evidence of fibrinolysis induced by drugs.
An Evaluation of the Nitrous Oxide Method for the Quantification of Left-to-Right Shunts
Authors: SANDERS RICHARD J. , COOPER THEODORE , MORROW ANDREW G.
Published: June 2012

Extensive clinical use has now been made of the nitrous oxide test for the detection and localization of left-to-right circulatory shunts. On theoretical grounds the magnitude of such a shunt should be related to the systemic and pulmonary arteriovenous differences in nitrous oxide content measured early in the period of inhalation. In order to determine the validity of the nitrous oxide method for the quantification of a left-to-right shunt, total pulmonary and shunt flows were directly measured in experimental animals as nitrous oxide tests were performed simultaneously.
Design of a Clinical Ultra-Low Frequency Ballistocardiograph
Authors: DONALDSON ROBERT R. , CUNNINGHAM DON M. , GRISWOLD HERBERT E. , REAUME RALPH B.
Published: June 2012

The potential advantages of an ultra-low frequency ballistocardiograph are presented.
Right Atrial Myxoma
Authors: BELLE MARTIN S.
Published: June 2012

A case of myxoma of the right atrium with physiologic, surgical, and angiocardiographic findings has been presented together with a review of 6 other published cases.

Several findings have been emphasized that may call attention to the possible diagnosis of right atrial myxoma: right-sided heart failure; intracardiac calcification of the right heart; enlargement of the right ventricle and right atrium; electrocardiographic findings of a prominent P wave and low voltage over right precordium simulating that found in Ebstein's anomaly and marked variation in heart rate not related to any physiologic event or change in rhythm; use of intracavitary electrode catheter to rule out Ebstein's anomaly; and finally, analysis of the right atrial curve may lead one to suspect that other than valvular stenosis is present.

Angiocardiography gives a definitive diagnosis.

Cure may now be obtained with surgical removal of myxomas; therefore, it is important that they be detected during life.
Clinical Evaluation of Chlorothiazide
Authors: KIRKENDALL WALTER M.
Published: June 2012

In the 2 years chlorothiazide has been available, it has been demonstrated to have many of the characteristics of the ideal diuretic agent. It has become an important drug in the treatment of patients with edema and hypertension. Experience has indicated that the side effects and toxic reactions are not severe nor do they prohibit long-term use of the drug. In the vast majority of patients, clinical effectiveness has persisted for the duration of the study, up to 2 years in some and more than a year in many.

Chlorothiazide is a new type of powerful diuretic agent. Surely other similar compounds will be introduced. For these reasons, it is especially important that we understand its mechanism of action and shortcomings. Interest in the pharmacology of chlorothiazide already has brought us new information about certain fundamental problems of kidney function and systemic arterial hypertension.
Standardizing Factors in Electrocardiography
Authors: CRONVICH JAMES A. , CONWAY JOHN P. , BURCH GEORGE E.
Published: June 2012

Modifications in recorder standardization are required to correct inherent scalar differences among potential differences measured in a given electrocardiographic reference frame. In the frontal plane, agreement between the resultant vectors calculated from unipolar limb lead measurements and from standard lead measurements can be obtained by standardizing the galvanometer for recording the unipolar limb lead potentials at √3 cm. per millivolt. A method for calculating this "standardizing factor" and similar factors for other reference frames is presented and applied to calculations for the equilateral tetrahedron, the isosceles tetrahedron, and the cube.
The Validity of the Equilateral Tetrahedron as a Spatial Reference System
Authors: ABILDSKOV J. A. , BURCH G. E. , CRONVICH J. A.
Published: June 2012

The error involved in the use of the equilateral tetrahedron reference system for electrocardiographic or vectorcardiographic studies has been investigated by means of an electrical dipole placed in the esophagus. Vectors plotted from the potential differences between electrodes defining the reference system were found to correspond fairly closely to the actual position of the dipole, indicating that the error is small.
An Approximate Derivation for Stereoscopic Vectorcardiograms with the Equilateral Tetrahedron
Authors: CRONVICH J. A. , ABILDSKOV J. A. , JACKSON C. E. , BURCH G. E.
Published: June 2012

A simple electrode arrangement, which permits the derivation of stereoscopic projections of the spatial vectorcardiogram, eliminates the need for constructing models. The visual impression obtained from this method agrees satisfactorily with that from carefully constructed models.
Comparison of Heart Vectors Calculated with Different Systems of Leads
Authors: MCFEE RICHARD
Published: June 2012

Einthoven's equations for the heart vector are based on the assumption that voltages measured across the trunk horizontally (or vertically) are proportional to the horizontal (or vertical) component of the dipole moment of the heart's electromotive forces. One necessary consequence of this assumption is that all the horizontal (or vertical) voltages be similar, and that heart vectors calculated with different sets of these voltages and appropriate formulas be the same. An experimental test of this predicted result is described in this paper.
Peri-Infarction Block; Electrocardiographic Abnormality Occasionally Resembling Bundle Branch Block and Local Ventricular Block of Other Types
Authors: FIRST SAFETY R. , BAYLEY ROBERT H. , BEDFORD D. R.
Published: June 2012

Curves which represent bundle branch block can usually be identified. More important are those which represent peri-infarction block. Multiple unipolar leads enable identification of the latter from the former, which they may closely resemble in the limb leads, and from intraventricular block of other types. Criteria and examples of peri-infarction block are presented and an incidence and explanation are offered.
Excitation of Human Auricular Muscle and the Significance of the Intrinsicoid Deflection of the Auricular Electrocardiogram
Authors: HECHT HANS H. , WOODBURY LOWELL A.
Published: June 2012

The technic of endocardial electrocardiography has been useful in applying certain basic concepts to the interpretation of an electrocardiogram. One of the earliest intra-auricular records, obtained in 1944, is here analyzed in detail. It led to a reaffirmation of the dipole concept of cardiac excitation. A number of selected auricular electrocardiograms recorded by simultaneous tracings from the chestwall and the esophagus demonstrate the direct clinical usefulness of the theoretic postulates.
An Integrating Circuit for Measurement of the Areas of the Waves in the Electrocardiogram
Authors: JOHNSTON FRANKLIN D. , MCFEE RICHARD , BRYANT J. MARION
Published: June 2012

An electronic circuit capable of integrating the electrocardiogram is described. The net areas of the QRS complex, the T wave and of the entire ventricular complex, QRS-T, in the standard leads may be estimated by measurement of the length of two vertical lines in each of the integrated records. The manifest areas of QRS, T and the gradient (QRS-T) with the orientation of these vectors are easily calculated from the data. An example of an integrated electrocardiogram is reproduced, and the procedure for estimation of the gradient is presented.
Other QRS-T Patterns that May Be Mistaken for Myocardial Infarction
Authors: MYERS GORDON B.
Published: June 2012

The electrocardiograms of patients in whom myocardial infarction was excluded at autopsy are presented to bring out (1) differentiation of patterns due to subendocardial ischemia or hypopotassemia from those due to subendocardial infarction; (2) differentiation of cove-plane T inversion associated with subepicardial myocarditis or ischemia from that accompanying myocardial infraction; (3) errors resulting from attempts to draw diagnostic inferences from the registraition of prominent Q waves and/or cove negative T waves in ectopic beats or tachycardias.
Impending Hemorrhagic Shock and the Course of Events following Administration of Dibenamine
Authors: WIGGERS HAROLD C. , GOLDBERG HAROLD , ROEMHILD FRANK , INGRAHAM RAYMOND C.
Published: June 2012

By blocking sympathogenic vasoconstrictor mechanisms with dibenamine, a dog's tolerance to severe hemorrhagic hypotension states is definitely improved. New evidence is presented that partial release from vasoconstriction achieved by, giving small doses of dibenamine during the impending shock state seems to provide animals with even greater tolerance to this standardized form of stress. Although the use of dibenamine clinically for this purpose seems contraindicated, the dangers of at administering vasoconstrictor drugs to patients in impending shock are emphasized.
The Electrokymograph: Studies in Recording Fidelity
Authors: ZINSSER HARRY F. , KAY CALVIN F. , BENJAMIN J. MALVERN
Published: June 2012

Several electrokymographs were subjected to study of their recording fidelity. Distortions were found in respect to
time
and
amplitude
of recorded response. The recording defects were analyzed quantitatively, and the degree to which the various components of the electrokymograph contribute to these distortions was measured. The significance of these deviations in recording fidelity is discussed in reference to the application of the electrokymograph to the study of cardiovascular dynamics.
The Effects of Intravenous Aminophylline upon the Coronary Blood-Oxygen Exchange
Authors: FOLTZ ELWOOD L. , RUBIN ALAN , STEIGER WILLIAM A. , GAZES PETER C.
Published: June 2012

The effects of intravenous injections of aminophylline on the coronary blood flow, cardiac oxygen consumption, cardiac work, and cardiac rate were studied by catheterization of the right ventricle and coronary sinus in anesthetized dogs. There was no substantial increase in coronary flow when cardiac activity increased following injection of the drug; this suggested that the oxygenation of the myocardium in general was not improved. Further studies on coronary blood-oxygen saturations substantiated this concept as pertaining to the infarcted heart of dogs as well as the normal. Nitroglycerin however increased general myocardial oxygenation in normal hearts.
Blood Vessels of the Skin in Chronic Venous Insufficiency
Authors: KULWIN MYRON H. , HINES EDGAR A.
Published: June 2012

This study concerns an evaluation of the anatomicopathologic changes found in blood vessels of the skin in areas of venous insufficiency in the lower legs. These changes have been compared with the vascular structure in comparable areas of skin in normal persons. Apparently evidence of arteriolar damage is more a concomitant finding in the clinical picture of chronic venous insufficiency than are venular changes. This is demonstrated in a study of 30 patients. The vascular changes show no correlation with the condition of the skin at the site from which the biopsy material was taken.
Electrical Effects of Stimulating the Endocardial Surface of the Right Ventricle of the Dog
Authors: ATTYAH ALBERT M.
Published: June 2012

The endocardial surface of the right ventricle in four dogs was stimulated by a unipolar electrode introduced into the cavity of the right ventricle by means of a catheter. Electrical changes at a suprajacent point on the right wall were recorded by the V lead method of Wilson. In every experiment the induced QRS complexes were initiated by a positive electrical change.
Ventricular Tachycardia during Cardiac Catheterization of Patient with Wolff-Parkinson-White Syndrome
Authors: BRUCE ROBERT A. , YU PAUL N. G. , LOVEJOY FRANK W. , MCDOWELL MARION E. , PEARSON RAYMOND
Published: June 2012

Cardiac catheterization of a patient with probable Wolff-Parkinson-White syndrome was attempted to clarify the possibility of coexistent congenital heart disease. Introduction of the catheter into the heart induced a multifocal ventricular tachycardia which endangered the life of the patient. After quinidine and other drugs had failed to control the arrhythmia that persisted for nine hours, a prompt and gratifying conversion to supraventricular tachycardia, and subsequently to sinus rhythm, followed the intravenous administration of atropine sulfate.
Electrokymographic Studies of the Normal Cardiac Cycle
Authors: MEDNICK HENRY , SCHWEDEL JOHN B. , SAMET PHILIP
Published: June 2012

Normal subjects were studied by employing two electrokymograms simultaneously. By comparing the sequence of events in the carotid pulse, auricle and ventricle, measurements were made of the phases of the cardiac cycle. The normal electrokymogram is discussed and illustrated. Simultaneous electrokymography of the right- and left-sided chambers and vessels of the heart provides a simple method for comparing synchronicity of events in normal and pathologic states. Data obtained in normal subjects is presented.
The Use of Digitalis in Spite of the Presence of Ventricular Tachycardia
Authors: GILSON J. S. , SCHEMM F. R.
Published: June 2012

The authors' observations throw some doubt on the validity of objections to the use of digitalis in the presence of ventricular tachycardia. These observations demonstrate that digitalis can be used liberally and that it does not appear to interfere with conversion to a normal mechanism. They suggest that digitalis may even set the stage for reconversion by aiding the failing heart.
Localized Interlobar Effusion in Congestive Heart Failure
Authors: GEFTER WILLIAM I. , BOUCOT KATHARINE R. , MARSHALL E. WAYNE
Published: June 2012

Four illustrative cases of localized interlobar effusion as a manifestation of congestive heart failure are presented. The right transverse fissure was most often involved. The x-ray shadow was dense and variable in shape, frequently resembling a tumor mass, and consequently presented a diagnostic problem. Diagnosis was confirmed by demonstrating the disappearance of the "tumor" following diuresis and restoration of cardiac compensation. The disorder is apparently not rare.
Intrabronchial Electrocardiography
Authors: LANGNER PAUL H. , ATKINS JOSEPH P.
Published: June 2012

The Einthoven hypothesis implies that differences in the conductivity of body tissues are not sufficiently great to invalidate the concept that the body is a homogeneous volume conductor. Some investigators believe the lungs are sufficiently poor conductors to make questionable the concept that the body can be regarded as a homogeneous volume conductor. Intrabronchial electrocardiography is presented as a possible method for studying this problem. In ten individuals without manifest cardiac disease the distribution of potential variations in the lungs as manifested by the QRS complexes corresponded approximately and qualitatively with the distribution of the QRS complexes recorded from the body surfaces.
Transfixion of the Heart by Embedded Ice Pick Blade with Eight Months' Survival
Authors: LOWEN HARRY J. , FINK SEYMOUR A. , HELPERN MILTON
Published: June 2012

A case is presented of a 24 year old Puerto Rican man whose heart was transfixed by the anterior end of an ice pick blade, with the posterior end of the blade fixed in the body of the sixth doisal vertebra. The patient survived for eight months. Roentgenologically, the patient presented a problem in determination of the path of the foreign body. At autopsy, vegetations were found in the heart on the perforated mitral valve; these were the source of multiple embolizations.
Coronary Embolism: Review of the Literature and Report of a Unique Case
Authors: MORAGUES VINCENT , BAWELL MALCOLM B. , SHRADER E. LEE
Published: June 2012

This is a brief review of the literature on coronary embolism and a case report of a very unique type of coronary embolus—a piece of calcium from a calcified aortic valve. Microscopic sections revealed that the calcium plaque was covered by endothelium which had grown out from the vessel wall, thus attaching it to the coronary artery. The patient lived approximately two months after the embolism occurred.
Primary Systemic Amyloidosis Mimicking Chronic Constrictive Pericardial Disease
Authors: COUTER WILLIAM T. , REICHET RUDOLPH E.
Published: June 2012

The characteristically altered physiologic pattern in chronic constrictive pericarditis is the resultant of the diminished cardiac expansibility. A widespread infiltrative myocardial disease in which cardiac expansibility was equally limited should simulate the former entity very closely. This extremely rare entity is illustrated in this case report.