bluuebunny/crossref_metadata_2025 huggingface dataset:
Anomalous Atrioventricular Excitation Produced by Catheterization of the Normal Human Heart
Authors: KOSSMANN CHARLES E. , BERGER ADOLPH R. , BRILLER STANLEY A. , RADER BERTHA , BRUMLÍK JOSEPH
Published: June 2012

During the withdrawal of a catheter-electrode through the right ventricle of 2 normal subjects the electrogram displayed briefly a short P-R interval and an aberrant QRS. In the simultaneously recorded standard lead, the phenomenon simulated what is seen in the Wolff-Parkinson-White syndrome. The findings are presented in support of the physiologic, rather than anatomic, explanation for anomalous atrioventricular excitation.
Clinical Method of Photographing the Smaller Blood Vessels and the Circulating Blood in the Bulbar Conjunctiva of Human Subjects
Authors: DITZEL JØRN , ST. CLAIR RICHARD W.
Published: June 2012

During a long-term study of the vascular disease of the smaller blood vessels in diabetes mellitus, the conjunctival vessels in more than 1200 diabetic and nondiabetic subjects have been examined. As part of the ideal delineation of these vessels it was found essential to develop a technic to produce highly magnified, wide-field photographs of the smaller blood vessels and of the circulating blood in human subjects. This technic is presented and the possibility of the clinical application is emphasized.
Clinical Trial of Ilidar, a New Dibenzazepine Adrenergic Blocking Drug, in the Treatment of Peripheral Vascular Diseases and Miscellaneous Complaints
Authors: GREEN HAROLD D. , DUBOSE HUGH H.
Published: June 2012

Ilidar, a new adrenergic blocking drug, has been administered to 116 patients; follow-up was adequate on 86. The drug was highly effective in patients with predominantly vasospastic disorders and in patients with postphlebetic syndrome, and moderately effective in patients with thromboangiitis and arteriosclerosis. Most patients could tolerate 50 to 75 mg. three to four times a day. Side effects were principally those to be expected from the moderate postural hypotension associated with effective sympathetic blockade, namely, weakness, dizziness, nausea.
A Theoretic Analysis of the Effects of Dipole Eccentricity upon the Manifest Vectors, the Manifest QRS Loops and the Potential of the Central Terminal
Authors: GARDBERG MANUEL
Published: June 2012

Assuming homogeneous conductivity and a limitless medium, a theoretic analysis accomplished by employing a model leads to the conclusion that dipole eccentricity produces a systematic error in the magnitude and direction of the instantaneous manifest vectors, the manifest QRS loops and the potential of the central terminal. Exaggeration of the electrical rotation of the heart and other electrocardiographic problems are discussed as possible manifestation of dipole eccentricity. Certain correlations applying to spatial vectorcardiography are made from simultaneous study of the theoretic back potential, the AP lead of the cube, and the potential of the central terminal.
Hemodynamic Studies in Sickle Cell Anemia
Authors: LEIGHT LEONARD , SNIDER THOMAS H. , CLIFFORD GEORGE O. , HELLEMS HARPER K.
Published: June 2012

Hemodynamic studies in 13 unselected patients with sickle cell anemia are reported. Twelve of these patients were also studied during mild exercise. The cardiac output at rest was elevated in all and rose significantly with exercise in 9 of the 12 patients. The importance of the increased percentage extraction of oxygen by the tissues in modifying the response of the cardiac output is discussed. The similarity of the response to exercise in the majority of these chronically anemic patients compared with the normal response is described. Included in this series is one case with secondary cor pulmonale and one case of concurrent rheumatic heart disease.
Clinical Experience with Dipaxin and with the Combined Use of Prothrombopenic Agents
Authors: KATZ RICARDO , DUCCI HÉCTOR , ROESCHMANN WERNER , TORIELLO LUCÍA
Published: June 2012

The experience with a new prothrombopenic agent, Dipaxin, is presented. With a 30 mg. dose a prothrombin complex concentration under 30 per cent is reached in 41 hours or less. When associated with 1500 mg. of Tromexan the latent period is reduced to 24 hours. The prothrombopenic action of Dipaxin is readily counteracted with vitamin K
1
administered either orally or intravenously.
Changes of Ventricular Impulse Formation during Carotid Pressure in Man
Authors: GOLBEY M. , LADOPULOS C. P. , ROTH F. H. , SCHERF D.
Published: June 2012

No proof exists that carotid sinus pressure influences ectopic automatic ventricular impulse formation in man. Two patients are described who revealed during carotid pressure slowing of a ventricular parasystolic focus and a change of the area of impulse formation respectively.
Treatment of Angina Pectoris with Cinchona Alkaloids
Authors: RISEMAN JOSEPH E. F. , STEINBERG LESTER A. , ALTMAN GEORGE E.
Published: June 2012

Reports indicating the value of quinidine sulfate in angina pectoris led to (1) a search for related drugs which were equally effective but less toxic, and (2) a study of the mode of action of these drugs. It was found that quinidine, quinine, cinchonadine, and cinchamidine decrease the frequency of attacks in daily life and increase the exercise tolerance as measured by a standardized test. Quinine sulfate (0.3 to 0.4 Gm. every eight hours) appears to be the drug of choice from the standpoint of availability and low toxicity as well as effectiveness. The value of these drugs is apparently due to a vasodilating action which in turn is dependent on the presence of the quinoline ring.
"Isolated" T-Wave Negativity in the "Ischemic Phase" of Myocardial Infarction in Man
Authors: SCHLANT ROBERT C. , LEVINE HAROLD D. , BAILEY C. CABELL
Published: June 2012

T-wave inversion, in leads localized to a small segment of the precordium, has in rare instances been described as a normal variant. The present report concerns a number of individuals in whom more or less similar T-wave changes developed under circumstances suggesting myocardial ischemia, and who went on to develop acute infarction of the anterior wall of the heart. This may be a clinical analogue of the brief T-wave inversion which has been observed early in experimental coronary artery compression.
The Misinterpretation of Electrocardiograms with Postprandial T-Wave Inversion
Authors: ROCHLIN ISIDORE , EDWARDS W. L. JACK
Published: June 2012

Postprandial changes in the electrocardiogram are generally considered to be slight and not subject to misinterpretation. Four patients are presented in whom a diagnosis of coronary artery disease had been made because of flattening or inversion of the T waves in the bipolar or lateral V leads. The changes in T waves were temporary and could be produced by a high-carbohydrate meal. In addition, T-wave changes after a similar meal were studied in 85 normal young adults and 47 patients.
Electrocardiographic Findings in Epidemic Hemorrhagic Fever
Authors: PEARSON CARL M. , HALL ROBERT J.
Published: June 2012

Mounting experiences with the newly discovered disease, epidemic hemorrhagic fever indicate that the basic pathologic lesion affects the vascular system. An electrocardiographic survey in 53 cases has disclosed that during the acute phase of the illness more than 50 per cent of patients show alterations. These, however, are nonspecific and resemble changes recorded in other acute infections. There was no clinical or electrocardiographic evidence of residual cardiac injury in many cases re-evaluated up to six months after the acute illness.
Studies on Tolerance to Ganglionic Blocking Agents in Man
Authors: DONTAS A. S. , HOOBLER S. W.
Published: June 2012

The hypotensive effects of intravenous injections of tetraethylammonium and hexamethonium chloride diminish and finally become pressor during the course of short-term treatment with subcutaneous hexamethonium. Evidence is presented to indicate that this "tolerance" is associated with a decreased sympathetic tone in the feet and forearm and is not due to increased amounts of circulating adrenal medullary or cortical hormones. Possibilities are discussed for this apparent vascular autonomy and the locus of vasoconstriction. Cross tolerance appeared between several ganglionic blocking agents tested and extended to a minor degree to adrenergic blocking agents.
Does Mitral Stenosis Recur after Commissurotomy?
Authors: GLOVER ROBERT P. , DAVILA JULIO C. , O'NEILL THOMAS J. E. , JANTON O. HENRY
Published: June 2012

The ultimate fate of the incised commissure following surgery for mitral stenosis will remain unknown for years to come. A clinical appraisal of patients living five years after commissurotomy and a review of available autopsy material from patients surviving surgery for periods up to four years indicates that valvular restenosis does not occur within the first half decade provided the commissurotomy has been properly performed.
Effects of Acute Removal of Potassium from Dogs
Authors: WELLER JOHN M. , LOWN BERNARD , HOIGNE ROLF V. , WYATT NORMAN F. , CRISCITIELLO MODESTINO , MERRILL JOHN P. , LEVINE SAMUEL A.
Published: June 2012

Potassium has been rapidly removed from the circulating blood of dogs in 22 experiments in which other extracellular electrolytes were maintained constant. In these experiments potassium extraction occurred in an acute phase accompanied by a reduction in serum level and a second phase of continued extraction with little change in the extracellular concentration. In the first phase the P wave increased markedly in amplitude and width. The A-V conduction time became prolonged. The QRS complex widened, the T wave became broadened and rounded, and the S-T segment depressed, the latter change occurring in the second phase of dialysis. In these experiments, acute depletion of potassium in dogs consistently reflects the electrocardiographic changes ascribed to hypokalemia.
Experimental Bacterial Endocarditis Due to Streptococcus Mitis
Authors: RABENS ROBERT A. , GERACI JOSEPH E. , GRINDLAY JOHN H. , KARLSON ALFRED G.
Published: June 2012

It is important in order to advance the increasingly successful attack on subacute bacterial endocarditis to be able to produce the disease experimentally and to treat it with new and improved therapeutic regimens. Since endocarditis caused by
Streptococcus mitis
has not been consistently produced previously in the dog, a study was undertaken in which cardiovascular stress was created by the establishment of aortico-inferior vena caval and bilateral iliofemoral arteriovenous shunts. After a period of antibacterial treatment and of stabilization, daily intravenous injections of broth cultures of
S. mitis
were begun. In 50 per cent of 24 animals bacterial endocarditis developed,simulating that found in clinical cases at necropsy. These animals had widely patent fistulas and 11 showed evidences of congestive heart failure. Of the remaining 12 animals, five with patent fistulas died of the effects of multiple infected pulmonary emboli. Seven others whose shunts had closed were killed and found to have no significant lesions other than healed caval infections.
The Diagnosis of Tricuspid Insufficiency
Authors: SEPULVEDA GONZALO , LUKAS DANIEL S.
Published: June 2012

In a series of 146 patients with mitral stenosis studied by cardiac catheterization, 60 were found to have right atrial pressure curves diagnostic of tricuspid insufficiency. The clinical and hemodynamic features of these patients are reviewed. The oft-cited, classic manifestations of tricuspid insufficiency were found with relative infrequency and the diagnosis had been made clinically in less than one fourth of the cases. Modification of criteria for the diagnosis of tricuspid insufficiency is suggested.
Norepinephrine and Epinephrine Content of Normal and Diseased Human Hearts
Authors: RAAB WILHELM , GIGEE WILDA
Published: June 2012

Because of the exquisitely oxygen-wasting and potentially hypoxia-producing effect of epinephrine on the myocardium, its relative (compared with norepinephrine) and absolute concentration in 85 human hearts was investigated. Significant increases above normal were found in cases of fresh myocardial infarction, in congestive heart failure, and in renal uremia. It is believed that the hypoxiating action of excess epinephrine in the heart muscle constitutes an important pathogenic factor in the origin of certain forms of functional and degenerative heart disease. Prolonged illnesses of various kinds seem to reduce the myocardial norepinephrine content.
Differential Analysis of Opacification in Angiocardiography
Authors: LIND J. , SPENCER R. , WEGELIUS C.
Published: June 2012

Each individual exposure in an angiocardiogram gives a picture of the arrested motion of the heart in successive stages of opacification. By combining these isolated views in a graph, a continuous dynamic process can be visualized. The chambers of the heart can be analyzed separately, and by correlating the opacification in the various chambers, the function of the heart as a whole can be studied.
Complications Following Infundibular Resection in Fallot's Tetralogy
Authors: MCCORD MALCOLM C. , BLOUNT S. GILBERT
Published: June 2012

Two patients are presented to demonstrate complications that may arise following infundibular resection in patients with the tetralogy of Fallot. An aneurysm of the infundibular chamber developed in one patient following removal of the infundibular stenosis. A left to right blood flow at the ventricular level occurred postoperatively in a second patient with marked cardiac enlargement and left ventricular hypertrophy.
The Dynamics of Ventricular Contraction and Relaxation in Patients With Mitral Stenosis as Studied by the Kinetocardiogram and Ballistocardiogram
Authors: EDDLEMAN E. E. , YOE ROBERT H. , TUCKER WILLIAM T. , KNOWLES JOHN L. , WILLIS KATHRYN
Published: June 2012

Kinetocardiograms (precordial movements) and ballistocardiograms were studied in patients with "pure" mitral stenosis. The findings were correlated with catheterization data and clinical findings. Certain characteristics of the kinetocardiograms were presented as well as hypothesis for the movements of the heart and dynamics of ventricular contraction and relaxation in patients with mitral stenosis.
Dye Dilution Curves and Cardiac Output in Newborn Infants
Authors: PREC KLARA J. , CASSELS DONALD E.
Published: June 2012

The pattern of dye dilution curves and the cardiac output was studied in 29 healthy newborn infants during the first 26 hours of life by the method of Wood and his associates. Thirty-six per cent of all infants studied had curves of normal contour which occurred mostly in infants older than 15 hours. Infants younger than 15 hours tended to have curves of abnormal shape. These were either diphasic or had the appearance of curves associated with left-to-right shunts and were probably caused by a patent ductus arteriosus. The mean cardiac output was 540 cc. per minute.
Measurement and Significance of Cancellation Potentials on the Human Subject
Authors: FRANK ERNEST
Published: June 2012

A versatile four-electrode single-channel system is described which is useful for precise research measurements of mirror patterns on the intact human subject, and the theoretic significance of results obtained on normal subjects for the QRS complex is presented in detail. It is concluded that the QRS complex at all points on the body of normal human subjects, including the precordium, can be considered to arise from a fixed-location equivalent heart dipole to an average accuracy of 5 per cent. Therefore, the "proximity" potential concept is untenable for the normal QRS complex.
Dissecting Aneurysm Produced by Diet
Authors: BEAN WILLIAM B. , PONSETI IGNACIO V.
Published: June 2012

Spontaneous dissecting aneurysm of the aorta in man is most commonly a sequel of hypertension but sometimes occurs in association with degenerative liquefaction of the media of the aorta. New light has been thrown upon dissecting aneurysm by its production in growing rats by a diet high in sweet peas. The offending agent has been isolated and a number of simpler related compounds have been synthesized and found effective. The relationship of this syndrome to a spontaneous dissecting aneurysm of the aorta in man is reviewed and some suggestions are made for investigation which may lead to newer methods of therapy.
Inositol and Mannitol Hexanitrates in Hypertension Management
Authors: BERNSTEIN LIONEL M. , IVY A. C.
Published: June 2012

This clinical study was undertaken because the clinical literature dealing with the use of mannitol and inositol hexanitrate and to a large extent other nitrites and nitrates which have been used in the management of hypertension fails to consider the development of tolerance. It was found that tolerance to the vasodilator action of mannitol and inositol nitrate develops in from 8 to 14 days and is lost completely within 10 days after withdrawal of the drug. The use of these nitrates should be carefully individualized by determining the optimal dose and the period required for the development and loss of tolerance.
Newer Drugs in the Treatment of Hypertension
Authors: RAST CHARLES L. , ORGAIN EDWARD S. , MULLER JOHN C. , PRYOR WILLIAM W. , SIEBER HOMER A.
Published: June 2012

Sixty-one patients exhibiting severe hypertensive vascular disease were treated with hexamethonium in combination with hydralazine for periods up to 22 months. Results, in terms of blood pressure control, were considerably better with combined therapy than with hexamethonium alone regardless of whether hydralazine was added to hexamethonium initially or later. Improvement in retinopathy and in the electrocardiogram was noted. The malignant phase of hypertensive disease was reversed in eight of nine instances. Late systemic reactions to hydralazine occurred in seven patients. One death, attributed to possible hexamethonium poisoning, was observed. Hexamethonium-hydralazine therapy represents a potent combination of drugs for the treatment of severe hypertensive vascular disease.
Exercise and Cardiac Work Response at High Altitude
Authors: THEILEN ERNEST O. , GREGG DONALD E. , ROTTA ANDRÉS
Published: June 2012

The response to treadmill exercise of the left ventricle of natives of the region of Morococha, Peru (elevation 14,900 feet), and of natives of the region of Lima, Peru (elevation 500 feet), was studied at the elevation where they had always lived. In both groups the external work of the left ventricle was effected by a combination of a large increase in cardiac output and a mild increase in systemic blood pressure. Stroke volume and stroke work were only mildly elevated since the heart rate was concurrently greatly increased. As a result, the increase in work of the left ventricle was largely accomplished by an increase in heart rate and to a lesser extent by an increase in stroke work. For comparable amounts of external work, the left ventricle of the native to high altitude and performing at high altitude responded with considerably greater effort than did the left ventricle of the native of low altitude performing at sea level. Some of the data may have approximated the maximum effort of which the normal left ventricle was capable.
Dynamic Comparison of Current Ballistocardiographic Methods
Authors: TALBOT SAMUEL A. , HARRISON W. KIRBY
Published: June 2012

This paper will be presented in three parts, appearing in successive issues of Circulation. In Part I certain force artefacts arising from the method of supporting the body, are compared with the "true" cardiovascular forces. This is done for the methods of Burger, v. Wittern, Dock-Taubman, Smith and Walker. These are approximately
single-mass
systems in which platform effects prove negligible or absent; so that at the lower ballistocardiographic frequencies, the internal driving forces on the body are opposed by relatively simple constraints. At this stage also, we will examine the complementary meanings of displacement, velocity and acceleration records. The same record (e.g. "body displacement") can have various physical meanings, depending on what aspect of cardiovascular dynamics the reader wishes to refer to. If, however, resonance occurs in the spectrum (direct-body methods), it is shown why no clear physical meaning applies to any of the records: displacement, velocity, or acceleration.

In Part II we show experimentally that a similar analysis in terms of
two masses
applies fairly well to the bed methods. This analysis shows how the platforms of Starr, Nickerson, Burger and v. Wittern affect the errors over a wider BCG frequency band. Principles and methods for minimizing these errors will be examined.

In Part III we examine the validity of the standard assumptions of ballistocardiography, employed in Parts I and II. Using ballistocardiographic records taken with and without beds, and subtracting the effects of the supports under the usual assumption, we show that mechanical errors still remain. Constraints to ground as stiff as the direct-body and Starr supports seem to excite more errors of body complexity than do the softer supports of Nickerson and Burger or v. Wittern, beyond the obvious distortions from resonance. Conclusions are drawn about the direction of progress toward more informative and reliable BCG records.
De-Epicardialization: A Simple, Effective Surgical Treatment for Angina Pectoris
Authors: HARKEN DWIGHT E. , BLACK HARRISON , DICKSON JAMES F. , WILSON HUGH E.
Published: June 2012

Removal of the epicardium of the dog's heart with 95 per cent phenol permits anastomoses between pericardial vessels and the coronary arteries that are large enough to carry the Schlesinger mass (40 micra or larger). In 18 patients suffering from intractable angina pectoris an operation consisting of phenolization, instillation of talc and pneumonopexy has resulted in consistent relief of pain. The simplicity of the procedure exposes the patient to minimum risk of fresh thrombosis; its effectiveness justifies further trial.
The Changes in the Intra-Arterial Pressure during Immersion of the Hand in Ice-Cold Water
Authors: GODDEN JOHN O. , ROTH GRACE M. , HINES EDGAR A. , Schlegel Jerry F.
Published: June 2012

The response of the intra-arterial pressure to the cold immersion stimulus was studied in 42 healthy young adults, continuous direct (arterial-pressure) recording being used. The average systolic elevation was 22.6 mm. Hg and the average diastolic elevation was 16.3 mm. Hg. The difference between direct and indirect methods of measuring blood pressure was studied in 351 simultaneous determinations in 35 of these young adults. The direct systolic pressure averaged 9.7 mm. Hg higher and the diastolic pressure was 7.3 mm. Hg lower than the indirect measurement.
Studies on Water Excretion Following Intravenous Hydration and the Administration of Pitressin or Nicotine in Congestive Heart Failure
Authors: HANENSON IRWIN B. , GOLUBOFF BERNARD , GROSSMAN JACOB , WESTON RAYMOND E. , LEITER LOUIS
Published: June 2012

The diuretic response to intravenous infusions of 5 per cent glucose in water and the antidiuretic response to intravenous injections of nicotine salicylate and aqueous Pitressin, during maximal water diuresis, were studied in normal subjects and patients in congestive failure of varying severity. Patients in moderately severe congestive failure exhibited normal diuretic responses during the periods of intravenous hydration and normal antidiuretic responses following nicotine or Pitressin injections. Patients in more severe congestive failure failed to achieve comparable diuretic responses, following intravenous hydration; in the course of this, signs of increasing congestive failure developed, which were associated with further decrease in urine flows, at times, without any further decrease in renal hemodynamics. These studies confirm the impression that patients in moderate congestive failure have neither increased sensitivity to, nor reduced ability to, inactivate endogenous or exogenous antidiuretic hormone. In addition, the observation, that patients in more severe failure do not achieve adequate water diuresis during intravenous hydration, suggests that sustained production of antidiuretic production, independent of normal osmoreceptor control, may be contributing to their fluid retention.
A Controlled Study of the Effect of Intermittent Heparin Therapy on the Course of Human Coronary Atherosclerosis
Authors: ENGELBERG H. , KUHN R. , STEINMAN M.
Published: June 2012

Heparin, 200 mg. subcutaneously, was administered twice weekly to a group of 105 patients with known previous myocardial infarction. A comparable control group of 117 individuals received saline placebos. Over a two-year period, there were 21 deaths due to cardiovascular disease in the placebo group, 4 cardiovascular deaths in the heparin group. The observed differences in deaths between the two groups is statistically significant,
p
< .01. The results indicate that heparin, in the dosage and manner administered, retards the progress of atherosclerotic disease in patients with coronary atherosclerosis.
Observations on Angina Pectoris during Drug Treatment of Hypertension
Authors: JUDSON WALTER E. , HOLLANDER WILLIAM , WILKINS ROBERT W.
Published: June 2012

Antihypertensive drug treatment is capable of aggravating angina pectoris in hypertensive patients with coronary artery disease. The complication appears to be due to different hemodynamic mechanisms. Angina pectoris caused by hydralazine may result not only from a reduction in aortic perfusion pressure but also from increases in cardiac output and pulse rate which the drug produces. Coronary insufficiency, after the administration of hexamethonium, is usually associated with severe hypotension and results primarily from a reduction in aortic perfusion pressure. Hexamethonium was not found to prevent the anginal effects of hydralazine. Intravenous hydralazine is a sensitive test for coronary insufficiency but is not without untoward reactions.
The Effect of Hyperventilation on the Normal Adult Electrocardiogram
Authors: WASSERBURGER R. H. , SIEBECKER K. L. , LEWIS W. C. , Lloyd C. Janet
Published: June 2012

The effect of brief hyperventilation on the precordial T waves of 350 normal adults is described. Evidence is presented that brief hyperventilation initiates a vagal reflex which results in the T-wave inversion. Supportive data are also given to exclude respiratory alkalosis as a possible mechanism. Caution is advised in interpreting isolated T-wave inversions as indicative of organic heart disease. It is proposed that isolated T-wave inversion be deleted as a criterion for a "positive" exercise test.
Status of Fifty Patients Four and a Half to Seven Years after Mitral Commissurotomy
Authors: JANTON O. HENRY , DAVILA JULIO C. , GLOVER ROBERT P.
Published: June 2012

The first 50 consecutive patients undergoing mitral commissurotomy approximately 4½ to 7 years ago have been subjected to a detailed analysis in an attempt to ascertain their present subjective and objective status. Operative mortality was 6 per cent and late mortality was 12 per cent. Forty-one patients (82 per cent) are living and have formed the basis for conclusions. After a comprehensive study of each living patient, including an appraisal of the patient's subjectively reported clinical state, as well as a correlation of the clinical findings, electrocardiographic tracings, teleroentgenograms, and catheterization data, we conclude that 29 patients (71 per cent of those living or 58 per cent of the original 50) are in better condition and living a more nearly normal life than they were prior to surgery.
Congenital Aortic Stenosis
Authors: DOWNING DANIEL F.
Published: June 2012

Thirty-seven patients with congenital aortic stenosis have been studied. Only a few were without symptoms referable to the defect. Characteristically, the patients had a loud, harsh systolic murmur, accompanied by a thrill, to the right of the sternum. On x-ray examination the most frequent manifestation was dilatation of the ascending aorta. Electrocardiographic evidence of left ventricular hypertrophy was found in 60 per cent. Nineteen patients have been operated upon with 2 deaths. The procedure has been tolerated amazingly well. Although it is too early to judge the results, all but 2 of the surviving patients appear to have been helped.
Rauwolfia serpentina
in the Treatment of Angina Pectoris
Authors: LEWIS BERNARD I. , LUBIN ROBERT I. , JANUARY L. E. , WILD JOHN B.
Published: June 2012

Fifteen subjects with coronary artery disease and angina pectoris were given alternate courses of the alseroxylon fraction of
Rauwolfia serpentina
and placebo. Fourteen improved on the drug as determined by independent clinical evaluations and the "Daily Report Card" data. Seven developed normal electrocardiograms, 2-step tests or ballistocardiograms, that previously had been abnormal. Alseroxylon appeared to induce an unusually prolonged therapeutic effect that was revealed only by an individual "sequential" analysis of each course of drug and placebo. The nature of the underlying mechanism is not clear. Serious hypotensive responses and acute depressive reactions are infrequent at the dosage levels used, but do occur.
Left Axis Deviation
Authors: GRANT ROBERT P.
Published: June 2012

Our understanding of the meaning of the electrocardiogram is greatly furthered by careful comparison of cardiac hypertrophy and cardiac damage observed post mortem with electrocardiograms taken during the last weeks of life. An electrocardiographic-pathologic correlation of 672 cases is reported in which the roles of left ventricular hypertrophy, myocardial infarction, and other factorsin the production of left axis deviation are examined. A heretofore unrecognized QRS-complex syndrome of infarction is described in which the QRS forces are diagnostically abnormal but no "Q waves" are seen in the conventional leads. The roles of hypertrophy, variations in body build, chronic pulmonary disease, and various types of "parietal block" in the production of left axis deviation are studied.
Survival Rates after Acute Myocardial Infarction with Long-Term Anticoagulant Therapy
Authors: KEYES JOHN W. , DRAKE ELLET H. , SMITH F. JANNEY
Published: June 2012

Evidence is set forth to show the value of continuous long-term anticoagulant therapy by comparison with a control group of patients who have also had multiple coronary occlusions or single infarcts, followed by severe angina pectoris or episodes of coronary failure. Statistical life-estimate determinations are included. Bleeding complications are encountered less frequently with improved methods of management and are considered a justifiable risk, in view of the serious consequences of the natural progress of the disease. After a program of long-term anticoagulant treatment has been instituted, cessation of therapy may be hazardous.
Angioscopic Changes in the Smaller Blood Vessels in Diabetes Mellitus and their Relationship to Aging
Authors: DITZEL JØRN
Published: June 2012

Observations with the stereoscopic dissecting microscope of the bulbar conjunctiva disclose vascular changes before pathologic changes are seen with the ophthalmoscope. In diabetic subjects lesions concomitant with aging are accelerated and, in addition, specific abnormalities characteristic of diabetes are observed.
Five-Year Postoperative Results of First 500 Patients with Blalock-Taussig Anastomosis for Pulmonary Stenosis or Atresia
Authors: WHITE B. DANIEL , MCNAMARA DAN G. , BAUERSFELD S. RICHARD , TAUSSIG HELEN B.
Published: June 2012

The evaluation of surgical corrective procedures depends to an important degree on the long-term benefits derived from the operation. Three hundred and eighty-nine of the first 500 patients with a Blalock-Taussig anastomosis for pulmonary stenosis or atresia survived 6 months or longer. Detailed information is now available on 244 of these patients, who were originally improved by operation and who have been followed for 5 years or longer. The results obtained on patients with tetralogy of Fallot are compared with those with other malformations. The alteration of the size of the heart over a period of years has been studied. A comparison between the preoperative and postoperative hemograms and arterial oxygen saturations is presented. The optimum age for operation, the causes of late deaths, and the incidence of bacterial endocarditis are discussed.
Effect of Carotid Sinus Stimulation on the Electrocardiograms of Clinically Normal Individuals
Authors: HEIDORN G. H. , MCNAMARA A. P.
Published: June 2012

The cardioinhibitory effects of carotid sinus stimulation were studied by electrocardiographic means in 40 clinically normal, adult males. Although the carotid sinus reflex is of clinical importance, the measure of its effects in normal individuals is little known. Electrocardiographic changes were varied and occurred in nearly all. Almost one fourth of the patients developed ventricularasystole, and symptoms were induced in another fourth. The wide range of effects emphasizes the importance of this reflex even in normal persons and underscores the need for rigid criteria in the diagnosis of the hypersensitive carotid sinus syndrome.
Abnormality of the U Wave and of the T-U Segment of the Electrocardiogram
Authors: FURBETTA D. , BUFALARI A. , SANTUCCI F. , SOLINAS P.
Published: June 2012

The U wave is considered to represent repolarization of the papillary muscle and neighboring structures. In this study the various types of abnormalities in U wave and T-U segments are outlined and are related to the cardiac involvement. The common factor underlying the varied cardiac pathology is regarded to be ischemia, "strain," or other functional derangement of the papillary muscles in the right or left ventricles.
Treatment of Rheumatic Fever
Authors: BYWATERS E. G. L.
Published: June 2012

The treatment of active rheumatic fever has changed little over the course of years; bed rest is believed to be necessary for the lessening of residua although there is only slight evidence for this belief. The virtues of salicylates in high and low dosage and of similar compounds, of corticotropin, cortisone and its analogues continue to be discussed but chiefly now in the light of those studies that are well designed and include adequate control observations. There is still some hope that a drug in the steroid or salicylate class might be found that would make suppression worth while. What is really wanted is something that will inhibit the consequences of streptococcal infection at the stage of rheumatic fever in a more basic way. Achieving this goal depends upon knowing more about the etiologic mechanisms involved.
Primary Pulmonary Hypertension
Authors: CHAPMAN DON W. , ABBOTT JACK P. , LATSON JOSEPH
Published: June 2012

A brief historical review of primary pulmonary arteriosclerosis and hypertension has been given. Ten additional cases with detailed laboratory, roentgenographic, electrocardiographic, cardiac catheterization, and angiocardiographic studies are presented. The findings on 4 necropsied cases are also included. Progressive exertional shortness of breath, syncope, left chest pain, right ventricular hypertrophy, and pulmonary arterial dilatation, combined with high right ventricular and pulmonary arterial pressure and normal pulmonary capillary pressure in the absence of pulmonary disease, should be extremely suggestive of primary pulmonary hypertension. An unrelenting downhill course of right ventricular failure is usually seen.
Relation of the Postcommissurotomy Syndrome to the Rheumatic State
Authors: LARSON DANIEL L.
Published: June 2012

The postcommissurotomy syndrome is a frequent troublesome complication after mitral valve surgery, the etiology of which is still obscure. In this study of 137 patients who survived surgery the clinical features of this complication are carefully detailed, possible associated conditions are studied, and pathologic findings in the atrial appendages are analyzed. In particular, the relation of this syndrome to the rheumatic state is critically examined.
Measurement of Cardiac Output and Central Volume by a Modified Decholin Test of Circulation Time
Authors: CONN HADLEY L. , HEIMAN DONALD F. , JOYNER CLAUDE R.
Published: June 2012

A technic is described for determining mean circulation time, cardiac output, and central blood volume by use of graded dosages of sodium dehydrocholate (Decholin) administered into a peripheral vein. The indicator-dilution curves derived by the technic were compared with radiopotassium-dilution curves obtained simultaneously in 12 patients. The results showed a surprisingly good agreement between the 2 methods and indicate that the traditional Decholin test of circulation time can be modified to provide much more information than it has in the past.
Isolated Congenital Mitral Stenosis
Authors: BRAUDO J. L. , JAVETT S. N. , ADLER D. I. , KESSEL I.
Published: June 2012

Of the 8 cases of isolated congenital mitral stenosis reported in the literature the authors add 2 cases personally observed. The postmortem findings in one of these patients is described; in the other, improvement was noted following surgical intervention. The literature is reviewed aind the diagnostic criteria, including angiocardiographic findings, are described.
Biochemical Observations of Human Atheromatosis
Authors: NOBLE NANCY L. , BOUCEK ROBERT J. , KAO KUNG-YING TANG
Published: June 2012

Atherosclerosis develops chiefly in the intima of the artery. Biochemical changes associated with atheromatosis were studied serially in human aortic intima by a gross division of the intima into normal tissue, early and advanced atheromata. Earliest alterations observed are increases in collagen concentration and in binding of hexosamine with scleroprotein. Elevation of lipids occurs only after development of the atherosclerotic lesion. There appear to be more biochemical alterations in female intima with atheromatosis and age than in male tissue. Calcium concentration does not increase with age in normal intimal tissue.
The Ausculatory Gap in Arteriosclerotic Heart Disease
Authors: RODBARD SIMON , MARGOLIS JACK
Published: June 2012

Auscultatory gaps, found in some patients with arteriosclerotic heart disease, can be elicited in others by reducing blood flow in the extremity. Reactive hyperemia eliminates the gap in every instance. The gap therefore appears to represent a vasospastic disturbance that limits the blood flow to the extremities, despite the presence of an enhanced pressure head.
Idiopathic Myocardial Failure in the Last Trimester of Pregnancy and the Puerperium
Authors: MEADOWS W. R.
Published: June 2012

Instances of congestive heart failure due to unexplained myocardial disease are not infrequently discussed in the literature. The present study, an extension of a similar study reported by Hull in 1937, relates this type of case to the terminal aspects of pregnancy and the puerperium with an incidence of 1 in 1300 deliveries. Four case reports with necropsy findings, together with the clinical observations made on a total of 15 cases are presented. The frequency of recurrence of the syndrome with subsequent pregnancies and the predominance in the puerperium of this type of congestive failure over those of the usual etiologies suggests that the relationship to pregnancy is not fortuitous.
Coronary Arteries in Fetuses, Infants, and Juveniles
Authors: MOON HENRY D.
Published: June 2012

The coronary arteries of young individuals ranging from fetuses to young adults were studied. Sclerotic lesions were not demonstrated in the coronary arteries of fetuses. In infants the early stages of arteriosclerosis were frequently present and consisted of rupture, degeneration and regeneration of the internal elastic membrane, deposition of mucopolysaccharide, and proliferation of endothelial cells and fibroblasts. These alterations were most prominent in infants of 3 to 4 months. In older individuals there was an apparent decrease in the rate of intimal fibrosis. The lesions of the coronary arteries of young individuals were identical with the early phases of arteriosclerosis in adults.
Effects of Serotonin Antagonists in Normal Subjects and Patients with Carcinoid Tumors
Authors: SCHNECKLOTH ROLAND , PAGE IRVINE H. , GRECO F. DEL , CORCORAN A. C.
Published: June 2012

The pathogenesis of flushing attacks in patients with malignant carcinoid tumors is attributed to the direct pharmacologic effect of excessive amounts of circulating serotonin. It was hoped that potent serotonin antagonists might relieve symptoms of the carcinoid syndrome in the inoperable patient. The nature of flushing attacks was studied in carcinoid patients and the influence thereon of 3 serotonin antagonists, a benzyl analog of serotonin, bromo-lysergic acid diethylamide, and chlorpromazine. The systemic, subjective, and vascular effects of these antagonists in normal subjects were also investigated.
Electrocardiographic Diagnosis of Myocardial Infarction in the Presence of Left Bundle-Branch Block
Authors: CHAPMAN MYRON G. , LEE PEARCE MORTON
Published: June 2012

It is generally accepted that most myocardial infarctions are obscured on the electrocardiogram by left bundle-branch block. The number of published cases in which this could be evaluated, however, is small, and the case reports are scattered. We have studied 30 cases of myocardial infarction with left bundle-branch block in which the location of the infarction could be determined with certainty, by autopsy, or by a previous electrocardiogram with normal intraventricular conduction. Twenty such published cases have also been collected. Electrocardiographic abnormalities have been correlated with infarctions in different locations. The possible specificity of these abnormalities is discussed.
The Normal QRS Loop Observed Three Dimensionally Obtained with the Frank Precordial System
Authors: SEIDEN GEORGE E.
Published: June 2012

By means of a relatively orthogonal lead system combined with the use of an electronic resolver, 3-dimensional QRS loops of normal individuals have been seen broadside in 2 dimensions after proper rotation. QRS loops so visualized have been studied by certain quantitative measurements which it is hoped may be of assistance in distinguishing normal from abnormal loops.
Dissecting Aneurysm of the Aorta Secondary to Tuberculous Aortitis
Authors: MEEHAN JOHN J. , PASTOR BERNARD H. , TORRE ANTHONY V.
Published: June 2012

Tuberculous aortitis is rare, only 29 cases having previously been reported. The first known case of dissecting aneurysm of the aorta secondary to tuberculous aortitis is described. The site of dissection was in the adventitia instead of the usual location in the media. The possibility of gradual aortic dissection without the classical acute picture is emphasized.
Cardiac Pain
Authors: WHITE JAMES C.
Published: June 2012

It may be concluded that the pathways of cardiac pain have been thoroughly established, with the exception of the conduction of anginal attacks occasionally referred to the neck and jaws. Afferent impulses traverse axons that travel in the cervical and thoracic sympathetic cardiac nerves. In the case of the cervical pathway, all impulses on entering the paravertebral ganglionated chain in the neck must descend to the upper thoracic level before they can gain access to the spinal cord. Other impulses reach the 3 superior thoracic ganglia via the more direct thoracic cardiac nerves. Both the cervical and thoracic fibers join the spinal nerves over the communicant sympathetic rami. After passing through the intervertebral foramina, they enter the posterior roots and terminate in the lateral horn of the spinal cord. Here they establish synapses with secondary afferent neurons of the spinothalamic tract, decussate to the opposite anterior column, and are carried rostrally to the nucleus ventralis posterolateralis of the thalamus. This is the principal locus in the brain for the perception of visceral pain. In contrast to well-defined cutaneous sensibility, there is no cortical area for exact visceral localization in the postcentral region of the cerebral cortex.

Another factor in the poor localization of cardiac pain is the paucity of sensory endings in the heart. A third appears to be the limited number of secondary sensory fibers in the spinothalamic tracts. These central axons must be shared with other impulses from the surface of the body. As a result, pain from the heart is in large part referred to the cutaneous distribution of the upper 4 thoracic spinal segments. Accounting for the superficial reference of visceral pain by Mackenzie's theory of a viscerocutaneous reflex is no longer justifiable. Even after cutaneous afferent fibers are interrupted by procaine or amputation of the arm, pain from the heart can still be felt over its previous distribution.

Neither stimulation of the vagi nor interruption of transmission in these nerves has been found to have any beneficial effect in patients suffering from angina pectoris. Sensory denervation of the heart must therefore be carried out by destruction of the upper ganglia in the thoracic sympathetic trunks or by severing the corresponding posterior spinal roots.
Effect of Sitosterol on the Concentration of Serum Lipids in Patients with Coronary Atherosclerosis
Authors: RILEY FLETCHER P. , STEINER ALFRED
Published: June 2012

The oral administration of large amounts of sitosterol to patients with coronary atherosclerosis has resulted in statistically significant decrease in serum cholesterol in one half of the trial periods. However, because of the fluctuation of the serum cholesterol that occurs in patients with coronary atherosclerosis, further study will be necessary to demonstrate that the decrease in serum cholesterol coincident with sitosterol administration is not due to the lability of the serum lipids in this group of individuals.
Quantitative Analysis of the Electrocardiographic Pattern of Hypopotassemia
Authors: SURAWICZ BORYS , BRAUN HAROLD A. , CRUM WILLIAM B. , KEMP ROBERT L. , WAGNER SEYMOUR , BELLET SAMUEL
Published: June 2012

Electrocardiographic patterns typical of hypopotassemia and compatible with hypopotassemia were defined on the basis of the number of electrocardiographic signs of hypopotassemia present in 2 leads (generally leads II and V
3
). In 50 hypopotassemic patients a good correlation was found between the electrocardiographic pattern and plasma potassium concentration. Appearance of the electrocardiographic signs of hypopotassemia was not prevented by disturbance of other plasma electrolytes or by blood pH.
Effects of Upright Posture and Exercise on Pulmonary Hemodynamics in Patients with Central Cardiovascular Shunts
Authors: BRUCE ROBERT A. , JOHN GREGORY G. , Wiederhielm Curt A. , Hamilton Charlotte , Morgan Claire , Kendall Elizabeth
Published: June 2012

Previous hemodynamic studies of patients with septal defects, or patent ductus arteriosus, have been made with the patient recumbent in the horizontal posture. Our studies indicate unexpected changes in pulmonary blood flow with the upright posture, and often further increments in flow during walking that are different from those reported for exercise in recumbency. It is suggested that such defects reveal the complexity of factors regulating preferential flow under these circumstances.
Nitroglycerin and Other Nitrites in the Treatment of Angina Pectoris
Authors: RISEMAN JOSEPH E. F. , ALTMAN GEORGE E. , KORETSKY SIDNEY
Published: June 2012

The close chemical relationship between glyceryl trinitrate and erythrol tetranitrate suggests that these 2 drugs, despite clinical evidence to the contrary, should be equally effective in preventing attacks of angina pectoris. This proved to be true when the drugs were administered by the same route. Thus, erythrol tetranitrate when administered sublingually (instead of being swallowed, as is the custom) behaves like nitroglycerin and is one of the most effective vasodilators available. Conversely, nitroglycerin when swallowed (instead of being taken sublingually, as is the custom) is ineffective and erratic in activity. A similar striking increase in vasodilating action on sublingual administration is seen also with mannitol hexanitrate and triethanolamine trinitrate and to a lesser extent with pentaerythritol tetranitrate but not with sodium nitrite.

The prolonged effect of erythrol tetranitrate, when administered sublingually or in the buccal pouch, makes it particularly valuable in the clinical management of patients with angina pectoris.