bluuebunny/crossref_metadata_2025 huggingface dataset:
Valsalva termination of ventricular tachycardia.
Authors: Waxman M B , Wald R W , Finley J P , Bonet J F , Downar E , Sharma A D
Published: June 2012

Nine patients with recurrent ventricular tachycardia (VT) that could be repeatedly terminated by a Valsalva maneuver are described. In two, the tachycardia would cease for only a few seconds and then resume, whereas in seven, the tachycardia could be permanently and reproducibly terminated with a Valsalva maneuver. In all patients the tachycardia ended during the strain phase of the Valsalva maneuver, when blood pressure and radiographic measurement indicated that cardiac dimensions had been reduced dramatically. The speed with which the Valsalva maneuver terminated VT incresed in direct proportion to the strain pressure. Maneuvers such as standing or nitroglycerin, which independently reduce cardiac dimensions, enhanced the potency of the Valsalva maneuvers. Pretreatment with atropine or propranolol in four patients did not alter the response of VT to the Valsalva maneuver. Thus, it appears that a strong Valsalva maneuver can terminate some forms of VT, most likely related to an abrupt reduction in cardiac dimensions.
Is right bundle branch block aviodable in surgical correction of tetralogy of Fallot?
Authors: Hazan E , Bical O , Bex J P , Dubuis C , Lecompte Y , De Riberolles C , Neveux J Y
Published: June 2012

Right bundle branch block (RBBB) is usually considered almost unaviodable after repair of teralogy of Fallot (TOF). By modifications of the standard technique, its frequency has been decreased to 32% in a series of 1000 consecutive patients. These modifications are: (1) a very short right ventricular incision avoiding the ventriculotomy-induced RBBB pattern; (2) an infundibular resection limited to the septal attachment of the infundibular septum; and (3) closure of the ventricular septal defect with a patch sutured to the very edge of the muscular septum, avoiding injury to the right bundle along the right aspect of the septum. No patient in this series sustained permanent complete atrioventricular heart block. Among patients with RBBB, five had a left anterior hemiblock. Postoperative intraventricular conduction was related to age at operation: The incidence of RBBB was significatively higher in infants. The beneficial effects of a low incidence of postoperative RBBB after repair of TOF are not known.
Marked thrombosis and calcification of porcine heterograft valves.
Authors: Platt M R , Mills L J , Estrera A S , Hillis L D , Buja L M , Willerson J T
Published: June 2012

Prosthetic valvular dysfunction resulting in clinically significant complications occurred in six patients with Hancock porcine heterografts. In one patient with a prosthetic valve in the aortic position, massive prosthetic thrombosis resulted in sudden death. In two patients who had a mitral prosthesis, thrombosis resulted in congestive heart failure and systemic embolization; in one of the latter patients, the thrombi were infected with Candida sp. Calcification of organizing thrombi and cusp tissue resulted in valvular stenosis and congestive heart failure in one patient with an aortic prosthesis and in two patients with mitral prostheses. Four of the six patients died. The prosthetic valves had been in place for 6 months to 3 years before onset of complications. During the same 4-year interval, over 400 porcine prosthese were inserted. This report provides further clarification of the nature and frequency of clinical complications related to degeneration and thrombosis of Hancock porcine heterograft valves.
Paroxysmal hypotension associated with sympathetic withdrawal. A new disorder of autonomic vasomotor regulation.
Authors: Williams R S , Bashore T M
Published: June 2012

We evaluated a patient who had transient episodes of hypotension with clinical and laboratory features apparently distinct from previously recognized disorders of vasomotor regulation. In between his abrupt attacks of hypotension, the patient is asymptomatic and demonstrates normal autonomic modulation of heart rate and blood pressure in response to changes in body position, Valsalva maneuver, cold, and exercise. During periods of hypotension, his plasma norepinephrine falls markedly and he has blunted or absent responses to stimuli that normally have a pressor effect due to sympathetic efferent discharge. Mechanical or known hormonal disorders that produce episodic hypotension have been excluded by extensive testing. We suggest two possible causes for our patient's paroxysmal sympathetic withdrawal: first, a centrally mediated inhibition of sympathetic discharge to peripheral resistance and capacitance vessels, but with no afferent stimulus reflexly producing sympathetic withdrawal readily evident; or second, an episodic release of an unknown endogenous compound with inhibitory effects upon central or preganglionic sympathetic neurons or upon postganglionic sympathetic neurons by a presynaptic inhibition of norepinephrine release.
The "compensatory pause" of atrial fibrillation.
Authors: Pritchett E L , Smith W M , Klein G J , Hammill S C , Gallagher J J
Published: June 2012

A long pause after an abnormal heat during atrial fibrillation has been called a "compensatory pause" and has been used to identify premature ventricular complexes (PVCs) and to differentiate them from supraventricular beats with aberration. The diagnostic value of the compensatory pause is controversial and has not been tested systematically with programmed stimulation and intracardiac recordings. In this study we used these methods to determine if PVCs induced during atrial fibrillation were followed by compensatory pauses. Five patients were studied who had ECGs with a normal PR interval and a normal QRS duration and morphology during sinus rhythm. Atrial fibrillation was induced by rapid atrial pacing. PVCs were induced by coupling a ventricular extrastimulus to every eighth or tenth QRS complex during atrial fibrillation. The coupling interval of the PVC was changed in 10- or 20-msec increments until the entire cardiac cycle was scanned. The mean duration of recorded atrial fibrillation was 15.7 minutes. Fifty-seven to 163 PVCs were induced in each patient. The mean cycle after the induced PVC was calculated and compared with the mean control cycle. The mean cycle after the PVC was 107-136 msec longer than the mean control cycle (p < 0.001 in every patient). This study confirms the presence of a compensatory pause after stimulated PVCs in atrial fibrillation.
New vectorcardiographic criteria for diagnosing right ventricular hypertrophy in mitral stenosis: comparison with electrocardiographic criteria.
Authors: Cowdery C D , Wagner G S , Starr J W , Rogers G , Greenfield J C
Published: June 2012

Frank-lead vectorcardiograms (VCGs) and standard 12-lead electrocardiograms (ECGs) were analyzed to develop simple, linear, quantitative criteria for the diagnosis of right ventricular hypertrophy (RVH). The study subjects included a population with a definite RVH (84 patients with mitral stenosis proved by cardiac catheterization and pulmonary arterial systolic pressure > 40 mm Hg) and a population with minimal likelihood of RVH (173 young, healthy volunteers and 151 normal subjects proved by cardiac catheterization). VCGs were evaluated to identify criteria that provided maximum sensitivity and at least a 95% specificity: the maximum QRS magnitude had to be < 1.8 mV and either (1) the amplitude at -45 degrees (transverse plane) had to be < 0.3 mV or (2) the maximum anterior amplitude plus the maximum rightward amplitude minus the amplitude at -45 degrees must be greater than or equal to 0.5 mV. Application of these criteria achieved 60% (50 of 84) sensitivity in patients with RVH, similar to that for previous VCG criteria but significantly better (p < 0.01) than the best sensitivity with any ECG criteria (27%, 23 of 84). The specificity of the proposed criteria was 96% (310 of 324), significantly better (p < 0.001) than the 78% specificity (252 of 324) of existing VCG criteria. Thus, linear measurements of the QRS complex displayed on the VCG identify 60% of patients with moderate-to-severe RVH and falsely indicate RVH in only 4% of normal subjects.
Possible detection of atherosclerotic coronary calcification by two-dimensional echocardiography.
Authors: Rogers E W , Feigenbaum H , Weyman A E , Godley R W , Johnston K W , Eggleton R C
Published: June 2012

Using two-dimensional echocardiography, a technique was developed for digitizing reflected acoustic signals and performing variable signal processing. This resulted in accentuation of differences in focal reflectivity of target tissues and improved ultrasonic tissue characterization. Study of a learning population of 200 patients demonstrated abnormal specular reflections from the proximal left coronary artery in patients with coronary artery disease. A prospective study of 100 patients was then performed to test the reliability of this method in predicting the presence of significant stenosis. Abnormal echocardiograms were a highly sensitive (94%) but less specific (65%) indicator of significant atherosclerosis of the left coronary symstem. One-third of patients had fluoroscopically identifiable coronary calcification, and 95% had abnormal echocardiograms. We postulate that our echocardiographic findings may be secondary to the presence of small amounts of coronary calcification. Echocardiographic tissue differentiation, therefore, may prove to be a noninvasive means of evaluating patients for coronary atherosclerosis.
Echocardiographic determination of contraction and relaxation measurements of the left ventricular wall in normal subjects and patients with muscular dystrophy.
Authors: Goldberg S J , Feldman L , Reinecke C , Stern L Z , Sahn D J , Allen H D
Published: June 2012

Boys with Duchenne's muscular dystrophy (DMD) usually have a cardiomyopathy characterized by fibrosis of the epicardial half of the left ventricle. This cardiomyopathy is difficult to detect by noninvasive techniques. We report a technique that evaluates incremental left ventricular posterior wall thickening and thinning. High-quality left ventricular posterior wall echoes in 24 boys with DMD and 32 controls were recorded at chordal level two times 1 year apart. Endocardial and epicardial echoes and a timing ECG were digitized and analyzed by minicomputer. Left ventricular wall amplitudes were determined at standardized temporal increments during contraction and relaxation. To compare with this left ventricular assessment technique, systolic ejection times, shortening fraction and mean velocity of circumferenial fiber shortening (Vcf) were also computed in the standard way. Mean year-to-year changes were minor. Mean Vcf, the ratio of preejection period to left ventricular ejection time and shortening fraction during the first year were statistically similar to those of the controls. Shortening fraction decreased slightly during the second year and became significantly different from the control, but remained within the normal range. Left ventricular wall thickness and cavity size were significantly less in boys with DMD than in controls. Therefore, we had to normalize incremental wall thickness to determine if any significant difference occurred. To do this, we evaluated the percentage of maximal wall thickness which occurred at a given percent of systole and diastole. Using this technique, it was shown that thickening during systole was a nearly linear process with respect to time in both groups. However, relaxation was significantly different between the groups. Relaxation was found to be an alinear process, and most thinning occurred in the first 40% of diastole. The major findings of this investigation was that the left ventricular wall of boys with DMD thinned at a slower rate than that of normal subjects. This new technique appears to be sensitive and demonstrates subtle changes in the left ventricular posterior wall.
Noninvasive quantitation of valvular regurgitation by gated equilibrium radionuclide angiography.
Authors: Sorensen S G , O'Rourke R A , Chaudhuri T K
Published: June 2012

R-wave synchronous equilbrium radionuclide angiography (RNA) is a noninvasive method that provides time-activity curve count information proportional to ventricular volumes and is used for relative volume comparisons within the left or right ventricle to derive the ejection fraction. Comparison of the ventricular count output between both ventricles may permit quantitation of the relative amount of valvular regurgitation, i.e., the regurgitant fraction. We performed resting gated RNA in 30 consecutive patients undergoing cardiac catheterization and quantitative contrast ventriculography for aortic or mitral valvular regurgitation. RNA regurgitant fraction correlated well with cardiac catheterization regurgitant fraction (r = 0.85). In 11 patients imaged before and 1-4 months after successful valve replacement, the regurgitant fraction declined from 0.68 +/- 0.11 to -0.09 +/- 0.13 (p < 0.001). In 20 control patients without valvular regurgitation, the calculated regurgitant fraction did not exceed 0.20. We conclude that valvular regurgitation may be accurately detected, quantitative and followed serially after therapeutic intervention using gated RNA.
Mitral cleft in ostium primum atrial septal defect assessed by cross-sectional echocardiography.
Authors: Beppu S , Nimura Y , Sakakibara H , Nagata S , Park Y D , Baba K , Naito Y , Ohta M , Kamiya T , Koyanagi H , Fujita T
Published: June 2012

We attempted to detect mitral deformities in ostium primum atrial septal defect using real-time cross-sectional echocardiography. Transverse sections of the anterior mitral leaflet echo were examined in 11 patients with this malformation who subsequently received surgical treatment. The section for observing the transverse view of te anterior leaflet was along the sagittal plane of the body, because of the deformity of the mitral annulus. Each echocardiographic finding was compared with the surgical and angiographic findings. On the echocardiogram, the superior and inferior parts of the anterior mitral leaflet separated into two parts during diastole in all patients with mitral cleft. Thin linear echoes connected the ridges of the cleft and the ventricular septum in seven patients in whom the accessory chordae at that area were revealed at surgery. The systolic configuration of the anterior leaflet echo varied among the patients. The severity of the miral regurgitation seemed to relate not only to the size of the cleft but also to the systolic configuration of the anterior mitral leaflet. After surgery, diastolic separation of the anterior leaflet echo was no longer observed. However, the abnormal systolic configuration of the anterior leaflet was unchanged.
Ultrastructural evidence of microvascular damage and myocardial cell injury after coronary artery occlusion: which comes first?
Authors: Kloner R A , Rude R E , Carlson N , Maroko P R , DeBoer L W , Braunwald E
Published: June 2012

Both microvascular damage and myocardial cell injury occur after coronary occlusion, but the relationship of these two events is unclear; specifically, it is unknown whether microvascular damage causes myocardial cell injury. Dogs were subjected to coronary occlusion for 20, 40, 60, 90 or 180 minutes, after which subendocardial and subepicardial biopsies were obtained for electron and light microscopy of 1-mu sections. Of 312 biopsies of ischemic myocadium, 181 showed myocardial cell injury with no microvascular damage; 131 showed myocardial cell injury and microvascular damage; but none showed microvascular damage without myocardial cell injury. Although ultrastructural evidence of myocardial cell damage was present in the subendocardium after 20-40 minutes of ischemia, ultrastructural evidence of microvascular damage was not prominent until 60-90 minutes after coronary artery occlusion. Morphologic ultrastructural evidence of microvascular damage lagged behind myocardial cell injury, suggesting that ultrastructural microvascular damage is not a primary cause of ultrastructural myocardial cell injury.
Predictive accuracy of coronary artery calcification and abnormal exercise test for coronary artery disease in asymptomatic men.
Authors: Langou R A , Huang E K , Kelley M J , Cohen L S
Published: June 2012

To determine the predictive accuracy of fluoroscopically detected coronary artery calcification (CAC) and a positive submaximal exercise test, 129 asymptomatic men were screened; 13 had both coronary artery calcification and positive exercise test (greater than or equal to 1.0 mm ST-segment depression). These 13 men were studied at coronary arteriography. They had a mean age of 44 years (range 41-56 years); none had history or symptoms of heat disease and all had normal resting ECGs at entry. CAC was detected in one artery in 10 men, in two arteries in two men, and in three arteries in one man. Coronary artery disease (CAD) was considered clinically significant if any major coronary branch was narrowed > 50%. Coronary arteriography revealed 12 men with clinically significant CAD (one-vessel CAD in four, two-vessel CAD in five and three-vessel CAD in three men) and one man with minor one-vessel CAD. The predictive accuracy was 100% for minor CAD and 92% for clinically significant CAD. The location of CAC and CAD correlated, but the absence of CAC did not rule out the presence of CAD at coronary arteriography. Furthermore, CAC did not indicate the location of the highest stenotic (most occlusive) lesions seen at arteriography. Follow-up for the 13 patients was 36 months; three patients developed typical angina and one patient developed a transmural myocardial infarction. This study suggests that the predictive accuracy of CAC and a positive exercise test in the middle-aged non-hyperlipidemic asymptomatic male is very high (100% for CAD and 92% for clinically significant CAD) and that CAC and a positive exercise test predict an early appearance of angina or myocardial infarction in previously asymptomatic men.
The human sinus node electrogram: a transvenous catheter technique and a comparison of directly measured and indirectly estimated sinoatrial conduction time in adults.
Authors: Reiffel J A , Gang E , Gliklich J , Weiss M B , Davis J C , Patton J N , Bigger J T
Published: June 2012

To improve methods for evaluating human sinus node function (SNF), we developed a transvenous electrode catheter technique for direct recording of sinus node electrograms in adults. Sinus node electrograms (SNE) characterized by low-frequency, anatomically localized pre-P-wave potentials were obtained in 19 of 23 patients. The SNE configuration was similar to that previously found for endocardial SNE recordings in in vitro atrial preparations, in open-chest dogs and during human open heart surgery. In 16 patients with normal SNF, directly recorded sinoatrial conduction times (SACTs) were 46-116 msec. In three patients with sick sinus syndrome, SACT was 110-126 msec. In 15 of the 19 patients, SACT was estimated by the atrial premature stimulus technique and was compared with the directly measured SACT. When atrial premature depolarizations produced no sinus node depression, the mean differences between the direct and estimated SACT was 1.8 +/- 5.6 msec.
Idiopathic hypertrophic subaortic stenosis with split His bundle potentials. Electrophysiologic and pathologic correlations.
Authors: Bharati S , McAnulty J H , Lev M , Rahimtoola S H
Published: June 2012

A 25-year-old white female had idiopathic hypertrophic subaortic stenosis proved by catheterization. The ECG revealed left bundle branch block. Electrophysiologic studies revealed normal PA and AH intervals, but the HB interval was prolonged (70 msec). The width of the His spike was 20 msec. A clear, reproducible split His potential was demonstrated with the atrial extrastimulus technique. Because the patient was symptomatic, a permanent pacemaker was inserted. One week later the patient died suddenly. Autopsy revealed an enlarged heart with a markedly thickened and sigmoid ventricular septum and a small and coarsely trabeculated lumen. Histologically the common bundle was situated on the right side of the septum. It was intact at its origin, but showed fibrotic changes more distally. The beginning of the left bundle branch was markedly disrupted as it traversed the septum. The right bundle was moderately fibrosed. There was excellent correlation between the electrocardiographic and electrophysiologic findings and the findings in the conduction system. The cause of the sudden death was related either to the outflow obstruction or to an arrhythmia, or both.
Intramural Depolarization Potentials in Myocardial Infarction
Authors: PRINZMETAL MYRON , KENNAMER S. REXFORD , SHAW CLINTON MCK. , KIMURA NOBORU , LINDGREN INGA , GOLDMAN ALFRED
Published: June 2012

By means of small intramural electrodes, potentials at multiple depths within the ventricular wall were recorded in myocardial infarction and in normal hearts. In 41 animals with coronary artery occlusion, electrocardiographic and histologic correlations indicated that coronary QS waves may represent negative potentials transmitted from viable intramural muscle as well as from the cavity. Coronary QR waves were obtained over transmural infarcts containing a mixture of viable and dead tissue, but not over purely subendocardial lesions. In the normal ventricle, positive depolarization potentials greatly predominated over negative potentials. Clinical applications are discussed.
Prevention of Plasma Cholesterol Elevation and Atheromatosis in the Cholesterol-Fed Bird by the Administration of Dihydrocholesterol
Authors: SIPERSTEIN M. D. , NICHOLS C. W. , CHAIKOFF I. L.
Published: June 2012

The effect of the addition of dihydrocholesterol to a high cholesterol diet has been studied in the chicken. It is shown that in this species the elevated plasma cholesterol and resulting atherosclerosis can be reduced to normal levels by such a procedure.
Observations on the Carotid Sinus Reflex and Angina Pectoris
Authors: FREEDBERG A. STONE , RISEMAN JOSEPH E. F.
Published: June 2012

The effect of carotid sinus pressure on the duration and character of attacks of angina pectoris induced by exercise under controlled conditions has been studied in 13 patients. Observations are presented which are consistent with the hypothesis that stimulation of the carotid sinus induces relief of cardiac pain by interruption of sympathetic reflex arcs or sensory pathways. The usefulness of carotid sinus pressure as a diagnostic test and a therapeutic measure in angina pectoris is discussed.
The Effect of Exercise on Coronary Blood Flow, Myocardial Oxygen Consumption and Cardiac Efficiency in Man
Authors: LOMBARDO THOMAS A. , ROSE LEONARD , TAESCHLER MAX , TULUY S. , BING R. J.
Published: June 2012

It has been known that exercise causes an increase in the coronary blood flow in animals. The present work has been carried out to study the effect of exercise on coronary blood flow and myocardial oxygen consumption of the human heart in vivo. The results indicate that the heart responds to the increased load of exercise with a rise in coronary blood flow. Since the arteriovenous coronary oxygen difference shows little change, the increase in oxygen consumption of the heart muscle is primarily the result of an increased coronary blood flow. As the cardiac work rises more than the myocardial oxygen consumption, the left ventricular efficiency increases. The response of the failing heart muscle to acute increases in load produced by exercise does not differ from that of the normal heart or of the isolated heart.
The Relation between Retinal and Cerebral Vascular Reactivity in Normal and Arteriosclerotic Subjects
Authors: HICKAM J. B. , SCHIEVE J. F. , WILSON W. P.
Published: June 2012

It has been found that retinal arterial reactivity to oxygen is diminished in persons with retinal arteriosclerosis, and that cerebral blood flow and the increment in cerebral flow upon inhalation of carbon dioxide are diminished in persons with cerebral arteriosclerosis. The present study demonstrates that there is a significant positive correlation between retinal arterial reactivity on the one hand, and cerebral blood flow and reactivity, on the other. This finding is taken to mean that arteriosclerosis severe enough to affect measurements of this sort is apt to involve retinal and cerebral vessels together.
Effect of Neck Compression on Sodium Excretion in Subjects with Congestive Heart Failure
Authors: LOMBARDO THOMAS A. , HARRISON TINSLEY R.
Published: June 2012

Previous studies on normal subjects have shown that neck compression causes increased urinary excretion of sodium in the sitting position, but has little or no effect in the recumbent position. In the present study, patients with congestive heart failure have exhibited no increase in urinary sodium excretion after neck compression.
Studies on the Renal Excretion of Radioactive Digitoxin in Human Subjects with Cardiac Failure
Authors: OKITA G. T. , KELSEY F. E. , TALSO P. J. , SMITH L. B. , GEILING E. M. K.
Published: June 2012

Randomly labeled C
14
-digitoxin was used in a quantitative study of the renal excretion of unchanged digitoxin and its metabolites in three human subjects with cardiac insufficiency. The elimination of approximately 60 to 80 per cent of an administered dose through the kidney suggests that the major route of elimination of digitoxin in cardiac patients is through the urinary route. There is a marked initial excretion of digitoxin during the first two days after administration of the radioactive drug followed by a gradual leveling off of the excretion gradient thereafter. Minute amounts of unchanged digitoxin have been detected in the urine up to the fortieth day after administration of a single dose of the glycoside, while C
14
-labeled compounds were detected up to the seventy-fourth day.
Isolated U Wave Negativity
Authors: PALMER J. H.
Published: June 2012

Inversion of U as the only abnormal electrocardiographic finding is here shown to be the first change to occur in certain cases of hypertension, coronary artery sclerosis, and other organic heart disease. It is also found in association with certain metabolic and electrolyte changes. Its recognition will enhance the value of the electrocardiogram in clinical diagnosis.
Coccidioidal Pericarditis
Authors: LARSON ROGER , SCHERB ROBERT E.
Published: June 2012

In endemic areas where coccidioidomycosis is encountered, pericarditis of an occult etiology warrants a careful search for coccidioidomycosis. A coccidioidin skin test is helpful. The established diagnosis, however, depends upon positive coccidioidal complement fixation and precipitin tests, or recovery of the organism from the sputum or the pericardial fluid.
Alterations of the Lesions of Acute Rheumatic Myocarditis during Cortisone Therapy
Authors: GOLDEN ABNER , HURST JOHN WILLIS
Published: June 2012

The changes in the cardiac lesions of a patient dying with acute rheumatic heart disease treated with cortisone are reported. The findings indicate that the effect of this hormone upon the lesions consists in an inhibition of the inflammatory reaction without demonstrable alteration of the collagen injury.
Ballistocardiography
Authors: RAPPAPORT MAURICE B. , SPRAGUE HOWARD B. , THOMPSON WILLIAM B.
Published: June 2012

A physical analysis is presented of the Starr, Nickerson, and Dock methods for registering the ballistocardiogram. It is shown that many forms of distortion are present. Some of the distortion may be present in the instrumentation which may be controlled, and other forms of distortion are inherent in the subject under test which are most difficult to control or evaluate. The effects which some of the uncontrollable variables have upon the amplitudes and temporal positioning of the registered ballistocardiographic waves is analyzed. The status of static and dynamic standardization procedures is discussed. A "Glossary of Technical Terms" is appended.
Ballistocardiography
Authors: THOMPSON WILLIAM B. , RAPPAPORT MAURICE B. , SPRAGUE HOWARD B.
Published: June 2012

In this study, the normal ballistocardiogram is interrelated with various cardiac events in order to establish the origin of its component waves. It is apparent that the ballistic F, G, H, I, J, K, L, M and N waves bear a definite relationship to known cardiac events, although in some cases the temporal positioning of the complexes is shifted by uncontrollable forms of distortion. When calculated correction factors are introduced, the ballistic waves tend to assume their correct temporal relationship. A composite pictorial sketch is presented which shows the temporal relationships of the phonocardiogram, the apex cardiogram, two commonly observed forms of the normal ballistocardiogram, the electrocardiogram, and the carotid pulse.
Responses of the Ballistocardiogram in Hypertensive Patients to the Acute Administration of Apresoline, Hexamethonium, Veratrone, Regitine and Sodium Amytal
Authors: ROEHM DAN C. , KORY ROSS C. , MENEELY GEORGE R.
Published: June 2012

Acute ballistocardiographic responses to five hypotensive drugs have been evaluated in 15 patients with essential hypertension in conjunction with depressor effects. In the majority of experiments qualitative and quantitative ballistocardiographic improvement paralleled the pressure reductions. On occasion the reverse was true. Inferences were drawn from these reactions based on the pharmacodynamics of the drugs. Because of the fundamental nature of the ballistic record, it is concluded that the capacity of the hypertensive heart to respond ballistocardiographically to a depressor agent permits a useful evaluation of its functional reserve and aids in a more physiologic selection of a hypotensive agent.
Phenolic Compounds in the Treatment of Rheumatic Fever
Authors: CLARKE NORMAN E. , MOSHER ROBERT E.
Published: June 2012

The absorption and excretion of gentisic acid has been studied to help clarify the confusion that exists in the literature. Data are given that support the retarding action of methyl cellulose and Benemid and also the manner in which these compounds are metabolized in the human body. The first metabolic study of the ethanolamide of gentisic acid in human subjects is described. Evidence is presented that the antirheumatic property of certain phenolic compounds may be explained by the phenomena of chelation and the possible existence of a reversible hydroquinone-quinone system in the blood stream.
"Phlebodynia"—A New Epidemic (?) Disease
Authors: PEARSON JOHN S.
Published: June 2012

During the fall and winter of 1950-1951 a group of student nurses was seen with a syndrome, which, to our knowledge, has not been reported previously. The common characteristic of all cases was incapacitating pain and exquisite tenderness along the course of the superficial venous tracts of one or more extremities. Numerous clinical, epidemiologic and laboratory investigations were made without establishing a specific etiologic diagnosis. Several cases are reported in detail to illustrate the condition.
Temporary Hemiplegia from Cerebral Injection of Diodrast during Catheter Aortography
Authors: PEIRCE E. CONVERSE
Published: June 2012

Brain damage manifested by convulsions, hemiplegia, or death may result whenever concentrated Diodrast is injected into the cerebral circulation. Reactions are fairly common following cerebral giography but may follow contrast visualization of the thoracic aorta by any method. The greatest danger is in aortography when the maximum dye concentration is in the aortic arch. The reactions probably do not result from vascular spasm but from an alteration in the blood-brain barrier. It is possible to minimize the danger of reactions in aortography by observing certain simple precautions. Treatment of brain damage when it occurs, however, is not satisfactory.
A Quantitative Metabolic Defect in Lipid Metabolism Associated with Abnormal Serum Lipoproteins in Man
Authors: BIGGS MAX W. , COLMAN DAVID
Published: June 2012

Tritium-labeled cholesterol has been fed to a selected series of patients to demonstrate a quantitative metabolic defect in lipid metabolism in the presence of abnormal serum lipoprotein spectra. Patients with abnormal serum lipoprotein spectra carry a greater fraction of their newly absorbed cholesterol in the esterified form than do normals.
Effects of Posture on Renal Excretion of Sodium and Chloride in Orthostatic Hypotension
Authors: BACHMAN DANIEL M. , YOUMANS WILLIAM B.
Published: June 2012

Large decreases in the rates of sodium excretion, chloride excretion, and glomerular filtration were observed in patients with orthostatic hypotension when they assumed the upright posture following a period of recumbency. When they returned to the recumbent position, sodium excretion typically was not restored immediately in spite of immediate restoration of filtered sodium load. The decreased sodium excretion found to occur in patients with orthostatic hypotension when they are in the upright posture is considered to be due in part to the decreased filtered sodium load and in part to changes in tubular reabsorption that are independent of filtered sodium load.
Alterations in Numbers of Circulating Platelets Following Surgical Operation and Administration of Adrenocorticotropic Hormone
Authors: WARREN RICHARD , LAURIDSEN JAMES , BELKO JOHN S.
Published: June 2012

The factors influencing alterations in circulating platelets following surgical operations are analyzed. There is probably no bone marrow depression following surgery which might be responsible for the early thrombocytopenia, nor is operative hemorrhage sufficient to do so. Evidence procuredfrom administration of adrenocorticotropic hormone suggests that adrenal hyperactivity, a result of the stress of operation, may play an important part in the early postoperative thrombocytopenia. The later thrombocytosis was, however, not observed following administration of this drug.
Effects of Regitine (C-7337) in Patients, Particularly Those with Peripheral Arterial Vascular Disease
Authors: GREEN HAROLD D. , GRIMSLEY WILLIAM T.
Published: June 2012

This is a study of the clinical effects of Regitine, a new antiadrenergic drug, the pharmacologic properties of which are similar to those of Priscoline. Thirty-four patients, whose diagnoses fall into the peripheral vascular disease group and into a miscellaneous group were first given thedrug intravenously and the responses were studied with skin temperature recordings in an attempt to predict the response to therapeutic administration of Regitine. The drug was then given orally for varying periods of time, with subjective and objective evidences of response, as well as side effects being noted. The results of these observations are set forth in the paper.
Studies of the Spatial Vectorcardiogram in Normal Man
Authors: BURCH G. E. , ABILDSKOV J. A. , CRONVICH J. A.
Published: June 2012

The spatial vectorcardiograms of 75 normal subjects have been studied and some features of these records are described. The QRS sÊ and T sÊ-loops were found to have only two basic spatial configurations but with a variety of orientations thus giving widely different planar projections and in part accounting for the wide range of normal electrocardiograms. The significance of this and other findings is discussed and certain concepts pertinent to the study of the vectorcardiogram are presented.
The Spatial QRS Loop in Right Ventricular Hypertrophy with Special Reference to the Initial Component
Authors: FOWLER NOBLE O. , HELM ROBERT A.
Published: June 2012

Spatial vectorcardiograms were recorded from 18 subjects with normal electrocardiograms and from 14 subjects with electrocardiograms indicative of right ventricular hypertrophy. In the latter group there was a significant incidence of deviation of the initial portion of the QRS loop from the normal direction of inscription, suggesting that activation of the interventricular septum oftenproceeds in an abnormal manner in right ventricular hypertrophy. A statistically significant difference in the direction of rotation of the entire QRS loop in the transverse and sagittal planes was noted in the two groups. The relationship between the direction of inscription of the QRS loop in the transverse plane and the timing of the intrinsicoid deflections of precordial leads is discussed.
The Heparin-Like Action of Treburon in Abolishing Alimentary Lipemia in Normal Individuals
Authors: ACKERMAN ROBERT F. , ZILVERSMIT D. B.
Published: June 2012

The effectiveness of Treburon in clearing alimentary lipemia in young adults has been studied. It is shown that the optical density of plasma at 650 mµ is a satisfactory measure of "physical" lipemia. A significant difference was noted in the extent of alimentary lipemia of young malesand females.
Electrophoretic and Ultracentrifugal Analysis of Serum Lipoproteins of Normal, Nephrotic and Hypertensive Persons
Authors: LEWIS LENA A. , PAGE IRVINE H.
Published: June 2012

Using a method of ultracentrifugation which brings out clearly the α and β lipoprotein components of serum, studies of normal, hypertensive and nephrotic human beings have been made. There are striking differences in distribution of lipoproteins among the different ages and sexes. During the stages of active atherogenesis in hypertensives and nephrotics, both the α and β lipoproteins and the lighter, higher molecular weight aggregates contribute importantly to the superabundance of plasma lipoproteins. The attribution of an exclusive atherogenesis to any one plasma fraction does not seem to us justified by these or other studies.
Cardiac Output, Central Volume and Dye Injection Curves in Traumatic Arteriovenous Fistulas in Man
Authors: SCHREINER GEORGE E. , FREINKEL NORBERT , ATHENS JOHN W. , STONE WILLIAM
Published: June 2012

Although arteriovenous fistulas are frequent in wartime, few measurements of cardiac output have been carried out by direct methods. Analysis of the curve obtained after rapid injection of T-1824 shows the feasibility of this method in patients with arteriovenous fistulas. Such patients have elevated cardiac indices, enlarged central blood volumes and acceleration of peak and manifest recirculation times. The abnormalities are corrected by surgery. Diagnostic use of the dye curve is suggested.
Studies of the Cerebral Circulation and Metabolism in Congestive Heart Failure
Authors: NOVACK PAUL , GOLUBOFF BERNARD , BORTIN LEONARD , SOFFE ALVIN , SHENKIN HENRY A. , BATSON PETER , GOLDEN DORIS
Published: June 2012

In a study of the cerebral circulation and metabolism in congestive heart failure, using Kety's nitrous oxide technic, it was found that no significant alterations of the cerebral circulation were present when the quantities measured were compared with values determined for a control group. A decrease in cerebral blood flow and oxygen consumption below values established for normal young individuals was demonstrated to be secondary to the presence of arteriosclerosis and not to cardiac decompensation as had previously been concluded. It was also found that in the series studied the increased venous and cerebrospinal fluid pressures were not of sufficient magnitude to affect the cerebral circulation. The factor of a decreased arterial carbon dioxide tension as a cause for diminished cerebral blood flow in cardiac decompensation was similarly considered and dismissed.
Correlation of Ballistocardiogram with Work Performance and Energy Cost for Guidance in Rehabilitation of Cardiac Patients
Authors: BROWN HENRY , RINZLER SEYMOUR H. , BENTON JOSEPH G.
Published: June 2012

Correlative studies of the resting ballistocardiogram and the ability to expend energy in cardiac patients indicate that the resting ballistocardiogram may be a useful tool in evaluating the functional or work capacity of a cardiac patient for rehabilitation purposes and vocational guidance, and may serve as a screening device for finding those cardiacs, other things being equal, who possess the functional capacity to perform jobs or activities whose energy requirements are known or can be estimated. However, in view of the relatively higher incidence of abnormal resting ballistocardiograms in the older age groups, for practical purposes, this usefulness of the ballistocardiogram may be limited to the cardiac patient under the age of 50.
Atrial Septal Defects in Children
Authors: LIND JOHN , WEGELIUS CARL
Published: June 2012

Atrial septal defects in children have been examined with an angiocardiographic technic which permits conclusions concerning the dynamics of the heart. This method combines direct synchronous biplane photography at a speed of 10 to 12 pictures per second with simultaneous electrocardiograms.
Transposition of the Great Vessels
Authors: KEITH JOHN D. , NEILL C. A. , VLAD PETER , ROWE R. D. , CHUTE A. L.
Published: June 2012

The vast majority of cases of transposition of the great vessels can be diagnosed in the first few weeks of life with electrocardiogram, x-ray and fluoroscope. The clinical pattern and the diagnostic features are described in detail. The degree of cyanosis, the characteristic heart shape and progressive increase in size coupled with generous hilar shadows all suggest this diagnosis. A new suggestion is made regarding possible surgical therapy using an extracorporeal circulation.
The Relationship between the Anatomic Position of the Heart and the Electrocardiogram
Authors: GRANT ROBERT P.
Published: June 2012

Using a method for identifying precisely the lie of the ventricular structures in the body at autopsy, the anatomic position of the heart was compared with the directions of the QRS electrical forces in a large number of subjects with and without heart disease. While the mean QRS axis varied through 180 degrees in these subjects, the anatomic position of the left ventricle varied less than 45 degrees. No instances of significant rotation of the heart around its long axis were encountered, and it is shown that the unipolar electrocardiographic criteria for position and rotation of the heart have little validity. An explanation for the axis deviations of ventricular hypertrophy is offered.
The Electrocardiographic Efects of Intravenous Veratrum Viride
Authors: ELEK STEPHEN R. , MCNAIR J. DOUGLAS , GRIFFITH GEORGE C.
Published: June 2012

Previously unnoted T-wave inversions in the precordial leads resulting from the intravenous injection of veratrum viride are described. Evidence is presented that these changes are not caused either by the hypotensive action of the drug or by myocardial anoxia or by hypopotassemia. The T-wave inversions probably. result from vagal stimulation which cause altered ventricular repolarization.
The Right Auricular Electrokymogram of Normal Subjects
Authors: BOOTH EARNEST , WILLIS KATHRYN , REEVES T. J. , HARRISON T. R.
Published: June 2012

The numerous waves of the right auricular electrokymograms of normal subjects are interpreted on the basis of simultaneously recorded electrocardiograms, and jugular and carotid pulse tracings. The factors responsible for shape as well as volume changes of the auricles are discussed. Auricular contractions in patients with heart block are included to illustrate the isolated dynamic auricular movements.
Studies Made by Simulating Systole at Necropsy
Authors: STARR ISAAC , SCHNABEL T. G. , MAYOCK R. L.
Published: June 2012

This paper describes results obtained during the last three years with special emphasis on those secured since the development of the technic which permits us to employ compatible blood as perfusion fluid. Using the method of paired experiments, data have been obtained on the effects on the pulse wave and the ballistocardiogram which follow changes in the total energy of the simulated systole, changes in the way that energy is applied during the systole, changes in resistance as measured by diastolic pressure, and differences in the amount of arteriosclerosis present in various subjects.
The Effect of a Threshold Electrical Stimulus upon the Repolarization Process of the Left Ventricle of the Intact Dog Heart
Authors: NAHUM L. H. , LEVINE H. , GELLER H. , SIKAND R.
Published: June 2012

A threshold stimulus applied either at apex or base of the intact dog ventricle at any depth of the myocardium produces a delay in repolarization during the following three to four normal beats, in an area equivalent to the size of the proximal zone of the precordial lead. This change in repolarization is not caused by postextrasystolic distension of the ventricle. The question is discussed whether a threshold stimulus initiates a propagated disturbance from the point of the electrodes or the larger area whose repolarization is altered.
A New Index for Quantitative Ballistocardiography: The Velocity of Body Displacement
Authors: MASINI VINCENZO , ROSSI PAOLO
Published: June 2012

Calculation of the velocity of body displacement and of the momentum of the body from 100 normal ballistic tracings shows that the values of the velocity of body displacement present a small scatter (mean value 68.3 ± 13.9 mm. per second) and are independent of body weight and surface area. For uniformity of values and simplicity of calculation, which can be effected also on many abnormal tracings, it is suggested that the velocity of body displacement be used as an index of quantitative ballistocardiography.
Mitral Commissurotomy in the Older Aged Patient
Authors: JANTON O. HENRY , GLOVER ROBERT P. , O'NEILL THOMAS J. E.
Published: June 2012

An analysis of 20 consecutive cases of mitral stenosis (from a total of 400 cases) in patients between the ages of 50 and 61 treated by mitral commissurotomy from May 1951, to October 1952, is presented. The data suggests that the patient over 50 with symptomatic mitral stenosis can have a functionally satisfactory commissurotomy performed without undue operative risk and with essentially the same ultimate degree of improvement enjoyed by patients requiring treatment at an earlier age.
Rheumatic "Activity" as Judged by the Presence of Aschoff Bodies in Auricular Appendages of Patients with Mitral Stenosis
Authors: MCNEELY WILLIAM F. , ELLIS LAURENCE B. , HARKEN DWIGHT E.
Published: June 2012

Clinical data have been correlated with heart muscle biopsy findings in 183 patients undergoing operation for mitral stenosis. It was not possible to relate the finding of Aschoff lesions to the usual clinical or laboratory evidences of rheumatic carditis, although older patients and those exhibiting auricular fibrillation were least likely to be histologically "active." The possible significance of these findings is discussed.
Studies of Quantitative Ballistocardiography
Authors: MASINI VINCENZO , ROSSI PAOLO
Published: June 2012

The speed of body displacement was calculated on 70 per cent of the ballistocardiograms recorded in 128 patients suffering from heart disease. Results show that the values are generally lower in cardliac patients than in normal subjects, with the exception of cases with high stroke volume. The diminution of the speed of body displacement is proportional to the severity of ballistic abnormalities and to the functional state of the heart. A tentative explanation of the findings is presented.
The Electrocardiogram of a Beluga Whale
Authors: KING ROBERT L. , JENKS JAMES L. , WHITE PAUL D.
Published: June 2012

In the course of our study of the comparative anatomy and physiology of the mammalian heart, it became necessary to develop a technic to obtain the electrocardiogram of the largest mammal of all. Because of its availability, the small white Beluga whale in northern waters was the first object of this research, prior to obtaining the record of a large whale, which is our ultimate aim. This article describes the process of obtaining the electrocardiogram and presents the electrocardiogram itself.