bluuebunny/crossref_metadata_2025 huggingface dataset:
A clinical study of left ventricular relaxation.
Authors: Hirota Y
Published: June 2012

Left ventricular (LV) relaxation was studied in patients with hypertrophic cardiomyopathy (HCM, n =18), congestive cardiomyopathy (CCM, n = 11), hypertensive heart disease (HHD, n = 8), coronary artery disease (CAD) without left ventricular (LV) asynergy (n = 9) and with LV asynergy (n =17), mitral stenosis (MS, n = 16), and mitral regurgitation (MR, n = 8). The time constant T and peak negative dP/dt were used as indexes of LV relaxation, and 18 normal subjects served as controls. The time constant T was higher in elderly patients among normal contros (r = 0.652, p < 0.01), which suggests that prolongation of relaxation is a phenomenon of aging. The normal value of the time constant T was 33 +/- 8 msec (mean +/- SD), and that of peak negative dp/dt was 1864 +/- 390 mm Hg/sec. The time constant T was significantly higher in HCM (64 +/- 20 msec), CCM (56 +/- 14 msec), CAD without asynergy (53 +/- 16 msec), CAD with asynergy (57 +/- 13 msec) and MS (47 +/- 12 msec). Peak negative dP/dt was significantly lower in HCM (998 +/- 303 mm Hg/sec), CCM (1060 +/- 334 mm Hg/sec), CAD with asynergy (1370 +/- 299 mm Hg/sec), MS (1367 +/- 313 mm Hg/sec) and MR (1139 +/- 305 mm Hg/sec). Although the genesis of LV relaxation abnormality is not clear from this investigation, it seems to have multiple causes. Relaxation abnormality seems to be one of the earliest manifestations of mechanical dysfunction of the human left ventricle.
Evaluation of left coronary artery anatomy in vitro by cross-sectional echocardiography.
Authors: Rogers E W , Feigenbaum H , Weyman A E , Godley R W , Vakili S T
Published: June 2012

This study was undertaken to provide a better anatomic description of the location and course of the left coronary artery within a commonly used ultrasonic tomographic plane. Twenty-three hearts were excised at autopsy and scanned in vitro. The locations of the left main (LMCA), left anterior descending (LAD), and left circumflex (LCCA) coronary arteries were confirmed by direct cannulation, by Cardio-Green injection, and by subsequent dissection. While the proximal LMCA was recorded in all specimens, the entire LMCA was visible in only 70%. Proximal portions of the LAD and LCCA were also identifiable in 70% of examinations, and their spatial positions were defined. In most recordings, the first branch of the LAD OR LCCA arose distal to the segment seen echocardiographically. The spatial orientation of the ultrasonic beam relative to the LAD and LCCA and the presence of other overlying cardiac structures limit the imaging of these vessels by cross-sectional echocardiography to only their most proximal portions.
Development of the ductus arteriosus in right ventricular outflow tract obstruction.
Authors: Santos M A , Moll J N , Drumond C , Araujo W B , Romao N , Reis N B
Published: June 2012

We studied the morphology of the ductus arteriosus in 14 infants, ages 2--90 days. Eight (group 1) had pulmonary atresia (structural and functional) with an intact interventricular septum; six (group 2) had pulmonary atresia with a ventricular septal defect. The inferior angle of the ductus arteriosus at the aortic junction was measured in each patient. In group 1, this angle was obtuse in all but one patient. In group 2, the angle was acute in all. Further study of intracardiac anatomy suggested that in group 1, the obtuse inferior angle of the ductus arteriosus was the result of a late and progressive obstructive phenomenon that allowed normal right-to-left flow through the ductus arteriosus during much of fetal life. In group 2, the direction of ductus arteriosus flow (normally from the pulmonary trunk to the aorta) was reversed, and flowed from the aorta to the pulmonary trunk. This reversal of flow was probably of early onset in the fetus, the aorta receiving the total combined ventricular output, and produced a small ductus arteriosus with an acute inferior angle. It is extremely important not to rule out pulmonary atresia with an intact interventricular septum when aortography in the newborn shows a normal-sized ductus arteriosus with an obtuse inferior angle. Despite existing pulmonary atresia, these patients have neither a hypoplastic right ventricle nor discontinuity of the right ventricle with the pulmonary artery.
The anatomic substrate for preexcitation in corrected transposition.
Authors: Bharati S , Rosen K , Steinfield L , Miller R A , Lev M
Published: June 2012

We report three cases of corrected transposition (CT), all with Ebstein's disease, ventricular septal defect (VSD) and ventricular preexcitation. In cases 1 and 2, the ECG revealed sinus rhythm, with type A fusion preexcitation QRS complexes, suggesting left-sided Kent bundles and intact conduction system (CS). Complete serial section (SS) of the CS in both cases revealed an anterior CS and a Kent bundle in the posteroseptal wall of the morphologic right ventricle (MRV). Case 3 had intermittent preexcitation, with periods of complete atrioventricular (AV) block with narrow QRS escape rhythm. The preexcitation complexes suggested the presence of a left lateral Kent bundle. SS of the CS revealed a blind posterior and two anterior AV nodes, one on either side of the pulmonary trunk. The left anterior AV node was blind. The right anterior node formed the anterior bundle, which ended blindly. This bundle emerged again and joined a posterior bundle to form an interrupted sling around the closed VSD. In addition, there was a tenous Kent bundle at the posterolateral wall of the MRV. In summary: (1) preexcitation in CT with Ebstein's disease of the left AV valve is associated with Kent bundles; (2) fusion complexes reflected intact CS; and (3) intermittent preexcitation with AV block was associated with the presence of tenuous Kent bundl and discontinuity of the CS.
Developmental progress after cardiac surgery in infancy using hypothermia and circulatory arrest.
Authors: Clarkson P M , MacArthur B A , Barratt-Boyes B G , Whitlock R M , Neutze J M
Published: June 2012

Seventy-two of 76 long-term survivors who had surgical repair of congenital heart lesions at 11 days to 26 months of age using profound hypothermia and circulatory arrest underwent psychometric testing (Stanford-Binet) late postoperatively. The mean IQ of the 72 patients was 92.9 +r16.5 (SD). Stanford-Binet scores bore no relationship to the duration of circulatory arrest or other aspects of surgical technique. Scores were significantly lower in those who had a low birth weight for gestational age, important neurologic problems preoperatively or were in the lower socioeconomic classes. An "ideal" control group of 69 children randomly selected from patients satisfying certain criteria based on birth and neonatal characteristics had a mean IQ of 106.2 +r11.6. Twenty-five patients who had surgical treatment of cogenital heart disease met the criteria for the control group except for their heart lesions. Their mean IQ was 101.4 +r15.0(NS). We could not demonstrate any significant deleterious effect that could be attributed to the surgical methods. Rather, the postoperative IQ scores reflected characteristics related to individual patients.
Diagnostic criteria for acute myocardial infarction in patients undergoing coronary artery bypass surgery.
Authors: Raabe D S , Morise A , Sbarbaro J A , Gundel W D
Published: June 2012

Current techniques for diagnosing perioperative myocardial infarction were studied in 58 patients who underwent coronary bypass surgery. All patients had preoperative and postoperative ECGs and technetium-99m stannous pyrophosphate myocardial scintigrams; serum CK-MB was measured immediately after surgery and daily for 3 days. Postoperative bypass graft visualization and left ventriculography were performed before hospital discharge in every patient. Nine patients (16%) had new Q waves postoperatively. Five of these nine patients had positive pyrophosphate scintigrams, postive CK-MB and new wall motion abnormalities, and the remaining four had negative CK-MB, negative phyrophosphate scintigrams and no new wall motion abnormalities. Seven patients (12%) had newly positive postoperative pyrophosphate scintigrams, positive CK-MB and new wall motion abnormalities on postoperative ventriculography, but only four had new Q waves postoperatively. Eight patients (14%) had new wall motion abnormalities; seven had positive pyrophosphate scintigrams and all had positive CK-MB, but only five had new Q waves. Sixteen patients (28%) had positive CK-MB, including all patients with either positive pyrophosphate scintigrams or new wall motion abnormalities, Eight patients had positive CK-MB without other evidence of perioperative infarction. A newly positive postoperative pyrophosphate scintigram is more senstive and specific than the development of new postoperative Q waves for the diagnosis of hemodynamically significatn perioperative myocardial in farction. CK-MB is highly sensitive, but too nonspecific to be useful for the diagnosis of perioperative infarction.
Effects of respiration and posture on paroxysmal supraventricular tachycardia.
Authors: Waxman M B , Bonet J F , Finley J P , Wald R W
Published: June 2012

The capacity of deep inspiration and the dependent body position to terminate episodes of tachycardia was studied in 11 patients with recurrent paroxysmal supraventricular tachycardia (PSVT). In eight patients, a deep inspiration and a dependent position repeatedly terminated episodes of PSVT. Reasons for failure were found in the other three patients. A deep inspiration or assumption of a dependent position dramatically raised arterial blood pressure and terminated episodes of PSVT by reflexly increasing vagal drive. The magnitude of the rise in blood pressure was directly proportional to the depth of the inspired volume and to the extent of body dependency. The upright position attenuated the respiratory-induced increase in blood pressure and blocked PSVT termination. Likewise, vagal blockade with atropine did not affect the effects of respiration or dependent position on blood pressure but prevented termination of PSVT.
Effect of atenolol on left ventricular function in hypertensive patients.
Authors: Ibrahim M M , Madkour M A , Mossallam R
Published: June 2012

No information is available about the effects of oral atenolol, a cardioselective beta-adrenergic blocking agent with no intrinsic sympathomimetic activity, on left ventricular function. Atenolol, 100 mg/day, was given to 12 hypertensive patients for 8 weeks, and its effects on mean arterial pressure (MAP), cardiac index (CI) and ejection indexes of myocardial performance were examined by echocardiography. Echocardiographic studies were performed before treatment, after 4 weeks of placebo, and repeated after 4 and 8 weeks of atenolol therapy. MAP fell by 14% and 21% after 4 and 8 weeks, respectively. CI fell by 22% and 20% and stroke index (SI) fell by 11% and 7%. Calculated peripheral resistance did not change significantly. Fractional shortening, ejection fraction and normalized mean rate of circumferential fiber shortening did not change. The normalized mean posterior wall velocity decreased after 4 weeks but returned to pretreatment levels after 8 weeks. The septal velocity increased after 8 weeks. End-diastolic volume index (EDVI) did not change, and there was no relationship between changes in heart rate and EDVI. The study shows that atenolol in the resting state has no effect on certain echocardiographic indexes of left ventricular (LV) function when given orally to hypertensive patients with normal LV size and function. The reduction in CI and SI were presumably secondary to a decrease in cardiac venous filling.
Echocardiographic measurements in normal subjects from infancy to old age.
Authors: Henry W L , Gardin J M , Ware J H
Published: June 2012

Echocardiographic data from 92 younger normal subjects (1 month to 23 years of age) and 136 older normal subjects (20-97 years of age) were pooled and analyzed to obtain prediction equations for normal echocardiographic values. Using a bivariate regression model with the assumption that variability is constant as a percentage of the expected value, we developed regression equation and graphs that allow calculation of a 95% prediction interval for several echocardiographic measurements as a function of the subject's age and either body weight or body surface area. Body weight could be substituted for body surface area with no loss of precision. Further, examination of residuals showed that the linear prediction model fit well for all ages and all echocardiographic measurements studied. The measurements were obtained using the recently published standards recommended by the American Society of Echocardiography.
Dicrotic pulse after open heart surgery.
Authors: Orchard R C , Craige E
Published: June 2012

Pre- and postoperative echophonocardiograms (EPCGs) and preoperative hemodynamic data of 108 patients who underwent valve replacement were reviewed to establish the frequency and significance of a dicrotic pulse (DP) postoperatively. DP occurred almost exclusively in patients who underwent valve replacement for regurgitant lesions (20 of 28 with aortic regurgitation, nine of 25 with mitral regurgitation, and four of six with both aortic and mitral regurgitation). These patients were divided into dicrotic and nondicrotic groups. Preoperatively, the dicrotic group had significantly larger end-diastolic volumes (p < 0.01) and end-systolic volumes (p < 0.01) and significantly lower ejection fractions (p < 0.01). Echocardiographically, the dicrotic group had larger left ventricular dimensions, both systolic (p < 0.01) and diastolic (p < 0.05), reduced percentage fractional shortening of the left ventricular cavity (p < 0.01) and poor thickening properties of the left ventricular posterior wall (% delta Th-LVPW) (p < 0.01). Postoperatively the dicrotic group had a slightly larger end-diastolic dimension (p = NS) and markedly depressed % delta Th-LVPW (p < 0.001) compared with the nondicrotic group. On follow-up EPCG the persistence of a DP correlated with continued left ventricular dysfunction by echocardiographic and hemodynamic studies and an extremely poor clinical course. DP after valve replacement is therefore an important prognostic sign.
The angiographic effect of ergonovine and nifedipine in coronary artery spasm.
Authors: Rich S , Ford L E , Al-Sadir J
Published: June 2012

In a patient with variant angina, we have shown that the calcium-channel blocker nifedipine inhibits both spontaneous and ergonivine-induced coronary artery spasm. It had no effect, however, on the dose-related diffuse vasoconstriction caused by ergonovine, suggesting two distinct responses of coronary arteries to ergonovine provocation. Nifedipine did not cause epicardial coronary artery dilatation, as did nitroglycerin, supporting the rationale of using both therapies together to treat coronary artery spasm.
Internal mammary artery-to-pulmonary artery fistulas. Case report and review of the literature.
Authors: Hearne S F , Burbank M K
Published: June 2012

A case of internal mammary artery-to-pulmonary artery fistula is presented, and all previously reported cases are reviewed. This represents a rare cause of a continuous precordial murmur that may be confused clinically with a patent ductus arteriosus. Patients are usually asymptomatic, and routine diagnostic tests may be of little help in establishing a diagnosis. Selective internal mammary angiography is the procedure of choice for confirmation and localization. The question of advisability of surgery for these patients remains unanswered.
Transient QRS changes simulating acute myocardial infarction.
Authors: Hassett M A , Williams R R , Wagner G S
Published: June 2012

The purpose of this study was to determine the characteristics and incidence of abrupt occurrence of abnormal initial QRS forces that cannot be explained by acute myocardial infarction or left or right ventricular overload. Computerized data from 3175 patients with suspected acute infarction were reviewed to identify those in whom the ECGs revealed QRS complexes considered to be diagnostic (Q wave or markedly diminished R wave) in the presence of persistently normal profiles of both creatine kinase and lactic dehydrogenase isoenzymes. Lead misplacement had been minimized by obtaining multispace tracings and vectorcardiograms. Eight patients (0.25%) were identified. The abnormal forces were confined to leads V 1-3 in six, V 4-6 in one, and involved all precordial leads in the last. These QRS changes resolved completely within 6 days in all eight patients, which suggests that they did not have an acute infarction. This theory was supported by postmortem examination in one patient. An extremely low incidence (0.25%) has been documented for a syndrome characterized by transient loss of initial anterior forces with persistently normal isoenzyme profiles. Although no etiology could be determined, a transient conduction block of the septal fascicle of the left bundle could have been the cause in seven of the eight patients.
Sustained ventricular tachycardia in recent canine myocardial infarction.
Authors: Garan H , Fallon J T , Ruskin J N
Published: June 2012

To study recurrent ventricular tachycardia in the late phase or myocardial infarction (MI), transmural anteroapical infarcts were created by ligation of the left anterior descending (LAD) coronary artery in 25 dogs. Twenty dogs survived LAD ligation and underwent an open-chest electrophysiologic study an average of 20 days after MI. Programmed electrical stimulation was carried out using the extrastimulus technique and short bursts of rapid ventricular pacing via bipolar electrodes positioned at multiple left ventricular endocardial sites. Sixteen dogs had electrically induced ventricular tachycardia, and in 11, sustained ventricular tachycardia was reproducibly initiated and terminated by programmed ventricular stimulation. Short bursts of rapid left ventricular pacing from areas in periinfarct zone was the most effective technique for initiating ventricular tachycardia. The electrophysiologic phenomena in this model of sustained ventricular tachycardia in 3-week-old MI included electrically induced changes in rate and morphology and biventricular capture without termination during tachycardia.
Nonclinical polymorphic ventricular tachycardia induced by programmed cardiac stimulation: incidence, mechanisms and clinical significance.
Authors: Reddy C P , Sartini J C
Published: June 2012

We analyzed the morphology and rate of ventricular tachycardia induced by programmed cardiac stimulation in 18 patients with recurrent sustained ventricular tachycardia who had only one type of ventricular tachycardia during spontaneous episodes. In nine of 18 patients, we induced only one type of ventricular tachycardia, with a morphology and rate similar to those noted during spontaneous ventricular tachycardia. In the other nine patients, the induced ventricular tachycardia was either different from spontaneous ventricular tachycardia (two patients) or was polymorphic (seven patients). The multiple morphologies were induced in addition to those similar to spontaneous ventricular tachycardia. Seven of these nine patients had ischemic heart disease. Only one patient had a left ventricular aneurysm. The morphology and rate of induced tachycardia could be changed by changing the basic cycle length (two patients), the method of initiation of tachycardia (one patient), and by introducing paced ventricular beats during tachycardia (four patients). Our data suggest that ventricular tachycardia induced by programmed cardiac stimulation is nonclinical in 50% of patients with recurrent ventricular tachycardia. The clinical course and prognosis of patients with polymorphic ventricular tachycardia compared with those without polymorphic tachycardia are not known.
Early heart failure as a cause of growth and tissue disorders in children with congenital heart disease.
Authors: Baum D , Beck R , Kodama A , Brown B
Published: June 2012

Height, weight, total body fat, lean body mass, size of fat cells and total number of lipid-containing fat cells were compared in two groups of children, ages 2-6 years, with congenital heart disease. Twelve children who developed heart failure in infancy made up one group and 14 asymptomatic patients made up the other. No patient was cyanotic or had undergone surgical repair. Patients with heart failure were shorter and lighter than asymptomatic patients. Whereas both fat and lean tissues were less in the heart failure group, reduction in body fat was more important in producing underweight. Although there was no difference in the size of fat cells, the number of lipid-laden fat cells was diminished in the children who had early heart failure. Thus hypocellularity of fat cells appeared to be the major determinant of diminished body fat with heart failure. Because shortness and decreased lean tissue were associated with these adipose tissue abnormalities, it is likely that widespread changes are caused by early heart failure. As previously reported with hypoxemia, the early development of heart failure seems to produce tissue changes that handicap growth.
Relative effects of aspirin on platelet aggregation and prostaglandin-mediated coronary vasodilatation in the dog.
Authors: Capurro N L , Lipson L C , Bonow R O , Goldstein R E , Shulman N R , Epstein S E
Published: June 2012

Aspirin, as an inhibitor of platelet aggregation, may be of benefit in ischemic heart disease. However, aspirin blocks not only platelet aggregation but also synthesis of prostacyclin, a vasodilator and platelet deaggregator. The relative sensitivity of prostaglandin-mediated coronary vasodilatation and platelet aggregation to inhibition by aspirin remains uncertain. We therefore investigated the relative dose-response relationship of aspirin on arachidonic acid-induced increments in coronary blood flow and on ADP-induced aggregation of platelets. In 11 open-chest dogs, intracoronary arachidonic acid, 0.1-3.0 mg, produced dose-related increases in coronary blood flow that were inhibited progressively by i.v. aspirin over the dose range 0.3-3.0 mg/kg. Aspirin at 3 mg/kg almost completely obliterated the response to 3 mg of arachidonic acid. Similarly, aspirin doses of 0.3-3.0 mg/kg progressively raised the minimal concentration of ADP necessary for platelet aggregation. The threshold concentration of ADP that produced aggregation of platelets from 10 control dogs ranged from 2.3 x 10(-6) M to 1.2 x 10(-5) M. Aspirin at 3 mg/kg completely inhibited aggregation of platelets from 11 of 12 dogs, even with ADP at 2.3 x 10(-4) M concentration, the maximum tested. Aspirin at 0.1 mg/kg failed to inhibit either ADP-induced platelet aggregation or arachidonic acid-induced increments in coronary blood flow. Thus, the two test systems showed similar sensitivity to inhibition by aspirin with respect to threshold dose and maximal effect. These results show that very low doses of aspirin inhibit arachidonic acid-induced coronary vasodilatation and that aspirin at low doses does not appear to selectively inhibit platelet activity relative to coronary vasodilatation.
Significance of regional wall thickening abnormalities relative to transmural myocardial perfusion in anesthetized dogs.
Authors: Gallagher K P , Kumada T , Koziol J A , McKown M D , Kemper W S , Ross J
Published: June 2012

In 15 open-chest, anesthetized dogs, regional systolic wall thickening (% delta WT) was measured with sonomicrometry and regional blood flow was determined with tracer microspheres (7-10 micron) before and after various degrees of coronary artery narrowing were created with a hydraulic occluder. The stenoses were categorized into four groups by the effect on % delta WT, and the corresponding myocardial blood flow (MBF) was determined in four layers across the ventricular wall (layer 1: subendocardium; layer 4: subepicardium). In group 1, % delta WT decreased 44 +/- 10% and only layer 1 MBF was significantly reduced (-28%); in group 2, % delta WT decreased 77 +/- 8% and MBF was reduced in both layers 1 and 2 (-52% and -36%, respectively); in group 3, % delta WT decreased 104 +/- 3% and MBF was reduced in the three inner layers (layer 1: -65%; layer 2: -58%; layer 3: -34%); in group 4, % delta WT decreased 145 +/- 9% (systolic wall thinning) and transmural reduction of MBF was found (layer 1: -74%; layer 2: -68%; layer 3: -55%; layer 4: -29%). We conclude that (1) up to 75% reduction in systolic wall thickening may occur when perfusion to only the inner one-half of the myocardium is decreased; (2) akinetic wall motion may be observed when perfusion remains normal in the subepicardial one-fourth of the wall; and (3) dyskinesia (wall thinning) occurs when blood flow is reduced transmurally.
The relationship of vascular injury and myocardial hemorrhage to necrosis after reperfusion.
Authors: Fishbein M C , Y-Rit J , Lando U , Kanmatsuse K , Mercier J C , Ganz W
Published: June 2012

Early reperfusion may salvage ischemic myocardium; late reperfusion often intensifies morphologic changes of necrosis and causes hemorrhage. To determine whether hemorrhage after reperfusion increases the extent of myocardial infarction, six closed-chest, anesthetized dogs underwent balloon occlusion of the left anterior descending coronary artery for 5.5 hours, followed by 30 minutes of reflow. Colloidal carbon was injected distal to the balloon before reperfusion to label injured vessels. After sacrifice, the area of myocardial necrosis was measured by planimetry of 1-cm-thick serial slices of left ventricle stained with triphenyl tetrazolium chloride. Areas of hemorrhage and vascular injury were also measured. In all hearts, the extent of hemorrhage and vascular injury was less than the extent of necrosis (10.2 +/- 4.6% vs 19.8 +/- 8.6% [mean +/- SD], p < 0.01). Further, hemorrhage was always within the area of necrosis, primarily in the subendocardial portion. Hemorrhage after reperfusion occurred only in necrotic tissue where carbon labeling indicated severe vascular injury before reperfusion, suggesting that the hemorrhage was the consequence of preexisting microvascular injury, not its cause.
Serial M-mode echocardiography in severe chronic aortic regurgitation.
Authors: McDonald I G , Jelinek V M
Published: June 2012

Thirteen patients with severe chronic aortic regurgitation (mean age 52.5 years) were studied by serial M-mode echocardiography. When first studied, none had breathlessness caused by left ventricular failure (LVF). Nine of these patients remained asymptomatic over a mean period of 4 years, 3 months (no LVF group); the other four patients developed left ventricular failure with dyspnea after a mean interval of 3 years, 11 months (LVF group). For both of these groups, we compared the echocardiographic measurements from the first and last of the serial studies. For the LVF group, end-diastolic left ventricular internal dimension increased 14%, end-systolic dimension increased 35%, fractional shortening decreased 45% and left atrial dimension increased 62%. All of these changes were significant. For the No LVF group, the change in end-diastolic left ventricular internal dimension was not significant, but the 6% increase in end-systolic dimension, 10% reduction in fractional shortening and 25% increase in left atrial size were all statistically significant. Although echocardiography could detect declining left ventricular function in a group of asymptomatic patients with severe chronic aortic regurgitation, the reproducibility of the technique was limited in individual patients. Therefore, serial echocardiographic studies should be interpreted in conjunction with clinical assessment and other investigations.
Subxiphoid cross-sectional echocardiographic imaging of the "goose-neck" deformity in endocardial cushion defect.
Authors: Yoshida H , Funabashi T , Nakaya S , Maeda T , Taniguchi N
Published: June 2012

The cross-sectional echocardiographic demonstration of the "goose-neck" deformity is described in four patients with endocardial cushion defect. The diagnosis was confirmed in each patient by left ventricular angiocardiogram. The subxiphoid approach of cross-sectional echocardiography in diastole allowed visualization of an elongated, narrowed, and somewhat horizontally inclined configuration of the left ventricular outflow tract, which appeared almost identical to that obtained by angiocardiography. In systole, the right border of the left ventricle was composed of the cleft anterior mitral leaflet, the left-sided line of which was convex toward the left ventricular cavity. The mitral valvular echoes were thickened, jagged and irregular, which seemed to correspond to the scalloped appearance of the right border of the left ventricular silhouette in a systolic phase of the left ventricular angiocardiogram. There were no obvious differences between the goose-neck configuration of complete-type endocardial cushion defect and that of ostium primum atrial septal defect.
Accessory atrioventricular pathways that conduct only in the antegrade direction.
Authors: Hammill S C , Pritchett E L , Klein G J , Smith W M , Gallagher J J
Published: June 2012

Patients with accessory atrioventricular pathways that conduct only in the antegrade direction represent an unusual variant of the Wolff-Parkinson-White syndrome. This report describes such patients and compares them with patients with accessory pathways that demonstrate bidirectional conduction. Of 143 patients with single accessory pathways, seven demonstrated exclusive antegrade conduction (study group), 111 demonstrated bidirectional conduction (control group), and 25 demonstrated exclusive retrograde conduction. Study group patients were significantly older than patients in the control group (42 +/- 9.8 years and 31.4 +/- 13.9 years, respectively, p < 0.0001). Refractoriness and conduction characteristics of the accessory pathways in the antegrade direction in the study group were not different from those in the control group. Control group patients presented with atrioventricular reentrant tachycardia (58 of 111), atrial fibrillation (23 of 111), both of these arrhythmias (19 of 111), or no documented arrhythmia (11 of 111). Study group patients presented with only atrial fibrillation (six of seven). An accessory pathway with only antegrade conduction is a rare cause of symptoms in the Wolff-Parkinson-White syndrome. These patients are asymptomatic until atrial fibrillation develops as the patient ages. Despite the absence of retrograde conduction over the accessory pathway, its antegrade functional properties are similar to pathways that demonstrate bidirectional conduction.
The Lewis A. Conner Memorial Lecture
Authors: RICHARDS DICKINSON W.
Published: June 2012

Dyspnea has many characteristics, differing from one clinical state to another. In pulmonary diseases the immediate cause is usually a disproportion between actual ventilation (breathing requirement) and breathing capacity. The hyperventilation of organic pulmonary disease is often mistakenly diagnosed as psychoneurosis. In early cardiac dyspnea, muscular fatigue associated with inadequate cardiac output may be a factor. True pulmonary congestion becomes important in more advanced left ventricular failure.
1-Hydrazinophthalazine (Apresoline in the) reatment of Hypertension: A Two Year Study
Authors: HAFKENSCHIEL JOSEPH H. , LINDAUER M. AUGUST
Published: June 2012

Patients with severe essential hypertension have been carefully studied periodically in an attempt to group them as to probable life expectancy. Forty such patients have been observed while on oral 1-hydrazinophthalazine and a low salt diet. Nineteen of the 33 patients in the groups having a relatively good prognosis for survival had some decrease in diastolic pressure. Only one of seven patients in Smithwick group IV had a satisfactory reduction in blood pressure.
Supraventricular Tachycardia Complicating Surgical Procedures
Authors: ROGERS WAYNE R. , WROBLEWSKI FELIX , LADUE JOHN S.
Published: June 2012

Persistent postoperative supraventricular tachycardia, despite adequate therapy, is a bad prognostic sign, and cardiac failure due to, or associated with, arrhythmia responds poorly to treatment. Of the 12 patients (24 per cent) resistent to therapy, eight developed congestive heart failure, with five dying as a result. The preoperative, intraoperative and postoperative factors contributing to the causes of this complication are reviewed, and the therapy, course and end results are discussed.
Renal Excretion of Water, Sodium and Chloride
Authors: BIRCHALL ROBERT , TUTHILL S. W. , JACOBS W. S. , TRAUTMAN W. J. , FINDLEY THOMAS
Published: June 2012

There has long been interest in the possibility that a relationship exists between essential hypertension and those endocrine aberrations that involve the hypothalamus, pituitary and adrenal cortex. This paper represents an attempt to study these relationships indirectly by an examination of the manner in which the kidneys of patients with these various diseases handle water, sodium, and chloride.
A Spatial Vector Analyzer for the Conventional Electrocardiogram
Authors: SIMONSON ERNST , ROSS JACK
Published: June 2012

Present methods of spatial vector analysis are descriptive rather than quantitative, or require lengthy calculations. With the spatial vector analyzer, the spatial vector is constructed from the conventional electrocardiogram, with only minor modifications of electrocardiographic routine. The method is simple, can be applied to mean and instantaneous vectors, and a quantitative characterization of any vector in terms of a horizontal angle, vertical angle, and magnitude can be obtained in about three minutes. It may be expected that the description of any deflection in simple, quantitative terms will improve the electrocardiographic interpretation by eliminating distortion resulting from the limitation to one (frontal) plane.
The Ballistocardiogram in Mitral Stenosis
Authors: DAVIS F. W. , SCARBOROUGH WM. R. , MASON R. E. , SINGEWALD M. L. , BAKER B. M. , LORE SALLE A. , TRANDES HELEN , MENZIES MADELON
Published: June 2012

The ballistocardiograms of 13 of 14 patients with "pure" mitral stenosis were found to show acharacteristic late diastolic and early systolic deformity. The deformity consists of a footward wave which precedes the I wave, often resulting in "doubling" of the I, or fusion with the I, producing a wide, deformed wave. Ballistocardiograms of patients with mitral insufficiency did not consistently show this deformity. Immediately after commissurotomy this abnormality was diminished, but was not completely eliminated. Some possible factors concerned in the genesis of this pattern are discussed.
The Interrelationships of Serum Lipids in Men and Women Past Sixty-Five Years of Age and Their Bearing on Atherosclerosis
Authors: GERTLER MENARD M. , OPPENHEIMER BERNARD S.
Published: June 2012

The interrelationships of serum lipids, that is, free cholesterol, esterified cholesterol, total cholesterol, lipid phosphorus, total lipids, neutral fats and S
f
10-20 molecules were determined in 91 women and 38 men past the age of 65 years. It was observed that all the serum lipids with the exception of neutral fats were statistically higher in the women. Furthermore, it was shown that the serum total cholesterol and serum S
f
10-20 molecules were correlated to a significant degree in the men, 0.59 ± .15, but to an insignificant degree in the women, 0.21 ± .12. It was also shown that the levels of serum total cholesterol and S
f
10-20 molecules increase with age within the age range 65 to 85 in the women but remain stationary or actually decrease in the men. The bearing of these findings on atherosclerogenesis is discussed.
Ventricular Arrhythmia and Stokes-Adams Syndrome
Authors: DUPLER DONALD A.
Published: June 2012

An unusual case of ventricular arrhythmia is reported with electrocardiograms showing complete attacks of ventricular tachycardia, ventricular flutter and ventricular fibrillation. The etiologyis unknown. Large doses of quinidine, to the point of toxicity, seemed to halt the arrhythmia but did not prevent its recurrence. Ephedrine was given with resulting immediate improvement and no recurrence of the arrhythmia. It is suggested that ephedrine may be of value in treating Stokes-Adams attacks due to ventricular arrhythmia in which there is no heart block but an underlying bradycardia.
A Study of Reflex Venomotor Reactions in Man
Authors: DUGGAN JOHN J. , LOVE V. LOGAN , LYONS RICHARD H.
Published: June 2012

By the use of simple clamps, a segment of a forearm vein was temporarily isolated from the circulation so that change in pressure within the segment measured change in venous tone. Reflex venoconstriction was elicited by appropriate stimuli. These reactions could be blocked by interruption of the sympathetic pathway to the vein under study. The magnitude of the responses obtained supports the concept that neurogenic venomotor reactions may be quantitatively significant in circulatory adjustments.
The Effect of the Valsalva Maneuver on the Circulation
Authors: ELISBERG E. , SINGIAN E. , MILLER G. , KATZ L. N.
Published: June 2012

The normal response following sustained straining, as in a Valsalva maneuver, is a rise in systemic arterial pressure and a reflex slowing of the heart rate. This response was found to be abolished in some patients with mitral stenosis, with organic heart disease, with pulmonary vascular disease (including kyphoscoliosis), or with congenital heart disease. It was abolished in all three instances of pericardial disease studied. The relationship of the presence or absence of a poststraining bradycardia to cardiovascular dynamics at rest and on exercise as determined by right heart catheterization is presented, and the suggestion is made that the Valsalva maneuver, when performed under electrocardiographic control, may be a simple, dynamic stress test of the circulation. This suggestion is waiting for further exploration.
A Study of the Usefulness and Limitations of Electrical Countershock, Cardiac Massage, Epinephrine and Procaine in Cardiac Resuscitation from Ventricular Fibrillation
Authors: WÉGRIA RENÉ , FRANK CHARLES W. , WANG HSUEH-HWA , MISRAHY GEORGE , MILLER ROBERT , KORNFELD PETER
Published: June 2012

The efficacy of electrical countershock, cardiac massage, epinephrine and procaine in stopping ventricular fibrillation and restoring a competent ventricular contraction was studied in anesthetized dogs. It was found that countershock is a reliable means of stopping fibrillation. However, it must be preceded by cardiac massage if not applied promptly after the initiation of fibrillation. Epinephrine helps restore a competent ventricular contraction once fibrillation has been stopped by countershock but it increases the incidence of recurrence of fibrillation. The doses of procaine which constitute a reliable means of stopping fibrillation depress the rhythmicity of the heart to such an extent that the cessation of fibrillation is followed by prolonged periods of cardiac standstill.
Measurement of Vasoconstrictor Tone in the Extremities in Hypertension
Authors: KOWALSKI HENRY J. , HOOBLER SIBLEY W. , MALTON S. DONALD , LYONS RICHARD H.
Published: June 2012

Tetraethylammonium (TEA) given intravenously decreases peripheral vascular resistance. The magnitude of the decrement is related directly to the prevailing level of neurogenic vasomotor tone. TEA was administered to hypertensive and normotensive subjects. The decrements in resistance of the foot did not differ between the two groups. The decrements of the forearm also did not differ. These findings suggest that the prevailing level of neurogenic vasomotor tone in the extremities is not increased in hypertension.
Pulmonary Function in Rheumatic Heart Disease and Its Relation to Exertional Dyspnea in Ambulatory Patients
Authors: WEST JOHN R. , BLISS HARRY A. , WOOD JOHN A. , RICHARDS DICKINSON W.
Published: June 2012

Pulmonary and cardiocirculatory function were studied in 21 ambulatory patients with rheumatic heart disease. A pattern of pulmonary function was observed which deviated from normal to a degree insufficient to account for the exertional dyspnea of these patients. The pathogenesis of this symptom is, therefore, discussed in relation to the observed cardiocirculatory abnormalities which were often pronounced.
The Hemodynamic Effects of Hypotensive Drugs in Man
Authors: FREIS EDWARD D. , ROSE JOHN C. , HIGGINS THOMAS F. , FINNERTY FRANK A. , KELLEY ROBERT T. , PARTENOPE EDWARD A.
Published: June 2012

Further data are presented concerning the unusual hemodynamic effects of 1-hydrazinophthalazine. Previous observations demonstrating a marked increase in cardiac output in normotensive subjects are confirmed in hypertensive patients. The splanchnic vascular bed is one of the sites of increased blood flow. The similarity between the hemodynamic effects of 1-hydrazinophthalazine and pyrogens is pointed out and the pharmacologic basis for the clinically observed additive effects of 1-hydrazinophthalazine and hexamethonium is discussed.
Atabrine in Ventricular Tachycardia
Authors: SAMIA ANTONIO M. , ALIMURUNG MARIANO M.
Published: June 2012

The therapeutic efficacy of Atabrine in ventricular tachycardia has not yet been clearly demonstrated. In this case report, Atabrine stopped ventricular tachycardia and restored normal sinus rhythm following the fifth two-hourly oral dose of 0.30 Gm. Nausea and vomiting were the only toxic effects noted. Ventricular tachycardia, in this case, occurred as a complication of acute myocardial infarction. The latter's characteristic electrocardiographic picture became obvious as the arrhythmia was corrected.
The Kinetocardiogram
Authors: EDDLEMAN E. E. , WILLIS KATHRYN , REEVES T. J. , HARRISON T. R.
Published: June 2012

A simple method of recording low-frequency precordial movements is presented and termed kinetocardiogram to indicate movements as the result of the motions of the heart. The normal precordial patterns are described as well as the time relationships to the cardiac cycle and ballistocardiogram.
Long-Range Observations of Sodium Exchange in Patients with Congestive Heart Failure
Authors: LUSK JOHN A. , PALMER S. DONALD
Published: June 2012

Long-term studies of sodium balance were made in three patients with congestive failure. The data indicate exchange of water and sodium between the intracellular and extracellular spaces. They suggest that a portion of the intracellular cation exists in a form which is not osmotically active. The term "quantometer" is applied to the previously described intracranial volume-regulating mechanism. An hypothesis is offered in which it is assumed that exhaustion of this quantometer may contribute to the retention of sodium as heart failure becomes manifest.
Antibiotic Therapy of Bacterial Endocarditis
Authors: GERACI JOSEPH E. , MARTIN WILLIAM J.
Published: June 2012

Twenty-three patients with endocarditis caused by penicillin-sensitive streptococci have received short-term treatment with penicillin and dihydrostreptomycin, combined, for two weeks. Five of the patients died from complications of their infection; 18 were living and well, at the time of this study, after an average follow-up period of more than one year. No failures in treatment or relapses have occurred. It is concluded from the study of these patients that 1,000,000 units of aqueous procaine penicillin-G and 1 Gm. of dihydrostreptomycin sulfate given intramuscularly every 12 hours for two weeks is curative for this type of endocarditis.
Vectorcardiography
Authors: BURCH G. E. , ABILDSKOV J. A. , CRONVICH J. A.
Published: June 2012

Both theoretic considerations and actual studies suggest that spatial vectorcardiography will eventually have practical applications. It is likely to furnish clinically useful information in addition to that provided by conventional electrocardiography. This is a statement of probability, however, and has not yet been established, nor have the circumstances in which it may apply yet been defined. For this reason the current status of vectorcardiography is properly that of a research method, not yet suitable for general clinical application.

Many technics have been employed to obtain the vectorcardiogram. The graphic derivation of vectorcardiograms from electrocardiographic leads is of historic interest only. The use of the cathode ray oscilloscope with suitable amplifiers is the method of choice. Many modifications of technic, such as recording on moving film, recording of successive complexes, and stereoscopic recording, are possible with the use of the cathode ray oscilloscope. It is not yet apparent which recording technic will prove to be most informative, so that studies with a variety of technics seem advisable.

Several systems of electrode placement have been advocated for obtaining the spatial vectorcardiogram. Since the application of any geometric reference frame to the human body necessitates several assumptions which are not actually true, it appears that the choice among reference frames cannot be made on the basis of their intrinsic validity. We are of the opinion that the equilateral tetrahedron introduced by Wilson and associates
12
offers advantages over other reference frames because:

(1) Only one electrode is necessary in addition to those employed to obtain the standard electrocardiographic leads.

(2) Electrodes are easily applied, and their positions are readily reproducible.

(3) The knowledge already available from experience with the standard leads of the electrocardiogram may be applied to spatial vectoreardiography.

(4) Each of the four surfaces defined by the electrode positions is an equilateral triangle.

(5) The disadvantages of this reference system are common to those of other proposed reference frames.

Variations of the spatial vectorcardiogram in normal man and in man with a variety of disease states have been studied by several groups of investigators with a variety of technics. These studies are of considerable importance, but as yet nearly all lack pathologic confirmation of the presence, site and size of suspected lesions. These data must be obtained and thoroughly correlated with the vectorcardiogram before vectorcardiography can be employed with certainty in general clinical practice.
Further Considerations on the Indications for and Limitations of Direct Surgery in Arteriosclerosis
Authors: DYE WILLIAM S. , OLWIN JOHN H. , JULIAN ORMAND C.
Published: June 2012

Segmental obstruction due to arteriosclerosis may occur in peripheral arteries. Further experience in resection of these obstructed segments and their replacement by vein grafts is reported. Replacement of segments of the femoral artery has been accomplished in 30 patients. The proper selection of patients is essential for success. The various causes of failure and the limitations of the procedure are emphasized.
Clinical Appraisal of a New Adrenergic Blocking Agent: Effect of Regitine on Digital Blood Flow in Normal Subjects and Patients with Peripheral Arterial Diseases
Authors: CLARKE CHARLES W. , HAYS DAVID RANDALL , VAN ITALLIE THEODORE B. , THOMPSON IRENE M.
Published: June 2012

By means of venous occlusion digital plethysmography, the authors have evaluated the peripheral vasodilating effect on normal and diseased arterioles of a new adrenergic blocking agent, Regitine, 2-[-(
m
-Hydroxy-N-
p
-tolylanilino)-methyl]-2-imidazoline. Results have been compared with the results of similar studies using Priscoline and indirect body heating to produce vasodilation. The effect of palrenteral Regitine on pulse and blood pressure has been noted as well as the clinical results obtained when this drug was used orally for the treatment of certain forms of peripheral vascular disease.