bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of Coronary Heart Disease in an Urban Population in Northern India
Authors: SARVOTHAM S. G. , BERRY J. N.
Published: June 2012

A prevalence survey of coronary heart disease (CHD) was carried out in a north Indian town involving a house-to-house clinical and electrocardiographic examination of all the 2,030 persons above the age of 30 years residing in the area. The sample is considered adequate and representative of urban population of northern India. The diagnosis of CHD was based on history of myocardial infarction or angina pectoris and electrocardiographic abnormalities according to criteria used by Epstein and associates.
1

The prevalence rates of CHD for men and women were similar to those found in Tecumseh.
1
The prevalence of CHD increased with age, with socio-economic status, with the sedentary nature of occupation, and in hypertensives. Those with CHD were more obese than others, and the prevalence showed a positive correlation with subscapular skinfold thickness in men. Sixty-two per cent of the men and 88% of the women had clinically silent CHD. No comparable published data on prevalence of CHD in the general population in India is available.
Hemodynamic Effects of Lidocaine in Patients with Heart Disease
Authors: SCHUMACHER RICHARD R. , LIEBERSON ALAN D. , CHILDRESS RICHARD H. , WILLIAMS JOHN F.
Published: June 2012

The intravenous administration of 50 mg of lidocaine as a single bolus to four patients with heart disease did not result in a significant change in cardiac output or left ventricular end-diastolic pressure (LVEDP). Two patients had moderate decrease in systemic arterial pressure which was not accompanied by symptoms, was of short duration, and did not require therapeutic intervention. Left ventricular function, as assessed by the relationship of changes in stroke volume index (SVI) and stroke work index (SWI) to changes in LVEDP, was not significantly affected nor was the maximum rate of rise of left ventricular pressure (dp/dt).

The intravenous injection of 100 mg of lidocaine into eight additional patients with heart disease did not produce a statistically significant change in any of these hemodynamic variables when compared to their respective control values. Examination of individual responses, however, revealed that some depression of left ventricular function occurred in at least three and probably four of these patients. Nevertheless, this depression of myocardial function was not of sufficient magnitude to produce symptoms or reduce the cardiac output and generally did not result in an inordinate increase in LVEDP.

It is concluded that 100 mg or less of lidocaine injected intravenously has remarkably few, if any, adverse hemodynamic effects of clinical significance in man.
Annuloplasty in Children and Young Adolescents with Severe Rheumatic Mitral Insufficiency
Authors: KLOTH HOWARD H. , REED GEORGE E. , TICE DAVID A. , DOYLE EUGENIE F. , KIELY BRIAN , SPAGNUOLO MARIO
Published: June 2012

Eleven patients aged 8 to 15 years underwent measured asymmetrical annuloplasty for severe mitral regurgitation in the years 1961 through 1966. They had had a total of 20 attacks of acute rheumatic fever. The intervals between the last attack of acute rheumatic fever and operation ranged from 2 to 8 years. The criteria for surgery were congestive failure and progressive cardiac enlargement. Using the hydraulic formula of Gorlin, a mitral annuloplasty was tailored to the size of each patient so that insufficiency was eliminated without producing hemodynamically significant stenosis.

In this group of 11 children there has been one death. The majority of our 11 patients reacquired murmurs of mitral regurgitation. Satisfactory results, however, are not dependent on complete hemodynamic correction. All patients have improved remarkably and have sustained this improvement up to 7 years. These results suggest that mitral annuloplasty should be the operation of choice in children with severe mitral regurgitation.
Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery
Authors: FLAMM M. D. , STINSON EDWARD B. , HULTGREN HERBERT N. , SHUMWAY NORMAN E. , HANCOCK E. W.
Published: June 2012

Two cases of anomalous origin of the left coronary artery from the pulmonary artery are reported in asymptomatic patients 15 and 27 years of age, bringing to 30 the total number of cases of this anomaly reported in the postinfantile age group. ECG exercise tests demonstrated marked ischemic changes in both patients, but angina or abnormal shortness of breath did not develop in either patient during or after exercise. The anomalous vessel was interrupted by closure of its ostium through a pulmonary arteriotomy during cardiopulmonary bypass, a procedure felt to offer a distinct technical advantage in the surgical treatment of this condition. Following ligation of the anomalous vessel, ECG exercise tests no longer showed definitive evidence of myocardial ischemia. This is interpreted as evidence that ligation should reduce the incidence of exercise-induced sudden deaths in this anomaly.
Prognosis for Patients with Ventricular Septal Defect and Severe Pulmonary Vascular Obstructive Disease
Authors: CLARKSON PATRICIA M. , FRYE ROBERT L. , DUSHANE JAMES W. , BURCHELL HOWARD B. , WOOD EARL H. , WEIDMAN WILLIAM H.
Published: June 2012

The status of 58 patients, 3 to 57 years of age, with ventricular septal defect and a marked increase in pulmonary vascular resistance (pulmonary obstructive disease) was determined 5 years or longer after diagnostic catheterization. Forty-six (80%) were alive 5 years after that study. The probability of living 5 years was 95% for patients aged 10 through 19 years and 56% for those 20 years of age or older. The dissimilarity of actuarial curves between these two groups is consistent with the hypothesis that pulmonary vascular obstructive disease develops under age 20. Calculated pulmonary resistance increased with age of patient on admission to the study, suggesting its progressive nature. Hemoptysis was rare under age 20, and its presence over this age indicated a poor prognosis. The most common causes of death were "sudden" or "unknown." Most surviving patients were gainfully employed or attending school without severe symptoms.
Systemic Vasoconstrictor and Renal Vasodilator Effects of PLV-2 (Octapressin) in Man
Authors: COHN JAY N. , TRISTANI FELIX E. , KHATRI IBRAHIM M.
Published: June 2012

The systemic and renal hemodynamic effects of PLV-2 (octapressin) were studied in patients with hypotension or decompensated cirrhosis of the liver. Low doses (0.004 to 0.02 units/min) increased renal blood flow (indicator-dilution technique), reduced renal vascular resistance, and produced a slight increase in arterial pressure and systemic vascular resistance. Higher doses (0.1 to 0.5 units/min) produced a sharp increase in arterial pressure and systemic resistance while renal resistance increased moderately and renal blood flow usually was maintained above control levels. Renal fraction was increased at all dose levels. The increased renal blood flow was accompanied by more rapid intrarenal dye transit time and slight increase in renal extraction ratio of paraaminohippurate suggesting a rise in cortical blood flow. It is concluded that PLV-2 in small doses produces renal vasodilatation and in larger doses preferential extra-renal vasoconstriction resulting in redistribution of blood flow to the kidney.
Studies on Coumarin Anticoagulant Drugs
Authors: O'REILLY ROBERT A. , AGGELER PAUL M.
Published: June 2012

Thirty normal subjects were given a single loading dose of warfarin sodium, 1.5 mg/kg of body weight. The drug was metabolized slowly (mean biological half-life, 47 hr) and showed a prolonged biological effect (over 6 days). In two separate experiments no loading dose was given; instead, daily doses of 15 mg and 10 mg were administered to 15 of the subjects. The prothrombin complex responses were compared with those obtained in the same subjects after the large loading dose. The mean time in days to reach the therapeutic range (prothrombin complex activity<35% of normal) was 1.1 days with the dose of 1.5 mg/kg of body weight, 2.7 days with the dose of 15 mg/day, and 5.2 days with 10 mg/day. With all three methods the therapeutic range was reached soon after a level of warfarin of 2 mg/L plasma was attained.

The rates of fall of the four vitamin K-dependent clotting factors (II, VII, IX, and X) with the large loading dose and with the daily dosage of 15 mg were compared in six of the subjects. With the loading dose, factor VII activity was less during the first 48 hr, but there was no other significant difference between the two methods of drug administration in the amount of reduction of any of the four factors.

Since the role of factor VII in thrombogenesis is questioned, these results provide a rational basis for the induction of prophylactic anticoagulant therapy without large loading doses of warfarin. Avoidance of the customary loading dose should reduce the danger of hemorrhage, particularly in patients who are sensitive to the drug because of advanced age, sepsis, liver disease, congestive heart failure, or recent surgery or trauma.
Intramural and Pericapillary Distribution of Lipids in Gingival Tissue of Patients with Carbohydrate-Induced Hyperglyceridemia
Authors: CORNOG JOHN L. , FITTS WILLIAM T. , KUO PETER T.
Published: June 2012

Gingival biopsy was performed on 16 patients with carbohydrate-induced hyperglyceridemia, in the attempt to discover histological abnormalities in the capillaries. For comparison, similar studies were also made on four patients with essential familial hypercholesteremia, on five whose hyperglyceridemia had been kept under control by a low carbohydrate diet for 6 to 26 months, and on eight healthy, normolipemic subjects. Variable amounts of Oil Red O-stainable lipid material were demonstrated both in and around the capillary wall in 13 of the 16 untreated hyperglyceridemic patients. Little or no such lipid-staining material was demonstrated in the biopsy material obtained from the remaining groups of subjects so studied. Microangiopathy of the pre-diabetic and diabetic type characterized by capillary basement membrane thickening was not demonstrated in any of the hyperlipemic patients in this series. Evidence is presented to support the concept that a sustained chylomicronemia is the primary factor in the production of the intramural and pericapillary collection of Oil Red O-staining lipids in these hyperglyceridemic patients.
Atrial Reciprocal Rhythm and Reciprocating Tachycardia in Wolff-Parkinson-White Syndrome
Authors: ROELANDT J. , VAN DER HAUWAERT LUC G.
Published: June 2012

In an infant with type A Wolff-Parkinson-White syndrome, atrial reciprocal beats and attacks of reciprocating tachycardia were repeatedly recorded. Their dependence on a prolongation of the P-R interval could be well demonstrated during Wenckebach periods. Because of the normal aspect of the QRS complex during arrhythmia, the short ventriculo-atrial conduction time (0.08 sec), and the vectorial orientation of the secondary P wave, it was concluded that retrograde reactivation of the atria probably took place via the anomalous bundle. The versatility of the conduction through the accessory bundle is shown by the fact that its direction may change from antegrade in one beat to retrograde in the next. The importance of a circus movement in the genesis of some types of tachycardia in the WPW syndrome is discussed.
Phonocardiographic Diagnosis of Aortic Ball Variance
Authors: HYLEN JOHN C. , KLOSTER FRANK E. , HERR RODNEY H. , HULL PAUL Q. , AMES ALAN W. , STARR ALBERT , GRISWOLD HERBERT E.
Published: June 2012

Fatty infiltration causing changes in the silastic poppet of the Model 1000 series Starr-Edwards aortic valve prostheses (ball variance) has been detected with increasing frequency and can result in sudden death. Phonocardiograms were recorded on 12 patients with ball variance confirmed by operation and of 31 controls. Ten of the 12 patients with ball variance were distinguished from the controls by an aortic opening sound (AO) less than half as intense as the aortic closure sound (AC) at the second right intercostal space (AO/AC ratio less than 0.5). Both AO and AC were decreased in two patients with ball variance, with the loss of the characteristic high frequency and amplitude of these sounds. The only patient having a diminished AO/AC ratio (0.42) without ball variance at reoperation had a clot extending over the aortic valve struts. The phonocardiographic findings have been the most reliable objective evidence of ball variance in patients with Starr-Edwards aortic prosthesis of the Model 1000 series.
Atrial Septal Defect
Authors: RAHIMTOOLA SHAHBUDIN H. , KIRKLIN JOHN W. , BURCHELL HOWARD B.
Published: June 2012

A total of 696 patients with atrial septal defect (ASD) of either the secundum (90.5%) or the sinus venosus (9.5%) type were operated on at the Mayo Clinic from 1954 through 1965. Pulmonary hypertension (PHT, defined as pulmonary artery systolic pressure of 60 mm Hg or greater) or chronic congestive cardiac failure (CCF) (or both) was associated with 80% of the hospital deaths. For the years 1958 through 1965 (531 cases), the hospital mortality for these three groups was 10% (three of 30), 14% (one of seven), and 18% (two of 11), respectively; only two (0.4%) of the remaining 483 patients died, and both were more than 45 years old (among a total of 93 patients more than 45 years old). There have been no operative deaths among those less than 45 years of age and without PHT or CCF (390 cases) in the years 1958 through 1965. No operative deaths occurred in the years 1963 through 1965. Of 16 patients 60 years or older (1954 through 1965), one has died.

A 6- to 12-year follow-up was possible on 397 patients operated on from 1954 through 1960. In the absence of PHT or CCF, 330 survived operation. Among the 53 patients more than 45 years old, four died later (not definitely related to closure of ASD), three were not well, 32 were in excellent health, and 14 were lost to follow-up in 1966. Among the 277 patients less than 45 years old, 10 died later (all but one probably unrelated to closure of ASD), three were unwell, 186 were in excellent health, and 78 were lost to follow-up in 1966.

Forty-two patients with PHT survived operation in the period from 1954 through 1960. Ten had pulmonary resistance of more than 640 dynes sec cm
-5
; four of these were well, two had died (with PHT), two had severe PHT, one was in CCF, and one was moderately disabled. Thirty-two had pulmonary resistances of 640 dynes sec cm
-5
or less; three of these had died (unrelated to closure of ASD), five were moderately disabled, 16 were in excellent health, and eight were lost to follow-up in 1966.

Eighteen patients with CCF survived operation in the period from 1954 through 1960. All had had grade IV disability (New York Heart Association classification). There were three late deaths (one due to severe pulmonary vascular disease and two unrelated to closure of ASD), one patient had grade IV disability, five had grades I to II disability, eight were in excellent health, and one was lost to follow-up in 1966.

Paroxysmal arrhythmia occurred in 75 of 397 patients (19%) operated on from 1954 through 1960. In 53 patients it was present preoperatively and persisted postoperatively in 15 of them (28%); in an additional 22 it appeared for the first time after closure of the ASD.
Left Ventricular Hemodynamics in Exercise-Induced Angina Pectoris
Authors: WIENER LESLIE , DWYER EDWARD M. , COX J. WILLIAM
Published: June 2012

The sequence of events characterizing the onset and course of exercise-induced angina pectoris was studied in 10 patients with ischemic heart disease during cardiac catheterization. Exercise produced a precipitous rise in left ventricular end-diastolic pressure prior to the onset of angina and electrocardiographic ischemia. A corresponding abnormal increase in pulmonary artery pressure occurred. Cardiac output increased commensurate with the degree of exertion and was accompanied by a slight reduction in stroke volume. Left ventricular work and stroke work paralleled the changes in cardiac output and stroke volume. Determinants of myocardial oxygen consumption, that is, heart rate, left ventricular systolic pressure, and left ventricular first derivative, were monitored continuously and noted to increase by 43%, 20%, and 38%, respectively, prior to angina. Ischemic ST-segment depression corresponded closely in time with angina. Angina and electrocardiographic and hemodynamic abnormalities persisted throughout exercise. Two minutes after exercise, hemodynamic values returned to normal along with a reduction in intensity of angina; ST-segment abnormalities persisted until 4 minutes after exercise. Pathophysiological mechanisms occurring during angina are described, and differences from typical heart failure are discussed.
Effects of Acute Elevation in Blood Pressure and of Atropine on Heart Rate in Chagas' Disease
Authors: AMORIM D. S. , GODOY R. A. , MANÇO J. C. , TANAKA A. , GALLO L.
Published: June 2012

Degeneration of the parasympathetic ganglia in the heart and in the smooth muscle (esophagus, colon, and bronchi) is known to occur in Chagas' disease. The reflex bradycardia associated with acute elevation in systemic arterial pressure and the blocking of this reflex effect with atropine are used in this investigation to study vagotonic influences on the heart in patients with Chagas' disease. Failure to increase heart rate following administration of atropine observed in cases of chronic Chagas' heart disease is believed to be a functional disorder related to degeneration of the neuronal supply to the sino-atrial region of the heart. To the authors' knowledge this report provides the first existing physiological investigation concerning the cardiovascular system in Chagas' disease.
Hemodynamic Effects of Artificial Pacing in Complete Heart Block Complicating Acute Myocardial Infarction
Authors: LASSERS B. W. , ANDERTON J. L. , GEORGE M. , MUIR A. L. , JULIAN D. G.
Published: June 2012

The hemodynamic changes associated with complete heart block complicating acute myocardial infarction and the effects of artificial pacing at various rates on these measurements were studied in 13 patients. Studies were performed on the first day of complete block in all patients and were repeated on subsequent days in six.

With two exceptions cardiac output was increased by pacing. In patients paced at progressively increasing ventricular rates, the rate associated with the maximal cardiac output exceeded 100/min, with one exception. However, an adequate response usually occurred between 80 and 90/min. Stroke volume fell as the rate was increased with pacing in most patients, but rose in some, suggesting improved myocardial performance. Systemic blood pressure increased, and the change paralleled cardiac output changes fairly closely as pacing rates were increased. The blood pressure did not, however, reflect reliably the absolute level of cardiac output either in heart block or after the return of sinus rhythm. Systemic vascular resistance was high in most patients with low cardiac outputs and fell with pacing at maximal output rates. There was no consistent change in mean right atrial or mean pulmonary arterial pressure with pacing during the period of study. Tension time index was low in heart block, and increased considerably with pacing, implying a corresponding increase in myocardial oxygen requirements.

Pacing improved signs of depressed mental function and poor skin circulation which were invariably associated with a severe reduction in cardiac output. These signs were found to be superior to heart rate and blood pressure in clinical evaluation of the adequacy of the cardiac output in heart block and the response to pacing.
Relationship Between the Plasma Level of Diphenylhydantoin Sodium and Its Cardiac Antiarrhythmic Effects
Authors: BIGGER J. THOMAS , SCHMIDT DONALD H. , KUTT HENN
Published: June 2012

The effect of diphenylhydantoin sodium (DPH, Dilantin) on a variety of arrhythmias was studied in relation to its plasma levels. DPH was administered in one of three ways: (1) multiple intravenous doses, (2) single intravenous doses, and (3) oral doses. Ventricular arrhythmias occurring in many clinical conditions and atrial tachycardia, particularly if caused by digitalis excess, responded well to treatment with DPH. Three fourths of the responsive arrhythmias were abolished at plasma levels of DPH of 10 to 18 µg/ml. In most cases a critical, effective plasma level could be demonstrated; this level had to be exceeded in order to suppress the arrhythmia being treated.

A method of rapidly effective oral therapy of arrhythmias with diphenylhydantoin is described, and a method of transition from intravenous to oral therapy is demonstrated.

The antiarrhythmic action of diphenylhydantoin was accompanied by neither depression of sinoatrial nodal activity nor atrioventricular or intraventricular conduction disturbances, but was accompanied by a shortening of the Q-T interval. Hypotension accompanying the intravenous use of this drug was minimized by administration of the full dose in increments.
Detection of Heart Disease in Children 1919-1967
Authors: HENIKOFF LEO M. , STEVENS WILLIAM A. , PERRY LOWELL W.
Published: June 2012

Since 1959, auscultation by physicians in screening 49,496 school children has yielded 4.5 cases of heart disease/1,000 students screened. Sensitivity by analysis of "inserted" cases averages 64%, but varies with capabilities of examining physicians.

X-ray and ECG evaluations on smaller populations have yielded, respectively, 2.7 and 2.8 cases/1,000 children screened, and sensitivity results average 30 to 40%.

The tape-recorded heart sounds technique has yielded 2.9 cases/1,000 in screening 188,925 children. Sensitivity by analysis of "inserted" cases averages 75% and, in the population of "naturally occurring" heart disease, 56%.

In 23,148 school children, an analog-digital device (PhonoCardioScan) has yielded 4.8 cases/1,000 children screened. Of "inserted" cases, 69% have been detected. Sixtyfour to 80% of "naturally occurring" cases have been detected.

With each technique, approximately 40% of the heart disease detected had been previously unknown. The specificity of these methods ranges from 95 to 99%.

For primary screening the analog-digital device is the most effective currently available alternative to examination by cardiologists.
Anomalous Origin of the Left Coronary Artery from the Pulmonary Trunk
Authors: WESSELHOEFT HADWIG , FAWCETT J. S. , JOHNSON ARNOLD L.
Published: June 2012

The congenital anomaly in which the left coronary artery arises from the main pulmonary artery is infrequent, but lethal, and since it can be alleviated surgically, its recognition and hemodynamic consequences are important. On the basis of 140 reported cases and our seven cases, it seems to present in one of four ways: (1) in infancy with angina-like symptoms or as cardiomyopathy, and later (2) as mitral insufficiency, (3) continuous murmur, or in adults (4) by sudden death. Visualization of the coronary arteries provides the definitive diagnosis, and the problem is the selection for this procedure. The electrocardiogram, the most helpful laboratory aid, is diagnostic of infarction in 80% of the infant group; in the remainder other forms of cardiomyopathy may be confused. Although blood flows directly into the pulmonary artery in the majority of cases, it flows in the reverse direction in a few and this must be determined preoperatively. Some unanswered questions are the subject of discussion: Why the majority of infants have onset of symptoms at about 8 weeks of age, and why some survive to childhood and adult life. The pathological findings are reviewed. Although the greatest surgical therapy experience has been with obliteration of the anomalous left coronary artery (ALCA) at its connection with the pulmonary artery, anastomosis between aorta and ALCA provides an additive supply for both the present and the future.
Transposition of the Great Arteries
Authors: RASHKIND WILLIAM J. , MILLER WILLIAM W.
Published: June 2012

A nonsurgical method of creating atrial septal defects using a balloon catheter has been reviewed, and important procedural and technical details have been presented. The results of balloon atrioseptostomy in 31 infants with transposition of the great arteries have been reported and compared with those from the surgical creation of atrial septal defects. All 31 patients survived balloon atrioseptostomy without complications; 26 of them (84%) had effective immediate palliation, and 22 (71%) are long-term survivors. These results demonstrate that effective palliation of transposition of the great arteries, with or without associated ventricular septal defect, can be provided rapidly and safely by balloon atrioseptostomy. All patients with transposition and a large ventricular septal defect should have balloon atrioseptostomy and may also need pulmonary artery banding. For some of these patients banding may be postponed safely for many months, may occur spontaneously, or may be avoided completely.

Atrioseptostomy by the balloon catheter technique requires neither sedation nor general anesthesia, and obviates the need for thoracotomy and cardiotomy. The rapidity with which it can be performed makes it particularly advantageous for the desperately hypoxic newborn with transposition of the great arteries who may be considered too sick to withstand major surgery.
Ascending Aorta-Right Pulmonary Artery Anastomosis
Authors: WALDHAUSEN J. A. , FRIEDMAN S. , TYERS G. F. O. , RASHKIND W. J. , PETRY E. , MILLER W. W.
Published: June 2012

The results of ascending aorta-right pulmonary artery anastomosis in 35 patients are reported. The patients ranged in age from 18 hours to 12 years; 16 were less than 12 months old. Seventeen had tetralogy of Fallot, six had pulmonary atresia and a ventricular septal defect, and eight had tricuspid atresia with hypoplasia of the right ventricle. In six infants under 4 months of age with tricuspid atresia, an atrial septal defect was made by the balloon catheter technique prior to the shunt operation. Four patients initially required digitalis for left heart failure. Three patients died in the postoperative period. The remaining 32 patients have been followed up to 3 years and have done well and maintained adequate shunts.
Labile Variations of Intraventricular Conduction Unrelated to Rate Changes
Authors: GOOCH ALDEN S. , CROW RICHARD S.
Published: June 2012

An example of unstable intraventricular conduction is presented. Several unusual features of this type of conduction are described. These are: (1) variable intraventricular conduction which was sensitive to multiple stimuli but not clearly related to changes in heart rate, (2) mid and terminal QRS changes reflected only in the left lateral chest leads and in the mid and terminal QRS portions of the vectorcardiogram, (3) constant association of prolonged P-R interval suggesting that this is a variety of bilateral bundle-branch block, and (4) apparent persistence of the peculiar intraventricular conduction for at least 4 years. Multiple involvement of the conduction system is probably present, and functional variations in distal portions of the left ventricular conduction system account for these labile changes. Predictable QRS patterns can be produced by various stimuli which alter intraventricular conduction.
An Attempt at the Assessment of Myocardial Contractility from Phonocardiographically Measured Time Components of Ventricular Contraction in Patients with Prosthetic Aortic Valves
Authors: BECK W. , SCHRIRE V.
Published: June 2012

The phonocardiographically recorded time interval between the first heart sound and the mid-ejection point is a rough guide to the time interval between the onset and the peak ventricular pressure in patients with the University of Cape Town aortic valve prosthesis. This time interval is insensitive to changes in stroke volume and aortic pressure produced by variations in ventricular filling and may be used to show changes in contractility in any one patient.

In a group of 42 patients with 64 postoperative phonocardiograms, mid-ejection time varied between 140 and 250 msec. A strong negative correlation with heart rate, and a strong positive correlation with the width of the QRS complex were present without any significant correlation with heart size or with other estimates of left ventricular function.

It is suggested that in the abnormal myocardium, ventricular asynchrony may seriously interfere with the velocity of the ventricular contraction invalidating the assessment of contractile element velocity from the velocity components of the ventricular pressure pulse.
Cardiac Surgery in Bacterial Endocarditis
Authors: STASON WILLIAM B. , DESANCTIS ROMAN W. , WEINBERG ARNOLD N. , AUSTEN W. GERALD
Published: June 2012

Open heart surgery has been performed at the Massachusetts General Hospital in 13 patients less than 6 months after the initiation of treatment for acute or subacute bacterial endocarditis. The endocarditis involved the aortic valve in 12 cases and a mitral valve prosthesis in the other. In two patients there was concomitant rupture of chordae tendineae of the mitral valve. One patient received no preoperative antibiotics, and four were still receiving their initial course of therapy at the time of surgery. The primary indication for surgery in all cases was progressive or intractable congestive heart failure. Ten underwent replacement of the aortic valve alone, two had both aortic and mitral valves replaced, and one had a mitral prosthesis replaced.

Of the 13 patients, 10 are alive and doing well, although paraprosthetic insufficiency developed in three, two of whom required subsequent surgical repair. Three patients died, two in the early postoperative period, and one, 8 months after surgery from paraprosthetic regurgitation with hemolysis and heart failure. Antibiotics were given during and after surgery for as long as 6 weeks. In no case has recurrent sepsis been a problem.

Our experience indicates that open heart surgery, when necessitated by progressive congestive heart failure due to valve destruction, can be safely and effectively performed during or shortly after treatment of bacterial endocarditis.
Decreased Noradrenaline (Norepinephrine) Synthesis in Neurogenic Orthostatic Hypotension
Authors: GOODALL McC. , HARLAN W. R. , ALTON HAROLD
Published: June 2012

Three patients with idiopathic orthostatic (postural) hypotension were infused over a 4-hr period with 104.6 µc of 3-hydroxytyramine-2-
14
C, the immediate precursor in the synthesis of the sympathetic neurohormone, that is, noradrenaline (norepinephrine). Urine was collected during the infusion period and at various intervals thereafter for a total of 5 days. By means of column fractionation, the various metabolic products of hydroxytyramine, including endogenous noradrenaline and its metabolic products, were separated, identified, and their radioactivity measured.

From the comparison of the hydroxytyramine metabolic pattern of normal subjects to that of idiopathic orthostatic hypotensive patients, it was apparent that the greatest changes occurred in the formation of noradrenaline and 3-methoxy-4-hydroxymandelic acid (MOMA, VMA). The synthesis of noradrenaline was significantly reduced in the hypotensive patients, and there was also a marked reduction in the formation of MOMA, the principal metabolic product of noradrenaline. The implication of these findings is that the pathogenesis of idiopathic orthostatic hypotension is related to a defect in the neurogenic structures involved in the biosynthesis of noradrenaline. This conclusion is further supported by the fact that one of the subjects (M.Q.) at autopsy showed only degenerative changes in the sympathetic ganglia and neurons.
Digital Computer Model of a Total Body Electrocardiographic Surface Map
Authors: SELVESTER R. H. , SOLOMON J. C. , GILLESPIE T. L.
Published: June 2012

A 20-dipole digital computer model of the electromotive surface generated by the heart with a simulated human male torso, including lungs, is presented. The simulated torso-surface ECG equipotential maps were compared to those seen in normal human subjects by Taccardi and were found to resemble them to within the resolution of these maps throughout most of ventricular depolarization (QRS). On comparison of the simulated maps to those produced when the heart was considered to be a single equivalent dipole, it was found that normal surface maps contain considerable information not accounted for by an equivalent dipole source during the mid and terminal portions of the QRS. This information occurs in areas not sampled by a standard precordial electrocardiogram. The addition of the lungs did not appear to change the surface ECG map in any important respect.
Incomplete Left Bundle-Branch Block
Authors: BAROLD S. SERGE , LINHART JOSEPH W. , HILDNER FRANK J. , NARULA ONKAR S. , SAMET PHILIP
Published: June 2012

Rate-dependent intermittent incomplete and complete left bundle-branch block (LBBB) is described in a patient without other evidence of heart disease. Continuous electrocardiographic tracings revealed QRS complexes intermediate in configuration between normal conduction and complete LBBB during the transitional phase from normal to abnormal conduction. This provided an opportunity to study the various grades of incomplete LBBB in man. During the incomplete LBBB phase, the morphology of the QRS complexes bore a close resemblance to the QRS form in the Wolff-Parkinson-White syndrome (type B). The differences between these two entities are emphasized.
Controlled Heart Rate by Atrial Pacing in Angina Pectoris
Authors: LAU SUN HING , COHEN STAFFORD I. , STEIN EMANUEL , HAFT JACOB I. , KINNEY MICHAEL J. , YOUNG MELVIN W. , HELFANT RICHARD H. , DAMATO ANTHONY N.
Published: June 2012

This study was undertaken with a consideration of the physiological relationship between myocardial oxygen consumption and heart rate. Atrial pacing was performed in 63 resting subjects, 36 of whom had been referred for evaluation of angina pectoris. Pacing at critical controlled heart rates evoked angina pectoris in six patients of this group with chest pain and, consistently and more frequently, produced significant S-T segmental depression in 28 patients as a manifestation of myocardial ischemia. The functional test employing controlled heart rates has several advantages over other stress tests. The use of the sole stress of controlled atrial tachycardia is a new technique which has provided relatively safe, reproducible results in the objective evaluation and investigation of myocardial ischemia.
Study of the Cardiac Arrhythmias by the Ultrasonic Doppler Method
Authors: BELLET SAMUEL , KOSTIS JOHN
Published: June 2012

The Doppler tracing is a sensitive method for depicting movement of the heart wall, valves, and blood flow. This communication reports the authors' experience with the Doppler method in normal persons and patients with various cardiac arrhythmias.

Three main components are recognized in the Doppler tracing: the presystolic component,
a
; component

v
s

due to systolic movement of the ventricles; and component

v
d

corresponding to the movement of ventricles during early diastole. Evidence is presented that component
a
is due to atrial contraction. This has been substantiated in this study by the simultaneous recording of the Doppler tracing with the electrocardiogram, phonocardiogram, apex cardiogram, jugular venous tracing, right atrial pressure tracing, and the inscription of the Doppler tracing frame by frame in the right atrial cineangiocardiogram.

These findings are of interest since they introduce a relatively new method of studying cardiac wall movement, particularly that of the right atrium. In addition, simultaneous recording of the Doppler tracing of the atria with the electrocardiogram may be of help in the diagnosis of certain cardiac arrhythmias.
The Pulmonary Vasculature in Complete Transposition of the Great Vessels, Judged from Lung Biopsies
Authors: WAGENVOORT C. A. , NAUTA J. , VAN DER SCHAAR P. J. , WEEDA H. W. H. , WAGENVOORT NOEKE
Published: June 2012

Specimens of the lung taken for biopsy at operation on 80 patients with complete transposition of the great vessels were histologically studied in correlation with the clinical and hemodynamic data in these cases.

In a group of 31 cases of intact ventricular septum and patent foramen ovale, the media of the pulmonary arteries was generally thinner than normal, and to a lesser extent that of the pulmonary veins was also, while the lumina of the vessels were wide. This was especially observed in cases in which the hematocrit was high. Possibly, this phenomenon is based on dilatation of the arteries and is related to the increased total blood volume. Intimal fibrosis, when observed, was suggestive of organized thrombi.

In a group of 28 patients with ventricular septal defect and equal pressures in the left and right ventricles, there was generally marked medial hypertrophy and concentric intimal proliferation in the pulmonary arteries. In cases of pulmonic stenosis, on the other hand, the media of the pulmonary arteries was usually atrophic, while intimal fibrosis on the basis of thrombotic lesions was regularly present.
Autoregulation of Cerebral Blood Flow
Authors: AGNOLI ALESSANDRO , FIESCHI CESARE , BOZZAO LUIGI , BATTISTINI NOÈ , PRENCIPE MASSIMILIANO
Published: June 2012

Autoregulation of cerebral blood flow (constant perfusion despite variations in blood pressure) was studied in 15 control subjects and in 24 patients with cerebral vascular lesions. Thirteen patients were studied within the first 2 days of an episode of cerebral ischemia ("acute" group); 11 were studied from 15 days to several months after an ischemic episode ("chronic" group). Measurements of regional cerebral blood flow (rCBF) were made by recording extracranially in four to six locations the clearance of
85
Kr dissolved in saline and injected into the internal carotid artery. Blood flow values were calculated with a digital computer, using a compartmental analysis of the clearance curves. After measuring rCBF in the resting state, the blood pressure was increased by 30 to 40 mm Hg by the intravenous infusion of angiotensin amide (Hypertensin, Ciba). While the blood pressure was kept constant at the new level, a second series of measurements was made. Autoregulation was present in all normal subjects: no significant differences were found in average or compartmental flow rates between values obtained at normal and at hypertensive levels of blood pressure.

Loss of autoregulation was demonstrated in 10 of 13 patients of the "acute" group and in two of 11 patients of the "chronic" group. These data support previous observations that autoregulation is impaired during the first few days after an ischemic episode. The three patients of the "acute" group with a preserved autoregulatory response to hypertension had only transient ischemic attacks. In each of the other subjects of this group loss of autoregulation was found in one to three different regions of the brain. Our results suggest that regional loss of autoregulation is found frequently near the periphery of the ischemic brain. Impairment of autoregulation is one of the types of derangement of cerebral circulation that occurs after an ischemic episode.
A Comparative Study of Cerebral Atherosclerosis in Males and Females
Authors: FLORA GEORGE C. , BAKER A. B. , LOEWENSON RUTH B. , KLASSEN ARTHUR C.
Published: June 2012

An evaluation of the influence of sex upon cerebral atherosclerosis was carried out in 5,033 consecutive autopsies studied by a special well-standardized coding technique. A sex difference in frequency of cerebral atherosclerosis appears from the fourth to the sixth decade. During this period the percentage of female cases with no atherosclerosis lags behind the percentage of male cases by a 15-year period. After the sixth decade, the frequency of cerebral atherosclerosis increases more rapidly in females, so that beyond the age of 65 years the frequency of cerebral atherosclerosis is equal in the two sexes. Furthermore, younger males show a higher degree of cerebral atherosclerosis than females of the same age and a reverse trend appears in the oldest age groups. Diabetic females have more cerebral atherosclerosis than nondiabetic males, and beyond the fourth decade they have at least as much involvement as the diabetic males.
Circulatory Control in Idiopathic Orthostatic Hypotension (Shy-Drager Syndrome)
Authors: BOTTICELLI JAMES T. , KEELAN MICHAEL H. , ROSENBAUM FRANCIS F. , LANGE RAMON L.
Published: June 2012

Of three patients with Shy-Drager syndrome, two presented with syncope related to exercise and, in all three, exercise stress clearly defined the element of orthostatic hypotension. Autonomic cardiovascular regulatory function was absent in two, but some residual autonomic function was present in the form of heart rate response in one patient who had milder postural hypotension. Hemodynamic studies were carried out with subjects supine and tilted 45° before and after exercise, following plasma volume expansion, and during the effects of isoproterenol and atropine. Despite disordered venoconstrictor responses demonstrated during exercise, hyperventilation, and after the Valsalva maneuver, decrease in central blood volume and right atrial pressure were not excessive with tilt, and total systemic vascular resistance remained essentially unchanged as did heart rate. Cardiac index may have decreased excessively (–24%), suggesting a cardiac component in production of hypotension. Absence of sympathetic cardiac effects, both chronotropic and inotropic, may play a significant role in orthostatic hypotension by limiting heart rate and preventing shift of the Frank-Starling curve to the left. Amelioration of postural effects by plasma volume expansion was noted along with increased cardiac output, stroke volume, and pulse pressure indicating that myocardial heterometric regulation was operative. Atropine had little effect, eliminating the possibility that parasympathetic depressor effects were responsible for postural hypotension. Exercise, by decreasing systemic vascular resistance even though venous return was adequate, produced hypotension even in recumbency and aggravated postural effects. Similarly, isoproterenol caused marked hypotension in supine subjects. Exercise, by reducing systemic vascular resistance, has a deleterious effect despite increased venous return and may precipitate postural symptoms. Exercise stress is of value in the evaluation of patients with syncope or cerebral ischemia secondary to autonomic dysfunction where orthostatic hypotension is of doubtful significance at rest.
The Mechanism of Synchronization in Isorhythmic A-V Dissociation
Authors: WALDO ALBERT L. , VITIKAINEN KARI J. , HARRIS PAUL D. , MALM JAMES R. , HOFFMAN BRIAN F. , Innes Bruce J. , Kaiser Gerard A.
Published: June 2012

We studied 11 patients with spontaneous isorhythmic atrioventricular (A-V) dissociation occurring during cardiac surgery. The period of synchronization or accrochage was shown to result from retrograde capture of the atria by an A-V junctional rhythm. The P wave in leads II, III, and aV
F
was biphasic (–, +) during the period of synchronization, with the initial negative portion of the P wave or the entire P wave often buried within the QRS complex. It was concluded that isorhythmic A-V dissociation occurs only during the period when the rhythm alternates between an atrial rhythm and an A-V junctional rhythm and results when either the dominant pacemaker slows or the latent pacemaker accelerates.
Genesis of Body Surface Potentials in Varying Types of Right Ventricular Hypertrophy
Authors: BLUMENSCHEIN SARAH D. , SPACH MADISON S. , BOINEAU JOHN P. , BARR ROGER C. , GALLIE THOMAS M. , WALLACE ANDREW G. , EBERT PAUL A.
Published: June 2012

Isopotential body surface maps and the sequence of epicardial excitation were studied in children with three types of pure right ventricular hypertrophy; that is, secundum atrial defects, valvular pulmonic stenosis, and tetralogy of Fallot. Patients with similar types of hypertrophy demonstrated internal consistency as to the anatomy, sequence of epicardial excitation of the right ventricular free wall, and body surface potential distribution; however, these phenomena varied between the three groups for each type of hypertrophy. These studies indicate that diagnostic information is available on the body surface to distinguish: (1) right ventricular hypertrophy due primarily to dilatation (secundum atrial septal defects), (2) right ventricular hypertrophy with symmetrical increase in thickness throughout the right ventricle (valvular pulmonic stenosis with moderate to severe right ventricular hypertrophy), and (3) right ventricular hypertrophy proximal to infundibular narrowing (tetralogy of Fallot) from one another. The body surface events could be accounted for in part by the events measured at the epicardial surface.
Measurement of Central Venous Oxygen Saturation in Patients with Myocardial Infarction
Authors: GOLDMAN ROBERT H. , KLUGHAUPT MARTIN , METCALF THOMAS , SPIVACK ALFRED P. , HARRISON DONALD C.
Published: June 2012

Central venous oxygen saturation (CVSO
2
) was measured in 31 patients with myocardial infarction. CVSO
2
correlated well with the patients' clinical course. In those patients not in heart failure, mean ±
sem
for CVSO
2
was 70 ± 1%. When heart failure was present, CVSO
2
averaged 56 ± 1%. When both heart failure and shock were present, CVSO
2
averaged 43 ± 1%. In nine patients, serial determinations of arterial oxygen saturation and CVSO
2
were made. In 22 of 26 instances, either a fall in CVSO
2
was accompanied by an increase in the arteriovenous oxygen saturation difference or an increase in CVSO
2
was accompanied by a decrease in arteriovenous oxygen saturation difference. Serial measurements of CVSO
2
appear to be a useful method of monitoring changes in myocardial function in patients with myocardial infarction.
Renal Excretion of Sodium During Oral Water Administration in Patients with Systemic Hypertension
Authors: METZGER ROBERT A. , VAAMONDE LILIANA S. , VAAMONDE CARLOS A. , PAPPER SOLOMON
Published: June 2012

The renal excretion of sodium and water was studied in 10 hypertensive subjects following an oral sustained 20 ml/kg water load. The study was performed under conditions controlled for sodium content of the diet, time of the day, and posture; the urine was collected by spontaneous voiding. The results were compared with those obtained from 10 normotensive subjects studied under similar conditions.

The increased urine flow following the water load in the hypertensive subjects was not accompanied by increased excretion of sodium, a pattern similar to the one observed in the normotensive subjects.

Comparing the group of hypertensive subjects with previously studied normotensives revealed the following additional information. The hypertensive subjects responded to water administration by increasing volume and C

H
H2
O

more rapidly than the normotensives; however, the maximal response was not significantly different. The fractional reabsorption of sodium was less in the hypertensive subjects despite a lower filtered load of sodium. This suggests a difference in the renal tubular handling of sodium between hypertensive and normotensive subjects.