bluuebunny/crossref_metadata_2025 huggingface dataset:
Anti-Adrenergic Effects of Nitroglycerin on the Heart
Authors: RAAB W. , LEPESCHKIN E.
Published: June 2012

The therapeutic effect of nitroglycerin is generally attributed to its coronary dilator effect alone. In contrast, it could be shown that nitroglycerin also counteracts the chronotropic as well as the electrocardiographic T-wave depressing effects of epinephrine, arterenol and cardiac sympathin upon the heart. Accordingly, its therapeutic action in angina pectoris is suspected as being largely due to a chemical protection of the heart muscle against the chemically anoxia-producing effects of sympathomimetic amines.
The Syndrome of Bernheim as a Clinical Entity
Authors: RUSSEK HENRY I. , ZOHMAN BURTON L.
Published: June 2012

Can the right ventricle become partially obliterated by a bulging and hypertrophied interventricular septum so as to produce the clinical picture of isolated right heart failure? If so, the syndrome of Bernheim must be accepted as a distinct clinico-pathologic entity. The authors have previously reported 3 cases of right ventricular stenosis which appeared to originate in this manner. More recently, this evidence has been challenged and theoretic objections have been raised as to the possible existence of the syndrome. The present report attempts to answer these contrary assertions and records another instance in which the syndrome was diagnosed clinically and confirmed at autopsy.
Sclerosis of the Chordae Tendineae of the Mitral Valve
Authors: SOKOLOFF LEON , ELSTER SAMUEL K. , RIGHTHAND NORMAN
Published: June 2012

Thickening and sclerosis of the chordae tendineae of the mitral valve are seen fairly frequently in hearts that are not ordinarily considered to be rheumatic. In this report a systematic study of these lesions is presented. Factors involved in their pathogenesis and their significance in the development of the chronic rheumatic deformity are discussed.
Congenital Arteriovenous Fistulas of the Thoracic Wall
Authors: MAIER HERBERT C. , STOUT ARTHUR PURDY
Published: June 2012

Arteriovenous fistulas of the thoracic wall may produce murmurs and thrills which suggest an intrathoracic vascular abnormality. Congenital arteriovenous fistulas in the precordial region, the site of the fistula in the case here reported, may be confused with anomalies of the heart and great vessels. The differential diagnosis of blood vessel tumors of the chest wall is discussed. Occasionally arteriovenous fistulas involve both the thoracic wall and intrathoracic viscera.
Diverticulum of the Pericardium
Authors: BISHOP LOUIS FAUGERES , KIRSCHNER PAUL A. , PESSAR THEODORE
Published: June 2012

A case of true diverticulum of the pericardium is reported, with a review of the literature. A cure was effected by excision of the cystic pericardial diverticulum. Consideration of the etiology of true pericardial diverticulum is given, and possible explanation for accumulation of the fluid is suggested.
Studies of Tissue Response to Injections of Enzymes
Authors: SCHLAMOWITZ SAMUEL THEODORE , DEGRAFF ARTHUR C. , SCHUBERT MAXWELL
Published: June 2012

Hexosamine-containing polysaccharides have been demonstrated in plasma and various tissues including skin, cartilage and heart. Plasma hexosamine elevations have been observed in rheumatic fever, sterile infarcts and tuberculosis. It is possible that plasma polysaccharide changes reflect alterations of tissue polysaccharides. Thirty-six hours following a single subcutaneous injection of trypsin, a significant elevation of tissue hexosamine occurred at the injection sites. This appeared long before any visible or palpable change. The tissue hexosamine paralleled the developmental course of the "nodules." These findings appear specifically related to trypsin, since they failed to occur with other enzymes or test substances.
Hypersensitive Carotid Sinus Reflex Associated with Spontaneous, Transient Complete Heart Block
Authors: SCHWARTZ IRVING L. , EICHNA LUDWIG W.
Published: June 2012

A patient with transient, intermittent, complete heart block had periods of asystole, accompanied by syncope, whenever his cardiac rhythm shifted spontaneously from regular sinus rhythm to complete auriculoventricular dissociation. Similar clinical and electrocardiographic findings were produced by carotid sinus pressure when there was regular sinus rhythm. During the periods of heart block carotid sinus stimulation produced no effects. Physiologic studies suggested that the site of sensitivity of the hyperactive carotid sinus reflex was located at the effector end of the reflex arc. The possibility of structural damage to the heart from repeated stimulation of a hyperactive carotid sinus reflex is considered.
Auriculoventricular Nodal Escape in the Presence of Auricular Fibrillation
Authors: HWANG W. , LANGENDORF R.
Published: June 2012

The criteria for the diagnosis of A-V nodal escape are analyzed on the basis of electrocardiograms on patients with auricular fibrillation with digitalis-induced ventricular slowing.
Relation of Supraventricular Paroxysmal Tachycardia to Heart Disease and the Basal Metabolism Rate
Authors: KISSANE R. W. , BROOKS RICHARD , CLARK THOMAS E.
Published: June 2012

The records of 9,950 private patients were reviewed to determine the incidence of supraventricular paroxysmal tachycardia. The relationship of the tachycardia to the various types of heart disease was determined. The incidence of tachycardia in normal persons and in patients with hyperthyroidism or hypothyroidism was also studied.
A Slide Rule to Determine the Axis of the Electrocardiogram
Authors: BEATTY JOHN H.
Published: June 2012

A slide rule for determining the electrical axis of the electrocardiogram is presented. The device is a modification of the Dieuaide Chart. Construction of the slide rule and method of using it are described. Its use permits a very rapid calculation of the axis in degrees.
A Quantitative Comparison of Unipolar and Augmented Unipolar Limb Leads
Authors: SIMONSON ERNST , KEYS ANCEL
Published: June 2012

Goldberger has claimed that his augmented unipolar limb leads (aV) are identical—except for a 50 per cent larger amplitude—and interchangeable with Wilson's original V leads, but this claim was not supported by quantitative evidence. The advantage of larger amplitudes explains the increasing preference for the aV leads. A quantitative comparison between V and aV leads revealed such tremendous variability of the augmentation ratio, both interindividual and between leads in the same individual, that standards obtained with V leads are not applicable to aV leads and vice versa. V leads and aV leads are not interchangeable.
The Changes in Heart Size in Man During Partial Acclimatization to Simulated High Altitudes
Authors: GRAYBIEL ASHTON , PATTERSON JOHN L. , HOUSTON CHARLES S.
Published: June 2012

The heart size, as shown in serial roentgenograms, was determined in the case of 4 young volunteers who were continuously exposed to simulated high altitude over a period of one month. Sufficient adaptation occurred to allow them to remain at progressively higher altitudes up to 22,500 feet. A slight decrease in heart size was observed at all altitudes. This was thought to be due to decreased cardiac filling or smaller stroke volume or both. Doubt is expressed regarding the oft repeated statement that the heart in healthy persons exposed to anoxia readily increases in size.
The Effect of Nicotinic Acid on the Cerebral Circulation, with Observations on Extracerebral Contamination of Cerebral Venous Blood in the Nitrous Oxide Procedure for Cerebral Blood Flow
Authors: SCHEINBERG PERITZ
Published: June 2012

Measurement of cerebral blood flow by the nitrous oxide method before and during intravenous administration of nicotinic acid indicates that cerebral vessels do not respond to this drug. Evidence that contamination of cerebral by extracerebral blood occurs in about 20 per cent of subjects is adduced from the effects of nicotinic acid on the measured cerebral blood flows; studies making use of the intravascular catheter technic to sample internal jugular blood tend to confirm this hypothesis.
The Myocardium in Subacute Bacterial Endocarditis
Authors: SAPHIR OTTO , KATZ LOUIS N. , GORE IRA
Published: June 2012

An evaluation of electrocardiographic tracings as an index of myocardial damage in survivors of subacute bacterial endocarditis was undertaken in a study of 76 fatal cases of the disease. Anatomic changes, present in all, included myocarditis, perivascular infiltration and fibrosis, Aschoff bodies, infarcts, and intravascular emboli. Electrocardiographic tracings revealed changes which could be attributed to myocardial impairment confirmed at autopsy. Variation of pattern in serial records, although not diagnostic of specific disease, indicated an active process within the myocardium. Correlation of the electrocardiographic tracings with pathologic changes was not complete, but was sufficiently close to demonstrate the diagnostic value of electrocardiograms.
Effect of Digitalis on the Clotting of the Blood in Normal Subjects and in Patients with Congestive Heart Failure
Authors: CATHCART RICHARD T. , BLOOD DAVID W.
Published: June 2012

Two groups of subjects were studied in order to evaluate the effect of digitalis on the coagulation of blood. One consisted of hospital patients in congestive heart failure, the other of normal interns. Control determinations were made of clotting and prothrombin times. Various preparations of digitalis were then administered in therapeutic doses. During administration, serial determinations were made of clotting and prothrombin times. The results were tabulated and the effect of digitalis appraised.
The Q-T Interval in the Electrocardiogram of Children with Tuberculosis
Authors: FOX THEODORE T. , BERGER HERBERT , KAPLAN ELLIOTT , MARSHAL JOHN C.
Published: June 2012

It is stated that prolongation of the Q-T interval is a reliable criterion of active carditis. A control investigation of a group of tuberculous children was undertaken with particular reference to this point. It was observed that prolongation of the Q-T interval is a rather frequent finding in childhood tuberculosis, but is not an expression of the cardiac status of the patient. The value of the Q-T interval as an indicator of active carditis is therefore questioned.
Coronary Arteriography in the Intact Dog
Authors: PEARL FELIX , FRIEDMAN MEYER , GRAY NORMAN , FRIEDMAN BRUCE
Published: June 2012

A method is described whereby the coronary arteries of dogs with intact chests can be regularly demonstrated roentgenologically by the use of small amounts of Diodrast injected through a specially devised catheter which is passed to the aortic sinus through a peripheral artery. The artery is preserved by suture. Electrocardiograms taken during the procedure were normal. The aortic valves of two excised hearts previously subjected to forceful trauma by the catheter, showed no abnormality. Characteristic arteriograms are reproduced, showing coronary arteries, separate cusps of the aortic valves, and the proximal aorta.
Dicumarol Fatality in Severe Hypertensive and Arteriosclerotic Cardiovascular Disease Despite Controlled Therapeutic Level
Authors: LONDON ROSE E.
Published: June 2012

The following case demonstrates fatal widespread hemorrhage resulting from the use of dicumarol at what is ordinarily considered a safe and desirable therapeutic level. It is suggested that the accompanying severe hypertensive and arteriosclerotic cardiovascular disease may have injured the contiguity of the vascular tree to such an extent that active diapedesis occurred in the presence of dicumarol.
Ebstein's Anomaly of the Tricuspid Valve
Authors: ENGLE MARY ALLEN , PAYNE TORRENCE P. B. , BRUINS CAROLINE , TAUSSIG HELEN B.
Published: June 2012

In Ebstein's anomaly the tricuspid valve is displaced downward so that the upper portion of the right ventricle is incorporated in the right auricle. This imipairs the efficiency of the right side of the heart and produces a distinctive syndrome, which is described here for the first time. Diagnosis is important because this malformation, which is not amenable to surgery, may be confused with the tetralogy of Fallot.
A Direct Experimental Study of Three Systems of Spatial Vectorcardiography
Authors: FRANK ERNEST
Published: June 2012

Three commonly used systems of vectorcardiography are compared on an absolute and direct quantitative basis in terms of equations, geometric interpretations, scalar leads and vectorcardiograms, using experimental results obtained on an accurate, three-dimensional homogeneous torso model of the human subject with a dipole fixed in position in the center of the heart. It is concluded that the accuracy of the three systems, as presently used, is unsatisfactory and that further consideration of the systems of Duchosal and Grishman is questionable because of excessive intrinsic errors. Certain chance properties of the Wilson tetrahedron enable standardization modifications which lead to fairly accurate results for some dipole positions, and this system also possesses other features which appear to be desirable. The applicability of the results and conclusions to the human subject depends upon the degree to which the human heart may be represented by a fixed-position dipole and the degree to which human body electrical inhomogeneities influence body surface potentials.
Serum Lipoprotein Stability in Atherosclerosis
Authors: HORLICK LOUIS
Published: June 2012

The alpha toxin of
Clostridium welchii
is a potent lecithinase which disrupts the serum lipoproteins, eventually resulting in complete separation of the lipids from the protein fraction. This reaction is associated with the development of turbidity, the intensity of which is related to the quantitative level of serum lipids. The time of onset of turbidity, however, appears to relate to the stability of the serum lipoprotein bond. Individuals with coronary disease showed early development of turbidity and high final turbidity in 64 per cent as compared with 14 per cent in a control group and 6 per cent in a group of young normal subjects.
Persistent Supraventricular Tachycardia
Authors: SHACHNOW NORMAN , SPELLMAN STANLEY , RUBIN IRA
Published: June 2012

A summary of all reported cases of persistent supraventricular tachycardia, as contrasted with paroxysmal and repetitive tachycardia, is presented, along with an additional well-documented instance covering an 11-year period. The distinctive features of persistent tachycardia are included.
Estrogen Prophylaxis of Cholesterol-Induced Coronary Atherogenesis in Chicks Given Adrenal Corticoids or ACTH
Authors: STAMLER JEREMIAH , PICK RUTH , KATZ LOUIS N.
Published: June 2012

Estrogen prophylaxis of experimental cholesterol-induced coronary atherogenesis in cockerels is unimpaired by the hyperadrenalism and steroid diabetes variously produced by concomitant exhibition of desoxycorticosterone acetate (DCA), hydrocortisone, cortisone or adrenocorticotropic hormone (ACTH).
Intravenous Trypsin
Authors: TAYLOR ALEXANDER , WRIGHT IRVING S.
Published: June 2012

Studies were carried out regarding the effect of intravenous trypsin on rabbits. These included investigations into the toxicity and the tendency for the production of intravascular coagulation. The effect on artificial preformed thrombi was also observed. It was found that in the doses used, the intravenous administration of trypsin was not efficacious in the treatment of intravascular thrombosis. These studies failed to provide evidence to justify its use as a therapeutic agent in man.
Pulmonary Arteriosclerosis and Cor Pulmonale Due to Recurrent Thromboembolism
Authors: BARNARD P. J.
Published: June 2012

A long-term experiment will be described which has shown that repeated injections of minute autogenous blood clots in rabbits caused pulmonary arteriosclerosis and cor pulmonale. Pulmonary arterial lesions were of two main kinds with respect to circumference of the intimal coat: eccentric, ascribable to intimal incorporation of clot, and circumferential, probably ascribable to hypertension and vasospasm. A counterpart to this animal experiment is probably to be found in human pathology, as suggested by certain case reports, by the pathology of lymphangitis carcinomatosa and by evidence that circulating blood is not clot free.
Hyperventilation in Postural Hypotension
Authors: BURNUM JOHN F. , HICKAM JOHN B. , STEAD EUGENE A.
Published: June 2012

In normal subjects hyperventilation causes a drop in arterial blood pressure, apparently because of the direct effect of hypocapnia on the peripheral vessels. In persons with disease of the autonomic nervous system, the drop in blood pressure is much greater because it is not effectively opposed by reflex vasoconstriction. Consequently, hyperventilation caused by anxiety may greatly intensify postural hypotension in such patients and contribute significantly to their disability. A pertinent case is reported.
Measurement of Atropine-Induced Vascular Pooling
Authors: MILLER ROBERT D. , KALSER MARTIN H. , FRYE CHARLES W. , GORDON ARCHER S.
Published: June 2012

Postural hypotension resulting from 2 mg. of intramuscular atropine appears to be due to peripheral vascular pooling. Controlled studies on 31 normal adult males are reported here and reveal that external compression of the abdomen and lower extremities allows partial cardiovascular compensation. Simultaneous compression of both legs and abdomen is even more effective in preventing postural hypotension. The effects of 2 mg. of atropine appear to be due to partial vagal block, partial ganglionic block and central excitation.
Clinical Study and Treatment of Varicose Veins
Authors: MONTGOMERY HUGH , ZINTEL HAROLD A.
Published: June 2012

The widely different kinds of varices are easy to differentiate if the underlying anatomy and physiology are understood. Appropriate therapy is wholly dependent upon this understanding. Surgery is a reasonably definitive therapy of primary varices, but secondary varices usually require rest, elevation and elastic support.
Observations Concerning the Production and Excretion of Cholesterol in Mammals
Authors: FRIEDMAN MEYER , BYERS SANFORD O. , GUNNING BARBARA , OMOTO CLARENCE , HAYASHI WARREN
Published: June 2012

The possible role of the hepatic reticuloendothelial system in the synthesis as well as the disposition of endogenously produced cholesterol was studied in the rat by various means. Our results suggest that this system does not synthesize significant quantities of cholesterol nor participate in the egress of endogenously produced cholesterol from the plasma into the liver. It does however, play an important, perhaps indispensable, role in ridding blood of cholesterol derived from the diet.
Liver Function and Hypertension
Authors: RAASCHOU FLEMMING
Published: June 2012

The purpose of the present work was to study the incidence of arterial hypertension in a series of autopsied cases of chronic hepatitis. The frequency of patients with hypertension, examined according to three criteria (cerebral hemorrhage, hypertrophy of the heart, and incidence of hypertension as determined by actual measurements of blood pressure during life), is essentially lower in an autopsy series consisting of women who died of or with subchronic hepatitis than in a control series of autopsied female patients with the same age distribution who died of all other diseases.
Bacterial Endocarditis and Mural Thrombi in the Heart
Authors: WALLACH JACQUES B. , GLASS MACELLIS , LUKASH LESLIE , ANGRIST ALFRED A.
Published: June 2012

The infrequent occurrence of mural thrombi in the chambers of the heart is noted. The relevant literature is reviewed. The findings in eighty-two cases of bacterial endocarditis superimposed on rheumatic heart disease and in 47 examples of bacterial endocarditis without underlying rheumatic valvulitis are reported. These findings may reflect the infrequency of auricular fibrillation and of severe mitral stenosis in cases of bacterial endocarditis. The results further substantiate the origin of emboli from the valvular vegetations, bacterial or nonbacterial, rather than from the cardiac chambers, and this correlates with the bland character of most of the infarcts.
Observations on the Interatrial Pressure Gradients in Man
Authors: SHAFFER A. B. , SILBER E. N. , KATZ L. N.
Published: June 2012

It was possible to calculate pressure gradients across the interatrial septum in several cases of congenital heart disease. Gradients in cases of interatrial septal defect are similar to those found in animals with artificially produced defects. The data are used to form a rounded picture of the hemodynamics of interatrial septal defect. In pulmonic stenosis with interatrial communication, reversal of the usual left-to-right gradient may occur only during atrial systole. Under these circumstances it is often possible to distinguish a patent foramen ovale with competent valve from an interatrial septal defect.
Chemical Quantitation of Epinephrine and Norepinephrine in Thirteen Patients with Pheochromocytoma
Authors: MANGER WILLIAM M. , FLOCK EUNICE V. , BERKSON JOSEPH , BOLLMAN JESSE L. , ROTH GRACE M. , BALDES EDWARD J. , JACOBS MARTIN
Published: June 2012

Fluorescent quantitation of epinephrine and norepinephrine in plasma of patients suspected of having pheochromocytomas is of considerable diagnostic value. The concentrations of these pressor amines in normal subjects, patients with various diseases with and without hypertension, and 13 patients with pheochromocytomas are reported. In all patients with pheochromocytomas and sustained hypertension the concentrations of pressor amines were significantly elevated. However, in patients with paroxysmal hypertension secondary to pheochromocytomas the pressor amine concentrations may be unelevated when the blood pressures are normal. In this latter group provocative tests with intravenous histamine are indicated to induce hypertension prior to quantitating pressor amines.
Marcumar [3-(l'-phenyl-propyl)-4-hydroxy-coumarin]. A New Anticoagulant
Authors: BOURGAIN RENÉ , TODD MARGARET , HERZIG LORRAINE , WRIGHT IRVING S.
Published: June 2012

Marcumar [3-(1'-phenyl-propyl)-4-hydroxycoumarin] is a new anticoagulant. Marcumar acts more rapidly than Dicumarol, but not quite as rapidly as Tromexan. The action is more prolonged than Dicumarol. As with other anticoagulants, the administration of Marcumar requires conscientious observation and accurate prothrombin complex determinations.
The Control of Dicumarol Therapy in Myocardial Infarction by a Simple Blood Prothrombin Test
Authors: MANCHESTER BENJAMIN , RABKIN BORIS
Published: June 2012

Effective anticoagulant therapy is dependent upon adequate and reliable blood prothrombin determinations. The initiation of such therapy usually requires hospitalization. The currently available blood prothrombin tests require special laboratory facilities and trained personnel. The authors of this report present the results of Dicumarol in myocardial infarction and a simple blood prothrombin test for the control of such anticoagulant therapy. The test has been employed for more than eight years. The method has proved to be simple, accurate, and practical, and has made anticoagulants possible for patients at home as well as in the hospital.
The Spatial Vectorcardiogram in Left Ventricular Hypertrophy
Authors: HORAN L. G. , BURGH G. E. , ABILDSKOV J. A. , CRONVICH J. A.
Published: June 2012

A study of 90 patients with left ventricular hypertrophy revealed a typical configuration of the spatial vectorcardiogram in most of the subjects. Typically the QRS sÊ-loop was smooth, wide and rounded, inscribed in a counterclockwise direction and placed largely to the left and above the isoelectric point in its frontal plane projection. The left sagittal plane projection of the QRS sÊ-loop was long, narrow and directed largely upward and posteriorly. The typical T sÊ-loop was small, smooth, horseshoe-shaped and counterclockwise in inscription in both frontal and left sagittal plane projections. In some instances the QRS sÊ-loop was similar to that of the normal but was always accompanied by an abnormal T sÊ-loop.
Postoperative Changes in the Electrocardiogram in Congenital Heart Disease
Authors: LANDTMAN BERNHARD
Published: June 2012

Electrocardiograms of 41 cases of coarctation and of 73 cases of patent ductus arteriosus were analyzed before and after surgical correction of the defect. The changes in the electrocardiogram which occurred after surgical repair of the coarctation were considered to be due to the diminished load on the left ventricle. In 65 of the cases of patent ductus arteriosus, electrocardiographic signs of left ventricular hypertrophy were recorded. Eight patients, seven of whom presented atypical murmurs, showed evidence of right ventricular or combined ventricular hypertrophy. Following ligation of the ductus, the electrocardiogram became normal in the majority of the cases.
Metabolic and Hemodynamic Changes Induced by the Prolonged Administration of Dextran
Authors: JAENIKE JOHN R. , WATERHOUSE CHRISTINE
Published: June 2012

Large amounts of dextran were administered to human subjects under standardized metabolic conditions, with the following results: Dextran is a potent osmotic substance which produces marked salt and water retention and rapid plasma volume expansion. About 50 per cent of the amount given is excreted in the urine during the injection period. Nitrogen and phosphorus sparing and an antiketogenic effect are produced during the period of administration. A fraction of the dextran remains circulating for a prolonged period of time and is associated with a sustained depression of venous hematocrit. Metabolism of this fraction cannot be demonstrated, and its ultimate fate in the body is unknown.
Patterns of Surface Temperature Response to Various Agents
Authors: WERTHEIMER LOTHAR , REDISCH WALTER , HIRSCHHORN KURT , STEELE J. MURRAY
Published: June 2012

Surface temperature response to 15 agents was studied at 20 C. and 55 per cent humidity. Toe temperature was considered representative of the body's "glomus area." Temperatures at forehead and cheek represented the "blush area." Diethylaminoethanol, Hydergine, tetraethylammonium chloride, Priscoline, hexamethonium, Ilidar and Dibenzyline produced a prompt rise in temperature in the glomus area without affecting the temperature in the blush area; nicotinic acid, Roniacol, histamine and papaverine caused the opposite response. Nitroglycerin had no effect on the temperature in the blush area; with the subject recumbent, it caused a fall in the glomus area. Hypertonic saline, aminophylline and Banthine had no effect on either glomus or blush areas.
The Changing Electrocardiogram in Wilson Block
Authors: PAPP CORNELIO , SMITH K. SHIRLEY
Published: June 2012

The significance of the Wilson variety of right bundle-branch block was investigated on the basis of serial electrocardiographic changes seen in almost half of the series. Wilson block may originate from both anteroseptal and posterior infarction; in the former it may form a solitary relic without prognostic significance; in the latter it denotes extensive septal involvement. It may modify the injury pattern of anterior infarction and may abolish the signs of posterior infarction; cardiac infarction may approximate it to the classic form of right bundle-branch block. Except in two patients, less than 4 per cent of the series, it was related to pathologic causes; it should therefore be regarded as a sign of organic heart disease.
Right Ventricular Hypertrophy
Authors: WALKER ISOM C. , HELM ROBERT A. , SCOTT RALPH C.
Published: June 2012

The electrocardiograms of 22 cases showing isolated right ventricular hypertrophy at autopsy were examined for changes suggestive of right ventricular hypertrophy. Only 5 of 22 cases fulfilled at least one of the criteria of Sokolow and Lyon and only three could be diagnosed as having right ventricular hypertrophy by the criteria of Myers, Klein and Stofer. Factors contributing to the development of electrocardiographic changes of right ventricular hypertrophy are discussed.
Reflex Venomotor Activity in Normal Persons and in Patients with Postural Hypotension
Authors: PAGE E. B. , HICKAM J. B. , SIEKER H. O. , MCINTOSH H. D. , PRYOR W. W.
Published: June 2012

Reflex venomotor activity has been observed and measured in normal subjects by means of the pressures developed within isolated segments of superficial veins. Strong contractions are caused by the Valsalva maneuver, tilting, cold, exercise, and hyperventilation. After the Valsalva and after tilting there is a brief elevation of central venous pressure. Pulmonary vascular pressures are also increased after the Valsalva. This is taken to indicate a widespread venoconstriction with central shifting of blood. Persons with postural hypotension show little or no segment or central venous pressure response to these stimuli, indicating impaired reflex venomotor activity.
The Opening Snap of the Tricuspid Valve: A Physical Sign of Tricuspid Stenosis
Authors: KOSSMANN CHARLES E.
Published: June 2012

In two patients with rheumatic heart disease a short, loud, high pitched, early diastolic, snapping sound was heard at or below and to the right of the xiphisternum. Except for the different area of audibility it was similar on auscultation to the opening snap of the mitral valve. Both patients showed clinical evidence of tricuspid as well as mitral and aortic valvular disease. There was hemodynamic evidence of tricuspid disease in one, and the other displayed tricuspid stenosis at necropsy. The abnormal sound was regarded as the opening snap of the tricuspid valve.
A Critical Evaluation of the Roentgen Criteria of Right Ventricular Enlargement
Authors: SUSSMAN MARCY L. , JACOBSON GEORGE
Published: June 2012

We believe that right ventricular enlargement is "over-diagnosed" radiologically, and this becomes apparent when radiologic interpretation is attempted without the help of other data. We tested this impression in a study of 25 cases of tetralogy of Fallot and 40 cases of other types of congenital pulmonary stenosis. In these cases there was usually no right ventricular dilatation. The roentgen determination of right ventricular hypertrophy was found to be decidedly of limited value. There were few infants in the present study and the conclusion should not be construed as necessarily including this group.
The Demonstration of Left Atrial Enlargement by Body Section Radiography
Authors: PASTOR BERNARD H. , WOHL GEORGE T. , LAWRENCE L. THEODORE
Published: June 2012

The enlarged left atrium may be poorly demonstrated in conventional rcentgenograms. It can be delineated clearly in such cases by appropriate body section films. Body section radiography may also be helpful in the study of other ill-defined cardiac and vascular contours and in the demonstration of intracardiac calcification.
Hemodynamics in Patent Ductus Arteriosus Without a Murmur
Authors: SHEPHERD JOHN T. , WEIDMAN WILLIAM H. , BURKE EDMUND C. , WOOD EARL H.
Published: June 2012

The clinical and hemodynamic features are described in a 7½-year-old boy who had a patent ductus arteriosus and pulmonary hypertension without a murmur. Values for oxygen saturation of the blood and dye-dilution curves demonstrated that the flow through the ductus was mainly from pulmonary artery to aorta. This was reversed when the patient breathed 99.6 per cent oxygen. Blood shunted from right to left through the ductus could be detected at the right radial artery. Thus retrograde movement of blood occurred in the aortic arch. Clamping of the ductus caused an increase in pulmonary arterial pressure, a decrease in systemic arterial pressure, an increase in arterial oxygen saturation and a change in the arterial dye-dilution curve toward normal. Division of the ductus was followed by clinical improvement.
The Relief of Resistant Edema by Utilization of a Sump Phenomenon
Authors: SCHEMM FERDINAND R. , CAMARA AUGUSTO A.
Published: June 2012

Fourteen massively edematous patients with either cardiac disease or nephritis, who had hydrothorax and/or ascites, have proved resistant to the usual diuretic measures, but have been relieved of edema by repeated aspirations of fluid from either the pleural or peritoneal spaces. In the intervals between aspirations the fluid of the interstitial space appeared to seep readily into the
sump
from which fluid had just been removed. The repeated aspirations did not result in hyponatremia nor hypoproteinemia in these cases. As a means of by-passing "`reluctant" kidneys the utilization of the sump phenomenon has proved simple, safe and effective in some very obstinate cases.
Mechanisms of Intermittent Ventricular Bigeminy
Authors: LANGENDORF R. , PICK A. , WINTERNITZ M.
Published: June 2012

In order to analyze the cause for the appearance and disappearance of ventricular premature systoles giving rise to temporary bigeminal rhythm, the electrocardiographic material was divided into two major groups: group A, consisting of ectopic beats with fixed coupling occurring during grossly irregular dominant rhythms, and group B, consisting of ectopic beats with varying coupling occurring during regular dominant rhythms. Analysis of group A, the subject of the present report, shows a definite relationship between the duration of the ventricular cycle and the occurrence of ventricular premature systoles, in that long cycles favor their appearance whereas short cycles tend to preclude it. This "rule of bigeminy" is best explained on the basis of a re-entry mechanism of the ventricular premature systoles. Criteria are given for the differential diagnosis between ventricular premature systoles and aberrant ventricular conduction of supraventricular impulses which is prone to occur under similar circumstances. The analysis of group B is presented in a subsequent report.
Cardiac Output and Central Volume as Determined by Dye Dilution Curves
Authors: KATTUS ALBERT A. , RIVIN ARTHUR U. , COHEN AARON , SOFIO GILBERT S.
Published: June 2012

Dye dilution curves determined by the method of Hamilton have been obtained from a series of normal subjects and from a group of patients with various types of cardiovascular disorders. Cardiac indices calculated from these curves revealed expected values. Central volume, believed to be an index of pulmonary blood volume, was calculated from the slopes of the down strokes of the curves. Central volume indices in normal subjects averaged 0.590 liters. Central volume in patients with heart disease was frequently normal or less than normal. Only cor pulmonale patients with high output had central volumes significantly greater than normal.
The Surgical Relief of Aortic Stenosis by Means of Apical—Aortic Valvular Anastomosis
Authors: SARNOFF STANLEY J. , DONOVAN THOMAS J. , CASE ROBERT B. , WAITHE PHILIP E.
Published: June 2012

A means has been devised whereby the aortic valve can be effectively by-passed. Left ventricular blood leaves via the apex through a lucite tube in continuity with a modified Hufnagel valve and then enters the thoracic aorta. In dogs so treated the ascending arch of the aorta may be totally and permanently occluded without apparent impairment of the circulation. Postoperatively these dogs run, jump and swim and are not readily distinguishable from normal dogs. The entire ventricular manipulation is completed in 30 to 60 seconds. The applicability of this procedure to the alleviation of aortic stenosis in man is discussed.
Treatment of Cardiac Arrest and Slow Ventricular Rates in Complete A-V Heart Block
Authors: BELLET SAMUEL , WASSERMAN FRED , BRODY JEROME I.
Published: June 2012

Molar and half-molar sodium lactate was efficacious (a) in restoring the heart beat following episodes of cardiac arrest, (b) ventricular standstill occurring during repeated Stokes-Adams seizures and (c) in increasing the idioventricular rate in the presence of complete A-V heart block. The increase in rate was related to the rapidity and amount of injection. These effects were associated with an increase in blood pressure and other evidences of improvement in the clinical state. No ventricular extrasystoles or other dangerous types of ectopic rhythms were observed in these subjects. The possible mechanisms by which the sodium lactate produces these effects are discussed.
A New Orally Active Quaternary Ammonium, Ganglion Blocking Drug Capable of Reducing Blood Pressure, SU-3088
Authors: GRIMSON KEITH S. , TARAZI ANTONE K. , FRAZER JOE W.
Published: June 2012

Experiments were performed in animals to evaluate 4,5,6,7-tetrachloro-2-(2 dimethylaminoethyl)-isoindoline dimethochloride, (Su-3088), as an orally effective ganglion blocking drug. These demonstrated reduction of blood pressure, suppression of vasopressor reflexes and potentiation of the pressor action of epinephrine. Neostigmine deblocked drug effects and returned responses toward normal. Experiments in patients produced reduction of blood pressure, warming of extremities and delay of gastric emptying. Preliminary trial as a treatment for hypertension suggested that the drug may be useful. It has a long period of action, 12 hours or more and a small dose requirement, 50 to 100 mg.
The Functional Circulatory Consequences of Myocardial Infarction
Authors: BALL CON O. T. , BILLINGS F. TREMAINE , FURMAN ROBERT H. , BROTHERS GEORGE B. , THOMAS JOHN , MENEELY GEORGE R.
Published: June 2012

An analysis of what proportion of patients hospitalized with myocardial infarction follow the various circulatory pathways available and at what time in the course of the disease is presented. Patients who died with, but not necessarily because of, thrombosis or embolism outside the coronary vascular bed were withdrawn from the analysis. Almost half of the patients were able to resume usual or lighter activity and to enjoy, after two years, a survival rate similar to a Tennessee population of the same age, sex and racial distribution.
A Two-Dimensional Ballistocardiographic Study of 59 Apparently Normal Persons
Authors: MORRIS GWENDOLYN L. , BRAUNSTEIN JOHN R.
Published: June 2012

Simultaneous longitudinal and transverse ballistocardiograms were obtained from 59 apparently normal persons. A highly significant correlation was found to exist between body surface area and basal longitudinal "IJ" amplitude. The significance of this is discussed. The transverse IJ amplitude is shown to be related to the rotation of the heart about the anteroposterior axis of the body.
Intermittent Claudication
Authors: WESSLER STANFORD
Published: June 2012

The diagnosis and therapy of intermittent claudication are critically reviewed. A detailed, concrete and positive program is described whereby every physician can effectively treat patients with intermittent claudication without recourse to intricate diagnostic or therapeutic techniques. The value of this program is illustrated with four case reports.
Direct Arterial Study of the Blood Pressure Response to Cold of Normotensive Subjects and Patients with Essential Hypertension before and during Treatment with Various Antihypertensive Drugs
Authors: WINDESHEIM JOHN H. , ROTH GRACE M. , HINES EDGAR A.
Published: June 2012

The cold pressor test was performed three times at 15-minute intervals on 65 normotensive subjects and on 60 patients with essential hypertension both before and during treatment with antihypertensive drugs. The arterial pressure was recorded directly from the radial artery. On the basis of differences in the cold pressor response among individuals in the control group, the criteria for normal reaction and for hyperreaction were modified. The cold pressor response in the patients with essential hypertension was markedly depressed by the ganglionic blocking agents, but was not affected by various combinations of hydralazine, protoveratrine and reserpine.
The Electrocardiographic Pattern of Right Ventricular Hypertrophy in Chronic Cor Pulmonale
Authors: SCOTT RALPH C. , KAPLAN SAMUEL , FOWLER N. O. , HELM ROBERT A. , WESTCOTT RICHARD N. , WALKER ISOM C. , STILES WILLIAM J.
Published: June 2012

The electrocardiographic patterns encountered in 28 patients with pulmonary hypertension secondary to chronic lung disease have been studied. Thirteen had neither right ventricular hypertrophy nor right bundle-branch block; eight had either right ventricular hypertrophy alone or right ventricular hypertrophy and right bundle-branch block (complete or incomplete); and seven had incomplete right bundle-branch block. A statistical comparison is made between these various groups of the means of the following physiologic measurements: mean pulmonary artery pressure, total pulmonary resistance, arterial oxygen saturation, right ventricular work, arterial carbon dioxide content, and cardiac index. The significance of the pattern of right ventricular hypertrophy is discussed.
Factors in the Etiology of Constrictive Pericarditis
Authors: DETERLING RALPH A. , HUMPHREYS GEORGE H.
Published: June 2012

Because of uncertainty existing in respect to the etiologic factors in certain cases of constrictive pericarditis, an analysis of 25 proven cases and of additional series from the literature was conducted. It was evident that a fairly consistent clinical syndrome developed, but the factor of myocardial insufficiency deserves as much consideration as actual constriction by the pericardium. The survey supports the belief that the clinical picture of chronic constrictive pericarditis may result from tuberculosis in most cases, at times only by implication. In addition, cases can result from trauma to the chest, rheumatic heart disease and purulent pericarditis.
Calcification of the Pericardium in Apparently Healthy People
Authors: MATHEWSON F. A. L.
Published: June 2012

Case histories are presented of five apparently healthy persons showing pericardial calcification. Calcium deposits form in the dense pericardial scarring which is responsible for changes in the electrocardiogram. Awareness by the cardiologist of the possibility of pericardial scarring makes him particularly alert to electrocardiograms showing normal QRS complexes with T wave changes, particularly if the T waves point in a direction opposite to the main QRS deflection and are associated with RS-T segment depression. Low QRS voltage may or may not be present. Suspicion will be increased in serial records when the abnormalities remain constant over a period of years.
The Influence of Advanced Congestive Heart Failure on Pulsus Alternans
Authors: RYAN JOSEPH M. , SCHIEVE JAMES F. , HULL HUGH B. , OSER BERYL M.
Published: June 2012

Evidence is presented which indicates that in certain instances pulsus alternans may be abolished or diminished in the presence of advanced congestive heart failure. The observations suggest that in severe congestive failure the ventricular filling pressure may increase to the point where it causes the diastolic stretch of the left ventricle to be more equal from one beat to the next. This in turn would bring about more uniform systolic ejections and hence ventricular alternation would disappear or be lessened in degree.
The Relationship Between Impaired Retinal Vascular Reactivity and Renal Function in Patients with Degenerative Vascular Disease
Authors: SIEKER H. O. , HICKAM J. B. , GIBSON J. F.
Published: June 2012

In hypertension and diabetes retinal vascular changes which are evident on fundiscopic examination are usually accompanied by renal vascular changes which are evident on microscopic examination. It has been found that the retinal vessels of most patients with hypertension or diabetes fail to constrict normally when the blood oxygen tension is elevated. This investigation evaluates the clinical significance of decreased retinal vascular reactivity in patients with degenerative vascular disease by relating it to kidney function as measured by common clinical tests. The results of the study show that impairment of retinal arterial reactivity usually occurs in the course of degenerative vascular disease, particularly in hypertension, in advance of clinical evidence of altered kidney function. When clinical tests of renal function demonstrate renal damage, loss of retinal arterial and venous reactivity is marked.
The Hemodynamics of the Left Side of the Heart as Studied by Simultaneous Left Atrial, Left Ventricular, and Aortic Pressures; Particular Reference to Mitral Stenosis
Authors: BRAUNWALD EUGENE , MOSCOVITZ HOWARD L. , AMRAM SALOMAO S. , LASSER RICHARD P. , SAPIN SAMUEL O. , HIMMELSTEIN AARON , RAVITCH MARK M. , GORDON ALVIN J.
Published: June 2012

At operation the hemodynamics of the left side of the heart were studied in six patients without mitral stenosis, and in eight patients with mitral stenosis, by means of simultaneous needle puncture of the left atrium, left ventricle, and aorta. This technic permits analysis of the various phases of the cardiac cycle in normal subjects and in patients with mitral stenosis. The fundamental hemodynamic expression of mitral stenosis is the presence of an elevated left atrioventricular filling pressure sure gradient, which ranged from 4 to 20 mm. Hg, and after valvulotomy fell in relation to the adequacy of the procedure.
Renal Hemodynamic Response to Vasopressor Agents in the Treatment of Shock
Authors: MOYER JOHN H. , MORRIS GEORGE , BEAZLEY H. LISTON
Published: June 2012

Norepinephrine, when administered to normotensive subjects by continuous intravenous infusion produces a marked renal vasoconstriction and a reduction in renal blood flow. The opposite response is observed when this drug is given to patients in whom glomerular filtration rate and renal blood flow are already depressed due to shock. When the blood pressure in these patients is returned to normal with norepinephrine, there is an increase in both glomerular filtration rate and renal blood flow. There is also an increase in water and electrolyte excretion which is secondary to the increase in glomerular filtration rate.
The Theory of Kent
Authors: LEV MAURICE , LERNER RUTH
Published: June 2012

This is an anatomic study of an alternate theory of conduction, first advanced by Kent, that conduction from atria to ventricles is by way of numerous muscular communications, rather than exclusively through the bundle of His. The entire atrioventricular rings of 22 fetal and newborn hearts, in addition to the A-V node, bundle and bundle branches in five adult hearts, were serially sectioned. No muscular communications outside the conduction system were found. Communications between the A-V node, bundle and left bundle branch with the ventricular musculature were frequently found in the fetus, and less commonly in the adult.
Cholesterol Pericarditis
Authors: CREECH OSCAR , HICKS W. MORSE , SNYDER HARVEY B. , ERICKSON ETHEL E.
Published: June 2012

Although cholesterol pericarditis is usually associated with myxedema, it may occur as a result of tuberculous infection or hemopericardium. Cardiac constriction is apparently an uncommnon feature of the condition. A case of chronic constrictive cholesterol pericarditis was treated by pericardiectomy with complete relief of symptoms. Neither bacteriologic nor histologic studies of the resected pericardium revealed the etiologic basis for cholesterol accumulation within the pericardial sac.
Association of Hypotensive State in Myocardial Infarction with Subsequent Metabolic Reponses and Mortality in Elderly Subjects
Authors: BRUCE ROBERT A. , KOWALSKI HENRY J. , BERGY GORDON G. , Smart Thomas B. , Neilsen Robert , Carlson Emily R.
Published: June 2012

Ten elderly patients with typical findings of acute myocardial infarction were studied for two weeks on a metabolic ward. Blood pressures were determined hourly, and balances of nitrogen, water and electrolytes were computed daily. Surviving patients had higher blood pressures, lower heart rates, lost more weight, exhibited negative sodium balance and had earlier recovery from negative nitrogen and potassium balance. Early appearance of hypotension presaged clinical complications, unfavorable metabolic responses and a fatal outcome.
The Effect of Hyperventilation on Various Arrhythmias
Authors: SCHERF D. , GOLDFARB M. , BUSSAN R.
Published: June 2012

The influence of hyperventilation on various cardiac arrhythmias is examined. Auricular and ventricular extrasystoles disappear temporarily, paroxysmal auricular and ventricular tachycardias aswell as attacks of short paroxysmal auricular fibrillation are abolished by hyperventilation. An attempt is made to explain these phenomena.