bluuebunny/crossref_metadata_2025 huggingface dataset:
Radioelectrocardiographic Changes during Strenuous Exercise in Normal Subjects
Authors: BELLET SAMUEL , ELIAKIM MARCEL , DELIYIANNIS STAVROS , FIGALLO EDUARDO M.
Published: June 2012

The effect of strenuous exercise (riding a stationary bicycle at 20 to 25 mph for 3 minutes) on the electrocardiogram was studied in 135 normal subjects, aged 17 to 64 years. Radioelectrocardiography was used to record the tracings
during
and
after
the period of exercise.

The following electrocardiographic alterations
during
exercise were interpreted as representing a normal physiologic response; sinus tachycardia (100 per cent of the cases), increased P-wave amplitude (85 per cent), ST-segment depression of the junction type, 1 mm. or more (75 per cent), diminished (68 per cent) or increased (9 per cent) T-wave amplitude. A few ventricular premature beats were observed in only two subjects (1.4 per cent). All these changes were observed, although less frequently, in the period after exercise (1 minute after the cessation of exercise).

According to criteria for abnormality described previously,
23
34 of the 135 subjects (24.8 per cent) exhibited abnormal responses to the bicycle exercise test. Sixteen of the 34 "definitely" and "probably abnormal" responses (47 per cent) occurred only during the period of exercise, 12 were observed both during and after the exercise and six occurred only in the postexercise period.

The incidence of abnormalities in the group of subjects in the age group 40 to 64 years was 37 per cent, while that in subjects in the age group 17 to 40 years was 22.5 per cent.

A comparison between the Master two-step and the bicycle tests suggests that the latter may be more diagnostic for the detection of latent coronary artery disease and the evaluation of the state of physical fitness in subjects below the age of 40 years.
Carotid Kinking as a Cause of Cerebral Insufficiency
Authors: DERRICK JOHN R. , SMITH TAYLOR
Published: June 2012

With proper diagnosis based on history, physical findings, and arteriographic and pressure studies, it has become apparent that carotid artery kinking is a more common cause of strokes than was formerly believed. Because kinking is easily corrected, every patient with stroke deserves examination sufficient for determination of whether the carotid arteries are kinked. Two cases are cited in which multiple syncopal attacks were relieved when flow past a kink in the common carotid artery was reestablished.
Studies on Digitalis
Authors: BRAUNWALD EUGENE , BROCKENBROUGH EDWIN C. , FRYE ROBERT L.
Published: June 2012

The acute hemodynamic effects of 0.50 to 0.75 mg. ouabain were studied in six patients with valvular aortic stenosis and in four patients with idiopathic hypertrophic subaortic stenosis. Left atrial and left ventricular pressures were determined by means of transseptal left heart catheterization and cardiac output was measured by the indicator-dilution technic. In the patients with valvular aortic stenosis, ouabain either improved left ventricular function or had no discernible effect on it, but in no patient was left ventricular function depressed. Left ventricular end-diastolic pressure fell slightly or remained unchanged, while cardiac output rose in two of four patients. In the patients with hypertrophic subaortic stenosis, the left ventricular end-diastolic pressure and mean left atrial pressure rose significantly following ouabain administration; cardiac output either fell or remained unchanged and the systolic pressure gradient between the left ventricle and the brachial artery rose. These actions of ouabain in hypertrophic subaortic stenosis are considered to result from a sustained increase in left ventricular contractile force that increased the obstruction produced by the muscular outflow tract.
Quantitative Radiocardiography
Authors: DONATO L. , ROCHESTER D. F. , LEWIS M. L. , DURAND J. , PARKER J. O. , HARVEY R. M.
Published: June 2012

A technic for obtaining radiocardiograms has been described and a method of analysis of the curves presented.
The Two-Chambered Right Ventricle
Authors: HARTMANN ALEXIS F. , TSIFUTIS ARGYRIOS A. , ARVIDSSON HAKAN , GOLDRING DAVID , Crawford Charles E.
Published: June 2012

A relatively rare congenital cardiac malformation is described in nine patients and is characterized by aberrant hypertrophied muscular bands that divide the right ventricular cavity into two chambers. These hypertrophied muscular bands produce an effective stenosis and obstruct the outflow of blood from the right ventricle. An interventricular septal defect is usually seen in association with this abnormality. This cardiac malformation is anatomically distinct from the classic tetralogy of Fallot but may be mistakenly diagnosed as an acyanotic tetralogy of Fallot or an interventricular septal defect. The use of selective angiocardiography in conjunction with right-sided cardiac catheterization will establish the correct diagnosis. This congenital lesion is amenable to surgical correction, and five of the patients in this series were successfully operated upon with the aid of extracorporeal circulation. Surgery has been recommended for the remaining four patients because of the encouraging results.
The Present Role of Hypothermia in Cardiac Surgery
Authors: SPENCER F. C. , BAHNSON H. T.
Published: June 2012

A survey of the current use of hypothermia during cardiac surgery has been presented. Hypothermia remains a simple and safe method to permit the surgical correction of uncomplicated atrial septal defects, although it is gradually being displaced by pump-oxygenators as they become better understood.

In conjunction with extracorporeal circulation moderate and extreme ("deep") hypothermia has been employed. Moderate hypothermia is without any known deleterious effects and may be of benefit by lowering perfusion rates and decreasing intracardiac aspiration of blood. The role of deep hypothermia with circulatory arrest remains uncertain. It is a condition associated with extreme physiologic alterations, many of which are poorly understood, and the safe limits are not yet clearly defined.

Finally, hypothermia remains a beneficial technic for neurologic injury following resuscitation from cardiac arrest. Recent evidence indicates that the mechanism of benefit involves considerably more than simple reduction of cerebral edema.
Negative P Waves in Lead I in Dextroversion: Differential Diagnosis from Mirror-Image Dextrocardia
Authors: MIROWSKI M. , NEILL CATHERINE A. , BAHNSON HENRY T. , TAUSSIG HELEN B.
Published: June 2012

The electrocardiographic differentiation of dextroversion from mirror-image dextrocardia has frequently been based on the configuration of the P waves in lead I, the assumption being that P waves are upright in dextroversion and inverted in mirror-image dextrocardia.

A patient is presented with inverted P waves in lead I in whom an electrocardiographic diagnosis of dextroversion was made based on the analysis of the unipolar leads. This diagnosis was confirmed at surgery when a ventricular septal defect was successfully repaired.

The Sodi-Pallares method of analysis of the precordial leads is valuable in determining whether the left ventricle lies anteriorly and to the left as in dextroversion or posteriorly and to the right as in mirror-image dextrocardia. Because of the frequency of unusual atrial rhythms in patients with right-lying hearts, the configuration of the P waves is often unreliable. When there is a discrepancy between the result of analysis of atrial activation and that of ventricular activation, the latter should be used in determining whether dextroversion or mirror-image dextrocardia is present.
Mitral Insufficiency Simulating Aortic Stenosis
Authors: SLEEPER JULIAN C. , ORGAIN EDWARD S. , MCINTOSH HENRY D.
Published: June 2012

Two patients with mitral insufficiency presumably secondary to rheumatic heart disease are reported in whom loud systolic murmurs and thrills in the aortic area simulated aortic stenosis. Left heart catheterization in both patients disclosed significant mitral insufficiency but no evidence for aortic stenosis or intracardiac shunt such as ventricular septal defect. Phonocardiography demonstrated the holosystolic characteristics of the aortic area murmurs and was indispensable in documenting their mitral origin. A regurgitant jet striking the left atrial wall in close proximity to the aortic valve, previously reported in rupture of the chordae tendineae, appears the probable mechanism of the aortic murmur and thrill.
Reconstitution of Excitable Cell Membrane Structure in Vitro
Authors: MUELLER PAUL , RUDIN DONALD O. , TIEN H. TI , WESCOTT WILLIAM C.
Published: June 2012

Single stable bimolecular lipid and proteolipid membranes having the inert physical properties of cell membrane can be reconstituted in saline solution. After adsorption of appropriate molecules, these membranes become electrically excitable.
Cation Transport and Structure of the Red-Cell Plasma Membrane
Authors: HOFFMAN JOSEPH F.
Published: June 2012

This paper recounts recent work concerning the Na and K permeability of red blood cells. The discussion deals principally with results derived from isolated red-cell membranes, or ghosts. Using defined isolation techniques, a system of ghosts is described in which Na is actively pumped. Like intact cells, the pump requires extracellular K and energy derived from the metabolism. The source of energy for the pump has been assessed by incorporating normally impermeable substrates into the ghost interior at the time of hemolysis. The specific and direct substrate of the pump has been identified as ATP. Further studies are described that correlate the activity of the Na pump with an ATPase. This ATPase, like the pump, requires both Na and K for activity and is inhibited by cardiac glycosides. The evidence points toward the involvement of this ATPase as an intermediate component of the pump reaction.
Quadrilateral Peripheral Vascular Disease in the Young Adult
Authors: HERSHEY FALLS B. , PAREIRA MORTON D. , AHLVIN ROBERT C.
Published: June 2012

Seven cases of quadrilateral chronic occlusive arterial disease different from other known chronic occlusive arterial diseases as evidenced by arteriography, pathology, and clinical manifestations are reported. They resemble some of the cases originally described by Buerger.
The Effects of Surgical Abolition of Left-to-Right Shunts on the Pulmonary Vascular Dynamics of Patients with Pulmonary Hypertension
Authors: BRAUNWALD NINA S. , BRAUNWALD EUGENE , MORROW ANDREW G.
Published: June 2012

The preoperative and postoperative pulmonary artery pressures, the ratios of pulmonary to systemic arterial pressure, and of pulmonary to systemic vascular resistance were compared in 29 patients with congenital heart disease, left-to-right shunts, and pulmonary hypertension. These patients averaged 21 years of age and the time interval between operation and the postoperative catheterization averaged 11 months. The mean pulmonary artery pressure and the pulmonary artery to systemic artery pressure ratio fell significantly in all 12 patients with extracardiac left-to-right shunts (patent ductus arteriosus and aortopulmonary septal defect) and fell to normal in 10 of them. The pulmonary vascular/systemic vascular resistance ratio was abnormally elevated in only one patient postoperatively. In the 17 patients with atrial and ventricular septal defects the decline in pulmonary artery pressure and in the pulmonary/systemic arterial pressure ratio was less striking than in the patients with extracardiac shunts. These indices were normal postoperatively in only two of the nine patients with atrial septal defects and in none of the eight patients with ventricular septal defects. No significant changes were noted after operation in the pulmonary/systemic vascular resistance ratios in any of the 17 patients with intracardiac left-to-right shunts. From these observations it appears likely that some regression of the abnormalities in the pulmonary vascular bed occurs during the first year after closure of an extracardiac left-to-right shunt. On the other hand, there was little physiologic evidence that such favorable changes followed operation in the patients with atrial or ventricular septal defects.
Hemodynamic Studies of a Monoamine Oxidase Inhibitor, DL-Serine-N
2
-Isopropylhydrazide (RO 4-1038)
Authors: MAXWELL M. H. , GONICK H. C. , SCADUTO L. , PEARCE M. L. , KLEEMAN C. R.
Published: June 2012

Hemodynamic studies were performed on 11 patients with severe diastolic hypertension before and after the chronic administration of the monoamine oxidase inhibitor, RO 4-1038.

Although postural hypotension was more marked, the blood pressure decreased significantly in the supine position as well. The hypotensive effect was attributable almost solely to decreased total peripheral resistance and was unrelated to changes in cardiac output, blood volume, or sodium space. Renal plasma flow and glomerular filtration rate were unchanged.

Evidence is presented which suggests that the decrease in blood pressure was not caused by adrenergic blockade.

If RO 4-1038 is a representative monoamine oxidase inhibitor then its hemodynamic action is unique among the clinically useful hypotensive drugs.
Mitral Insufficiency Resulting from Rupture of Normal Chordae Tendineae
Authors: JANUARY L. E. , FISHER JUNE M. , EHRENHAFT J. L.
Published: June 2012

Mitral insufficiency resulting from rupture of normal chordae tendineae occurs and can be recognized. It is subject to surgical repair. A patient with refractory cardiac failure due to mitral insufficiency on this basis has been totally rehabilitated by surgical repair of the valvular restraining mechanism.
Primary Pulmonary Hypertension
Authors: SLEEPER JULIAN C. , ORGAIN EDWARD S. , MCINTOSH HENRY D.
Published: June 2012

The clinical features of 16 patients with primary pulmonary hypertension are reviewed. Repeated cardiac catheterizations at intervals of 1 to 4 years during the course of the disease were performed in five patients. In three of the five patients there was a progressive increase in pulmonary artery pressure, total pulmonary resistance, and a decline in cardiac output. In two patients the pulmonary hemodynamics remained unchanged between studies at intervals of 2 and 4 years. Arterial oxygen saturation decreased with progression of the disease, presumably reflecting the appearance of an uneven distribution of pulmonary capillary flow. The course of the illness was variable and unaffected by any mode of therapy, including long-term anticoagulation.
Function of the Contralateral Kidney in Renal Hypertension Due to Renal Artery Stenosis
Authors: THAL ALAN P. , GRAGE THEODOR B. , VERNIER ROBERT L.
Published: June 2012

Severe hypertension of at least 7 years' duration, due to coarctation of the right renal artery, was treated by reconstruction of the abnormal artery and restoration of blood flow to the coarcted kidney. Renal biopsies revealed normal microscopic architecture in the right kidney and advanced hypertensive pathology in the opposite kidney. After 8 months' observation of persistent, moderate hypertension, the left kidney was removed with prompt return of blood pressure to normal levels during the subsequent 2½ years.

These observations demonstrate the precise correlation of hypertension due to renal artery stenosis in the human with the experimental model in rats.
Prevention of Ventricular Tachycardia and Fibrillation by Intravenous Isoproterenol and Epinephrine
Authors: LINENTHAL ARTHUR J. , ZOLL PAUL M.
Published: June 2012

Isoproterenol and epinephrine were given intravenously in dilute solutions to nine patients with Stokes-Adams attacks due to ventricular tachycardia and fibrillation. The drugs produced ventricular acceleration and thereby controlled the attacks. This technic proved useful for prompt, short-term prevention of seizures; for the long term, direct electric stimulation with internal pacemakers was required.
The Relation of Precordial and Orthogonal Leads
Authors: ABILDSKOV J. A. , WILKINSON ROBERT S.
Published: June 2012

A systematic search was made for the effective axes from an orthogonal lead system that best duplicated the diagnostically significant features of precordial leads.

Only one of 240 precordial leads was not matched with a rotated orthogonal lead having the same features judged to be clinically significant.

The average rotated lead axes corresponding to precordial leads V
1
through V
6
were systematically located from an axis directed upward and to the right corresponding to V
1
to one directed downward and to the left corresponding to V
6
.

The location of these average rotated axes has been presented and the per cent contribution of XYZ leads to each of these axes has been calculated.

These results provide a guide to the orthogonal lead location of diagnostic information now obtained from precordial leads.
Right Ventricular Myxoma Simulating Pulmonic Stenosis
Authors: GOTTSEGEN G. , WESSELY J. , ÁRVAY A. , TEMESVÁRI A.
Published: June 2012

The fourth case of right ventricular myxoma is reported, the first one in which the tumor was removed surgically. The clinical picture was that of pulmonic stenosis with some unusual features: effort syncope, changing hemodynamic pattern, and a rapidly progressive clinical course of irreversible congestive heart failure. The importance of early diagnosis, the angiocardiographic findings, and the necessity of operation before development of serious myocardial damage are stressed.
Surgical Management of Echinococcal Cysts of the Heart and Pericardium
Authors: HEILBRUNN ALFRED , KITTLE C. FREDERICK , DUNN MARVIN
Published: June 2012

Surgical treatment of a 27-year-old man with an echinococcal cyst of the heart is reported, illustrating some difficulties and problems manifested by this lesion.

Twenty-seven other patients operated upon for cardiac hydatid disease are reviewed in tabular form.

Symptomatology, diagnosis, and management of this rare cardiac lesion are reviewed.
Experience with 200 Renal Artery Reconstructive Procedures for Hypertension or Renal Failure
Authors: MORRIS GEORGE C. , DEBAKEY MICHAEL E. , COOLEY DENTON A. , CRAWFORD E. STANLEY
Published: June 2012

Renovascular hypertension is the most common form of reversible hypertension.

An analysis of 200 renal artery reconstructive procedures identified atherosclerosis as the arteriopathic lesion in 83 per cent of cases and fibromuscular hyperplasia in 13 per cent of cases. Bilateral renovascular disease was found in 31 per cent of cases.

Renal arteriography is the most significant factor in the diagnostic evaluation of the hypertensive subject.

Bypass graft and patch-graft angioplasty were the most commonly employed principles of renal artery reconstruction in this series.

The occlusive process in the renal artery produced a pressure gradient exceeding 25 mm. Hg in 76 per cent of cases.

The average period of observation following operation in these 200 patients was 1.6 years, ranging between 3 months and 5 years. Eighty per cent of patients are now normotensive.

The primary goal of operation in 12 patients was reversal of renal failure due to severe bilateral renal artery occlusive disease. Disappearance of azotemia with improved renal function followed revascularization in 11 of 12 patients.
Effect of Cardiac Catheterization and Angiocardiography on the Serum Glutamic Oxaloacetic Transaminase
Authors: ADROUNY ZAVEN A. , STEPHENSON MAX J. , STRAUBE KURT R. , DOTTER CHARLES T. , GRISWOLD HERBERT E.
Published: June 2012

The effect of cardiac catheterization and angiocardiography on the SGO-T was studied in 46 patients. Abnormal enzyme elevations occurred in a significant number of subjects. Such procedures constitute an addition to the known causes of SGO-T elevation.
Survival After Mesenteric Arterial Occlusion by Treatment with Low Molecular Weight Dextran
Authors: D'ANGELO GEORGE J. , AMERISO LORENZO M. , TREDWAY JOHN B.
Published: June 2012

1. A segment of small bowel, approximately 30 cm., was acutely deprived of its arterial supply in 16 dogs.

2. Six dogs served as controls, receiving 15 ml./Kg. of 0.9 per cent saline or 1 ml./Kg. heparin. In all of these animals, the segment of bowel became necrotic.

3. Ten animals received 15 ml./Kg. of low molecular weight dextran after five hours of arterial occlusion, with survival of the involved bowel in all 10 dogs for a period of 48 hours to 3 weeks.

4. After five hours, the serum amylase in all animals decreased. In the control animals, the amylase value continued to decrease, whereas in the animals receiving the low molecular weight dextran it began to rise toward normal value.
Application to Coronary Arteries of the Basic Principles Governing the Development of Collateral Arterial Channels
Authors: SEWELL WILLIAM H.
Published: June 2012

The experiments performed on 350 dogs showed that when certain technical points were observed, a pedicle containing the mammary artery, mammary vein, and surrounding soft tissue consistently contributed large collateral channels which were capable of carrying the entire arterial blood supply to a large portion of the left ventricle of the heart of a dog with experimental chronic coronary arterial hypotension. Original plastic devices were used to produce controlled, gradual, coronary constrictions and occlusions.

Direction and velocity of movement and size of the donor arteries, the collateral channels, and the recipient coronary arteries were determined from frame-by-frame analysis of cinearteriograms.
Closure of Coronary Arteriotomy in the Dog by Means of an Autogenous Arterial Patch
Authors: CHATTERJEE KHAGENDRA N. , WARREN RICHARD
Published: June 2012

A simple technique of application of a patch graft to a coronary arteriotomy without using a cardiopulmonary bypass is described. Twelve dogs were subjected to this procedure, the circumflex coronary artery being used in eight, and the left anterior descending coronary artery in four. A 66 per cent patency of the segment was obtained. In one dog, a coronary arteriogram showed a patent segment six months later. Histological study revealed some intimal thickening of the patch, as well as of the host artery. Gross myocardial infarction was observed in those with occluded segments.
Newer Techniques of Transseptal Left-Heart Catheterization
Authors: COPE CONSTANTIN
Published: June 2012

1. Teflon tubing is ideally suited for transseptal catheterization because of its low coefficient of friction.

2. Catheterization of the left ventricle can be easily performed with a maneuverable spring guide.

3. A Teflon-tipped cannula and a tough, flexible, Teflon guide are used for percutaneous catheter insertions.

4. Safety measures used in transseptal puncture are described.

5. Simultaneous percutaneous insertion of a retrograde Teflon aortic catheter and the transseptal catheter permit transvalvular gradients to be obtained even when a diseased mitral or aortic valve cannot be crossed.
An Experimental Method for the Study of Aortic Insufficiency
Authors: NOLAN STANTON P. , MULLER WILLIAM H.
Published: June 2012

A method is presented for the experimental creation and correction of acute and chronic aortic insufficiency in dogs. Fifteen animals with acute, 11 with chronic, and 5 with corrected aortic insufficiency were studied. In all animals, mean central aortic blood pressure [see Table in PDF] was essentially normal, while pulse pressure was widened in the acute and chronic states, returning to normal with valvular repair. In the acute state, 41 per cent regurgitation was achieved without a significant alteration in stroke volume. However, in the chronic preperations, when 49 per cent regurgitation was present, there was a 70 per cent increase in stroke volume, accompanied by cardiac hypertrophy. Valvular repair in four of five animals reduced the aortic regurgitation to less than 10 per cent without altering cardiac output. Because of the consistent and predictable results, this method can be used for studies of the pathophysiological alterations attendant upon aortic insufficiency in humans.
Aortic Valvular Surgery with Artificial Valves
Authors: KAY EARLE B. , ZIMMERMAN HENRY A. , MENDELSOHN DAVID
Published: June 2012

An attempt has been made to present a profile of patients with aortic valvular disease who presented themselves for operative correction, and to demonstrate the effectiveness of prosthetic replacement in the surgical treatment. Experience to date, in 115 patients so treated, demonstrates the effectiveness of this technique. The operative mortality due to technical factors has been low, and the clinical results have been excellent. Since the operative mortality now occurs primarily in those patients with myocardial failure, its prevention, if possible, is advisable by earlier detection and surgical correction.
Sutureless Artificial Heart Valves
Authors: MAGOVERN GEORGE J. , KENT EDWARD M. , CROMIE HARRY W.
Published: June 2012

Valvular prostheses which incorporate an original method of mechanical fixation never previously described have been developed and successfully used in the aortic and mitral positions. Their principal advantage is a rapid,
non
suture method of permanent fixation which requires but a few seconds, thereby eliminating the need for prolonged cardiopulmonary bypass, myocardial perfusion, and hypothermia. The risk of subsequent thrombus formation has been reduced by the elimination of sutures and cloth cuffs ordinarily used for fixation to the tissues.
Correlation of the Extent and Severity of Atherosclerosis in the Coronary and Cerebral Arteries
Authors: MATHUR K. S. , KASHYAP S. K. , KUMAR V.
Published: June 2012

A study of correlation of the extent and severity of atherosclerosis in the coronary and cerebral arteries and between their individual branches has been undertaken in 200 consecutive medicolegal autopsies.

The coronary atherosclerosis developing first in the second decade appears about 20 years earlier than the cerebral atherosclerosis. There is, however, a significant correlation between the coronary and cerebral arterial beds.

There is a significant interbranch relationship within the coronary system. The atherosclerotic process starts earliest in the left anterior descending branch of the coronary arteries. The extent of correlation is more marked between the two branches of the left coronary artery than that of either of them with the right coronary artery. The interbranch relationship in the cerebral arterial bed also shows a significant correlation. Basilar artery shows the maximum atherosclerosis, next in order being middle cerebral artery; the postcerebral artery shows much less affliction to the atheroma and the anterior cerebral artery exhibits a high degree of freedom.
Idiopathic Cardiomyopathy in Children
Authors: BLOOMFIELD DANIEL K. , LIEBMAN JEROME
Published: June 2012

This report describes 27 cases of a clinical cardiomyopathic syndrome in clinically well children. Physical findings regularly observed include an abnormal left ventricular impulse, a prominent X and Y descent in the jugular venous pulse, and a characteristic, acquired, systolic murmur. These are associated with the laboratory findings of an enlarged left ventricle by electrocardiogram and x-ray. This syndrome may be the earliest manifestation of cardiomyopathic states, such as idiopathic myocardial hypertrophy or hypertrophic outflow tract obstruction, which usually appear in the third decade of life and beyond. The frequency of cases found suggests that the latter diseases, which are relatively rare, are possibly only the more malignant representatives of a broad spectrum of cardiomyopathic states.
Complete Transposition of the Great Vessels
Authors: ELLIOTT LARRY P. , NEUFELD HENRY N. , ANDERSON RAY C. , ADAMS PAUL , EDWARDS JESSE E.
Published: June 2012

This paper is based on a study of specimens of the heart that were obtained in 60 cases of complete transposition of the great vessels.

The external relationship of the aorta and pulmonary trunk usually differed from the classic description of the aorta lying directly anterior to the pulmonary trunk (type III). This relationship was present in only two of the 60 cases. In 39 cases, the relationship of the great vessels was oblique (type I). In 19 of the 60 cases, the relationship of the great vessels was side-to-side (type II).

There were two main patterns of origin of the coronary arteries. One had a tendency to be associated with the oblique (type I) relationship of the great vessels, which was most common; the other had a tendency to be associated with the side-to-side (type II) relationship of the great vessels, which was the second most common type.

A ventricular septal defect was present in 22 (37 per cent) of the 60 cases. The anatomic characteristics of these defects were the same as occur in cases of an isolated defect in the ventricular septum. It was of particular interest that a left ventricular-right atrial communication was observed in three cases.

Miscellaneous conditions observed include congenital obstruction of the aortic arch (eight cases), a right aortic arch in association with a ventricular septal defect and pulmonary stenosis (two cases), and juxtaposition of the atrial appendages (two cases).

The atrioventricular valves resembled the homolateral valves of normal hearts. An Ebstein-like malformation of the mitral valve was present in one case.
Hazard of Retrograde Aortography in Dissecting Aneurysm
Authors: HART WILLIAM L. , BERMAN EDWARD J. , LACOM RICHARD J.
Published: June 2012

During retrograde catheterization via the femoral artery and the brachial artery, the false lumen of a dissecting aneurysm was inadvertently entered in two patients. Bilateral carotid occlusion was produced in one by the high-pressure injection of contrast material into the false passage. A method is suggested to avoid this hazard.
Bigeminy on Exertion
Authors: RAZZAK MUHAMMAD ABDEL
Published: June 2012

Regularly occurring ventricular extrasystoles taking the form of bigeminy, trigeminy, or quadrigeminy may appear on exertion in an apparently otherwise normal heart.
Comparison of the Thrombotest with the Modified Quick Test
Authors: SHOSHKES MILTON , ODZE MELVIN , Lasser Paul J.
Published: June 2012

Forty-five patients, given anticoagulant therapy with prothrombinopenic drugs, were given 10 mg. of phytonadione intravenously. Thrombotest prothrombin times and modified Quick-test prothrombin times were compared as indices for measuring the resulting increase in prothrombin times. These increases were similar generally for both tests. The thrombotest times were lower, approximately 0.5 to 0.67 of the comparable Quick-test times, and on several occasions, grossly inaccurate results were found with the thrombotest. Blood samples stored for 24 hours in Lusteroid tubes lost a significant reproducibility of thrombotest time. Therapeutic thrombotest-time levels are inadequate for acceptable hypoprothrombinemia as judged by the Quick-test times.
Atrial Activity and Systemic Blood Pressure during Anesthesia in Man
Authors: LAVER MYRON B. , TURNDORF HERMAN
Published: June 2012

Atrial contribution to ventricular performance was evaluated during halothane anesthesia in man by a method whereby atrioventricular dissociation is readily induced. Three conditions are outlined that facilitate production of this arrhythmia in man: general anesthesia with a halothane-oxygen mixture by use of an average inspired halothane concentration of 0.5 per cent; controlled ventilation following muscle paralysis with d-tubocurare; and an exogenous stimulus, most easily provided by the onset of surgery. The last factor is probably mediated via direct sympathetic stimuli to the heart.

The change from sinoatrial to atrioventricular nodal rhythm was associated with a fall in arterial pressure and a rise in central venous pressure; the heart rate remained unaltered. The changes in the systemic and central venous pressures were attributed to failure of atrial systole to contribute to ventricular filling during diastole.

It is suggested that tricuspid regurgitation may occur during nodal rhythm, since synchronous atrioventricular contraction is required for adequate closure of the atrioventricular valve. Further studies of this problem in anesthetized man with this particular pharmacologic tool are indicated.
Hemodynamic Effects of Chronic Severe Anemia
Authors: ROY SUJOY B. , BHATIA MADAN L. , MATHUR VIRENDER S. , VIRMANI SHYAMA
Published: June 2012

Data on the cardiac output and circulatory dynamics obtained by cardiac catheter studies in 51 subjects with chronic severe anemia are presented. Patients are divided into two groups: group A consists of 26 subjects with an average hemoglobin value of 3.0 Gm. per 100 ml. (range 1.5 to 3.8 Gm.); group B, 25 patients with a hemoglobin level of 4.0 to 6.5 Gm., average 4.5 Gm.

Group A subjects have a somewhat faster heart rate (99 against 92 a minute), higher cardiac index (8.0 versus 6.3 liters per minute per square meter), and stroke index (88 and 68 ml. per beat per square meter) than group B patients.

The oxygen consumption values in both groups are normal (average 158 and 160 ml. per minute per square meter), while more oxygen is extracted by the tissue in group A subjects (61 and 53 per cent) whereas less oxygen is transported to the tissue (261 and 321 ml. per minute per square meter).

The stroke volume seems to bear a closer relationship to the high cardiac output than such other parameters as heart rate, right heart filling pressure, and velocity of blood flow. Apparently the presence of slow heart rate does not negate high cardiac output.

Data also suggest that systemic vascular resistance may play an important role in the high cardiac output as the two are inversely related, and by increasing the peripheral arterial pressure the output can be significantly reduced.

Restudy data after the treatment of the anemia (hemoglobin 10.0 to 12.5 Gm. per 100 ml.) show appreciable reduction in the cardiac output and in the right heart filling pressure, increase in the peripheral vascular resistance and oxygen transport values, and widening of the arteriovenous oxygen differences with concomitant decrease in the oxygen extraction by the tissue.
Hypertension and Ischemic Heart Disease in Hiroshima, Japan
Authors: SWITZER SAM
Published: June 2012

A random sampling of Hiroshima residents, comprising 1,051 males and 1,872 females, has been studied with respect to the interrelations of hypertension, ischemic heart disease, blood lipid levels, and ionizing irradiation experienced during the atom bombing of 1945. No significant effect of ionizing irradiation upon the cardiovascular system has been detected.

No major difference in age-sex specific mean blood pressures between Hiroshima residents and a suitable white American comparison group was found. Dissimilarities noted with other groups compared are considered due to the sum of sampling bias, varying technics, and coincidental environmental factors rather than a true racial difference. Blood pressure levels, stable from puberty through young adulthood, begin to rise early in middle age and continue to rise into old age. As a result, hypertension as clinically defined (140/90), is common in middle-aged and elderly Japanese. In 94.4 per cent of instances, or more, a demonstrable etiology for hypertension could not be found; these are considered to represent essential hypertension.

An accelerated course with fulminating vascular deterioration was suspected in only 1 per cent of the hypertensive subjects. As a result, advanced retinopathy and renal failure were rarely seen. Electrocardiographic evidence of left ventricular hypertrophy occurred in 7.2 per cent of the hypertensive Japanese in this study, and was readily correlated with the ambient systolic blood pressure. Evidence of ischemic heart disease and congestive failure is rare and distinctly less common than in American males unselected as to blood pressure levels. In contrast, mortality statistics indicate cerebrovascular disease to be at least as common in Japan as in the U. S.

Japanese exhibit low serum cholesterol concentrations by Western standards and elevated levels are predominantly limited to the obese. Both factors appear of importance in the occasional hypertensive Japanese with ischemic heart disease. The therapeutic implication of this observation is briefly discussed.
Coronary Heart Disease among Minnesota Business and Professional Men Followed Fifteen Years
Authors: KEYS ANCEL , TAYLOR HENRY LONGSTREET , BLACKBURN HENRY , BROZEK JOSEF , ANDERSON JOSEPH T. , SIMONSON ERNST
Published: June 2012

Relative weight, body fatness (skinfold thickness), blood pressure, and serum cholesterol are reported from 281 Minnesota business and professional men, initially clinically healthy and aged 45 to 55, who were followed by annual examinations since the winter of 1947-48. In 15 elapsed years, coronary heart disease developed definitely in 32 men and possibly in 16 other men.

The incidence of coronary heart disease tended to be higher among men above the median at first examination in relative weight, body fatness, systolic and diastolic blood pressure, and serum cholesterol concentration but these segregations were not statistically significant except with serum cholesterol, which was associated with
p
< 0.001. The data for the last pre-disease year on the men who developed coronary heart disease showed a significant relationship between incidence and systolic blood pressure as well as for cholesterol. Average data over all pre-disease years showed significantly reduced risk among the men in the bottom quartile for diastolic as well as for systolic blood pressure, while the cholesterol level was significantly prognostic over the entire range of that variable. The few men who developed coronary heart disease with low cholesterol values tended to be in the top 20 per cent of the distribution of blood pressure or relative weight or both.

Relative weight showed a high but still imperfect correlation with body fatness. Arterial blood pressure tended to be elevated in extremely obese or grossly overweight men. Serum cholesterol was not significantly related to any of the other variables.

Men who developed coronary heart disease tended to have low values for cholesterol in the alpha-lipoprotein fraction in the serum but the ratio of cholesterol in the alpha- to the beta-lipoprotein fraction of the serum was no more prognostic than total cholesterol alone.

Comparison with similar follow-up data from Framingham, Massachusetts, Albany, New York, and Chicago, show a high degree of concordance. In all series relative weight had least significance and the incidence of coronary heart disease rose continuously with the serum cholesterol level. With men classified according to pre-disease cholesterol level, about 80 per cent of the total variance in relative subsequent risk is accounted for by regression of risk on the cholesterol value raised to any power from 2 to 3 and the correlation between observed and predicted relative risk is of the order of r = 0.9.
Studies on the Metabolism and Mechanism of Action of Methyldopa
Authors: SJOERDSMA ALBERT , VENDSALU AADO , ENGELMAN KARL , Watts Miss Doris
Published: June 2012

The metabolism and particularly the decarboxylation of methyldopa were studied in hospitalized patients with uncomplicated hypertension. Both unlabeled and radioactive drugs were employed in these studies. Absorption from the intestine, as indicated by plasma levels of the drug and recovery of radioactivity in urine, was shown to be incomplete. The drug disappeared from the plasma with a half-time of less than 2 hours. On the average, about half of the radioactivity administered orally as 2-C
14
-methyldopa could be recovered in the urine. That portion not excreted in the urine appeared in the feces. Urinary excretion of radioactivity was rapid and essentially complete within 24 hours.

Confirming previous studies with
dl
-α-methyl-dopa, the major urinary excretory products of
l
-α-methyl-dopa (methyldopa, Aldomet) were found to be the drug itself and conjugates thereof. Small fractions appear as other metabolites, the most significant of which is the decarboxylated derivative, αmethyl-dopamine. The pharmacologically inert
d
-isomer of α-methyl-dopa was found not to be decarboxylated. Alpha-methyl-dopa hydrazine was shown to reduce significantly the excretion of α-methyl-dopamine during treatment with methyldopa but the effects of the latter drug on blood pressure were not altered. On the basis of unchanged urinary excretions of vanilmandelic acid, decarboxylase inhibition during treatment with methyl-dopa was judged to be inadequate to inhibit endogenous synthesis of norepinephrine.

The relationships between metabolism of the drug and clinical response are discussed. The hypothesis is presented and defended that the hypotensive effects of methyldopa are mediated by amine metabolites of the compound, which are formed following its decarboxylation. Probably norepinephrine depletion is the final denominator but other possibilities exist.
Congenital Aneurysm of Aortic Root with Fistula to Left Ventricle
Authors: MORGAN R. IRVIN , MAZUR JOHN H.
Published: June 2012

Clinical and autopsy findings in a case of a congenital aneurysm of the base of the aorta involving the right sinus of Valsalva and communicating with the left ventricle are presented. The mechanism of development and possible etiologic factors are discussed.
Studies on the Mechanism of the Abnormal Sodium Excretion in Arterial Hypertension
Authors: HANENSON IRWIN B. , RICANATI EDMOND , POLASKY NATHAN
Published: June 2012

Individuals with uncomplicated essential hypertension exhibit an abnormally high excretion of sodium and an associated impairment of urinary diluting and concentrating ability. Various possibilities have been considered to explain these related excretory changes including a solute diuresis resulting from diminished proximal tubular reabsorption of sodium, a reduction in sodium reabsorption from the ascending limb of the loop of Henle, and an increase in medullary blood flow. Evidence has been presented that does not support a defect in the sodium transport mechanism. On the other hand, the observed excretory abnormalities, when considered in terms of the reported pressure-dependent nature of the medullary circulation, could result from an increase in blood flow through the vasa recta secondary to the arterial hypertension.
Pathogenesis of Dissecting Aneurysm
Authors: BRAUNSTEIN HERBERT
Published: June 2012

A group of 35 cases of dissecting aneurysm was studied both clinically and pathologically, in order to evaluate the role of alterations in the aortic wall in the pathogenesis of dissecting aneurysm. It was concluded that the commonly observed dilatation and hypertension promoted the initial tear by increasing the tension on the intima of the aorta. The usual cause of the aortic dilatation in this study was severe atherosclerosis; a much smaller group revealed an idiopathic medial degeneration; muscular lesions were regarded either as insignificant or as a result of the dissection. Although in many instances the initial perforation occurred through an atherosclerotic plaque, dissection proceeded readily through histologically normal media. Accordingly, it was concluded that the two histologic lesions encountered produced their effects largely by provoking dilatation of the aorta rather than by promoting propagation of the dissection.
The Giant "A" Wave of the Left Atrial Appendage
Authors: MILLER D. EDMOND , TUCKER DONALD H. , JACOBY WILLIAM J.
Published: June 2012

Giant "a" waves, not present in any other location in the left atrium, were recorded in four cases in the left atrial appendage. The location was confirmed by cineangiocardiography.
The Electrocardiogram in Some Indian Population Groups
Authors: SRIKANTIA S. G. , PADMAVATI S. , GOPALAN C.
Published: June 2012

Of 941 subjects studied, there were 16 cases of myocardial infarction of which one was a silent infarct. Of these, nine were in the low-income group and seven in the high-income group. All the cases were among the civilian population.

About 11 of the subjects had high voltage in the chest leads without any evidence of hypertension or other heart disease. These were equally distributed at all ages in the different income groups, civil and military.

There was no significant difference in the incidence of ST-segment depression in the various groups. On the other hand, T-wave changes in standard leads, I, II and left chest leads was higher in the high-income groups at all ages than in the low-income groups and the increase was significant after the age of 50 years.

ST and T-wave changes following exercise were slightly higher in the high-income groups than in the low-income groups among the civilian subjects.

The incidence of Grusin's abnormality was higher in the low-income group, both civil and military, than in the high-income groups. The incidence of ischemic heart disease (and of electrocardiographic abnormalities generally) was very low in this study as compared to studies elsewhere.
Studies on Cardiac Dimensions in Intact, Unanesthetized Man
Authors: HARRISON DONALD C. , GLICK GERALD , GOLDBLATT ALLAN , BRAUNWALD EUGENE
Published: June 2012

The effects on ventricular dimensions of intact, unanesthetized patients of isoproterenol, a drug that stimulates beta adrenergic receptors, and of methoxamine, an agent that stimulates alpha adrenergic receptors, were studied by means of a cineradiographic technic. The administration of isoproterenol to 13 patients consistently resulted in a decline in the end-systolic dimensions of both ventricles. A smaller and less consistent decrease in ventricular end-diastolic dimensions was noted. In contrast, the administration of methoxamine resulted in an increase of ventricular end-diastolic dimensions in all 10 patients studied. Left ventricular end-systolic dimensions increased during methoxamine infusion in the eight patients in whom the measurements were made, but changes in right ventricular end-systolic dimensions were inconsistent. The alterations in heart rate induced by isoproterenol and methoxamine could account only in part for the observed changes in ventricular dimensions. It is anticipated that the experimental approach used in this study, that is, the measurement of ventricular dimensions in intact, unanesthetized human subjects, will help to provide a more complete analysis of the action of drugs on the circulation of man.
Syphilitic Aortitis
Authors: HEGGTVEIT H. ALEXANDER
Published: June 2012

The major clinical and pathologic features of 100 cases of syphilitic aortitis, autopsied from 1950 to 1960, are reviewed. Decreasing incidence, changing patterns of lesions, and reasons for the frequent failure to diagnose syphilitic heart disease are considered. Aortic insufficiency or aneurysm of the thoracic aorta, or both, accompanied by a history of syphilis or reactive serology are required to establish a definitive diagnosis. Syphilis still remains a real threat, and, until it is eradicated, it will continue to cause clinical and subclinical cardiovascular disease.