bluuebunny/crossref_metadata_2025 huggingface dataset:
Age, Serum Cholesterol and Coronary Artery Disease
Authors: GERTLER MENARD M. , GARN STANLEY MARION , BLAND E. F.
Published: June 2012

The question of an age-associated rise in serum cholesterol has been undecided. This communication presents evidence in favor of a rise in serum cholesterol with increasing age between the third and the fifth decades. In a control group of 146 individuals and a coronary disease group of 97 individuals, there was a positive correlation between age and serum cholesterol. In the coronary disease group, there was a rise in serum cholesterol superimposed upon an initially higher level of serum cholesterol. The concept of "cholesterol age" is presented on the basis that a patient with coronary heart disease at 25 has a serum cholesterol similar to a "normal" male at the age of 45. The role of serum phospholipids is considered in the age-associated rise in serum cholesterol.
The Effect of Desiccated Thyroid on Plasma and Tissue Lipids and Atherogenesis in the Stilbestrol-Treated Chick
Authors: STAMLER J. , MILLER A. J. , AKMAN L. , SILBER E. N. , BOLENE C. , KATZ L. N.
Published: June 2012

Repeated implantations of diethylstilbestrol pellets cause a sustained hyperlipemia in the chick, and atherosclerosis eventually supervenes. Desiccated thyroid significantly reduces the incidence and degree of the stilbestrol-induced atherosclerosis in the chick, although it is without sustained effect upon the plasma and tissue lipids.
Electrokymographic Studies of the Left Atrium in Normal and Diseased Hearts
Authors: MCKINNON J. B. , FRIEDMAN BEN
Published: June 2012

Electrokymographic tracings of left auricular pulsations in normal and diseased states are described. A characteristic abnormality observed in persons with organic mitral valve insufficiency is believed to be graphic evidence of regurgitation of blood from ventricle into atrium. Electrokymographic evidence of regurgitation was found in persons with mitral stenosis without an audible systolic murmur but instances of mitral stenosis without insufficiency were recorded. Patients with Austin Flint murmurs and individuals with murmurs mimicking mitral insufficiency showed uniformly normal atrial pulsations.
Normal Esophageal and Gastric Electrocardiograms
Authors: KISTIN ALBERT D. , BRILL WARREN D. , ROBB GEORGE P.
Published: June 2012

An analysis of normal esophageal and gastric electrocardiograms is presented. Some standards of abnormality in the literature are found to be unacceptable, principally with reference to Q and the diagnosis of infarction. The study of leads facing the dorsal and diaphragmatic cardiac surfaces seems to be a suitable test of current concepts of "electrocardiographic position." Some of these concepts are supported by this study, but others are questioned.
RS-T Segment Displacement in Induced Coronary Insufficiency as Studied with Esophageal Leads
Authors: SCHERLIS LEONARD , SANDBERG AVERY A. , WENER JOSEPH , MASTER ARTHUR M. , GRISHMAN ARTHUR
Published: June 2012

Esophageal electrocardiograms are utilized as a means of studying the left ventricular cavity potentials in induced coronary insufficiency in patients with angina pectoris. Depressions of the RS-T segment recorded in precordial leads after exercise were consistently associated with simultaneously recorded RS-T elevations at the atrial level. These RS-T deviations are interpreted as indicating that in coronary insufficiency there are widespread changes involving the subendocardial aspect of the left ventricle. A circuit is described to enable the recording of better technical esophageal records despite interference due to extraneous low frequency potentials.
A-V Conduction in Auricular Flutter
Authors: BESOAIN-SANTANDER M. , PICK A. , LANGENDORF R.
Published: June 2012

Flutter of the auricles may be associated with either a regular or an irregular ventricular rate. The former occurs as a rule in the untreated patient, the latter as a result of digitalis therapy. An attempt was made to explain the irregular ventricular response in auricular flutter as a result of a conduction disturbance similar to that seen in sinus rhythm with second degree A-V block characterized by progressive lengthening of the A-V conduction time preceding the dropped beat (Wenckebach phenomenon). Such an approach was suggested by the peculiar arrangement of the ventricular beats in some cases of auricular flutter. Similarly, in order to account for certain features of the arrhythmia it was assumed that some of the non-conducted flutter impulses penetrate into the A-V junction and thus influence the conduction of the subsequent flutter impulses.
The Fourth Walter Wile Hamburger Memorial Lecture, Institute of Medicine of Chicago
Authors: COURNAND ANDRÉ
Published: June 2012

A review of present day knowledge of the pulmonary circulation in man is presented. In particular the state of the lesser circulation in normal man at rest and under conditions of exercise and acute anoxia is defined in detail in order to provide the physiologic background against which to present the accumulated data in patients with certain types of chronic cardiopulmonary diseases.
Increasing Bacterial Resistance to the Antibiotics
Authors: LEVINSON DAVID C. , GRIFFITH GEORGE C. , PEARSON HAROLD E.
Published: June 2012

Observations on bacterial resistance to antibiotics in 64 patients with bacterial endocarditis are reported. Streptococcus endocarditis is contrasted with staphylococcus endocarditis as regards course, bacterial resistance to antibiotics, and mortality. The management of bacterial resistant patients is stressed and particular emphasis is placed upon the role of the newer antibiotics such as aureomycin.
The American Heart Association as a National Voluntary Public Health Agency
Authors: SHEPARD W. P.
Published: June 2012

The role of the voluntary health agencies in this country is well understood. Tuberculosis, blindness, venereal disease, cancer, and other major public health problems have been attacked by them with notable success, some for as long as 50 years. There is a well established pattern of cooperation with official health agencies and with organized medicine.

In its newly added role as a voluntary public health agency, it is important for the American Heart Association to understand these principles and patterns that are discussed here briefly with special emphasis on partnership with nonmedical community leaders, the relationship with the official agencies, including the National Institutes of Health, and on socialized medicine. Good public health work by voluntary organizations is a manifest of the concern of the medical profession with the health of the public and our first bulwark against compulsory government controlled medicine.
The Action of Cardiac Glycosides on Experimental Auricular Flutter
Authors: FARAH ALFRED , LOOMIS T. A.
Published: June 2012

The effect of cardiac glycosides on auricular flutter produced by the method of Rosenblueth and Garcia Ramos is studied. In the denervated heart these drugs produce an increase in the effective refractory period, a decrease in conduction velocity and excitability. The flutter is reverted to a sinus rhythm because of the increase in the effective refractory period. In the innervated heart these glycosides can change the auricular flutter to auricular fibrillation. This change is mediated through the vagus since atropine or cutting the vagi promptly reverts the fibrillation to a sinus rhythm. The change from auricular flutter to fibrillation was never observed in vagotomized dogs.
Analysis of H Wave of Ballistocardiogram
Authors: DE LALLA VINCENT , EPSTEIN MARVIN A. , BROWN HERBERT R.
Published: June 2012

The observations on which this analysis is based include simultaneous ballistocardiographic and electrocardiographic tracings on subjects with complete heart block, and auricular fibrillation. Deflections of the ballistocardiogram similar to the H wave were seen to occur at a constant time interval after P in the absence of a ventricular systole. However, in fibrillation H waves were also found occasionally. A G wave of the ballistocardiogram is described and the authors discuss the part played by auricular systole, the apex thrust, and venous pressure pulses in producing the G and H waves.
The Lewis A. Conner Lecture of the American Heart Association
Authors: BLOOMFIELD ARTHUR L.
Published: June 2012

Some considerations concerning the fundamental pathology of bacterial endocarditis which have a bearing on treatment are discussed. In using antibiotics the importance of time-dose relationships is emphasized. It is pointed out that tests for strain sensitivity give a useful clue to the total daily dosage but that regardless of this, treatment must be carried out over a period of at least a month in order to achieve permanent bacteriologic cures. The difficulties and complications of treatment are discussed. Special methods for the treatment of highly resistant strains and the results with some of the newer antibiotics are outlined.
The Subcutaneous Use of Heparin
Authors: DE TAKATS GEZA
Published: June 2012

The present use of anticoagulants is hampered by the necessity of giving a number of injections of heparin each day, or of using an oral anticoagulant which acts by throttling prothrombin delivery from the liver and does not seem to be a safe anticoagulant, since its laboratory control is not standardized. Because of this an attempt is made in this paper to show the effectiveness of administering heparin subcutaneously and of giving only enough to restore the clotting mechanism to its normal level but not necessarily prolonging the clotting time. With this principle a single injection of heparin a day or every second day seems sufficient, and the danger of hemorrhage is greatly minized.
Therapy of Paroxysmal Pulmonary Edema by Antifoaming Agents
Authors: LUISADA ALDO A.
Published: June 2012

Inhalation of certain volatile substances decreases the amount of foam in the respiratory passages and may be helpful in acute pulmonary edema. Experiments with several agents were performed in animals with different types of acute edema of the lungs. The best results were obtained with ethyl alcohol, which decreased the severity of the edema and prolonged the survival of the animals. Alcohol, while acting as an antifoaming agent, has no untoward side effects and is well tolerated. This method of therapy is now undergoing clinical tests.
Pitfalls in the Electrocardiographic Diagnosis of Left Ventricular Hypertrophy
Authors: GRIEP ARTHUR H.
Published: June 2012

The electrocardiographic diagnosis of left ventricular hypertrophy is uncertain at best and is largely based on useful clues. Reliance on the presence or absence of abnormally high QRS voltage or any of the other presently accepted criteria may lead to error. The author undertook evaluation of the reliability of the various electrocardiographic criteria, of left ventricular hypertrophy in a study correlating electrocardiographic and postmortem findings.
Effect of Anticoagulants on Experimental Cerebral Infarction
Authors: WHISNANT JACK P. , MILLIKAN CLARK H. , SAYRE GEORGE P. , WAKIM KHALIL G.
Published: June 2012

Cerebral infarction is attended by extravasation of blood in varying degrees. The present study was undertaken to learn whether anticoagulant therapy increases the extravasation and thereby diminishes or negates possibly favorable therapeutic effects. A series of experiments on dogs is described and the clinical implications are discussed.
Studies Made by Simulating Systole at Necropsy
Authors: STARR ISAAC
Published: June 2012

In a preceding communication
1
I have suggested that we are now in a position to look more closely at the higher dynamic aspects of cardiac function in our patients. From an analogy with common experience in automobiles, it is reasonable to expect that the first sign of myoeardial weakness will manifest itself in diminished ability to accelerate the blood, that is, in diminished cardiac forces. In this study we aim to establish a clinical method of detecting abnormalities of the initial cardiac forces by means of the ballistocardiogram.
Arachnodactyly Heart
Authors: VAN BUCHEM F. S. P.
Published: June 2012

Arachnodactyly is often associated with cardiovascular lesions. Most frequent are aortic abnormalities but congenital anomalies of the heart may be present. Another cardiac lesion has been found in some cases of arachnodactyly.
Hemodynamic Studies in a Case of Carcinoid Cardiovascular Syndrome
Authors: CHARMS B. L. , KOHN P. , APPLEBAUM H. I. , GELLER J.
Published: June 2012

A case of malignant carcinoid metastatic to the liver with the typical features of the carcinoid cardiovascular syndrome has been presented. Hemodynamic data obtained at cardiac catheterization indicated the presence of tricuspid insufficiency, low cardiac output, and slight pulmonary hypertension. Unilateral pulmonary artery occlusion studies were reported that suggest the absence of intrinsic pulmonary vascular disease in this syndrome. The paradox of infrequent instances of significant pulmonary hypertension in the presence of serotonin in the reported cases of carcinoid cardiovascular syndrome was discussed. The effect of reserpine on pulmonary artery pressure was reported.
Effect of Smoking on the Fasting Blood Sugar and Pressor Amines
Authors: REHDER KAI , ROTH GRACE M.
Published: June 2012

When 24 normal subjects under basal conditions smoked two thirds of 2 cigarettes, there was no appreciable rise in the levels of the fasting blood sugar and the epinephrine-like substances of the systemic venous blood. However, the smoking of two thirds of 2 cigarettes significantly raised the blood pressure and pulse rate, and decreased the skin temperature of fingers and toes.
Effect of Prolonged Use of Estrogens on Circulating Lipids in Patients with Idiopathic Hyperlipemia or Idiopathic Hypercholesteremia
Authors: FELDMAN ELAINE BOSSAK , WANG CHUNI , ADLERSBERG DAVID
Published: June 2012

The low incidence of atherosclerosis in premenopausal women and the effects of gonadal extracts on serum lipids indicate the desirability of further clinical and biochemical studies. Ethinyl estradiol was administered to 12 persons with idiopathic hyperlipemia or idiopathic hypercholesteremia. Medication was given for an average period of 16 months and was well tolerated, despite moderate gynecomastia, diminished libido, or uterine bleeding. The effects on the levels of circulating lipids and the clinical feasibility of this therapy are discussed.
Hemodynamic Sequelae of Sustained Elevation of Left Atrial Pressure
Authors: SELZER ARTHUR
Published: June 2012

A comparison of hemodynamic findings in 63 cases of mitral stenosis and in 35 cases of chronic left ventricular failure is presented. It is shown that circulatory dynamics of the 2 conditions are similar and only minor differences were detected.
Congenital Coronary Arteriovenous Fistula Associated with Large Patent Ductus
Authors: BOSHER LEWIS H. , VASLI SVERRE , MCCUE CAROLYN MOORE , BELTER LESTER F.
Published: June 2012

An unusual case of congenital coronary arteriovenous fistula is reported, bringing the total number of reported cases to 39.

This is the second case in which the left coronary artery system communicated directly with the right atrium, and also the second case associated with a patent ductus.

Our case is well documented by cardiac catheterization data, retrograde aortography, and postmortem findings.

Although surgical correction of both the patent ductus and coronary arteriovenous fistula was accomplished without great difficulty, the patient died 30 hours postoperatively, presumably from the effects of severe pulmonary hypertension.
Takayasu's Disease
Authors: COSMA JOHN , MARUYAMA YOSH , PETTET J. R. , CUTSHALL VINCENT
Published: June 2012

A case of "idiopathic panarteritis" (Takayasu's disease) of the great vessels in a young Japanese woman is reported and the angiocardiographic studies are presented.
Congenital Cardiovascular Anomalies in Twins
Authors: ROSS LUCILLE J.
Published: June 2012

An attempt was made to derive information about the types of mechanisms that can produce congenital cardiovascular anomalies from a study of twins. The presence or absence of a cardiovascular malformation in the twins and in their siblings, and the zygosity of each twin pair were determined.
Chronic Cor Pulmonale in Delhi
Authors: PADMAVATI S. , PATHAK S. N.
Published: June 2012

The incidence of chronic cor pulmonale in Indian states, including Delhi, is the highest reported in nonindustrial populations. The patients presented as acute severe congestive heart failure and at younger ages than those reported. In many cases there was only a short history of respiratory symptoms. Following the first attack of failure, repeated attacks were the rule and death ensued within 2 years. A study is presented of 127 patients of this type in Delhi with clinical and laboratory data and autopsy data of 4 cases. The probable causes of these peculiar features are discussed.
Effect of Mitral Valvulotomy on Tricuspid Insufficiency Associated with Mitral Stenosis
Authors: ANGELINO PIER FEDERICO , BUE BENIAMINO LO , LEVI VALERIA
Published: June 2012

Twenty patients, affected by mitral disease associated with tricuspid insufficiency and selected for mitral commissurotomy on the basis of clinical evidence of advanced heart disease, have been studied before and after surgery. The further course of the disease could be related to various clinical and pathophysiologic conditions, the importance of which in the selection of patients is stressed.
Nucleated Red Blood Cells in Congestive Heart Failure
Authors: FRUMIN ABRAHAM M. , MENDELL THEODORE H. , MINTZ SOLOMON S. , NOVACK PAUL , FAULK ARTHUR T.
Published: June 2012

Five patients with congestive heart failure who had peripheral nucleated red cells are reported and the literature is reviewed.

We believe that bone marrow anoxia is the cause for the premature or abnormal release of nucleated red cells in congestive heart failure.

The presence of nucleated red cells in the peripheral blood of patients with congestive heart failure is suggestive of a poor prognosis.
Effects of Infusion of Acetylcholine on Pulmonary Vascular Resistance in Patients with Pulmonary Hypertension and Congenital Heart Disease
Authors: SHEPHERD JOHN T. , SEMLER HERBERT J. , HELMHOLZ H. FREDERIC , WOOD EARL H.
Published: June 2012

Survival following surgical correction of congenital cardiovascular defects is unlikely if pulmonary hypertension cannot be decreased significantly. Infusions of acetylcholine decreased pulmonary vascular resistance in 6 of 11 patients having pulmonary hypertension associated with atrial or ventricular septal defects. When the acetylcholine was combined with the breathing of oxygen, resistance decreased further. These findings are consistent with the theory that, at some stage, the pulmonary hypertension in cases of congenital heart disease is maintained at least in part by vasoconstriction and therefore is potentially reversible.
The "Tough Case" of Bacterial Endocarditis
Authors: JAWETZ ERNEST
Published: June 2012

Many cases of bacterial endocarditis can now be cured rapidly and easily. However, there remains a group of patients in whom the eradication of the cardiac infection presents great problems. Some principles of treating these "tough cases" of endocarditis are outlined by means of illustrative patients. Stress is placed on early diagnosis, isolation of the etiologic microorganism, determination of bactericidal antibiotics or combinations, and use of the serum bactericidal test to establish an adequate dosage regimen.
Autopsy Studies in Atherosclerosis
Authors: WILKINS ROBERT H. , ROBERTS JAMES C. , MOSES CAMPBELL
Published: June 2012

The incidences of obesity, hypertension, nephrosclerosis, and rheumatic carditis in 500 adult patients were noted at autopsy, and were correlated with the distribution and severity of concomitant atherosclerosis.

In men, obesity uncomplicated by hypertension was associated with a significant increase in the severity of coronary atherosclerosis and the occurrence of cardiac catastrophes. Uncomplicated obesity in women appeared to have no effect upon concomitant atherosclerosis.

Hypertension in men was associated with significantly increased coronary and cerebral atherosclerosis, and with a greater occurrence of myocardial infarction. Hypertensive women had significantly more severe atherosclerosis than normotensive women in most of the arteries studied, and also had significantly more myocardial infarcts.

The atherosclerosis of patients who had nephrosclerosis was similar in distribution and severity to that of patients who had hypertension.

The presence of rheumatic carditis appeared not to influence the extent or severity of concomitant atherosclerosis.
Detection of Pulmonic and Tricuspid Valvular Regurgitation by Means of Indicator Solutions
Authors: COLLINS N. PERRYMAN , BRAUNWALD EUGENE , MORROW ANDREW G.
Published: June 2012

The presence of pulmonic and tricuspid valvular regurgitation may often be suspected from careful clinical examination. However, the validity of the generally accepted clinical criteria remain to be established by technics that permit the direct demonstration of reverse flow across these valves during life. This has been made possible by the detection of cardiogreen and of radioactive krypton (Kr
85
) in the right atrium or right ventricle after injection of these substances into a distal chamber.
Effect of Valsalva Maneuver on Oxygen Saturation in Patients with Intracardiac Shunts
Authors: CARTER STEFAN A. , BIRKHEAD NEWTON C. , WOOD EARL H.
Published: June 2012

Oxygen saturation of arterial and central venous blood was measured continuously during the Valsalva maneuver in patients with and without intracardiac defects. The majority of patients with atrial septal defects and patients with ventricular septal defects and high right ventricular pressure showed a sharp decrease in saturation of radial artery blood shortly after the maneuver. These changes were not recorded accurately by ear oximetry. The patients with shunts uniformly showed a rapid increase in saturation of pulmonary artery blood during the initial period of increased airway pressure. This effect was not observed in patients without shunts. These reactions may be of special diagnostic value under certain circumstances.
Paradoxical Results of Infundibular Resection in Tetralogy of Fallot
Authors: BESTERMAN E. M. M. , O'DONNELL T. V. , SOMERVILLE WALTER
Published: June 2012

The ultimate aim of surgical treatment of Fallot's tetralogy is complete anatomic repair by removal of the obstruction to pulmonary blood flow and closure of the ventricular septal defect. This ideal has been achieved by a small number of surgeons using a pump oxygenator and cardiac arrest. Until it can be realized by all, less complete operations will be performed that will improve the condition without correcting it. Considerable clinical improvement follows infundibular resection by open cardiotomy with or without pulmonary valvotomy. Paradoxically some of these patients may develop a syndrome of heart failure due to the development of a left-to-right shunt through the ventricular septal defect.
Transposition of the Great Vessels with Atrial Septal Defect
Authors: LENKEI SUSAN C. , SWAN H. J. C. , DUSHANE JAMES W.
Published: June 2012

In complete transposition of the great vessels, survival is possible only when a route of access exists by means of which venous blood may enter the lungs. This report concerns 2 patients in relatively good health in whom a high degree of mixing of venous and arterial blood occurred through an atrial septal defect. The diagnosis was established in both patients by cardiac catheterization.
Electrocardiogram of the Healthy Adult Negro
Authors: GREENE CHARLES R. , KELLY JOHN J.
Published: June 2012

The T waves of the precordial electrocardiograms are upright in healthy adult white subjects. On the other hand, several reports have drawn attention to T-wave inversion "juvenile pattern" in adult Negroes free of organic heart disease. This study demonstrated no increased incidence of the "juvenile pattern" in healthy adult Negroes. The standards for normality are identical for both white and Negro. When abnormalities of the T wave are found in Negroes, an explanation other than that of race should be sought.
Aberrant Left Coronary Artery
Authors: COHEN HARVEY , SIEW SHIRLEY
Published: June 2012

A case is reported of the anomalous origin of the left coronary artery from the pulmonary artery in a Bantu male infant aged 9 months. The clinical, radiologic, and electrocardiographic findings, and the cardiac pathology are presented.

The 45 cases previously reported in the literature are reviewed and the clinical syndrome and pathologic physiology of the aberrant left coronary artery are discussed.
Supplemental Value of the Intracavitary Electrocardiograph in Cardiac Catheterization
Authors: DICKERSON ROBERT B. , CARIS TIMOTHY N.
Published: June 2012

Characteristic intracavitary electrocardiographic complexes at various sites within the heart in normal individuals have been described previously. The intracardiac tracings in 150 catheterizations, 129 of which were abnormal hearts, predominantly congenital defects, were studied in relationship to the position within the heart as determined fluoroscopically. In our experience, the tracings remain sufficiently unchanged in abnormal hearts so that the intracavitary electrocardiogram may be used successfully as a guide, making it possible to decrease total x-ray exposure time considerably. In addition, the significance of an intracavitary injury current became apparent. A few diagnostically useful variants were found and are described.
The Kidney in Congestive Heart Failure
Authors: BARGER A. C.
Published: June 2012

As a more detailed picture of the pathogenesis of salt and water retention in congestive heart failure evolves, it appears that increased tubular reabsorption of sodium occurs very early in heart disease, with further enhancement of the fluid accumulation as filtration rate decreases later in the disease process. Increase in sympathetic activity in the kidney can be demonstrated before the development of frank failure, and probably is initiated reflexly by decreased baroreceptor activity, a response that occurs in various types of circulatory insufficiency. Blocking the adrenergic nerves of the kidney produces profound diuresis and natriuresis. Evidence is presented that the pressoreceptors may also play an important role in regulating aldosterone secretion. Thus, the change in body fluids seen in congestive heart failure may be part of the normal reflex adjustments maintaining blood pressure.
A Study of the Cardiac Stigmata in Prolonged Human Thiamine Deficiency
Authors: ROWLANDS DAVID T. , VILTER CARL F.
Published: June 2012

Eight clinically proved cases of prolonged thiamine deficiency were evaluated by routine pathologic study. The microscopic features were evaluated by comparison with sections of myocardium obtained from normal individuals and individuals suffering from cardiac diseases of other varieties. No specific transitory or permanent alterations were demonstrable. It is concluded that beriberi heart disease is largely the result of a reversible biochemical abnormality and is not characterized by specific pathologic lesions.
Chronic Idiopathic Pericardial Effusion
Authors: SCHEUER JAMES
Published: June 2012

Chronic idiopathic pericardial effusion is an unusual condition that causes severe congestive heart failure and may be an early stage in the development of constrictive pericarditis. A case is reported and some other cases from the literature are reviewed in order to present the clinical features and treatment of this condition.
Mitral Stenosis in an Atypical Case of Gargoylism: A Case Report with Pathologic and Histochemical Studies of the Cardiac Tissues
Authors: VANACE PETER W. , FRIEDMAN SIDNEY , WAGNER BERNARD M.
Published: June 2012

Severe alterations of cardiac tissue occur in association with complete and incomplete forms of gargoylism. It is the purpose of this paper to record the clinical, pathologic, and histochemical findings in the cardiovascular system of a child with an atypical form of gargoylism and mitral stenosis.
The Electrocardiogram and Ventricular Gradient in Isolated Congenital Pulmonary Stenosis
Authors: DEPASQUALE NICHOLAS , BURCH G. E.
Published: June 2012

The electrocardiogram and ventricular gradient were studied in 41 patients with isolated congenital pulmonary stenosis. The ventricular gradient was abnormal in 26 of the 41 patients (63 per cent). The Â
QRS
migrated to the right in the frontal plane and Â
T
migrated to the left. Following surgical reduction of the stenosis these vectors rotated rapidly toward the normal position.

The electrocardiographic pattern in isolated congenital pulmonary stenosis tended to be of 4 types that were generally related to the right ventricular systolic pressure. The electrocardiographic changes associated with this defect, in which the work of the right ventricle was increased because of right ventricular hypertension, were different from those associated with atrial septal defect in which right ventricular work was increased because of high volume output. The duration of the QRS complex was not prolonged in the electrocardiograms of patients with pulmonary stenosis, whereas it was characteristically prolonged in those with atrial septal defect.
Arteriosclerosis Obliterans: Review of 520 Cases with Special Reference to Pathogenic and Prognostic Factors
Authors: JUERGENS JOHN L. , BARKER NELSON W. , HINES EDGAR A.
Published: June 2012

The clinical and follow-up data on 520 non-diabetic patients less than 60 years of age who had a clinical diagnosis of arteriosclerosis obliterans of the lower extremities made at the Mayo Clinic in the period 1939 through 1948 were reviewed from the standpoint of pathogenesis, prognosis, and clinical course of the disease. The ratio of males to females was 11 to 1, and the mean concentration of plasma cholesterol in the male patients with arteriosclerosis obliterans was approximately 50 mg. per 100 ml. greater than that of either of 2 control groups of men without clinical evidence of atherosclerosis. The incidence of smoking among the men with this disease was higher than in a comparable group of men without it. Obesity was not commonly associated with arteriosclerosis obliterans, while hypertension was associated with the disease about 3 times as often as in a control group without the disease.

The survival rate for patients with arteriosclerosis obliterans was less favorable than that of a normal population of a similar age and sex distribution, and the survival rate for patients with atherosclerotic aorto-iliac occlusion was significantly less favorable than that of patients with atherosclerotic occlusion of the femoral artery. In approximately three fourths of the patients who died, the cause of death was thought to be disease of the coronary arteries. The presence of atherosclerosis elsewhere than in the arteries supplying the extremities, as manifested by clinical coronary artery or cerebrovascular disease at the time of diagnosis, had an adverse effect on survival.

Four per cent of the patients required amputation of a leg shortly after the diagnosis of arteriosclerosis obliterans was made at the clinic, and an additional 4.9 per cent subsequently required amputation during the 5-year period following the initial examination. Only 3.0 per cent of patients with intermittent claudication as the only symptom of their disease required an amputation during this period. Eleven and three-tenths per cent of patients who continued to smoke, but none who abstained from smoking, had amputations within 5 years.

Since all patients of the series were treated before the advent of direct arterial surgery for segmental arterial occlusion, it is believed that the subsequent course of the disease in these patients may be used as a basis for comparative evaluation of results in patients subjected to direct arterial surgical procedures.
Preparation of Electrocardiographic Data for Analysis by Digital Electronic Computer
Authors: PIPBERGER HUBERT V. , FREIS EDWARD D. , TABACK LEONARD , MASON HENRY L.
Published: June 2012

A pilot facility for automatic processing of electrocardiograms leading to their analysis by digital computer has been described. Wave forms from orthogonal electrocardiographic leads were recorded on magnetic tape. By means of newly designed conversion equipment these records have been converted from their original analog form into digital form. The further processing and analysis of the data thus becomes feasible through the use of commercially available digital electronic computers. It has been demonstrated that the electrocardiographic tracings as recorded from patients can be reproduced from the resulting numerical print-outs in their original and undistorted form. The further analysis of these records then requires only proper programming of a digital computer. The same equipment with minor modifications can be used for automatic processing of other analog data such as phonocardiograms, pulse tracings, and ballistocardiograms.
Serum Lipoproteins in Patients with Intermittent Claudication and Myocardial Infarction
Authors: NESTEL P. J.
Published: June 2012

The serum beta/alpha lipid ratios were estimated by electrophoresis in 4 groups of people. These comprised 44 male patients with intermittent claudication; 61 men who were matched for age with the previous group and who were clinically free of cardiovascular disease; 30 male patients who had recently had a myocardial infarction; and a further group of 30 male controls whose physical activity was limited by factors other than disease.

The highest mean serum beta/alpha lipid ratio was found among the patients with intermittent claudication and was very significantly higher than the ratios found among the other 3 groups. The difference in the ratios between the patients with myocardial infarction and the 2 control groups was not significant.

These differences and in particular the difference in the ratios between the patients with myocardial infarction and intermittent claudication are discussed.
Myocardial Infarction in Patients Treated with Sippy and Other High-Milk Diets
Authors: BRIGGS R. D. , RUBENBERG M. L. , O'NEAL R. M. , THOMAS W. A. , HARTROFT W. S.
Published: June 2012

A study has been made of the incidence of myocardial infarcts among 3 groups of autopsied patients who were matched for age, sex, race, and place and period of death: (1) patients with peptic ulcers who had been treated with a Sippy diet or milk products, (2) patients with peptic ulcers who were not known to have been so treated, (3) a group consisting of non-ulcer patients matched with the other 2 groups.

In the U.S.A. the incidence of myocardial infarcts was more than twice as high in the ulcer patients treated with Sippy diet than it was in either of the other 2 groups. The differences in each case were statistically highly significant. There was no significant difference in the incidence of myocardial infarcts between the ulcer patients not treated with the Sippy diet and the non-ulcer controls.

Differences and similarities of the same degree were noted among corresponding groups from Great Britain. It is tempting to think that the high incidence of myocardial infarcts among the Sippy-treated patients was a result of the butter-fat content of their diets. Mere association, however, does not constitute proof and further study is needed before definitive conclusions are drawn.
Epidemiology of Group-A β-Hemolytic Streptococci as Related to Acute Rheumatic Fever in Miami, Florida
Authors: SASLAW MILTON S. , JABLON JAMES M. , Saul Madelyn , Jenks Sallie Anne
Published: June 2012

Rheumatic fever and rheumatic heart disease are infrequent in Dade County, Florida.

Conversely, β-hemolytic streptococci are recovered frequently, particularly from the throats of children 6 to 9 years old.

The relationship between group-A β-hemolytic streptococci, clinical illness, and rheumatic illness may be different in South Florida from elsewhere in the United States.
Regulation of the Heart's Functions
Authors: RUSHMER ROBERT F.
Published: June 2012

If a regulating system consists of a mechanism for sensing the essential parameters, detecting deviations from a "set" value, and initiating corrective action, then the arterial pressure-regulating mechanism is the only regulating system described for the circulation in any detail. This mechanism appears to be important in maintaining a level of mean arterial pressure within a narrow range. It does not appear, however, to play a dominant role in adjusting the level of the circulation to meet spontaneously changing circulatory demands under many circumstances. During spontaneous activity by intact dogs, an increase in systolic ventricular pressure (and mean arterial pressure) is frequently accompanied by tachycardia as though some other mechanism were overriding the pressoreceptor mechanism. Thus, it appears that the circulatory system as a whole is largely controlled by neural mechanisms, usually initiated by higher levels of the nervous system. Very little is known of the sensory limbs of reflex arcs that can serve to regulate the cardiovascular system as a whole.
Pharmacologic and Chemical Tests as an Aid in the Diagnosis of Pheochromocytoma
Authors: ROTH GRACE M. , FLOCK EUNICE V. , KVALE WALTER F. , WAUGH JOHN M. , OGG JAUNEITA
Published: June 2012

Today pharmacologic and chemical tests are helpful in screening a relatively large number of patients for pheochromocytoma and are a definite aid to a correct diagnosis. No one test is infallible, and knowledge concerning the drugs used or the manner in which the blood and urine are collected, or both, is necessary to avoid a false-positive or false-negative result from the tests.
Ion Exchange Mechanisms in the Nephron
Authors: BERLINER ROBERT W.
Published: June 2012

Accumnulating evidence favors the view that in biologic systems, the active transport of strong electrolytes involves coupled exchanges of ions, usually of sodium for potassium. In the present paper, the author considers the renal exchange of potassium, sodium and hydrogen in this light, and reviews current concepts concerning the mechanisms involved in the secretion of these ions by the kidney. He indicates that new investigative technics will be required to establish that the kidney behaves with respect to coupled ion exchanges as do nerves, red blood cells and frog skin. He concludes by cautioning against extrapolation of experimental results from one species to another.
The Significance of Vertebrate Metamorphosis
Authors: WALD GEORGE
Published: June 2012

It is generally recognized that the anatomical metamorphosis of the vertebrates seems to recapitulate their evolutionary history. However, little attention has been paid to the biochemical changes which precede or accompany the anatomical changes. In the present paper, the author uses the biochemistry of vision as the point of departure for considering the parallel changes in biochemistry, anatomy, and ecology which are involved in vertebrate metamorphosis.
Intracardiac Injection of Radioactive Krypton
Authors: LONG ROBERT T. L. , BRAUNWALD EUGENE , MORROW ANDREW G.
Published: June 2012

Following injection of krypton
85
in solution into the right side of the heart, approximately 95 per cent is cleared during 1 passage through the pulmonary circulation. Arterial blood activity is low when radioactive Kr
85
is injected in the absence of, or distal to, the origin of a right-to-left shunt. However, when injected proximal to the origin of such a shunt, a fraction of the Kr
85
bypasses the pulmonary capillary bed and appears in arterial blood. Thirty to 50 µc. Kr
85
were injected into the right heart, and arterial blood was sampled during the next 15 seconds. In 19 patients without right-to-left shunts, the activity per milliliter of arterial blood was always less than 9.0 x 10
–5
and averaged 2.5 ± 2.6 x 10
–5
of the total radioactivity injected. In 9 patients with proved right-to-left shunts, the radioactivity per milliliter of arterial blood always exceeded 8.2 x 10
–5
and averaged 30.1 ± 12.2 x 10
–5
of the total activity injected. By appropriate rearrangement of the Stewart-Hamilton formula the data permit calculation of the magnitude of the right-to-left shunt.

Following injection into the left heart, proximal to the origin of a left-to-right shunt, Kr
85
promptly arrives in the pulmonary vascular bed and immediately appears in the expired gas, where it may be readily detected. In 22 such patients Kr
85
appeared in the expired gas in an average of 4.0 ± 1.6 seconds. However, after injection distal to the origin of a left-to-right shunt in 18 patients, the appearance of Kr
85
in the expired gas was delayed to a mean of 15.0 ± 5.0 seconds.

The technics described are convenient, simple to apply during cardiac catheterization, and sufficiently sensitive to detect and localize even small cardiac shunts.
Severe Congenital Pulmonic Stenosis without Marked Right Ventricular Hypertension
Authors: VEROSKY JOHN M. , CROSSETT E. S.
Published: June 2012

Obligatory relations exist between orifice size, flow, and pressure gradient across a stenotic pulmonary valve. If the cardiac output is reduced, the patient may have severe stenosis and present only moderate right ventricular hypertension. This situation may be an acute one, which will produce progressive symptomatology, or a chronic one, which, in the growing child, will produce poor physical growth. Catheterization should be done if any of the following is present: severe symptoms, severe right ventricular hypertrophy electrocardiographically, or evidence of reduced cardiac output (such as otherwise unexplainable poor physical growth). Operation is urgently indicated if catheterization reveals either right ventricular systolic hypertension greater than 90 to 100 mm. of mercury or if there is evidence of a very small pulmonary orifice.
Pulmonary Vascular Volume, Resistance, and Compliance in Man
Authors: MILNOR WILLIAM R. , JOSE ANTHONY D. , MCGAFF CHARLES J.
Published: June 2012

Pulmonary blood volume was measured in 19 patients, with use of a dye-dilution method and simultaneous bilateral cardiac catheterization. Pulmonary mean transit time was measured by subtracting left atrial-to-peripheral artery mean transit time from pulmonary artery-to-peripheral artery mean transit time.

Average pulmonary blood volume was 365 ml. per M.
2
(range 126 to 598 ml. per M.
2
). This value is significantly smaller than previous estimates by less direct methods.

The ratio of pulmonary blood volume to mean intravascular pressure was used as an indication of pulmonary vascular compliance. Patients with high pulmonary vascular resistance had relatively low pulmonary vascular compliance.

A significant correlation between pulmonary blood volume and stroke volume was found, lending support to the hypothesis that the volume and elasticity of the pulmonary vascular bed contribute to the regulation of cardiac output.
Successful External Electrical Defibrillation in Acute Myocardial Infarction
Authors: NAST PHILIP R. , PENNYPACKER CHARLES S. , WAGNER JOSEPH A.
Published: June 2012

A patient with an acute myocardial infarction was observed who gave all the appearances of being dead; the electrocardiogram attached at the time showed ventricular fibrillation, which persisted for at least 6 minutes.

Regular sinus rhythm was restored within 2 minutes after external defibrillation with the Zoll-Electrodyne External Defibrillator with use of 60-cycle alternating current at 350 volts every 10 seconds for 3 shocks.

No other similar case that survived has been found in the literature.

The necessity of immediate recognition of ventricular fibrillation in acute myocardial infarction is pointed out in cases of "sudden death."

The preference of external electrical defibrillation over direct heart defibrillation is discussed.
Interarterial Coronary Anastomoses and Coronary Arterial Pattern
Authors: PEPLER W. J. , MEYER B. J.
Published: June 2012

The coronary arterial pattern and coronary anastomoses have been investigated in 90 European and 98 Bantu hearts.

A significantly better coronary anastomotic blood supply has been demonstrated in Bantu hearts. This was found to be present from a very early age onward and not related to hypertrophy, atherosclerosis of the coronary arteries, or to gross anatomic differences of the arterial tree, such as a third primary division of the left coronary artery. The latter was found to be more common (74 per cent) in Bantu than in European hearts (38 per cent).

It is suggested that the reason for the better anastomoses might be the high incidence of megaloblastic and iron-deficiency anemia in Bantu children.

The low incidence of the severe degrees of coronary atherosclerosis and its complications has been reaffirmed in the Bantu hearts.
Auscultatory and Phonocardiographic Assessment of Fallot's Tetralogy
Authors: VOGELPOEL LOUIS , SCHRIRE VELVA
Published: June 2012

A clinical and phonocardiographic study has been made on 62 cases of Fallot's tetralogy in order to determine the value of auscultation and phonocardiography in assessing the severity of the stenosis.

The severity of the tetralogy, as determined by clinical methods, was correlated with the length and loudness of the murmur and other auscultatory signs.

Increasingly severe stenosis was shown to be associated with a shorter, earlier, and softer systolic murmur. In extreme tetralogy, the murmur was invariably soft and very short, being confined to early systole and ending in midsystole. An aortic ejection sound was usually audible and the second sound invariably loud and single. In severe tetralogy, the murmur was usually loud and short, with its crescendo before midsystole and termination before the aortic second sound. A pulmonary component was never audible. In moderate cases, the murmur was loud and longer, with its crescendo at midsystole and termination before or at the aortic second sound, which was never obscured by the murmur. A very soft pulmonary component was only rarely recorded. In mild cases, the murmur was loud and more prolonged with the crescendo in the latter half of systole and extension into, but rarely much beyond, the aortic component. Although at times loud at the aortic component, the murmur totally obscured this sound in only 1 case. A pulmonary component was frequently recorded and often heard; it was extremely soft and localized, but occasionally relatively loud. Splitting was always wide (average 0.09 second). The loud, long murmur reflected good pulmonary flow; the audible or recordable pulmonary component, a relatively normal pulmonary arterial pressure.

Since the length and loudness of the systolic murmur reflect the volume rate of blood ejected through the stenosis, auscultation is believed to be a most valuable method of assessing both the severity of stenosis and fluctuations in blood flow, which may result from changes in systemic resistance and tonus of the infundibulum of the right ventricle. The change in murmur during cyanotic or syncopal attacks has thrown considerable light on the mechanism of such attacks.