bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnesium Metabolism in Patients Undergoing Cardiopulmonary Bypass
Authors: SCHEINMAN MELVIN M. , SULLIVAN ROBERT W. , HYATT KENNETH H.
Published: June 2012

Magnesium metabolism was studied in patients undergoing cardiopulmonary bypass. In 12 patients the mean preoperative serum magnesium level of 1.56±0.10 mEq/L fell to abnormal levels in all patients (1.07±0.04 mEq/L;
P
<0.001). The decrease in serum magnesium that occurred during bypass is explained by dilution of extracellular volume, as there was no significant difference between mean preoperative and bypass extracellular magnesium. The further postoperative fall in serum magnesium was less than predicted on the basis of magnesium excretion and dilution, implying movement of magnesium from intracellular to extracellular sites. Although the level of serum magnesium correlated poorly with cardiac rhythm or gross neuromuscular abnormalities, three patients with resistant ventricular fibrillation were successfully defibrillated after intravenous bolus injections of magnesium sulfate.
Myocardial Potassium and Lactate Balance during Valve-Replacement Surgery
Authors: MCCORD COLIN W. , CRAMPTON RICHARD S. , NASSER MICHEL G. , CASE ROBERT B. , Wachter Anna Maria
Published: June 2012

Coronary venous drainage was isolated, and arterial and coronary venous lactate and potassium concentrations were determined during valve-replacement surgery in 15 patients. Coronary flow was measured in seven. Fourteen had diminished lactate uptake during control periods of normothermic bypass whereas potassium uptake or loss was variable. The recovery period after intermittent anoxic cardiac arrest for 10 to 20 minutes at 28° C (five patients) and 4° C (seven patients) was associated with lactate production and large potassium losses. Continuous coronary perfusion at 28° C and 150 to 250 ml/min flow (three patients) was associated with continuous lactate production and potassium loss. Total myocardial potassium loss averaged 1.15 mEq. In most patients lactate production diminished and rapid potassium uptake occurred when normal coronary perfusion was reestablished while still on bypass. In spite of these shifts in potassium balance, myocardial function was regained promptly upon defibrillation without serious arrhythmias.
Effect of a Nonionic Surface-Active Agent on Blood Viscosity and Platelet Adhesiveness
Authors: GROVER FREDERICK L. , HERON MICHAEL W. , NEWMAN MELVIN M. , PATON BRUCE C.
Published: June 2012

The effects of Pluronic F68, a nonionic surface-active agent, on blood viscosity and platelet adhesiveness during extracorporeal circulation were investigated. Blood viscosity was significantly decreased. Platelet adhesiveness decreased markedly in six patients within ten minutes after intravenous injection. Pluronic F68 has many properties and actions which make it a useful additive to perfusion systems. Its potential in the treatment of diseases in which high viscosity or increased platelet adhesiveness are present deserves investigation.
Human Cardiac Transplantation
Authors: COOLEY DENTON A. , BLOODWELL ROBERT D. , HALLMAN GRADY L. , LEACHMAN ROBERT D. , NORA JAMES J. , ROCHELLE DONALD G. , MILAM JOHN D.
Published: June 2012

Transplantation of the human heart may provide palliation for patients with end-stage cardiac disease for whom no other treatment is available. Cardiac transplantation was performed in 17 patients undergoing 18 heart transplants. Five early deaths occurred: three from acute cardiac rejection after one week and one each from pre-existing diseases and complications of immunosuppressive therapy. The transplanted heart provided effective cardiac function for each surviving patient. Two late deaths occurred from sepsis. Three patients died between five and nearly seven months after operation from chronic cardiac rejection. Clinical investigations of the role of histocompatibility testing, methods of immunosuppressive therapy, recognition and management of rejection, search for preformed anti-heart antibodies, physiological evaluation of the denervated transplanted heart, and causes of histological changes in the transplanted hearts are continuing. Further clinical trial is needed to determine the role of cardiac transplantation in palliating advanced myocardial insufficiency.
Reconstructive Coronary Artery Surgery: Postoperative Assessment
Authors: SHELDON WILLIAM C. , SONES F. MASON , SHIREY EARL K. , FERGUSSON DAVID J. G. , FAVALORO RENE G. , EFFLER DONALD B.
Published: June 2012

Results of 288 direct coronary artery reconstructive operations in 281 patients have been reported. Selected patients with segmental obstructive lesions in their coronary arteries can be helped with direct reconstructive surgery. Best results have been achieved in patients with isolated segmental obstructions in the predominant right coronary artery. With the saphenous vein graft technique, surgical mortality has been reduced to 5.1%, and angiographic evidence of improvement has been achieved in three of four of the survivors.

The direct surgical reconstruction of segmental occlusive disease offers the advantage of
immediate
improvement of myocardial perfusion, attendant protection against myocardial infarction, and immediate improvement if not complete remission of symptoms of myocardial ischemia. Excellent long-term results have been obtained in many patients who underwent patch-graft reconstruction; early experience indicates that saphenous vein graft reconstruction can be accomplished for patients with a greater variety of obstructive lesions, with better reliability, and lower risk. Its ultimate role in the surgical treatment of coronary atherosclerosis, however, will require a longer period of observation.
Chronic Left Ventricular Bypass with an Implantable Ventricular-Aortic Assist Pump
Authors: BERNHARD WILLIAM F. , LAFARGE C. G. , JOCKIN H. , KITRILAKIS S. , ROBINSON T.
Published: June 2012

This investigation represents definite progress in the field of assisted circulation. Experiments involved the maintenance of partial left ventricular bypass in 25 calves by means of a new, implantable, left ventricular assist pump. Flow rates of 800 to 3,000 ml/ min were employed continuously for periods of 6 to 120 days. Flocked Dacron fibrils were applied to all pump surfaces to serve as a matrix for adherence of a fibrin-cellular (pseudoendothelial) layer. Serial hematological studies carried out during assisted circulation did not disclose any evidence of severe blood damage.
Hemodynamic Accompaniments of Angina
Authors: O'BRIEN KEVIN P. , HIGGS LAWRENCE M. , GLANCY D. LUKE , EPSTEIN STEPHEN E.
Published: June 2012

The hemodynamic responses of nine patients with severe coronary artery disease were studied during the precipitation of angina by both supine exercise and increasing rates of atrial pacing. Tension-time index and the first derivative of left ventricular pressure pulse (LV dp/dt) at the onset of angina were significantly higher (
P
<0.01) in each patient when angina was induced by exercise than when angina was provoked by atrial pacing. Heart rate, in contrast, was significantly greater (
P
<0.05) when angina was precipitated by atrial pacing. Left ventricular end-diastolic pressure (LVEDP) was abnormally elevated in each patient when angina occurred during supine exercise, whereas LVEDP was normal in all patients at the onset of angina provoked by atrial pacing. On the basis of these results it appears that the hemodynamic accompaniments of angina depend to a large extent on the particular circumstances leading to the development of angina. Tension-time index, LV dp/dt, and heart rate are major determinants of myocardial oxygen consumption, and the interrelationships between the determinants of myocardial oxygen consumption are complicated. Thus, changes in any one of these determinants after a therapeutic intervention must be viewed in relation to possible changes in the others.
Comparative Effects of Aging and Coronary Heart Disease on Submaximal and Maximal Exercise
Authors: KASSER IRWIN S. , BRUCE ROBERT A.
Published: June 2012

The relative contributions of aging and coronary heart disease to the impairment of functional capacity were assessed in 117 coronary patients, 117 age-matched healthy middle-aged men, and 62 healthy young men by utilizing a multistage treadmill test of maximal exercise.

With aging alone, duration of exertion and maximal exercise heart rate were diminished while maximal systolic pressure increased. The percentage of heart rate reserve from submaximal (stage 1) to maximal exercise was unaltered so that the relative heart rate stress of submaximal work on the heart was not affected. Transient postexertional S-T depression was related to increasing age and high cardiac work loads.

With coronary disease, maximal duration, maximal heart rate, maximal systolic pressure, and heart rate difference (maximal heart rate during exercise minus resting heart rate just before exercise) were all reduced, while the relative heart rate stress of submaximal exercise was greater.

The frequency of S-T depression was both age and disease dependent. Postexertional S-T depression of myocardial ischemia was prolonged and usually associated with angina in patients with coronary occlusive disease and subnormal performance in contrast to a more transient painless response which occurred in healthy subjects with performance which was "supernormal" in comparison with normals who exhibited no S-T depression.
Cardiovascular Function in Children with Severe Anemia
Authors: CROPP GERD J. A.
Published: June 2012

We investigated the hemodynamic status of seven children (aged 7 months to 14 years) with severe iron-deficiency anemia or anemia due to renal disease before and after the anemias were corrected by isovolumetric exchange transfusions. In the anemic state (Hb 1.9 to 3.8 g/100 ml) mean values for cardiac index were 7.71 L/min/m
2
, for heart rates 129/min, for stroke index 61.7 ml/m
2
, for diastolic pressure 61 mm Hg, and for systemic vascular resistances 11.5 resistance units (RU). After the anemias were corrected, mean values for cardiac index fell to 4.58 L/min/m
2
, heart rate to 92/min, and stroke index to 50.5 ml/m
2
; diastolic pressure rose to 74 mm Hg, and systemic vascular resistance to 22.8 RU. Post-exchange values were statistically significantly different from anemic values and were within normal limits for children. The mean cardiac index in anemic children was approximately the same as in adults with equally severe anemia; in children, increases in heart rate were greater and increases in stroke volume less than in equally anemic adults. Heart size (estimated by cardiothoracic ratio in eight anemic children) was increased. After the exchange transfusions it decreased from a mean of 55.4% to 51.2% (
P
<0.05) in four of the five patients who were not in congestive heart failure; but the abnormally large heart size of three anemic children in failure did not decrease. Blood volumes were normal in five anemic children who were not in failure and were abnormally large in two of the three anemic children in cardiac failure.
Cardioversion of Supraventricular Tachycardias
Authors: VASSAUX CARLOS , LOWN BERNARD
Published: June 2012

Cardioversion was employed in 33 episodes of supraventricular tachycardia in 25 patients. Of these, 18 were episodes of paroxysmal atrial tachycardia with block and the remainder were atrial, junctional, and undefined supraventricular tachycardias. Cardioversion was successful in restoring sinus rhythm in 23 (70%). A major problem was to identify when digitalis intoxication was the cause of the supraventricular mechanism. By progressive titration of the shock energy, it was possible to determine the presence of digitalis intoxication. This was manifested by emergence of ventricular ectopic beats and acceleration in atrial rate. The use of lidocaine abolished the ventricular extrasystoles. Of the 10 patients failing to revert, seven had digitalis toxic arrhythmias. No complications were encountered.
Regional Ventilation in the Differential Diagnosis of Pulmonary Embolism
Authors: MEDINA JOSE R. , L'HEUREUX PHILIPPE , LILLEHEI JAMES P. , LOKEN MERLE K. , Ponto Richard
Published: June 2012

In the diagnosis of pulmonary embolism by lung scanning, clinical errors of interpretation may arise. Diseases that affect the distribution of pulmonary blood flow, such as pulmonary emphysema and bronchial asthma, may be confused with pulmonary embolism.

With the addition of ventilation studies with
133
xenon to the perfusion scans, distinct differences appear between patients with emboli and those with obstructive lung disease. In patients with pulmonary emboli, ventilation is preserved in the areas of decreased perfusion, whereas patients with obstructive lung disease show both decreased ventilation and perfusion in the affected areas.
Large Anomalous Fibrous Sac in the Right Side of the Heart
Authors: SUTHERLAND R. D. , STANGER PAUL , CLIMIE A. R. W. , QQINN MICHAEL H. F. , EDWARDS JESSE E.
Published: June 2012

In an adult with atrial septal defect, an unusual conical-shaped fibrous sac resembling a closed windsock occupied the right ventricle and main pulmonary artery. The base of the sac being attached by fibrous strands to the right atrium suggests that the structure is derived from the right valve of the sinus venosus.

The sac is considered to have filled with blood, thereby reducing potential right ventricular diastolic volume.

It is probable that the sac emptied into the right atrium during right ventricular systole, thereby creating a functional state comparable to that of tricuspid insufficiency. Occupation of right ventricular space by the sac established a state somewhat comparable to that in Ebstein's anomaly of the tricuspid valve.
Congenital Aneurysm of the Pulmonary Sinus of Valsalva
Authors: PAGE DAVID L. , WILLIAMS GARY M.
Published: June 2012

A case of congenital aneurysm of the pulmonary sinus (sinus of Valsalva) in a 7-year-old child is described. The child met a traumatic death and manifested no symptoms or definite signs of his valvular defect. The heart was of normal weight, and no other abnormalities of the heart or other organs were present. This is the first report of sinus aneurysm of the pulmonary valve. The pathogenetic implications and possible clinical consequences of this defect are discussed.
The Deposition of Digitoxin in the Tissues of the Rat After Parenteral Injection
Authors: BINE RENÉ , FRIEDMAN MEYER , BYERS SANFORD O. , BLAND CATHARINE
Published: June 2012

Quantitative studies regarding the fate of parenterally injected digitoxin in the rat were made by assaying extracts of rat tissue by the embryonic duck heart method. The concentration of digitoxin found in heart muscle was similar to that found in lung and kidney and greater than the concentration in skeletal muscle. The greatest amount was found in the liver and suggested the importance of this organ in the excretion or destruction of digitoxin.
Oxygen Tension of Tissues by the Polarographic Method
Authors: HORWITZ ORVILLE , PEIRCE GEORGE , MONTGOMERY HUGH
Published: June 2012

Simultaneous measurements of skin oxygen tension by polarography and skin temperature by thermocouple were made in patients with peripheral arterial disease and in individuals with normal extremities over a range of skin temperature of 10 to 50 C. The oxygen tension of the skin was found to increase as the skin temperature was raised to about normal body temperature in the ischemic extremity and to significantly higher temperature in the normal extremity. Possible reasons for these changes are discussed.
Experimental Reversal of Capillary Blood Flow
Authors: HEIMBECKER RAY , THOMAS VIVIEN , BLALOCK ALFRED
Published: June 2012

Beck, Sciaroni and others have made clinical and experimental attempts to reverse the direction of flow of blood across the capillary bed by the anastomosis of arteries and veins. The present authors have shown by the microscopic observation of capillaries in acute experiments on cats, dogs and rabbits that a reversal of blood flow in mesenteric capillaries will occur following the connection of an artery to a vein provided the collateral arteries and veins are obstructed. Furthermore, it was shown that blood flowing in a reverse direction through capillaries loses oxygen.
Electron Micrograph of Plasna Lipoprotein Molecule (S
f
10-20)
Authors: PRENDERGAST JOHN J. , TEAGUE D. MAXWELL
Published: June 2012

As part of a current study of cardiovascular disease, electron microscope photographs were obtained which confirm the presence of a lipoprotein molecule comparable in size to the S
f
10-20 molecules found with the ultracentrifuge.
Lipoproteins, Liver Disease, and Atherosclerosis
Authors: PIERCE F. T. , GOFMAN J. W.
Published: June 2012

The blood levels of the S
f
10-20 class of giant cholesterol-bearing lipoproteins were studied in a group of patients with cirrhosis. No significant difference was observed between the blood levels of this group and of a similar group of normal individuals of corresponding age and sex. This observation suggests that patients with cirrhosis are as susceptible to atherosclerosis as the general population.
The Effect of Carbon Tetrachloride Poisoning on Serum Lipoproteins Associated with Atherosclerosis
Authors: PIERCE F. T. , GOFMAN J. W.
Published: June 2012

Carbon tetrachloride was injected into normal rabbits and the levels of S
f
3-12, 12-20, and 20-40 classes of lipoproteins were determined during the course of these injections. A marked increase in concentration of these three classes of lipoproteins occurred during the administration of carbon tetrachloride. After the cessation of this drug, the lipoproteins of largest S
f
rate returned to normal first with those of lower S
f
rate returning to normal levels in the order of decreasing S
f
rates. Rabbits fed cholesterol were also injected with carbon tetrachloride, and their lipoproteins continued to increase after cessation of this drug.
Observations with Radioactive Hydrogen (H
3
) in Experimental Atherosclerosis
Authors: BIGGS MAX W. , KRITCHEVSKY DAVID
Published: June 2012

Tritium has been used to study certain aspects of endogenous and exogenous cholesterol metabolism in normal and hypercholesterolemic rabbits. Special attention is given to turnover studies on aortic cholesterol. Labeled cholesterol has been used for feeding experiments and the subsequent rise of serum cholesterol specific activity has been investigated.
Hypercholesteremia and Atheromatosis in Chicks on a Restricted Diet Containing Cholesterol
Authors: RODBARD S. , BOLENE C. , KATZ L. N.
Published: June 2012

Restriction of dietary intake even to the point of emaciation gave no protection against atheromatosis or hypercholesteremia in chicks on a diet supplemented with cholesterol. These results show that there is no necessary relationship between the amount of body fat and atherosclerosis.
Respiratory Complications from Tetraethylammonium Ion
Authors: MCLEMORE GEORGE A. , GREEN HAROLD D. , LIDE THOMAS N.
Published: June 2012

Ill effects of tetraethylammonium ion reported in the current literature are reviewed. Two deaths are reported which are considered to be attributable to this substance; one resulted from a myocardial infarction, the other was due to respiratory failure. Four dogs were given progressively increasing doses of tetraethylammonium ion and all ultimately died of respiratory failure.
Congestive Heart Failure
Authors: STOCK RICHARD J. , MUDGE GILBERT H. , NURNBERG MIRIAM J.
Published: June 2012

Metabolic studies were made on the effects of salt restriction and the administration of mercurials on the electrolyte metabolism of patients in congestive failure. Varying degrees of hyponatremia and hypochloremic alkalosis were noted. Significant disturbances in potassium balance were not observed and normal potassium values were found in biopsy specimens of skeletal muscle. The alkalosis can be attributed to the effect of mercurials on chloride excretion which is relatively greater than their effect on sodium. The continued administration of mercurials resulted in electrolyte disturbances which prevented diuresis. When these abnormalities were corrected the mercurials again became effective.
Studies on Congestive Circulatory Failure
Authors: SCHROEDER HENRY A.
Published: June 2012

Chloride balances were determined in 40 patients suffering from congestive circulatory failure and 6 with normal cardiac function, while diuretics were administered. The effect of digitalis was to increase the renal excretion of chlorides and water about equally; this action was significant in only one-third of the cases. Mercurial diuretics primarily increased the urinary concentration of chlorides in every case except when plasma chlorides were low. A xanthine (theobromine) appeared to exert a greater action on the excretion of water than on chlorides.
The Hyperabduction Syndrome
Authors: BEYER JOHN A. , WRIGHT IRVING S.
Published: June 2012

The hyperabduction syndrome was described in 1945. This report includes information and experience gained from the study of 52 patients suffering from its consequences and of many others in whom the diagnosis was necessarily considered. The signs and symptoms and age and sex incidence are summarized. Among the most striking findings was the fact that Raynaud's syndrome occurred in 20 of the 52 patients, an incidence far greater than anticipated in the general population. In some patients elimination of the hyperabduction position abolished Raynaud's syndrome. So far as we can determine this relationship has not been previously reported.
Further Studies of the Cerebral Chemoreceptor Buffers as Influenced by Vasoconstrictor and Vasodilator Drugs and Veratrum Viride
Authors: TAYLOR ROBERT D. , PAGE IRVINE H.
Published: June 2012

These experiments extend our studies on the newly described cerebral chemoreceptors to show that most pressor drugs cause peripheral hypotension when perfused through the brain of the animal isolated except for nervous connections with its body. Depressor drugs usually act oppositely and cause hypertension. The cerebral chemoreceptors thus seem to act as a buffer mechanism. The receptors may be inactivated to some drugs without blocking the neurogenic hypertension response elicited by cerebral ischemia. Veratrum viride is shown to be such a drug. Besides initiating the von Bezold reflex, veratrum lowers blood pressure by direct central action.
The Effect of Amytal on the Cardiac Output and Peripheral Resistance of Man
Authors: WINCHELL PAUL , TAYLOR HENRY LONGSTREET , CHAPMAN CARLETON B.
Published: June 2012

Measurements of cardiac output and intra-arterial pressure on 5 normal young men and 5 hypertensive patients before and during sedation with Amytal demonstrated a decreased cardiac output and an increased peripheral resistance during the period of sedation. It is concluded that the theoretic basis for the use of Amytal sedation as a device for selection of hypertensive patients for sympathectomy is not valid.
Selective Synchronous Recording of the Batlistocardiogram and Electrocardiogram on a Single Channel
Authors: GUBNER RICHARD
Published: June 2012

Identification of ballistocardiographic waves is difficult unless reference can be made to another simultaneously recorded event in the cardiac cycle. By hooking up an electrocardiographic lead in parallel circuit with the ballistocardiograph and interposing a rheostat of variable resistance in series in one of the electrocardiographic lead wires, the electrocardiogram may be selectively tuned in or out of the circuit. At resistances of 50,000 to 100,000 ohms the QRS complex appears only as a small spike preceding the ballistocardiographic waves and readily permits their identification. This simple expedient renders unnecessary the use of multiple recording channels in clinical ballistocardiography.
Coarctation of the Aorta Complicated by Patency of the Ductus Arteriosus
Authors: JOHNSON ARNOLD L. , FERENCZ CHARLOTTE , WIGLESWORTH F. W. , MCRAE DONALD L.
Published: June 2012

The study of the anatomic and hemodynamic relationships in a case of coarctation of the aorta complicated by patency of the ductus arteriosus and pulmonary hypertension indicated the necessity for a physiologic approach to the classification of coarctation of the aorta. The origin of existing classifications has been briefly traced and basic anatomic and physiologic considerations in this malformation have been reviewed. A classification is presented which takes into account the state of the ductus arteriosus, its relationship to the coarcted segment and the influence of the collateral circulation. The microscopic appearance of the pulmonary vessels is included.
The Effect of Pancreatectomy on Lipemia, Tissue Lipidosis and Atherogenesis in Chicks
Authors: STAMLER J. , KATZ L. N. , Bolene C.
Published: June 2012

Following complete pancreatectomy, chicks exhibit an excessive hypercholesterolemia when fed a diet containing cholesterol plus cottonseed oil. This inordinate hypercholesterolemia is accompanied by intensified atherogenesis, compared with unoperated controls on the same diet. Dietary neutral fat is essential for these excessive cholesterolemic and atherogenic responses. The possible significance of these findings for the pathogenesis of atherosclerosis in diabetic man is discussed.
Transposition of the Aorta and Pulmonary Artery
Authors: CAMPBELL MAURICE , SUZMAN S.
Published: June 2012

Transposition of the aorta and pulmonary artery is now more frequently diagnosed in life. It must be distinguished from Fallot's tetralogy because it is not helped by the Blalock-Taussig operation: indeed, the blood flow to the lungs is increased instead of reduced. This picture of pleonemic lungs can be recognized by radioscopy and indicates a left to right shunt; when combined with central cyanosis, complete or partial transposition is the most common cause. The general picture seen in 25 cases, in 6 of which the diagnosis was confirmed by cardiac catheterization and angiocardiography, is described. Two cases where the features of transposition were obscured by the presence of pulmonary stenosis are included.
Some Effects of Digoxin on the Heart and Circulation in Man
Authors: HARVEY RÉJANE M. , FERRER M. IRENÉ , CATHCART RICHARD T. , ALEXANDER JAMES K.
Published: June 2012

The early effect of intravenous Digoxin was observed in 12 patients with cardiac enlargement in whom there was no clinical or physiologic evidence of failure. There was either a fall or no change in the cardiac output and the intracardiac pressures did not alter following administration of the drug. The reaction to Digoxin in this type of patient with heart disease was in no way different from the response seen in two normal subjects included in the study but is in sharp contrast to the response elicited in patients in congestive heart failure.
A Study of the Effect of Procaine Amide Hydrochloride in Supraventricular Arrhythmias
Authors: MCCORD MALCOLM C. , TAGUCHI JAMES T.
Published: June 2012

The effect of the intravenous administration of procaine amide in 25 patients with supraventricular arrhythmias is reported. The data, including six conversions of auricular fibrillation, indicate a pronounced effect of this drug on the auricles as well as on the heart as a whole. Special attention is directed to the finding of frequent and undesirable electrocardiographic and hypotensive effects of this drug.
A New Tolerance Test as a Guide to Clinical Heparin Therapy
Authors: MCCLEERY ROBERT S. , YARBOROUGH JOHN A. , Ball Con O. T.
Published: June 2012

It is a common clinical observation that the response to a specific dose of heparin in a retarding menstruum is unpredictable. The fallacy of using weight as a guide to dosage is well shown by the results here reported. To simplify the approach to a therapeutic regimen, it seemed advisable to assess all of the variables in an individual patient by the administration of a test dose of intravenous heparin. A dosage schedule is outlined, based on the response to the tolerance test, which proved accurate in 105 patients and requires the performance of only one coagulation time every 24 to 36 hours.
The Management of Cardiac Patients in Relation to Surgery
Authors: ERNSTENE A. CARLTON
Published: June 2012

Skillful anesthesia and surgical operations do not significantly increase the demands upon the heart for work. Patients who have organic heart disease but who have been able to carry on normal daily activities without symptoms referable to the heart tolerate anesthesia and operation without difficulty provided that anoxia, hemorrhage and shock are avoided. Hypertension, cardiac enlargement, valvular disease other than advanced aortic stenosis, and electrocardiographic abnormalities, per se, do not increase surgical mortality or postoperative morbidity. When symptomatic myocardial insufficiency or evidence of congestive heart failure is present, a period of preoperativre treatment with rest, digitalis, sodium restriction and mercurial diuretics is advisable. Treatment should be as thorough as possible during the interval in which the operation can be safely delayed. With adequate management, patients who have had myocardial failure can be expected to tolerate aniesthesia and surgery satisfactorily. Postoperative complications, such as pneumonia, atelectasis, thromboembolic accidents and abdominal distention, are not well borne, however, and may be responsible for a return of cardiac decompensation.

Patients who have auricular fibrillation or auricular flutter should be digitalized before operation even though there have been no symptoms of impaired myocardial reserve and regardless of the ventricular rate.

Surgery should be avoided if possible in persons who have severe coronary disease, aortic stenosis, coronary ostial steniosis due to syphilitic aortitis, and high grade or complete auriculoventricular block complicated by the Stokes-Adams syndrome. Spinal anesthesia should not be employed in the presence of these conditions.

The decision as to the exact type of operation to be performed is seldom influenced by the existence of organic heart disease.

The presence of organic heart disease is only occasionally of more than secondary importance in determining the choice of the anesthetic agent to be given by inhalation. Cyclopropane, however, should not be used.

Although unimportant disturbances of cardiac rhythm occur frequently during anesthesia and operation, serious complications such as ventricular tachycardia, standstill of the heart and ventricular fibrillation are uncommon. The treatment of these conditions has been discussed.

Postoperative cardiac complications are not common and are seldom responsible for death of the patient. The greatest incidence occurs in patientswhohaveseverecoronaryarterydisease.

The intravenous administration of fluids which contain sodium should be avoided during operation and the postoperative period unless their use is specifically indicated.
The Relief of Acute Right Ventricular Strain by the Production of an Interatrial Septal Defect
Authors: BRECHER GERHARD A. , OPDYKE DAVID F.
Published: June 2012

Since sudden resistance increase in the pulmonary circulation leads to right ventricular overdistension and subsequent failure, the question was studied whether or not the existence of an experimentally produced interatrial septal defect could prevent an overstretching of the right myocardium in acute pulmonary stenosis. It was found that myocardial overdistention could be prevented by a small interatrial septal perforation without essentially changing normal interatrial pressure relations. A large defect, which also protected the right heart muscle from overstretching, changed atrial pressure relations and cardiac dynamics entirely.
A Study of the Central and Peripheral Arterial Pressure Pulse in Man
Authors: SALANS A. H. , KATZ L. N. , GRAHAM G. R. , GORDON A. , ELISBERG E. I. , GERBER A.
Published: June 2012

This communication describes and discusses the results obtained in studying central and peripheral arterial pressure pulses in man by means of retrograde aortic catheterization. The pressure pulse transformation and pulse transmission in the aorticobrachial system are presented and compared with comparable tracings reported in the dog. Several normal subjects and patients with hypertension, aortic regurgitation and coarctation of the aorta were studied. The genesis of the central pulse contour in aortic regurgitation is reconsidered. The changes in central pulse pressure, produced by the Valsalva-like maneuver, and ventricular premature systoles have been investigated, especially in their relationship to cycle length, end-diastolic volume and peripheral resistance. The technic of obtaining pulse pressure recordings by retrograde aortic catheterization is recommended for determining the location, size and dynamic significance of coarctation of the aorta. As an additional study, aortic densograms and border electrokymograms from the aortic arch and left ventricular border were correlated with simultaneously recorded central aortic pressure tracings.
Quinidine Lactate and Gluconate in the Suppression of Ectopic Ventricular Tachycardias Associated with Myocardial Infarction
Authors: HARRIS A. SIDNEY , ESTANDÍA ANTONIO , FORD TEDROE J. , TILLOTSON REX F.
Published: June 2012

In dogs with myocardial infarction, produced by a standard technic, rapid persistent ectopic ventricular tachycardia develops. Intravenous quinidine lactate and quinidine gluconate effectively control the arrhythmia in 56 to 60 per cent of the animals, but produce toxic reactions in many of them. Morphine sulfate prevents vomiting and diarrhea from quinidine, but does not prevent convulsive movements. The most effective treatment of the arrhythmia was by use of morphine followed by quinidine gluconate. This combination was successful in 89 to 100 per cent of the cases. Principles for guidance in the treatment of severe ventricular arrhythmias have been drawn from these studies.
Effect of Pulse Pressure and Mean Arterial Pressure Modification on Renal Hemodynamics and Electrolyte and Water Excretion
Authors: SELKURT EWALD E.
Published: June 2012

Studies were conducted to evaluate the influence of pulsatile versus nonpulsatile arterial perfusion pressure on plasma flow, filtration rate, sodium excretion, and urine volume. Through a wide range of mean renal arterial pressures, reduction of pulse pressure was without effect on renal function. The level of the mean arterial pressure, however, had a very dominant role in the electrolyte and water handling, decreases and increases in excretion paralleling the direction of change of the mean pressure. These alterations were observed even though filtration rate and plasma flow exhibited a marked degree of autonomy in the face of these pressure variations. Mechanisms by which these modifications in salt and water excretion could result from alteration in the mean arterial pressure are discussed.
The Determination of Cardiac Output by a Continuous Recording System Utilizing Iodinated (I
131
) Human Serum Albumin
Authors: MACINTYRE WILLIAM J. , PRITCHARD WALTER H. , ECKSTEIN RICHARD W. , FRIEDELL HYMER L.
Published: June 2012

A method is outlined for the determination of cardiac output by the injection of iodinated (I
131
) human serum albumin and continuous recording of the dilution curve. The calibration of the flow system by means of the final dilution and blood volume is discussed along with the possible application to an external measuring method. The results of eight dilution curves obtained from dogs are presented and the calculated cardiac outputs compared with the values measured by the rotameter method.
Macrophage Migration in Experimental Atherosclerosis
Authors: SIMONTON JOHN H. , GOFMAN JOHN W.
Published: June 2012

With the object of testing the importance of macrophage transport of lipid in the production of atheromas, a radioisotope was employed in labeling reticuloendothelial cells. Rabbits were injected with this isotope, and lipemia induced by cholesterol feeding. Subsequently the animals were sacrificed and the distribution of the label determined. High concentrations of the label were found in Kupffer cells, in splenic and marrow macrophages, but no significant increase was demonstrated in aortic atheromas. This finding is interpreted as evidence against the macrophage theory of genesis of atherosclerosis.
Heart Disease Case Finding by Means of 70 Millimeter Photofluorographic Films
Authors: RUTSTEIN DAVID D. , WILLIAMSON CHARLES R. , MOORE FELIX E.
Published: June 2012

These studies concern the value of the 70 mm. photofluorographic tuberculosis film as a heart disease case finding procedure. The yield of cases discovered and benefited in the group I study would be considered satisfactory in comparison with yields usually obtained in mass surveys for other diseases. This was not so in the group II study, and the reasons for the differences are discussed.
Screening Tests in Mass Surveys and Their Use in Heart Disease Case Finding
Authors: RUTSTEIN DAVID D. , Craige Ernest
Published: June 2012

Wherein certain principles governing screening tests for case finding in the general population are defined and the heart disease case finding studies in Boston are evaluated.
Effect of Small Doses of Heparin in Increasing the Translucence of Plasma during Alimentary Lipemia
Authors: BLOCK WILLIAM J. , BARKER NELSON W. , MANN FRANK D.
Published: June 2012

Heparin administered intravenously increases the translucence of plasma during alimentary lipemia. This apparently is solely a physical change. This article reports observations concerning this phenomenon in normal persons and atherosclerotic patients. For purposes of maximal sensitivity, exceedingly small amounts of heparin are used, and distinct differences between the normal and the atherosclerotic individuals are noted, with the atherosclerotic failing to clear well on the same empiric dose of heparin as the normal persons. An unexpected observation was that the normal men developed a significantly greater degree of lipemia than did normal women after ingestion of the same fat meal.
Physiologic and Physical Factors that Govern the Clinical Appreciation of Cardiac Thrills
Authors: COUNIHAN TIMOTHY B. , RAPPAPORT MAURICE B. , SPRAGUE HOWARD B.
Published: June 2012

Palpable cardiac thrills have been considered valuable diagnostic findings. The present study indicates that they add little information to that obtained by careful evaluation of auscultatory findings, and that the quality of cardiac murmurs is a much safer guide in diagnosis than are the palpable vibrations produced by the same mechanism.
Experimental Arterial Disease
Authors: WARTMAN WILLIAM B. , HUDSON BRYAN , JENNINGS ROBERT B.
Published: June 2012

Rabbits were injected with saline suspensions of fibers of filter paper and of mixtures of filter paper and human fibrin or filter paper and rabbit whole blood. The emboli became impacted in the pulmonary arteries or adhered to the intima. In one rabbit an embolus adhered to the endocardium of the right ventricle. An acute arteritis resulted which was finally organized leaving a diffuse or eccentric scar on the intima. The filter paper fibers were surrounded by a foreign body granuloma and localized in either the intima or adventitia. Frequently they passed entirely through the wall clausing varying amounts of injury and were found in the adventitia or perivascular lung tissue. This is interpreted as indicating the existence of a mechanism for ridding the circulation of foreign material in the blood.
Interarterial Coronary Anastomoses in the Human Heart, with Particular Reference to Anemia and Relative Cardiac Anoxia
Authors: ZOLL PAUL M. , WESSLER STANFORD , SCHLESINGER MONROE J.
Published: June 2012

In an unselected series of 1050 human hearts the coronary arteries were uniformly injected at necropsy with a standardized radiopaque mass. Interarterial coronary anastomoses were clearly demonstrated by this method and were studied with respect to their incidence and pathogenesis. Anastomoses were significantly increased in hearts with coronary artery occlusion or marked narrowing in cor pulmonale, in cardiac hypertrophy and valvular lesions, and also in normal hearts from patients with anemia. Relative cardiac anoxia is present in all these conditions; it appears to be a common underlying stimulus for the development of interarterial coronary anastomoses.
Rheumatic Fever and Rheumatic Heart Disease
Authors: BLAND EDWARD F. , JONES DUCKETT
Published: June 2012

Herewith is presented an interim report on a long-term study of 1000 patients followed since their childhood rheumatism. The dominant role of rheumatic recurrences and the fatal features are reviewed. The benign nature of uncomplicated chorea is stressed, the disappearance of physical signs of heart disease in some patients is contrasted with the delayed and even remote appearance of valvular deformity in others, and finally, the favorable course to date in the majority of cases is emphasized.
The Pharmacologic Action of Thevetoidin, a Cardioactive Substance Obtained from a Mexican Species of Thevetia
Authors: MÉNDEZ RAFAEL , SODI-PALLARES ERNESTO , NAVA ARMANDO
Published: June 2012

Thevetoidin is a digitalis-like substance isolated from a Mexican species of thevetia. Study of its action on the isolated frog heart, on the anesthetized dog, and on the failing heart of the heart-lung preparation reveals therapeutic and toxic effects of unmistakable digitalis-like character which are quickly established and wear off rapidly. The dose for the treatment of cardiac disorders was deduced from experiments on the failing heart of the heart-lung preparation on the basis of a comparison with ouabain.
The Distribution of Body Fluids in Congestive Heart Failure
Authors: SQUIRES R. D. , CROSLEY A. P. , ELKINTON J. R.
Published: June 2012

The balance technic was applied in six studies of patients with congestive heart failure during the diuresis of their edema fluid. From the data so obtained changes in the extra- and intracellular phases of the body fluids were calculated, as well as transfers of sodium and potassium between the several phases and between the body and external environment. The results indicate that abnormalities of intracellular fluid exist in this condition.
In Vitro Studies of the Coronary Arteries of Man and Swine as Demonstrated by a New Technic, Angioplethysmokymography
Authors: SMITH DURWOOD J. , SYVERTON JEROME T. , COXE JOSEPH W.
Published: June 2012

A new in vitro technic for the study of isolated surviving arteries and veins is described. Observations of the reactivity of 21 human and 68 swine coronary arteries to histamine, acetylcholine,
l
-epinephrine and
l
-norepinephrine are reported. Histamine and acetylcholine uniformly caused vasoconstriction of the coronary arteries of man and swine. Three potential mechanisms of coronary artery vasoconstriction in these species are suggested. The blocking action of antihistaminic drugs on vasoconstriction due to histamine, and of atropine on vasoconstriction due to acetylcholine is demonstrated. It is suggested that combined therapy with these drugs may be useful in treatment of diseases of the coronary arteries.
Circulatory Failure in Metastatic Carcinoma of the Lung
Authors: STORSTEIN OLE
Published: June 2012

Four cases of extensive metastatic pulmonary carcinomatosis have been studied from the point of view of hemodynamics (cardiac catheterization) and pathology in order to evaluate the various factors in the pathogenesis of the subacute form of cor pulmonale. The author stresses the importance of distinguishing between the extensive destruction of lung tissue, leading to anoxemia, and the invasion of lung vessels by cancer cells, leading to pulmonary arterial hypertension and later to failure of the right ventricle.
Differences in Bile Acid Excretion
Authors: KOTTKE BRUCE A.
Published: June 2012

Total daily bile acid excretion was measured in 10 patients with primary hypercholesteremia and in nine patients with combined hypercholesteremia and hypertriglyceridemia by using
14
C-labeled cholic acid and
3
H-labeled chenodeoxycholic acid. The average bile acid excretion by the patients with primary hypercholesteremia was 282 mg/day; that by the patients with combined hypercholesteremia and hypertriglyceridemia, 1,094 mg/day. These findings suggest a fundamental difference in cholesterol metabolism in these two types of hyperlipidemia.
Postoperative Evaluation of Mitral Valve Function in Ostium Primum Defect with Cleft Mitral Valve (Partial Form of Atrioventricular Canal)
Authors: GRIFFITHS SYLVIA P. , ELLIS KENT , BURRIS JOHN O. , BUMENTHAL SIDNEY , BOWMAN FREDERICK O. , MALM JAMES R.
Published: June 2012

Postoperative cardiovascular studies were carried out in eight patients with ostium primum defect and cleft mitral valve. Apical systolic murmurs were present in all patients, but in seven of them no mitral regurgitation was detected by pulmonary wedge pressure and left ventricular angiography. Surgical repair of the cleft anterior leaflet without resection of subjacent chordae tendineae, as performed in these patients, usually results in a competent mitral valve. Postoperative angiograms showed persistence of the characteristic preoperative deformity of the medial border of the left ventricular outflow tract especially in systole. As illustrated in one of these patients, subaortic obstruction occasionally complicates abnormalities of the atrioventricular valves.
Ultrasound Localization of Left Ventricular Outflow Obstruction in Hypertrophic Obstructive Cardiomyopathy
Authors: SHAH PRAVIN M. , GRAMIAK RAYMOND , KRAMER DAVID H.
Published: June 2012

Simultaneous recordings of reflected ultrasound from the anterior mitral leaflet and left ventricular outflow, the ECG, the phonocardiogram, and a recording of the carotid artery pulse were obtained in six patients with hypertrophic obstructive cardiomyopathy. Abnormal sharp systolic anterior movement (SAM) of the mitral leaflet was observed. This movement began with the onset of ventricular ejection and reached a peak with the initial peak in the arterial pulse. The leaflet was apposed to the interventricular septum up to 60% of the ejection period. In the latter part of systole as the mitral leaflet moved away from the interventricular septum, the arterial pulse showed a second systolic wave. Onset of SAM coincided with onset of the systolic murmur. Spontaneous variations in amplitude of SAM coincided with alterations in contour of the arterial pulse and in the intensity of the murmur. Administration of methoxamine to four patients resulted in disappearance of SAM. In one patient following surgery, the SAM of the mitral leaflet was noted only in the post-ectopic beats. This specific abnormality of mitral leaflet movement represents the localization of dynamic outflow obstruction in hypertrophic obstructive cardiomyopathy.
A Study of Atrioventricular Conduction in Man Using Premature Atrial Stimulation and His Bundle Recordings
Authors: DAMATO ANTHONY N. , LAU SUN H. , PATTON ROBERT D. , STEINER CHARLES , BERKOWITZ WALTER D.
Published: June 2012

In 20 subjects the effects of controlled premature atrial stimulation on atrioventricular conduction was studied using an electrode catheter technic for recording electrical activity of specialized conducting fibers. The least common type of response observed was that in which A-V conduction delay was limited only to the A-V nodal region (type A). This type of response was obtained whenever the conduction delay in the A-V nodal region increased in direct proportion to the prematurity of a propagated atrial impulse. It was characterized by a progressive prolongation in the P-H interval with ultimate failure of conduction occurring proximal to the His bundle. In type B response, conduction delay occurred in both the A-V nodal and His-Purkinje systems. The recording of a characteristic A-V nodal potential permitted the localization of A-V nodal delay to the N-H interval.