bluuebunny/crossref_metadata_2025 huggingface dataset:
Normal and Impaired Retinal Vascular Reactivity
Authors: SIEKER H. O. , HICKAM J. B.
Published: June 2012

Normal retinal arteries and veins will constrict when the arterial blood oxygen tension is increased and dilate when it is lowered. A technic, employing fundus photography, is described for measuring this reaction. The amount of constriction on breathing oxygen, and its trend with age, have been measured in normal subjects. The arteries of persons with well-established hypertension and diabetes usually show marked impairment of this constrictor reaction, presumably because of sclerotic changes. It is suggested that measurements of this reaction may prove to be a useful, quantitative extension of present retinal vascular grading technics.
Electrocardiographic Studies during Cardiac Surgery
Authors: JARUSZEWSKI E. J. , HELLERSTEIN H. K. , FEIL H.
Published: June 2012

The electrocardiographic behavior of the heart was observed in 100 patients undergoing heart operations. Most of the arrhythmias were unrelated to the cardiac operative procedure, but as in other thoracic procedures, were related to hypoxia, level of anesthesia, vagal reflexes, and changes in blood pressure. T
A
and S-T displacements occurred in all groups and were thought to be related to altered dynamics of the right auricle and ventricle. Prevention, recognition and control of disturbances of cardiac mechanism are discussed.
Electrocardiographic Findings in Cardiac Amyloidosis
Authors: JOSSELSON ALBERT J. , PRUITT RAYMOND D.
Published: June 2012

The electrocardiographic findings were analyzed in 15 patients found at the time of necropsy to have deposits of amyloid in the heart. Although 12 of the 15 tracings were regarded as abnormal, changes which could be held to be specific to cardiac amyloidosis have not been defined. The most common alterations encountered were auricular fibrillation, QRS complexes and T waves of low amplitude in the standard limb leads, and impaired auriculoventricular conduction.
Phenolic Compounds in the Treatment of Rheumatic Fever
Authors: CLARKE NORMAN E. , MOSHER ROBERT E. , CLARKE CHARLES N.
Published: June 2012

The chemical compounds known to suppress the manifestations of rheumatic fever are reviewed and the antirheumatic nature of certain phenolic compounds discussed. We report on 75 patients with acute rheumatic fever who have been treated with gentisate compounds and discuss the records of 44 of these patients who have been followed for 3 to 20 months after discontinuing drug therapy. These patients were treated with sodium gentisate, "Gen," methyl cellulose-sodium gentisate and gentisic acid ethanolamide. The urinary excretion records of these drugs are given with selected blood level studies. The antihyaluronidase effect of salicylic acid metabolites and the relationship of these phenolic compounds to the pituitary-adrenal axis are discussed.
Cardiovascular Collagenosis with Parietal Endocardial Thrombosis
Authors: BECKER B. J. P. , CHATGIDAKIS C. B. , VAN LINGEN B.
Published: June 2012

Forty cases of endocardial thrombosis of the heart were selected for pathologic study from a total of 9,500 autopsies performed during 1936 to 1951. Widespread focal involvement of the connective tissue throughout the body and particularly in the heart was demonstrated. Although the histopathologic features were similar to those found in the "diffuse collagen diseases" they did not show the characteristic lesions of rheumatic fever, periarteritis nodosa, lupus erythematosus or diffuse scleroderma. The clinical presentation of a rapidly progressive heart failure, together with the pathologic findings, were sufficiently distinctive to consider this condition as a cardiovascular collagenosis with parietal thrombosis. A similar condition has been described under a variety of names and would appear to constitute a large proportion of cases of so-called "idiopathic hypertrophy" or "myocarditis" of the heart.
The Weight of the Heart and Its Chambers in Hypertensive Cardiovascular Disease with and without Failure
Authors: JONES RUSSELL S.
Published: June 2012

The myocardial weights of the different cardiac chambers were determined in 130 cases of hypertensive cardiovascular disease, both with and without failure. The left ventricle hypertrophies before and continues to hypertrophy after the advent of congestive failure. The right ventricle and both auricles hypertrophy only after failure develops. In correlating the ventricular work with its muscle mass, the left ventricle apparently performs twice as much work per gram as the right ventricle. Several possible explanations for this apparent greater efficiency of the left ventricle are presented. The changes in chamber weights are discussed in relation to concepts of congestive failure.
Mercurial Diuretics: The Replacement of Parenteral Administration by a New Oral Preparation in Ambulatory Patients with Chronic Congestive Heart Failure
Authors: DIMITROFF SIM P. , THORNER M. C. , GRIFFITH GEORGE C.
Published: June 2012

Improvement in the usage of an effective therapeutic agent is highly desirable especially when the method of administration is simplified, the total dosage reduced, the toxicity of the drug diminished and the cost of medical care lessened. The replacement of parenteral injections of the mercurial diuretics by an oral preparation in ambulatory patients in chronic congestive heart failure represents a step forward in the management of this type of patient.
Acute Effects of Elevation of Coronary Sinus Pressure
Authors: ECKSTEIN RICHARD W. , HORNBERGER J. CARL , SANO TOYOMI
Published: June 2012

The acute physiologic effects of the aorta to coronary sinus anastomosis of Beck have been studied. The evidence presented shows that arterialization of the coronary sinus results in a small retrograde flow from the sinus through capillaries into the occluded artery and that such retrograde flow supplies from 14 to 25 per cent of the normal myocardial oxygen requirement. It is suggested that this is insufficient to maintain normal myocardial contraction, but probably prevents ventricular fibrillation. However, when the sinus is arterialized in the presence of normal or reduced coronary flow electrocardiographic and coronary inflow data show that there is myocardial anoxia. This is probably due to the restriction in capillary outflow and results in an expansion of the coronary vascular bed.
Recurrent Parietal Thromboendocarditis
Authors: NICOL CAMPBELL , MACMAHON H. EDWARD , BENENSON A. S. , WINSHIP THEODORE
Published: June 2012

A rare condition, which generally occurs in young adults and may simulate coronary disease, isdiscussed. The patients are afebrile, with low blood pressures, fast weak pulses and marked irregularities in cardiac rhythm. They are unresponsive to therapy and may survive initial attacks only to succumb to a recurrence. In the portions of the endocardium uninvolved by mural thrombi, there is marked collagenized subendocardial thickening devoid of elastic tissue. The etiology is unknown.
Effectiveness of Nupercaine Hydrochloride and Phenobarbital Sodium in the Suppression of Ventricular Tachycardia Associated with Acute Myocardial Infarction
Authors: BISTENI ABDO , HARRIS A. SIDNEY
Published: June 2012

In 22 dogs with ventricular tachycardia accompanying myocardial infarction, Nupercaine hydrochloride was found to be a potent suppressor of ectopic impulses. When used alone Nupercaine also produced vomiting and convulsive movements. When combined with morphine, vomiting was eliminated, but convulsions still occurred. When combined with phenobarbital sodium or pentobarbital sodium, the ectopic impulse suppressor action of Nupercaine was enhanced and both vomiting and convulsive movements were prevented. The duration of ectopic impulse suppressor action was significantly greater in the phenobarbital-Nupercaine experiments than in any other group. No deaths occurred.
Cardiovascular Dynamics, Blood Volumes, Renal Functions and Electrolyte Excretions in the Same Patients during Congestive Heart Failure and after Recovery of Cardiac Compensation
Authors: EICHNA LUDWIG W. , FARBER SAUL J. , BERGER ADOLPH R. , EARLE DAVID P. , RADER BERTHA , PELLEGRINO EDMUND , ALBERT ROY E. , ALEXANDER J. DEAVER , TAUBE HARRY , YOUNGWIRTH SOL
Published: June 2012

Largely on the basis of acute observations in cardiac patients during congestive heart failure and in noncardiac control subjects, two assumptions have been made: (a) that congestive heart failure develops as cardiovascular and renal functions change from the type found in the control subjects to the type found in decompensated cardiac patients, and (b) that a return to, or toward, the normal occurs in these functions as cardiac compensation is regained. That these assumptions are not necessarily valid is indicated by the herein reported simultaneous measurements of cardiovascular dynamics, renal functions, blood volumes and electrolyte excretions in eight patients during cardiac decompensation and after recovery of compensation.
Plasma Electrolyte Concentrations in Ambulatory Cardiac Patients
Authors: BRICKER NEAL S. , WESSON LAURENCE G.
Published: June 2012

The authors find that electrolyte concentrations of the plasma of the more severely ill cardiac patients attending two outpatient clinics are statistically indistinguishable from controls. They note, however, a slight tendency to metabolic alkalosis and occasionally a mild hyponatremia. No instance of "low salt syndrome" was found.
Successful Prevention of Experimental Hypercholesteremia and Cholesterol Atherosclerosis in the Rabbit
Authors: POLLAK O. J.
Published: June 2012

Cholesterol is absorbed by rabbits while its stereoisomer, sitosterol, is not resorbed. Cholesterol and sitosterol form nonseparable crystals. When the two sterols were fed simultaneously to rabbits, cholesterol was not absorbed, or was absorbed but partly. The degree of prevention of hypercholesteremia depended upon the amount of sitosterol fed with the cholesterol. A six-fold surplus of plant sterol was required in the experiments because the product employed contained but 75 to 80 per cent of sitosterol and because the supplied sitosterol binds not only exogenous cholesterol but also endogenous cholesterol present in the intestines. In the rabbit, prevention of hypercholesteremia is tantamount to prevention of atherosclerosis induced by cholesterol feeding.
Reduction of Blood Cholesterol in Man
Authors: POLLAK O. J.
Published: June 2012

Dietary cholesterol contributes to the development and maintenance of hypercholesteremia in man. Intake of sitosterol prevents cholesterol resorption. This results in lowering of blood cholesterols to a basal endogenous level. Upon cessation of sitosterol intake hemocholesterols return to the original level. Excess supply of plant sterol was required in clinical experiments because the material used contained but 75 to 80 per cent of sitosterol and because of the large amount of endogenous cholesterol which has to be inactivated by the sitosterol, besides exogenous cholesterol.
Calibration of the Direct Ballistocardiogram
Authors: REEVES T. J. , WILLIS KATHRYN , BOOTH EARNEST , ELLISON HASKELL
Published: June 2012

A simple method of calibrating the amplitude of the direct ballistocardiogram, utilizing a standard external force to the body, is described. Such a method tends to neutralize many of the variables in apparatus alignment and sensitivity, and provides a basis for comparison of amplitudes in the same and different subjects. Normals of different age groups were studied and the contrast with abnormals with known cardiovascular disease is shown.
Studies in Peripheral Arterial Occlusive Disease
Authors: WESSLER STANFORD , SILBERG NORMAN R.
Published: June 2012

A controlled clinical-pathologic study of peripheral arteriosclerotic gangrene is reported in which all amputated specimens were examined by a special technic of injection and dissection of the arteries. The type of patient in whom gangrene usually develops is defined. The effect of various clinical and pathologic conditions on the degree of arterial insufficiency is discussed from the viewpoints of pathogenesis and therapy.
The Significance of Changes in Amplitude of the First Heart Sound in Children with A-V Block
Authors: SHEARN MARTIN A. , TARR ELIZABETH , RYTAND DAVID A.
Published: June 2012

Curves which relate the peak intensity of the first heart sound to the P-R interval have been obtained from seven children with complete A-V block. The first sound is accentuated with short P-R intervals, becomes faint when the P-R interval is in the neighborhood of 0.20 to 0.30 second, and becomes loud again with relatively long P-R intervals. Repeated observations over a number of years demonstrated the effects of growth and aging on these phenomena. The data appear to indicate that the variable intensity of the first sound in complete A-V block is related to the position of the mitral valve at the time of ventricular systole.
Studies of Vasospasm
Authors: FOLEY WILLIAM T. , MCDEVITT ELLEN , TULLOCH J. A. , TUNIS MARTIN , WRIGHT IRVING S.
Published: June 2012

In the course of a physical examination one is often confronted with the question whether the inability to palpate a pulse in a usual location is the result of arterial spasm, occlusive arterial disease, or an aberrant location of the artery. Evidence is presented that the sublingual administration of glyceryl trinitrate (nitroglycerin) will frequently solve this problem. If the absent or markedly diminished pulse becomes bounding and objective tests confirm this, it can be concluded that the reduced pulsation was due to spasm of the artery under study. This is a simple test readily applied in clinical practice.
Mortality and Other Studies Questioning the Evidence for and Value of Routine Anticoagulant Therapy in Acute Myocardial Infarction
Authors: SCHNUR SIDNEY
Published: June 2012

This study of 1350 patients with acute myocardial infarction admitted to several hospitals during a 10-year period attempts to answer several questions currently in dispute: the correlation of the patient's condition on admission with the mortality rate, the relation of the patient's age to prognosis, and the value of routine anticoagulant therapy. It presents the major statistical objections to the study by the Committee for the Evaluation of Anticoagulants of the American Heart Association, questions the evidence upon which the Committee made its recommendations and concludes that incontrovertible proof of the advantages of routine anticoagulant therapy in patients mildly ill on admission to the hospital has not been presented thus far.
Studies Utilizing the Portable Electromagnetic Ballistocardiograph
Authors: MANDELBAUM HARRY , MANDELBAUM ROBERT A.
Published: June 2012

One hundred patients, who had survived their first episode of myocardial infarction, were studied by serial ballistocardiograms which provided a reliable index in determining myocardial functional recovery. The degree of ballistocardiographic reversion toward normal, as judged by an 18-month or longer follow-up period, has proved to be a valuable standard for prognosis.
An Analysis of Oscillometric Pulsations
Authors: RODBARD SIMON , JANNOTTA FRANK
Published: June 2012

The absolute lack of correlation of oscillometric pulsations with blood flow through vessels is demonstrated. The pulsations obtained are shown to depend primarily on the operation of simple hydrodynamic laws. A modified technic for oscillometric examination which gives a qualitative measure of normal blood flow through vessels is suggested.
The Treatment of Chronic Cor Pulmonale
Authors: HARVEY RÉJANE M. , FERRER M. IRENÉ , COURNAND ANDRÉ
Published: June 2012

In this presentation stress has been laid upon the concept that the treatment, as well as the prognosis of chronic cor pulmonale depend upon the underlying pulmonary disease. It has long been known that the chief causes of chronic cor pulmonale are chronic obstructive pulmonary emphysema and various forms of fibrosis, particularly the pneumoconioses. An understanding of the difference between these diseases, both as to their pulmonary dysfunction and their circulatory complications, is crucial to success in therapy. Management of the patient with chronic pulmonary emphysema and (or pulmoniale is quite different from that of the subject with fibrosis and right heart involxemenit.

Unfortuniately, little as yet is known about the circulation in the pulmonary fibroses. In patients with pulmonary fibrosis as well as those with granulomas of the lung it would appear that the anatomic pulmonary lesion is chiefly responsible for the pulmonary hypertension, in contradistinction to the patients with emphysema. Inasmuch as the anatomic lesions are for the most part irreversible, so is the pulmonary hypertension. This has limited our therapeutic approach in this form of chronic cor pulmonale to rigorous restriction of physical activity directed at minimizing exacerbations of pulmonary hypertension.

While emphasis has been placed upon the difference in management of the patient with emphysema or fibrosis and cor pulmonale, nonetheless it should be remembered that in any individual patient these two conditions may coexist. In that event, intensive therapy directed at the sequellae of emphysema may be very rewarding.
The Heart in Anemia
Authors: PORTER WILLIAM B. , JAMES G. WATSON
Published: June 2012

The following brief summary seems justified from the large volume of accumulated data dealing with the reaction of the cardiovascular system in the anemic patient.

There are four mechanisms operating in the anemic patient which may increase the supply of oxygen to the tissues when the oxygen carrying capacity of the blood is reduced. Under conditions of rest, a rapid velocity flow and tachycardia with an increase in minute volume of cardiac output is the first response to anemia. As compensation develops, tachycardia and increased velocity flow are largely replaced by selective shunting of blood and the removal of an increasing percentage of oxygen in the tissue capillaries from each gram of circulating hemoglobin.

These later physiologic mechanisms are best illustrated by patients with chronic parasitic anemias. Under conditions of physical stress each of the four physiologic mechanisms contribute in meeting the demands for increased oxygen requirements. Compensation is, however, never perfect; the status of the patient is determined by the reduction in hemoglobin, the tissue oxygen requirements, the presence of physical changes in the cardiovascular and pulmonary systems, degree of oxygen abstraction from the blood, and the selective shunting of blood.

In relatively acute anemia, dyspnea readily occurs on physical exercise. Reduction in the ventilatory capacity of the lung occurring in some anemic patients results from an over-all reduction in physical fitness due to the anemic state rather than to physical changes in the lung. In well compensated, chronic anemia, the vital capacity of the lungs is frequently above normal and similar to that observed in athletes and completely acclimatized, high altitude inhabitants.

In the absence of cardiovascular disease or physical or metabolic factors requiring increased cardiac output, true congestive heart failure rarely results from the anemic state.

Effort angina is uncommon in anemic patients and when present is usually related to underlying coronary artery disease.

Cardiac hypertrophy under certain conditions results from prolonged anemia. Since cardiac hypertrophy is rightly placed in the category of organic heart disease, one is justified in classifying chronic anemia as one of the etiologic factors in the production of heart disease.
The Syndrome of Patent Ductus Arteriosus with Pulmonary Hypertension
Authors: HULTGREN HERBERT , SELZER ARTHUR , PURDY ANN , HOLMAN EMILE , GERBODE FRANK
Published: June 2012

Eight cases of patent ductus arteriosus associated with marked pulmonary hypertension are presented with complete cardiac catheterization studies in six patients and autopsy studies in three cases. Four patients had clear evidence of a "reversed" shunt through the ductus, three presenting the clinical picture of cyanotic congenital heart disease. The authors discuss the nature of the increased resistance of the pulmonary vascular bed which is the basis of the circulatory changes in these cases.
Aging Processes in the Arterial and Venous Systems of the Lower Extremities
Authors: PAREIRA MORTON D. , HANDLER FRED P. , BLUMENTHAL HERMAN T.
Published: June 2012

Wear and tear degenerative patterns of the arterial system of the lower extremities have been studied in an age series. The intensity of these alterations has been correlated with the distribution of the atheromatous plaques and thrombosis as well as with the effective tension at various levels as calculated by Burton's formula. Evidence is presented for the concept that the lipids in atheromatous plaques arise as a product of these degenerative reactions within the vessel wall, rather than by diffusion from the circulation through the endothelial barrier.
Dye Dilution Curves in Cyanotic Congenital Heart Disease
Authors: SWAN H. J. C. , ZAPATA-DIAZ J. , WOOD EARL H.
Published: June 2012

Use of cuvette and earpiece oximeters facilitates the recording of the immediate dilution pattern of the dye T-1824 (Evans blue) in the arterial blood. In patients with venoarterial shunts the pattern of the dilution curves differs from normal. Quantitative analysis of such curves from patients with cyanotic congenital heart disease has been undertaken to establish the proportion of blood which bypassed the pulmonary circulation. The results obtained have been compared with estimates of the volume of the shunt from cardiac catheterization data and related to the arterial oxygen saturation.
The Effect of the Frequency Response of Electrocardiographs on the Form of Electrocardiograms and Vectorcardiograms
Authors: KERWIN A. J.
Published: June 2012

The spectrum of frequencies making up the cardiac potential has not been fully explored. Limitation in the high frequency response of most electrocardiographs suppresses in some tracings QRS components whose significance is at present obscure. Using the cathode ray oscillograph it was found that frequencies as high as 1300 cycles per second reveal characteristics not shown at lower frequencies. Frequencies as high as 6400 cycles per second are under investigation. Limitation of the low frequency response by the use of a condenser-resistor network to abolish extraneous potentials produces serious distortions of the RS-T segment.
Hypertension and Coronary Occlusion
Authors: MASTER ARTHUR M.
Published: June 2012

The problem of the relationship between hypertension and coronary occlusion has been re-examined. Using newly established limits of hypertension, 600 consecutive private patients with coronary occlusion—500 men and 100 women—all under 65 years of age, were studied. Hypertension did not appear to be a factor in producing coronary disease and occlusion among men, but was a definite factor in its causation among women. The possible relation of the serum cholesterol, the S
f
12-20 lipoprotein fraction, and the sex hormones to atherosclerosis and hypertension is discussed.
A Critical Evaluation of the Hypotensive Action of Hydrallazine, Hexamethonium, Tetraethylammonium and Dibenzyline Salts in Human and Experimental Hypertension
Authors: SHAPIRO ALVIN P. , GROLLMAN ARTHUR
Published: June 2012

The effects of hydrallazine and hexamethonium salts on blood pressure and related functions have been studied in a series of ambulatory and hospitalized hypertensive patients as well as in experimentally induced hypertension (rats and dogs). Comparative observations have also been made on the effects of tetraethylammonium chloride and Dibenzyline, a congener of dibenzylchlorethylamine (Dibenamine). Critical evaluation of the data indicates that the effectiveness of hydrallazine and hexamethonium salts, when used either alone or in combination, is not significantly greater in long term administration than that of previously existing regimens in the treatment of hypertensive vascular disease.
Parasystole
Authors: PICK ALFRED
Published: June 2012

Five instances of parasystolic rhythm are presented in which detailed analysis revealed some particular physiologic aspect pertinent to the understanding of this type of disturbance of rhythm. In four cases the ectopic parasystolic focus was localized in the ventricles and in one in or near to the A-V junction; in two of the former instances the site of the ectopic focus appeared to be the interventricular septum. The mechanism of protection of the parasystolic center, while not identical in every case, might be effected by an area of true block, as exemplified by one instance. Parasystole offers the rare opportunity to determine the refractory phase of the A-V junction or of the ventricular myocardium in the human heart. Occasionally parasystolic rhythm may appear in association with other types of manifest multiple cardiac pacemakers and produce very complex arrhythmias, which can be resolved by application of known physiologic principles.
The Circulatory Response to the Valsalva Maneuver of Patients with Mitral Stenosis with and without Autonomic Blockade
Authors: GREENE DAVID G. , BUNNELL IVAN L.
Published: June 2012

Patients with clinically significant mitral stenosis have been demonstrated to differ from other subjects in their circulatory responses to the Valsalva maneuver. During forced expiration most patients with mitral stencsis are able to maintain systolic pressure in the brachial artery at a level equal to or greater than the resting value, whereas most control subjects cannot. Autonomic blockade does not affect the ability of patients with mitral stenosis to maintain systolic pressure, whereas it abolishes such ability, when it is present, in control subjects. The unique response of patients with mitral stenosis under autonomic blockade is attributed to the physiologic consequences of the volume of blood in the dilated left atrium.
Hemodynamic Effects of Valvulotomy in Pulmonic Stenosis
Authors: LURIE PAUL R. , SHUMACKER HARRIS B.
Published: June 2012

Seven patients with mild to moderate pulmonic stenosis with intact ventricular septum were subjected to cardiac catheterization before and from 4 to 18 months after pulmonary valvulotomy. Despite uniform clinical improvement, remarkably slight changes were observed, following surgery, in right ventricular pressure, pulmonary artery pressure, pulmonary artery flow, and pulmonary valve area, when measured at rest. When present preoperatively, venoarterial shunt was reduced or eliminated after operation. It was speculated that further studies including the effect of exercise might show that valvulotomy increases the mobility of the valve under stress even when it does not increase valve area at rest.
The Kinetocardiogram
Authors: EDDLEMAN E. E. , WILLIS KATHRYN , CHRISTIANSON LYNN , PIERCE J. R. , WALKER R. P.
Published: June 2012

An analysis of the patterns and amplitudes of the precordial movements is presented. Normal young adult subjects had three types of patterns. Type I occurred in 78 per cent, type II in 14 per cent, and type III in 8 per cent of the subjects studied. The variations of the kinetocardiogram from apex cardiograms and pneumocardiograms are discussed.
Embolic Occlusion of Patent Foramen Ovale
Authors: ELLIOTT G. B. , BEAMISH R. E.
Published: June 2012

In the presence of a patent foramen ovale, pulmonary embolism may result in a right-to-left interatrial shunt which serves to alleviate the effects of the embolism. When the shunt is occluded by a subsequent embolus, sudden death occurs. The clinical and pathologic features of the syndrome are described.
Failure to Reduce the Size of Experimentally Produced Myocardial Infarcts by Cortisone Treatment
Authors: OPDYKE D. F. , LAMBERT A. , STOERK H. C. , ZANETTI M. E. , KUNA S.
Published: June 2012

Cortisone, whether used prophylactically or therapeutically, did not appear to have any beneficial effect in reducing the size of the myocardial infarcts produced by coronary artery ligation in dogs. No significant differences were noted between the control and cortisone-treated animals in respect to the vascularity of the infarcted area or the rate of healing.
Electrocardiographic Leads
Authors: MCFEE RICHARD , JOHNSTON FRANKLIN D.
Published: June 2012

This paper is the first of a series of three which will deal with the relationship between the voltages in electrocardiographic leads and the electromotive forces of the heart. The general purpose of this series is to discuss various experimental and theoretic technics which can be used in the analysis of a given lead, and in the building up, or "synthesis," of leads having desired characteristics. The procedures used are based on a fundamental theorem which takes into account not only the irregular shape and conductivity of the body but also the spatial dispersion of the electromotive forces within the heart. It is closely related to the "lead vector" concept of Burger and van Milaan.

In this first paper the basic definitions and theorems are developed. The second paper discusses various methods of analysing leads. The third and last presents a number of systematic procedures for designing leads, both vectorcardiographic and unipolar. Such leads can have substantially higher accuracies than those now in use, because their design takes into account the shape and conductivity of the body and its tissues, and the eccentric and extended location of the heart.
Facts and Fallacies Regarding the Blood Pressure of Different Regional and Racial Groups
Authors: BAYS ROBERT P. , SCRIMSHAW NEVIN S.
Published: June 2012

The blood pressure cuff reveals higher values in complex societies than in simpler social environments. Evaluation of the importance of this fact necessitates a more exact use of such terms as "high blood pressure" or "hypertensive disease' as applied to an individual, and "mean blood pressure" or "incidence of hypertension" as applied to groups. The inadequacies of the cuff method of blood pressure determination are particularly evident in group studies. From the available facts, a few cautious conclusions may be drawn.
Studies on the Control of Hypertension by Hyphex
Authors: SCHROEDER HENRY A. , MORROW JOHN D. , PERRY H. MITCHELL
Published: June 2012

This report is the first of a series on a method for treatment of hypertension by oral hexamethonium chloride and hydrazinophthalazine. When strictly followed blood pressure was maintained at reasonable or normal levels in 80 per cent of 258 cases of severe hypertension. The malignant stage, when present, was reversed. Renal insufficiency and severe cerebral atherosclerosis limit the effectiveness of the method for prolongation of life.
Demonstration of Differential Effects on Pulmonary and Systemic Arterial Pressure by Variation in Oxygen Content of Inspired Air in Patients with Patent Ductus Arteriosus and Pulmonary Hypertension
Authors: BURCHELL HOWARD B. , SWAN H. J. C. , WOOD EARL H.
Published: June 2012

Seven cases of patent ductus arteriosus with pulmonary hypertension and reversal of the usual direction of flow are described. Breathing of a low oxygen mixture either initiated or increased the reversed shunt, and breathing 100 per cent oxygen produced the reverse effect. Differences in oxygen saturation and dye-dilution curves recorded simultaneously from the radial and femoral arteries have allowed calculation of differences in the proportion of shunted blood flowing in these arteries and demonstrate that retrograde movement of blood in the aortic arch may occur.
Mechanical and Myocardial Factors in Chronic Constrictive Pericarditis
Authors: HARVEY RAJANE M. , FERRER M. IRENÉ , CATHCART RICHARD T. , RICHARDS DICKINSON W. , COURNAND ANDRÉ
Published: June 2012

The hemodynamic findings in five patients are presented in order to demonstrate the variability in the clinical and physiologic patterns that may be encountered in restrictive disease of the pericardium. The mechanical effects of pericardial encasement previously described were confirmed. Furthermore, it was found that myocardial insufficiency and hypervolemia were not only important causative agents in the circulatory dysfunction but were in some measure reversible, thus permitting resolution of the congestive state and disappearance of the "typical" hemodynamic findings of constrictive pericarditis.
Thiamine Deficiency in Organic Heart Disease
Authors: WOHL MICHAEL G. , SHUMAN CHARLES R. , TURNER RICHARD , FITTIPOLDI JOHN J.
Published: June 2012

Since cocarboxylase, derived from thiamine, is necessary for normal utilization of pyruvate by heart muscle, the importance of adequate body stores of thiamine in patients with chronic heart disease is quite obvious. In order to investigate the occurrence of subclinical thiamine deficiency in patients with chronic heart disease, the thiamine was determined in the four-hour specimen of urine after loading dose in 35 male patients with congestive heart failure and compared with thiamine excretion in 17 persons free from cardiac disease. It was found that the noncardiac group had a significantly higher excretion of thiamine after a loading dose than patients with heart disease. Nine patients with severe heart failure receiving mercurial diuretics in the course of treatment were studied using 24-hour urine collections before, during and after the injection of the mercurial. The 24-hour urinary thiamine content was measured, demonstrating significant increases in thiamine excretion with mercurial diuresis.
Pattern of Failure of the Homografted Canine Heart
Authors: WESOLOWSKI SIGMUND A. , FENNESSEY JOHN F.
Published: June 2012

A series of puppy hearts was homografted into the necks of adult dogs. The grafts were followed for viability by palpation and by electrocardiograms. Of the grafts studied none functioned longer than one week. Others removed on successive days after transplantation revealed a pattern of failure that suggests that incompatibility to the homografted canine heart is blood-borne.
Congestive Heart Failure Induced by Primary Systemic Amyloidosis
Authors: PRUITT RAYMOND D. , DAUGHERTY GUY W. , EDWARDS JESSE E.
Published: June 2012

This conference has been concerned with a case of primary systemic amyloidosis in which death occurred in the course of severe, congestive heart failure. Major emphasis has been attached to the diagnostic problems which were posed by a patient so afflicted. If comments regarding treatment have been of limited extent, so have been the results of treatment when applied.
Studies on the Control of Hypertension by Hyphex
Authors: MORROW JOHN D. , SCHROEDER HENRY A. , PERRY H. MITCHELL
Published: June 2012

Although effective in maintaining relatively normal levels of blood pressure in hypertensive patients and retarding some of the serious and fatal secondary consequences of the disease, hexamethonium ion and 1-hydrazinophthalazine can cause severe immediate and late reactions. The latter drug has produced collagen diseases of varying degrees of severity, all of which have regressed on cessation of medication, in 14 of 253 patients. The combination has given rise to fatal interstitial pneumonia in 5 of 89 in malignant stages of hypertension. Less serious side effects of each agent are also discussed.
Orthostatic Factors in Pulsus Alternans
Authors: FRIEDMAN BEN , DAILY WILLIAM M. , SHEFFIELD ROY S.
Published: June 2012

Ventricular alternans was present in three cardiac patients only in the erect or semierect position and disappeared with recumbency. The phenomenon which was regularly reproduced in the standing posture was prevented or minimized by exercise, digitalis, infusions of blood and norepinephrine and by application of external vascular support. Ventricular alternation in the supine patient was noted only after phlebotomy, or venous pooling combined with Valsalva maneuvers. The observations suggest that in the mechanism of this type of pulsus alternans there is an important peripheral hemodynamic factor which exerts its effect by changes in diastolic length of an injured ventricular muscle.
Studies on the Effect of Exercise on Cardiovascular Function
Authors: CHAPMAN CARLETON B. , FRASER ROBERT S.
Published: June 2012

For technical reasons, the measurement of cardiac output during brisk walking is difficult. By using a slight modification of the Hamilton dye-dilution method, such measurements, and measurements of mean circulation time, were made at rest and at the end of a moderate work load in normal subjects. A motor-driven treadmill was used for the exercise. It was found that the cardiac output increases 1.7 to 1.9 times and the mean circulation time decreases about 34 per cent in normal young men and women after a 10 minute walk at 3 miles per hour and 5 per cent grade.
Comparison of Visceral and Peripheral Vascular Beds in Hypertensive Patients
Authors: REDISCH WALTER , WERTHEIMER LOTHAR , DELISLE CLAUDE , STEELE J. MURRAY , MULCARE LOUISA
Published: June 2012

The responses of the kidney and the lower extremities to single intravenous doses of six "hypotensive" drugs were measured in eight patients diagnosed as having essential hypertension. Use of Hexamethonium, Ilidar and Hydergine was followed by increase in the flow to the extremity and simultaneous decrease in renal blood flow. In contrast, the administration of Apresoline was followed by decrease in flow to the extremity and an increase in renal blood flow. Regitine produced no significant change in either. After the administration of protoveratrine, renal blood flow decreased but a significant change in blood flow to the extremity was not observed. Changes in arterial pressure which occurred with some of the drugs were not correlated with the changes in blood flow to the extremities or to the kidney.
Clinical Appraisal of Intra-arterial Priscoline Therapy in the Management of Peripheral Arterial Diseases
Authors: PRANDONI ANDREW G. , MOSER MARVIN
Published: June 2012

Priscoline can be given intra-arterially without difficulty. Untoward reactions are infrequent even in older patients. Intra-arterial administration was often effective in patients who did not respond to oral Priscoline. Although maximal vasodilatation may not be achieved by giving Priscoline intra-arterially, the degree of vasodilatation obtained is often adequate for a clinical effect. Results in 250 patients indicate that intra-arterial Priscoline is most useful in the treatment of ischemic rest pain resulting from organic vascular disease. Improvement in exercise tolerance was infrequent. Causalgia, delayed wound healing and ulceration in Reynaud's disease responded favorably in some instances.
The Effect of Hypocapnia on Arterial Blood Pressure
Authors: BURNUM J. F. , HICKAM J. B. , MCINTOSH H. D.
Published: June 2012

In man, hypocapnia induced by hyperventilation causes a drop in arterial pressure. The calculated peripheral resistance is decreased, indicating a net vasodilatation. The forearm blood flow is markedly increased, and the vascular resistance of the forearm is much reduced. Persons with impaired function of the sympathetic nervous system continue to show these effects. The increase in forearm flow is not prevented by brachial block. These results suggest that hypocapnia acts directly on blood vessels to produce a net over-all vasodilatation and fall in blood pressure, and that this effect is not mediated through the nervous system, as usually supposed.
Congenital Mitral Stenosis
Authors: FERENCZ CHARLOTTE , JOHNSON ARNOLD L. , WIGLESWORTH F. W.
Published: June 2012

Nine cases of congenital mitral stenosis are presented, with a review of 34 cases from the literature. A high incidence of associated malformations of the aortic valve, the aorta and the ductus arteriosus is apparent. Clinical findings and results of investigative procedures have been reviewed. Mitral stenosis is responsible for severe circulatory alterations and the development of hypertensive pulmonary vascular changes. This malformation has serious consequences. It is associated with early mortality and renders ineffective the surgical repair of associated coarctation of the aorta or patent ductus arteriosus.
Studies on the Effect of Exercise on Cardiovascular Function
Authors: FRASER ROBERT S. , CHAPMAN CARLETON B.
Published: June 2012

Attempts to follow changes in blood pressure induced by exercise, using indirect sphygmomanometry, have yielded conflicting results. In the following study, blood pressure measurements were made at rest (standing), during a standard treadmill work load, and during a six-minute recovery period, using a direct method and a suitably damped recording system. It was found that during exercise systolic pressure rises and that diastolic pressure falls, the net result being very little change in the mean pressure. In some subjects there is a secondary rise in all three items between 10 and 30 seconds after cessation of exercise. Changes in pulse rate during exercise and recovery are also discussed.
Intravascular Aggregation and Adhesiveness of the Blood Elements Associated with Alimentary Lipemia and Injections of Large Molecular Substances
Authors: CULLEN CHESTER F. , SWANK ROY L.
Published: June 2012

Observations on the intact circulation of the hamster reveal that following a meal high in fat content there occurs increased adhesiveness and aggregation of the red blood cells and sometimes clumping of the platelets, accompanied by slowing of the circulation. These changes are reversible, the circulation resuming a normal appearance with complete clearing of the lipemia. Similar circulatory changes can be produced by the injection of large molecular solutions. These circulatory alterations, when severe enough, cause pathologic changes in the blood-brain barrier. The significance of these findings and their possible relationship to multiple sclerosis and vascular thrombosis are discussed.
Visualization of Valvular and Myocardial Calcification by Planigraphy
Authors: SOLOFF LOUIS A. , ZATUCHNI JACOB , FISHER HERBERT
Published: June 2012

A preoperative diagnosis of valvular calcification that indicates advanced degeneration and implies potential immobility is now of more than academic interest. It is also of importance in uncovering aortic valvular disease that may contraindicate mitral commissurotomy. Surgical experience indicates that conventional roentgenography has a low positive yield. Fluoroscopy, in our hands, has a high positive yield but has the disadvantages of dependence upon individual interest and knowledge and of failure to provide a permanent record verifiable by others. In this study, planigraphy is demonstrated to be superior to all other methods described for the detection of intracardiac calcification.
Circulatory Changes Produced by the Valsalva Maneuver in Normal Subjects, Patients with Mitral Stenosis, and Autonomic Nervous System Alterations
Authors: MCINTOSH H. D. , BURNUM J. F. , HICKAM J. B. , WARREN J. V.
Published: June 2012

The cardiac output has been measured during the immediate post-Valsalva maneuver recovery period in normal subjects, patients with clinically significant mitral stenosis, and patients with alterations of the autonomic nervous system. When compared with the resting value, it was found that normal subjects had a decrease in cardiac output during the immediate post-Valsalva recovery period, while patients with mitral stenosis had an increased output following the same stress. Three patients with alterations of the autonomic nervous system had a variable response. Changes in total peripheral vascular resistance usually were directionally opposite to changes in the cardiac output. The difficulties of attaching clinical significance to a patient's response to the Valsalva maneuver are considered.
The Incidence and Severity of Atherosclerosis in Estrogen-Treated Males, and in Females with a Hypoestrogenic or a Hyperestrogenic State
Authors: RIVIN ARTHUR U. , DIMITROFF SIM P.
Published: June 2012

Autopsy records of estrogen-treated men, castrated women, and women with breast carcinoma were analyzed with reference to the degree of atherosclerotic disease. Findings were then compared with those in similar groups of men and women whose estrogen supply was considered normal. Results obtained suggest: (1) that the male treated with estrogen has less atherosclerosis than the normal male; (2) that the oophorectomized female has an incidence of severe atherosclerosis approaching that of the male; and (3) that the hyperestrogenic female with breast carcinoma has less atherosclerosis than the normal female.
A Simple Geometric Analysis of Cardiac Potentials as Recorded at Points Close to the Heart
Authors: GARDBERG MANUEL
Published: June 2012

A simple geometric method is employed to investigate the theoretically expected potentials at an electrode close to the heart as a dipole moves about in an area in the chest occupied by the heart. The considerable error resulting from the assumption that the dipole remains at the center of a geometric frame of reference is thus disclosed. It is pointed out that errors in polarity which occur cannot be compensated for by alteration of the characteristics of the recording device. It is suggested that such errors account for the finding by spatial vectorcardiographers that many normal QRS loops point forward, a finding which does not correlate well with the Gardberg-Ashman hypothesis of ventricular accession. It is further suggested that the limb leads are not free of these effects and that exaggeration of the electrical rotation of the heart is thus accounted for. It is further pointed out that derivation of precordial potentials from vector loops or vice versa is not permissible.
The Origin of Aortic Phospholipid in Rabbit Atheromatosis
Authors: ZILVERSMIT D. B. , SHORE MORIS L. , ACKERMAN R. F.
Published: June 2012

Radioactive phosphorus (P
32
) was injected into normal and cholesterol-fed rabbits. A marked derangement of aortic phospholipid metabolism was found in the cholesterol-fed animals. The phospholipid found in the atheromatous aortas appeared to have been synthesized by the aorta itself rather than to have been deposited there from the plasma.
Studies Made By Simulating Systole at Necropsy
Authors: STARR ISAAC , SCHNABEL T. G. , ASKOVITZ S. I. , SCHILD A.
Published: June 2012

Data derived from experiments on cadavers have been used to test old methods and to design new methods of estimating cardiac stroke volume from estimations of blood pressure, made both by intra-arterial and standard clinical technics. From the data has been derived a method of estimating stroke volume from pulse pressure, diastolic pressure and age, which has reasonably good accuracy in the cadaver experiments, and which is so simple that it could be easily applied by any physician using the apparatus he now has.
Clinical Tests of the Simple Method of Estimating Cardiac Stroke Volume from Blood Pressure and Age
Authors: STARR ISAAC
Published: June 2012

The results secured by the simple method of estimating cardiac output, described in the previous paper, have been applied to data already in the literature. Hundreds of comparisons are possible between estimates of cardiac output made by our blood pressure method from values given by the authors, and the results of estimates of cardiac output by some other well known method employed at the same time. The correlations between the results secured by our method and those obtained by Fick, acetylene, ethyl iodide, and nitrous oxide methods are often surprisingly good. There is an unexplained difference in level between the Fick and blood pressure estimates, but not between the blood pressure estimates and those of the three older methods.
Anticoagulant Therapy in Private Practice
Authors: STEPHENS CHARLES A. L.
Published: June 2012

One hundred eighty-one patients suffering from 216 separate episodes of thromboembolism were treated with anticoagulants by the author in private practice. The indications and contraindications for anticoagulants are described and the results tabulated and analyzed. Practical methods of administration of anticoagulants are discussed. Long-term ambulatory anticoagulant therapy is considered as a special and important aspect of the problem of thromboembolism with the results indicating it to be a practical and feasible form of preventive therapy worthy of more widespread use.