bluuebunny/crossref_metadata_2025 huggingface dataset:
Mitral Insufficiency: Cardiac Mechanics as Studied with the Kinetocardiogram and Ballistocardiogram
Authors: TUCKER WILLIAM T. , KNOWLES JOHN L. , EDDLEMAN E. E.
Published: June 2012

Precordial movements (kinetocardiograms) and ballistocardiograms were studied in patients with "pure" mitral insufficiency. Certain characteristic features of the records were noted and contrasted with those found in patients with mitral stenosis. The finding suggests fundamental differences in the mode of ventricular contraction and relaxation in mitral insufficiency and mitral stenosis.
QS- and QR-Pattern in Leads V
3
and V
4
in Absence of Myocardial Infarction: Electrocardiographic and Vectorcardiographic Study
Authors: SURAWICZ BORYS , VAN HORNE ROBERT G. , URBACH JOHN R. , BELLET SAMUEL
Published: June 2012

A QS or QR pattern in the absence of myocardial infarction is frequently present in lead V
3
and occasionally in lead V
4
. Exploration by means of multiple chest and abdominal unipolar leads and vectorcardiograms revealed that in almost all such cases, the vector of the initial portions of the QRS complex is directed downwards. Accordingly, in the absence of infarction, patients presenting this pattern almost invariably showed an initial R wave in the leads recorded from positions below the standard level of V
3
and V
4
. The vast majority of patients with myocardial infarction with a similar QRS pattern showed a Q wave in the lower leads. Consideration of vertical components of cardiac voltages may be helpful in the interpretation of the precordial leads.
A New Quantitative Basis for Electrocardiographic Theory: The Normal QRS Complex
Authors: FRANK ERNEST , KAY CALVIN F. , SEIDEN GEORGE E. , KEISMAN ROBERT A.
Published: June 2012

A theory of electrocardiography based on a fixed-location, eccentric-dipole representation of ventricular depolarization and a homogeneous, resistive, linear medium in the shape of the human torso yields quantitative predictions of instantaneous amplitude and shape of QRS body surface potentials on one normal human subject to an accuracy of approximately ±15 per cent for electrodes dispersed over the entire torso.
The Heart Muscle and the Electrocardiogram in Coronary Disease
Authors: SAŸEN JOHN J. , SHELDON WARNER F. , WOLFERTH CHARLES C.
Published: June 2012

Methods, designed to study in detail the lesions resulting from coronary disease and to reconstruct accurately the form of all ventricular muscle lesions, have been applied to 100 consecutive electrocardiographed patients who were found to have at least one severe coronary narrowing. Reclassification of lesions into four categories was found necessary to deal with the patterns of damage disclosed. This approach permits conclusions regarding evolution of muscle damage, relationships of arterial obstruction to muscle damage distribution, and the significance of ischemia which would have been impossible otherwise. The value of the new classification for electrocardiography will be discussed in a subsequent section of the report.
Studies in Intravascular Coagulation
Authors: WESSLER STANFORD , MORRIS LESLIE E. , HO CAROL , MORAN JOAN
Published: June 2012

A method has been previously described whereby the infusion of canine serun and serum fractions rich in convertin, but essentially devoid of thromboplastin, prothrombin, ac-globulin and thrombin, initiates venous thrombosis in dogs at sites of partial or complete venous stasis far removed from the site of infusion. It has been suggested that the pathogenesis of venous thrombosis in various clinical states may be referable to local stasis combined with a transient increase in circulating convertin activity. The present study demonstrates that heparin is superior to dicumarol in inhibiting the evolution of such serum-induced intravascular thrombi in dogs.
Changes in Cardiac Output with Age
Authors: BRANDFONBRENER MARTIN , LANDOWNE MILTON , SHOCK NATHAN W.
Published: June 2012

In the first of two papers, the details and results of a systematic, carefully standardized application of dye dilution technic to the measurement of cardiac output are reported. A substantially reduced output was a consistent finding in older subjects. Factors responsible for this are analyzed in this article, and further interpretations are made in the succeeding article. One result of the analysis of time-concentration curves of dye provides an interesting relationship to clinical estimates of circulation time.
The Relation of Age to Certain Measures of Performance of the Heart and the Circulation
Authors: LANDOWNE MILTON , BRANDFONBRENER MARTIN , SHOCK NATHAN W.
Published: June 2012

The resting cardiac output measurements presented in the preceding article are analyzed in relation to intra-arterial pressure to provide estimates of peripheral circulatory state and of central cardiac performance. The calculated agewise increase in net vascular resistance which is responsible for the decrease in perfusion, indicates that circulatory attrition with age, on the average, outstrips the expected reduction in basal metabolism of the individual. Despite this lessened peripheral requirement, one may adduce evidences for a trend toward diminished cardiac reserve with age even in these subjects who revealed no clinical cardiac abnormality. The feasibility of predicting an individual's cardiac output from his blood pressure is commented upon.
The Effect of Nitroglycerine on the Ballistocardiogram of Persons with and without Clinical Evidence of Coronary Heart Disease
Authors: STARR ISAAC , PEDERSEN ELAINE , CORBASCIO ALDO N.
Published: June 2012

Nitroglycerine has been given to a series of patients and its effect on the ballistocardiogram oserved. Attacks of angina pectoris are accompanied by great deterioration of the record; if nitroglycerine is given at such a time, the record improves as pain passes off. Given between attacks to patients having coronary heart disease with abnormal ballistocardiograms, nitroglycerine is often followed by improvement in the record. Also given to older patients who have abnormal ballistocardiograms but no clinical evidence of coronary heart disease, nitroglycerine is often followed by improvement in the record, a fact consistent with the view that coronary heart disease is present in such cases. However, nitroglycerine is sometimes followed by deterioration of the ballistocardiogram, the possible reasons for this unexpected finding are discussed; attention is called to recent evidence indicating that serious toxic effects may follow exposure to nitrites in industry.
Cardioaortic Fistula
Authors: BROWN J. W. , HEATH D. , WHITAKER W.
Published: June 2012

A case of cardioaortic fistula, due to rupture of an aneurysm of a sinus of Valsalva into the right ventricle, is described. This case was diagnosed in life and treated surgically one year later when the patient was admitted to hospital with bacterial endocarditis. The clinical features are discussed and the role of special methods of investigation in the diagnosis of the condition is defined. The importance of cardiac catheterization is stressed. The operative technique is described briefly. Following the patient's death from the uncontrolled infection an autopsy examination was carried out and the findings in the heart and small pulmonary vessels are given.
General Networks for Central Terminals in Electrocardiography and Vectorcardiography
Authors: MARCHAND NATHAN , BRILLER STANLEY A. , KOSSMANN CHARLES E.
Published: June 2012

A method is described for obtaining true orthogonal components of the heart vector by measuring the differences in potential between resistor networks which are connected to the limbs and to the back. The values of the resistors in the networks are determined by solving equations into which the scalar coefficients for the limbs and for the back are inserted.
The Effect of Prolonged Corticotropin Therapy For Rheumatic Fever on the Exchangeable Sodium Content and Body Weight
Authors: AIKAWA JERRY K. , RHYNE MARIE B. , BLUMBERG AARON J.
Published: June 2012

Serial measurements of the body weight and the exchangeable sodium content were made in young patients with acute rheumatic fever who were being treated with large doses of corticotropin. All but one subject developed the clinical signs of hyperadrenalism. Eight of the 11 subjects showed at least a 20 per cent increase in body weight which could not be explained on the basis of the changes in exchangeable sodium content. This change in body composition is thought to be due primarily to an increase in total body fat.
Studies Made by Simulating Systole at Necropsy
Authors: STARR ISAAC , ASKOVITZ S. I. , FEDER W. , SCHILD A.
Published: June 2012

"Left ventricular" work can be estimated with great accuracy in cadaver experiments in which both pressure curves and curves of cardiac output at each instant of systole were recorded. Using these accurate estimates as a target, methods have been sought which would permit the estimation of cardiac work from measurements which could be made in the clinic and the accuracy of such methods has been assessed. A method of approximating the left ventricular work has been devised which is so simple that it could be used by any doctor practising medicine.
The Effect of Large Intravenous Doses of Sodium Borate on the Human Myocardium as Reflected in the Electrocardiogram
Authors: CONN HADLEY L. , ANTAL BERNIECE B. , FARR LEE E.
Published: June 2012

Large intravenous doses of sodium borate, given to seven patients with brain tumors, caused development of temporary but consistent hypoxic-type abnormalities in the S-T segments and the T waves of the electrocardiogram. Correlation of these electrocardiographic changes with blood boron concentrations, determined up to 48 hours after boron injection, indicated that the changes were probably the result of damage by boron, present intracellularly in the myocardium. The intracellular concentrations which cause electrocardiographic abnormalities are considered to be of the order of 100 µg. per milliliter, similar to concentrations which have been shown to inhibit respiration in in vitro myocardial preparations.
Hemodynamic Changes Associated with Fluid Retention Induced in Noncardiac Subjects by Corticotropin (ACTH) and Cortisone; Comparison with the Heinodynamic Changes of Congestive Heart Failure
Authors: ALBERT ROY E. , SMITH WARREN W. , EICHNA LUDWIG W.
Published: June 2012

This study proposed to determine whether marked fluid retention, induced by ACTH and cortisone, produces hemodynamic alterations similar to those of clinical congestive heart failure. Of 20 noncardiac subjects, four gained marked amounts of fluid, became edematous and three developed symptoms and signs consistent with congestive heart failure. The associated hemodynamic changes were similar to those of congestive heart failure in that the heart enlarged, "blood volume" increased and right heart and venous pressure rose, but differed in that cardiac ouput and A-V oxygen difference remained normal. It is suggested that the hemodynamic state associated with marked fluid retention is a noncardiac circulatory congestion which simulates congestive heart failure in several non-specific hemodynamic functions but differs in that primary cardiodynamic functions remain normal and the heart does not fail as a pump.
Mitral Commissurotomy Performed During Anticoagulant Prophylaxis with Dicumarol
Authors: STORM OLE , HANSEN ANDERS TYBJÆRG
Published: June 2012

Since it is possible to perform major surgical interventions on patients with lowered prothrombin-proconvertin concentration we have selected a group of patients suffering from mitral stenosis for further evaluation of this prophylactic measure. These patients are highly predisposed to thromboembolic complications. The controllable risk of hemorrhage might, therefore, be preferred to the heavy risk of thrombosis. The results of our investigations indicate a decrease in incidents of thromboembolism. No serious risk of bleeding is apparently introduced when an accurate and sensitive method of estimating the prothrombin level is used in the control of the treatment.
Acute Pulmonary Edema
Authors: LUISADA A. A. , CARDI L.
Published: June 2012

Acute pulmonary edema may be associated with the most varied clinical conditions including cardiovascular, renal, cerebral, and pulmonary diseases, trauma to the skull or chest, infections, and shock. Many drugs and physical means have been employed in the treatment of this syndrome. Two main clinical types of pulmonary edema may be differentiated because of the different effect of therapy in each of them. Antifoaming therapy, a purely symptomatic method of treatment, tends to break a vicious circle and may be lifesaving. It should be employed initially while the patient is being examined and drugs or other remedies are being selected for possible additional treatment.
Dialyzable Currents of Injury in Potassium Intoxication Resembling Acute Myocardial Infarction or Pericarditis
Authors: LEVINE HAROLD D. , WANZER SIDNEY H. , MERRILL JOHN P.
Published: June 2012

A byproduct of experience with the artificial kidney was the detection of reversible electrocardiographic "currents of injury" in patients with electrolyte imbalance. These changes occurred irrespective of anatomic alterations and resembled the changes of acute pericarditis or myocardial infarction. The electrolyte basis for the "current of injury" was established by the prompt abolition of the RS-T segment elevations, when the electrolyte imbalance was corrected by means of artificial hemodialysis.
The Influence of the Sex Hormones on the Circulating Lipids and Lipoproteins in Coronary Sclerosis
Authors: OLIVER M. F. , BOYD G. S.
Published: June 2012

The administration of ethinyl estradiol to 100 survivors of myocardial infarction resulted in uniform correction of the abnormal circulating lipid and lipoprotein concentrations. Gynecomastia and depression of libido were well tolerated by the patients but were not ameliorated by an androgen preparation nor by a progesterone analogue. Methyl testosterone, which partly inhibited the estrogen effect, increased the concentration of cholesterol on the beta lipoprotein fraction. Progesterone had no significant effect on the circulating lipids and lipoproteins. Assessment of the effect of ethinyl estradiol on human atherogenesis must depend on long-term evaluation of its influence on morbidity and mortality rates.
Effect of Hypotension due to Spinal Anesthesia on Coronary Blood Flow and Myocardial Metabolism in Man
Authors: HACKEL DONALD B. , SANCETTA S. M. , KLEINERMAN JEROME
Published: June 2012

The induction of spinal anesthesia resulted in hypotension and decreased coronary blood flow and myocardial oxygen consumption. At the same time the myocardial extraction coefficient of oxygen was not increased, indicating myocardial oxygenation to be adequate for the lower work load. This does not imply that local ischemia might not occur in the presence of coronary artery sclerosis. The coronary arteriovenous differences of glucose, lactate and pyruvate were not changed during the period of hypotension.
Some Clinical and Physiologic Effects of Mitral Commissurotomy
Authors: WOOD JOHN A. , ALEXANDER JAMES K. , FRANK CHARLES W. , WEST JOHN R. , RICHARDS DICKINSON W.
Published: June 2012

Eighteen patients, selected for mitral commissurotomy on the basis of appreciable hemodynamic abnormalities as well as physical disability have been studied prior to and following surgery. The results suggest that well compensated patients with mitral stenosis, normal sinus rhythm and pulmonary hypertension are likely to benefit from operation. Patients with atrial fibrillation, good compensation and moderate pulmonary hypertension may benefit from mitral commissurotomy. In patients with atrial fibrillation, marked pulmonary hypertension and congestive heart failure, operation is hazardous and the likelihood of benefit is small. The importance of myocardial function in the production of these results is discussed.
Myocarditis and Myocardosis
Authors: BLANKENHORN M. A. , GALL EDWARD A.
Published: June 2012

Search of 3,141 autopsies found 108 examples of myocardial disease of which 77 were inflammatory (nonrheumatic) and 31 noninflammatory but degenerative and not due to sclerosis or hypertension. These are designated myocardosis. Myocarditis was associated with infections in a manner often described; myocardosis was associated with a variety of noninfectious disorders. A discussion of the use of this term is elaborated. Clinical records also were studied to find what part such lesions played in causing death and how such myocardial lesions could be diagnosed with more certainty.
Angiocardiographic Observations of Intracardiac Flow in the Normal and in Mitral Stenosis
Authors: SOLOFF LOUIS A. , ZATUCHNI JACOB , STAUFFER HERBERT M. , KELLY EUGENE W.
Published: June 2012

Intracardiac flow of intravenously injected radiopaque material was studied by means of rapid simultaneous biplane stereoscopic angiocardiography. Intracardiac circulation times thus determined may be found useful in recognizing structural abnormality and in detecting changes in cardiac function. In mitral stenosis, a distinctive, but not specific, pattern was recognized whether or not mitral valvotomy had been performed. No relationship was found between left atrial size and left atrial circulation time or between the degree of opacification of the left atrium and that of the left ventricle to differentiate "pure" mitral stenosis from mitral stenosis with regurgitation as diagnosed at the time of surgery or to predict the degree of mitral stenosis reported by the surgeon.
Relationship of the Natural Body Damping and Body Frequency to the Ballistocardiogram
Authors: TANNENBAUM OSCAR , VESELL HARRY , SCHACK JEROME A.
Published: June 2012

By means of a direct body ballistocardiograph the relationship of body frequency and damping to the ballistocardiogram in normal subjects was investigated. The influence of age and body measurements were studied and the findings subjected to statistical analysis. The degree of body damping was related to age but not to anthropometric measurements. Overweight and underweight influenced body frequency but not body damping. Respiratory changes had no influence on either body frequency or damping. It was suggested that to record a true ballistocardiogram of the cardiovascular forces more consideration must be given to body damping.
The Persistent Ostium Primum Atrial Septal Defect
Authors: BLOUNT S. GILBERT , BALCHUM OSCAR J. , GENSINI GOFFREDO
Published: June 2012

Five patients with an ostium primum type of atrial septal defect were studied by clinical and laboratory methods and the diagnosis was verified either at the time of open-heart surgery and/or at autopsy. The atrioventricular valves formed the floor of the defect and were deformed in 4 of the 5 patients. Mitral insufficiency was present as a result of this valvular deformity in these four patients. This valvular deformity resulted in a high pitched blowing systolic murmur, audible over the apical and lower left sternal areas, and left axis deviation and indications of left ventricular hypertrophy, determined by electrocardiography. The deformity of the mitral valve is considered to be the basis for these variations from the typical findings found in the patient with an ostium secundum type of atrial septal defect and make the differential diagnosis of the persistent ostium primum possible under these circumstances.
The Significance of the Intensity and Time of Appearance of the Korotkoff Sounds in Auricular Fibrillation
Authors: RODBARD SIMON , MARGOLIS JACK
Published: June 2012

Aside from their value in the indirect determination of the blood pressure the sounds at the brachial artery provide other valuable clinical information. Their value in blood pressure determination in auricular fibrillation generally has been found to be limited. By using a simple technic involving the counting of the brachial-artery-sound deficit, a satisfactory, repeatable method of blood pressure estimation is achieved in such patients with marked pulse rate irregularities. Other information, including a rough estimation of left ventricular stroke output, pulse wave force and velocity, are also appraised by analysis of these bruits.
The Effects of Intravenous Apresoline (Hydralazine) on Cardiovascular and Renal Function in Patients with and without Congestive Heart Failure
Authors: JUDSON WALTER E. , HOLLANDER WILLIAM , WILKINS ROBERT W.
Published: June 2012

Intravenous Apresoline is a powerful renal vasodilator in cardiac as well as in noncardiac patients. In hypertensive patients in congestive heart failure, the drug produces a striking improvement in both cardiovascular and renal function. The increases in renal plasma flow are inconsistently related to changes in arterial pressure and cardiac output Unlike many hypotensive drugs, Apresoline usually causes no decrease in the renal excretion of sodium and water. Circulatory collapse produced by the drug may occur in the presence of an increased cardiac output but is accompanied by a deterioration of the arterial pressure pulse and a reduction in sodium and water excretion.
Plasma Lipids and Proteins and their Relationship to Coronary Disease among Navajo Indians
Authors: PAGE IRVINE H. , LEWIS LENA A. , GILBERT JARVEY
Published: June 2012

Coronary disease is rare among the Navajo Indians. Their plasma proteins and lipids differ from those of the population of Cleveland in that albumin is low normal and α- and γ-globulin elevated; total cholesterol was much lower. Since the diet and living habits are not strikingly different from those of the control group, it is suggested that heredity, in this case, is the most likely explanation for the low incidence of coronary disease and low level of cholesterol. Neither in the control nor Navajo group did mean serum total cholesterol rise with age.
Aberrant Ventricular Conduction of Escaped Beats
Authors: PICK ALFRED
Published: June 2012

Escape beats recorded in clinical electrocardiograms sometimes differ in contour and QRS duration from conducted beats, and this in spite of their having a relatively short cycle length. This suggests a location of the subsidiary pacemaker above the bifurcation of the common A-V bundle. While this, unlike other types of aberrant ventricular conduction, cannot be explained on a functional basis, recent investigations on the structure of the normal A-V junction suggest that "paraspecific" A-V connections may act as preferential pathways to the ventricles in some A-V nodal escape beats. Difficulties and guides in differentiating A-V nodal from ventricular escapes under such circumstances are pointed out. On the basis of clinical, electrocardiographic and anatomic facts such a
normal preferential
A-V conduction must be distinguished from an abnormal accessory A-V conduction causing the pre-excitation (Wolff-Parkinson-White) syndrome. However, the two may occur in association.
Dilatation of the Pulmonary Artery in Pulmonary Stenosis
Authors: VAN BUCHEM F. S. P.
Published: June 2012

Dilatation of the pulmonary artery occurs frequently in cases of valvular pulmonary stenosis and is often called "poststenotic." We determined the diameter of the pulmonary artery angiocardiographically and compared this with the data obtained by heart catheterization in cases of pulmonary stenosis and of idiopathic dilatation of the pulmonary artery. Features are presented which constitute arguments in favor of Laubry's suggestion that we are dealing with two different abnormalities, namely, a valvular stenosis and a dilatation of the pulmonary artery though hydraulic forces may contribute to the final development of the dilatation.
The Hemodynamic Results of Surgical Correction of Atrial Septal Defects
Authors: KIRKLIN JOHN W. , WEIDMAN WILLIAM H. , BURROUGHS JOHN T. , BURCHELL HOWARD B. , WOOD EARL H.
Published: June 2012

An experience with surgical treatment for atrial septal defects in 59 patients has given evidence as to the safety and efficacy of the procedure utilizing the atrial-well technic. Data from the first 33 cases of this series are presented in detail, to allow analysis by others of the basis for these conclusions.
The Use of Aramine in Clinical Shock
Authors: STECHEL GEORGE H. , FISHMAN STANLEY I. , SCHWARTZ GEORGE , TURKOWITZ HYMAN , MADONIA PETER F. , FANKHAUSER ARTHUR
Published: June 2012

The use of vasopressor agents in shock is of established value and has become a common form of treatment. Aramine was used in over 250 unselected cases of shock of varied etiology, of which 42 cases are reported in some detail. This agent continues to produce a vasopressor effect after the actual cessation of administration, and its use is characterized by ease in maintaining the desired blood pressure level. Distressing side effects, such as thrombophlebitis or tissue slough, do not occur.
Results of Prolonged Treatment with Pentolinium Tartrate
Authors: FREIS EDWARD D. , WILSON ILSE M.
Published: June 2012

A series of 96 patients with severe hypertension has been treated with pentolinium tartrate for an average period of 12 months. Seventeen patients died. Therapy was more effective in arresting changes in the optic fundi and in the heart than in the kidneys. Various combinations of hypotensive agents were tested and it was concluded that in general the combination of pentolinium tartrate, Rauwolfia and hydralazine resulted in the greatest reduction of blood pressure with the least degree of side effects due to ganglionic "blockade."
Oscillation-Free Ballistocardiography
Authors: HOFFMAN IRWIN , KISSIN MILTON , SCHWARZSCHILD MYRON M.
Published: June 2012

Body motion resulting from cardiac forces may be recorded as displacement, velocity or acceleration by a variety of methods. None of these is identical with the cardiac force curve because of distortion due to body oscillations. Schwarzschild devised an electronic mixer that combines displacement, velocity, and acceleration in any proportion desired. This device permits recording ballistocardiograms that are free of oscillations due to body resonance. Validity of the technic was established by the identity of strain gage records of forces applied to a log phantom with simultaneous records obtained with the method presented.
Studies on the Control of Hypertension. VII. Effects of Ganglionic Blockade Combined With Hydralazine on the Malignant Stage Complicated by Renal Azotemia
Authors: PERRY H. MITCHELL , SCHROEDER HENRY A.
Published: June 2012

The malignant stage of arterial hypertension complicated by azotemia is usually a rapidly fatal disorder. The elevated blood pressures of 82 patients in this stage were chronically lowered by the regular, continued use of oral ganglionic-blocking agents and hydralazine hydrochloride in doses sufficient to control their hypertension without provoking dangerous hypotension or further azotemia. By careful administration of these potent antihypertensive drugs the mortality rate of azotemic patients was significantly reduced. The malignant stage of hypertension that has progressed to moderate renal insufficiency is no longer a rapidly fatal disease when properly treated, while that which has progressed further is usually uninfluenced.
The Angiocardiographic Diagnosis of Left Atrial Thrombosis
Authors: SOLOFF LOUIS A. , ZATUCHNI JACOB
Published: June 2012

With the advent of modern cardiac surgery the clinical diagnosis of intramural thrombi, ball valve thrombi and myxomatous and other tumors in the left atrium has assumed great importance. It is shown here that a diagnosis of thrombosis within the left atrium is possible by angiocardiography. The angiocardiographic features of mural and ball valve thrombi of the left atrium and of left auricular thrombosis are described.
Atrioventricular Synchronization and Accrochage
Authors: MARRIOTT HENRY J. L.
Published: June 2012

Complete heart block implies an absolute independence between atria and ventricles that does not in fact always exist. Segers showed that, after complete block was artificially produced in the frog's heart, atria and ventricles would sometimes begin to beat exactly in phase, most commonly in a 2 to 1 ratio. He subsequently reported one clinical example of 2 to 1 A-V synchronization in a patient with complete heart block. Two further cases that may illustrate different varieties of synchronization are here presented.
The Relation of Cardiovascular Phenomena to Metabolic Changes in a Patient with Chronic Hypokalemia
Authors: HUTH EDWARD J. , SQUIRES RUSSELL D.
Published: June 2012

Cardiovascular phenomena were studied and correlated with metabolic data in an adult male with chronic hypokalemia. The appearance and disappearance of postural hypotension, the changes in heart rate, the S-T segment shifts, and the U-wave amplitudes correlated well with the changing serum potassium level during experimental acute potassium depletion. QRS and T-wave changes could not be correlated with metabolic data. Comparison with the cardiovascular manifestations of experimental potassium depletion in normal subjects suggested that this patient had a chronic potassium depletion of at least 300 mEq.
Comparison of Limb and Precordial Vectorcardiographic Systems
Authors: FRANK ERNEST , SEIDEN GEORGE E.
Published: June 2012

Two advanced types of vectorcardiographic systems have been applied to 104 miscellaneous patients for the purpose of comparing practical features and electric results. The 2 systems showed satisfactory average agreement, as expected, but there were marked individual differences in many cases. Despite corrections for torso shape and typical eccentric ventricle location, the limb electrode system yielded results significantly outside attainable limits, and hence is considered unsatisfactory for quantitative work despite its practical advantages.
Arteriovenous Fistula of the Renal Vessels
Authors: MYHRE JON R.
Published: June 2012

Hematuria presents an urgent problem in differential diagnosis. A patient was observed with hematuria for renal colic with characteristic radiation in whom an arteriovenous fistula due to vascular erosion by adenocarcinoma of the kidney was found. This condition has been reported only rarely. Previous reports of this condition are reviewed and the findings discussed.
Quantitative Estimation by Indicator-Dilution Technics of the Contribution of Blood from Each Lung to the Left-to-Right Shunt in Atrial Septal Defect
Authors: SWAN H. J. C. , HETZEL PETER S. , WOOD EARL H.
Published: June 2012

A method based on the initial portion of indicator-dilution curves has been used to determine the proportion of blood from each lung which drains anomalously. The results obtained appear to substantiate the derivation and permit the expression, in numerical values, of the greater proportion of anomalous drainage of blood from the right lung in the usual case of atrial septal defect. The principal assumptions pertaining to the method are discussed in some detail.
Pressor and Depressor Responses to Tilting in Hypertensive Patients
Authors: GREEN ROBERT S. , IGLAUER ARNOLD , SCOTT RALPH C.
Published: June 2012

The responses of intra-arterial blood pressure to passive head-up and head-down tilting are described for 50 patients with well established hypertension and compared to results obtained in subjects with normal cardiovascular systems. This study indicates that abnormal depressor and pressor responses are present in many patients with hypertension, that depressor reflexes are independent of pressor reflexes, that marked variations of depressor and of pressor reflex activity occur between hypertensive patients, but that the combination of depressor-pressor responses in a given patient usually remains constant.
Differential Diagnosis of Angina Pectoris
Authors: RISEMAN JOSEPH E.F.
Published: June 2012

The diagnosis and differential diagnosis of angina pectoris depend on obtaining an adequate history. Problems in diagnosis arise because of confusion of terminology, language difficulties, symptoms resembling noncardiac disease or vice versa, and the coexistence of angina pectoris with disease of other organs. Problems in differential diagnosis arise because symptoms resembling angina may result from disease or abnormal function of the brain, skeletal system, gastrointestinal system, or structures in the bony thorax or within the thoracic cage. The most difficult problems in differential diagnosis arise from psychoneurosis and gallbladder disease. Careful history taking will resolve the problem in most instances, prolonged observation will settle the question in others. To date, no objective tests have been adequate to determine whether or not the patient is subject to attacks of pain due to the physiologic effects of coronary artery pathology or dysfunction.
Factors Influencing Conversion of Chronic Atrial Fibrillation with Special Reference to Serum Quinidine Concentration
Authors: SOKOLOW MAURICE , BALL ROBERT E.
Published: June 2012

Opinion differs greatly about the value and risk of quinidine. The present communication attempts to demonstrate that more rational use of quinidine is possible by emphasis on serum quinidine concentration rather than on dose alone. Conversion of chronic atrial fibrillation and the appearance of myocardial toxicity are related more closely to the concentration of quinidine in the blood than to the dose. The serum concentration achieved with equal doses of the drug varied strikingly in different individuals; myocardial toxicity was infrequent at levels less than 6.0 /g=m/g./ml. and increased proportionately as this level was exceeded. These levels could not always be predicted from the dose given.
Quinidine as a Cause of Sudden Death
Authors: THOMSON GEORGE W.
Published: June 2012

Sudden death and arterial embolism are unpredictable hazards of quinidine therapy for atrial fibrillation that act as deterrents to its most effective use. In this paper an attempt is made to determine the incidence of these accidents as reported in the literature. The mechanism of sudden death is also examined. The difficulty of determining the role of quinidine in producing these accidents in seriously ill patients is clarified.
Massive Thrombotic Occlusion of the Large Pulmonary Arteries
Authors: BALL K. P. , GOODWIN J. F. , HARRISON C. V.
Published: June 2012

In 23 cases of massive thrombotic occlusion of the large pulmonary arteries thrombosis secondary to pulmonary embolism was the major cause, but a proportion (30 per cent) was considered to have primary thrombosis in situ. The pathologic criteria, symptoms, signs, and results of special investigations are given in detail, and the diagnosis, etiology, and precipitating factors are discussed.
Anomalies of the Coronary Arteries and their Clinical Significance
Authors: ALEXANDER RALPH W. , GRIFFITH GEORGE C.
Published: June 2012

Fifty-four cases with anomalies involving the coronary artery circulation were found among 18,950 autopsies during a 10-year period at the Los Angeles County Hospital. The purpose of this survey is to present the different types of coronary artery anomalies and to elucidate their practical clinical significance.
The Abnormally Situated Azygos Vein
Authors: ARMEN ROBERT N. , MORROW CHARLES S.
Published: June 2012

The azygos vein may be abnormally situated due to anomalous embryologic development. Its abnormal location is infrequent, but radiologic recognition is much easier than that of the normal vein. This vein, normal or abnormal, becomes distended in conditions with an elevated venous pressure, systemic or portal. Changes in the size of the azygos vein on x-ray are noted to parallel fluctuations of venous pressure. We have demonstrated such changes in a patient with an abnormally situated vein during congestive failure, after recovery, and in various physical positions. X-ray demonstration of such changes can have significant diagnostic application.
Experiences with Pulsus Alternans
Authors: RYAN J. M. , SCHIEVE J. F. , HULL H. B. , OSER B. M.
Published: June 2012

Three years' experience with pulsus alternans, including its production with exercise, has shown that alternans may exhibit at least 3 types of behavior, and has led the authors to believe that the type of behavior a patient presents is related to the degree of heart failure present. Those patients who developed alternans following exercise were not in cardiac failure clinically, and yet hemodynamic data indicated myocardial insufficiency. A sustained pulsus alternans at rest seems to have no special prognostic significance in heart failure.
The Heart and Electrocardiogram of an Alligator
Authors: BLACKFORD L. MINOR
Published: June 2012

The phylogenetic evolution of the cardiovascular system of animals and man has been a subject of continued interest. The reported study of the cardiovascular system and electrocardiogram of the alligator bears on this subject. The author has cogently remarked that this journal, which has reported similar studies in the beluga whale, should be the vehicle of his report.—Ed.
Comparison in Man of Adrenergic Blockade Produced by Dibenzyline, Ilidar, Priscoline, and Regitine
Authors: GREEN HAROLD D.
Published: June 2012

A method is presented for analyzing the probable effectiveness of blocking drugs in relieving vasospasm in the extremities, and comparison is given of the relative potency and side effects of 4 adrenergic blocking drugs and of their effects on heart rate, arterial pressure, and cardiac output, as estimated from a "circulatory index." Data are also given on the use of these drugs in evaluation of the circulation in patients.
A Heart Function Test with Continuous Registration of Oxygen Consumption and Carbon Dioxide Production
Authors: JONGBLOED J. , VAN NIEUWENHUIZEN C. L. C. , VAN GOOR H.
Published: June 2012

The authors present a test of myocardial function based on the continuous registration of pulmonary exchange of oxygen and carbon dioxide during rest and a standard amount of work. The authors believe that the test is simple enough for wide clinical application. The "functiocardiogram" is of considerable physiologic and clinical interest. The normal values of the test are defined and afew examples of abnormal tests are discussed.
Alveolar Walls in Mitral Stenosis
Authors: O'NEAL ROBERT M. , THOMAS WILBUR A. , LEE KYU TAIK , RABIN ERWIN R.
Published: June 2012

Pathologic alterations of alveolar walls in 95 autopsied patients with mitral stenosis were not frequent. The most frequently encountered change was capillary dilatation, and in 83 per cent of the patients, even this change was slight or absent. Other alterations were focal and involved only small proportions of the area of tissue examined. A generalized increase in the thickness of basement membranes could not be demonstrated.
Ebstein's Anomaly
Authors: BLOUNT S. GILBERT , MCCORD MALCOLM C. , GELB IRA J.
Published: June 2012

Four cases of Ebstein's anomaly are described, revealing that the clinical features permit diagnosis in the majority of instances and that cardiac catheterization affords precise confirmation of the diagnosis. The occurrence of this anomaly in acyanotic adults is pointed out, and the similarity to acquired valvular rheumatic heart disease is stressed.
Effect of Prolonged Steroid Therapy for Rheumatic Fever on the Exchangeable Potassium Content and Body Weight
Authors: AIKAWA JERRY K. , Blumberg Aaron J.
Published: June 2012

Serial measurements of the body weight and exchangeable potassium content were made in 13 children with acute rheumatic fever who were being treated with large doses of corticotropin or cortisone. In 8 subjects the clinical signs of hyperadrenalism developed. Seven of the 13 subjects showed at least a 20 per cent increase in body weight, which could not be explained on the basis of changes in the body's exchangeable potassium content. This weight gain is thought to be due to an increase in total body fat.
Immunologic Evidence of Group A Streptococcal Infection in Patients Undergoing Mitral Commissurotomy
Authors: STOLLERMAN GENE H. , LYNCH WILLIAM F. , DOLAN MARIO A. , YOUNG DENNISON , SCHWEDEL JOHN B.
Published: June 2012

Serum levels of 3 group A streptococcal antibodies were determined in 53 patients prior to mitral commissurotomy and monthly for 3 to 6 months postoperatively. Significant elevation of antibody titers was relatively infrequent prior to commissurotomy and the presence of chronic productive inflammatory lesions in the biopsied atrial appendage was usually unrelated to recent streptococcal infection. The "postcommissurotomy syndrome" also occurred in some patients without evidence of such infection. Postoperative subclinical streptococcus infection occurred frequently enough, however, to suggest the need for vigorous preoperative penicillin therapy and careful postoperative prophylaxis.
Effects of Meals of Different Fats on Blood Coagulation
Authors: KEYS ANCEL , BUZINA RATKO , GRANDE FRANCISCO , ANDERSON JOSEPH T.
Published: June 2012

Previous work has shown that a high-fat meal produces an increased coagulability of the blood. This fact is of interest in view of the effects of dietary fat on the serum cholesterol and its association with coronary disease. Since fats containing large amounts of unsaturated fatty acid tend to reduce the serum cholesterol rather than increase it, it is important to examine the effects of fats with different fatty acid composition on blood coagulation. Comparisons are presented of the effect on blood coagulability of feeding butterfat, corn oil, hydrogenated coconut oil, and a marine fish oil.
Distribution of Pain in Myocardial Infarction
Authors: KREINES KENNETH
Published: June 2012

In acute myocardial infarction the possible relation of localization and radiation of the pain to the localization and extent of the infarct has engaged the interest of many clinicians. The clinical records, electrocardiograms, and autopsy protocols of 104 cases of myocardial infarction were carefully examined to determine if there is an association between the location and extent of involved myocardium and the radiation of pain to "atypical" sites such as the back and the epigastrium.
Effect of Morphine and n-Allylnormorphine on Cerebral Hemodynamics and Oxygen Metabolism
Authors: MOYER JOHN H. , PONTIUS ROBERT , MORRIS GEORGE , HERSHBERGER ROBERT
Published: June 2012

The cerebral metabolic response to intravenously administered morphine was studied in human volunteers. Cerebral blood flow and cerebral vascular resistance were not altered by this drug although cerebral oxygen uptake was markedly depressed as a result of a decreased extraction of oxygen from the blood circulating through the brain. This response was rapidly reversed following the administration of n-allylnormorphine.
Extreme Bilateral Atriomegaly
Authors: ROGERS WAYNE R. , WITTELS BENJAMIN
Published: June 2012

Extreme enlargement of the atria is unusual and its mechanism is not clearly established. A case is reported here of extreme bilateral atriomegaly with some special features of interest and the entire problem is reviewed.
Bacterial Endocarditis Following Cardiac Surgery
Authors: DENTON CLARENCE , PAPPAS ELIAS G. , URICCHIO JOSEPH F. , GOLDBERG HARRY , LIKOFF WILLIAM
Published: June 2012

Intracardiac surgery for rheumatic and congenital heart disease entails direct trauma to both normal and abnormal endocardium. This communication inquires into the incidence and nature of the endocardial infections that develop subsequent to this injury. On the basis of an examination of 2,263 patients operated upon for acquired and congenital heart disease during a 5-year period terminating in November 1955, bacterial endocarditis appears to be an infrequent complication of surgery, is caused by organisms not so commonly encountered in unoperated patients, and is characterized by a clinical pattern quite different from that ordinarily associated with bacterial endocarditis. The rate of attrition in this group of patients is high, and unquestionably is related to the antibiotic resistance of the unusual organisms and the severity of the basic heart disease.
"Left Heart" Radiopotassium Dilution Curves in Patients with Rheumatic Mitral Valvular Disease
Authors: CONN HADLEY L. , HEIMAN DONALD F. , BLAKEMORE WILLIAM S. , KUO PETER T. , LANGFELD STEPHEN B.
Published: June 2012

"Left heart" radiopotassium-dilution curves were carried out in 9 patients with rheumatic mitral valvular disease. From the curves, blood flow, circulation times, and "left heart" and aortic volumes were calculated. When this technic is used along with "left heart" pressure measurements, it appears to have a satisfactory reliability in demonstrating abnormalities of flow, volume, and mitral valve function. In theory, its proper application permits complete quantitation of these parameters.
Healed Dissecting Aneurysm in Cystic Medial Necrosis of the Aorta
Authors: HUKILL PETER B.
Published: June 2012

Dissecting aneurysm of the aorta is a not uncommon disease that usually produces severe symptoms and often leads to an early death. This article reports an unusual case in which the patient was nearly asymptomatic and died of unrelated causes. Autopsy revealed a healed dissecting aneurysm. The literature on dissecting aneurysm, emphasizing its pathogenesis and its relation to cystic medial necrosis, is briefly reviewed.
Ventricular Arrhythmias after Intravenous Sodium Lactate in Heart Block
Authors: MURRAY JOHN F. , BOYER S. H.
Published: June 2012

Molar sodium lactate has been described as a safe and effective agent in the treatment of bradycardia accompanying complete heart block. However, in 12 patients with heart block, hypertonic lactate infusions produced ventricular tachycardia in 6 and an increased idioventricular rate in only 4. Isopropylnorepinephrine was more effective and without such hazard. The effects of alkalosis from molar lactate, 5 per cent sodium bicarbonate, and hyperventilation are compared. Of these 3, lactate was productive of the greatest ventricular acceleration.
Electrocardiographic and Plasma Potassium Responses Elicited on Cooling the Chest Wall of Man
Authors: KAMINER BENJAMIN , BERNSTEIN RALPH E.
Published: June 2012

The application of ice to the anterior chest wall in human subjects resulted in retardation of repolarization of the anterior myocardium and was accompanied by a decrease in the plasma potassium. These phenomena were tentatively related to the effects of local cooling of the myocardium.
Indications and Contraindications for the Use of Molar Sodium Lactate
Authors: BELLET SAMUEL , WASSERMAN FRED
Published: June 2012

The experience with molar sodium lactate has been extended to include 101 patients. Certain indications and relative contraindications to its use have crystallized. Administration of this agent is shown to be a physiologic and effective method for treating patients with severe hyperpotassemia, multiple Stokes-Adams, attacks, and cardiac arrest, particularly that occurring in the operating room complicating cardiac surgery. For many patients in these categories, sodium lactate was life saving even though it was generally given after other more commonly used drugs and methods of therapy had proved ineffective in restoring cardiac rhythm. In the total group of patients untoward effects were few.
Digitalis and the Electrocardiogram
Authors: PICK ALFRED
Published: June 2012

The various effects of digitalis upon the electrocardiogram are reviewed and grouped with regard to their clinical significance. Therapeutic or toxic actions of digitalis seem to depend on as yet poorly understood relationships to potassium metabolism. An insight into this relationship might be gained in the future in view of recent developments in the field of cardiac electrophysiology.