bluuebunny/crossref_metadata_2025 huggingface dataset:
The Straining Procedure as an Aid in the Anatomic Localization of Cardiovascular Murmurs and Sounds
Authors: ZINSSER HARRY F. , KAY CALVIN F.
Published: June 2012

Most heart murmurs diminish in intensity during straining. Those derived from the right heart and pulmonary circulation regain intensity immediately after straining. Those from the left heart and systemic circulation recover only after an appreciable delay. The murmurs of patent ductus arteriosus and of mitral stenosis each showed a modified, but characteristic response. These murmur changes were correlated with recorded dynamic cardiovascular changes produced by straining.
Recording and Visual Oscillometry by a New Standardized Technic
Authors: OSHLAG JULIUS A. , DURYEE A. WILBUR
Published: June 2012

Oscillometry offers knowledge of clinical importance, yet its value in presently used apparatus has recently been questioned. The criticisms include shifting base line, parallax in visual reading, aging of rubber parts with consequent loss of elasticity, friction and inertia of writing mechanisms, and failure to standardize. The method suggested below obviates these defects.
The Clinical Effect of Dihydroergocornine Methanesulphonate (DHO-180) in Arterial Hypertension: A Preliminary Report
Authors: TANDOWSKY R. M.
Published: June 2012

A controlled clinical and statistical study of 47 unselected patients with sustained arterial hypertension who received dihydroergocornine intravenously and orally is presented. The study demonstrates the central effect of this drug in temporarily lowering the systolic and diastolic blood pressure and pulse rate. This action occurs irrespective of associated pathology or extent of the hypertensive state when the drug is given parenterally. Orally, little effect was demonstrated.
Healed Dissecting Aneurysm of the Aorta Erroneously Diagnosed Paramediastinal Effusion; Death Following Attempted Aspiration
Authors: SMITH J. CHANDLER , SANCETTA SALVATORE M.
Published: June 2012

Approximately 1 per cent of dissecting aneurysms of the aorta develop re-entry tears and heal, forming the so-called "double-barrelled" aorta which is compatible with a variable period of survival. Occasionally a case is found wherein the dissection has remained limited to the media, healing without evidence of intimal tears. We describe such a case, so rare as to constitute a medical curiosity.
Standardization of the Ballistocardiogram by Simulation of the Heart's Function at Necropsy; With a Clinical Method for the Estimation of Cardiac Strength and Normal Standards for It
Authors: STARR ISAAC , HORWITZ O. , MAYOCK R. L. , KRUMBHAAR E. B.
Published: June 2012

The interpretation of ballistocardiograms has been attacked by a method entirely new; a physiologic experiment performed at necropsy. While the subject lies on the ballistocardiograph a normal diastolic pressure is created and the heart's function is simulated by injecting fluid into the aorta and pulmonary artery, the amount injected at each instant being recorded. The resulting ballistocardiograms can be directly compared with many aspects of cardiac function. The amplitude of the ballistocardiogram measures the maximum force exerted by the heart in moving the blood and preliminary normal standards for this estimate of cardiac strength have been set up.
Delayed Development of Ventricular Ectopic Rhythms following Experimental Coronary Occlusion
Authors: HARRIS A. SIDNEY
Published: June 2012

Following aseptic occlusion of the anterior descending artery of the dog's heart ectopic ventricular tachycardia develops after a latency of four and one-half to eight hours, and persists for two to four days. Large gross infarcts are found in all hearts. The duration of latency of onset of major ectopic activity approximates the minimal period of ischemia required to produce histologic signs of necrosis. It is suspected that products or processes of necrosis have excitatory effects on tissues bounding the ischemic zone. Evidences concerning various possible excitatory factors are briefly reviewed.
Relationship of Various Factors to the Degree of Coronary Atherosclerosis in Women
Authors: ACKERMAN ROBERT F. , DRY THOMAS J. , EDWARDS JESSE E.
Published: June 2012

The degree of coronary artery atherosclerosis present in 600 hearts obtained from women, 100 in each of the decades from 30 through 89 years, was determined by one observer. Coronary atherosclerosis increased with age until the eighth decade when the atherosclerosis tended to level off. Cardiac hypertrophy and diabetes were associated with increased degrees of atherosclerosis. Hearts from the undernourished exhibited less atherosclerosis than did hearts from average weight or overweight individuals. A comparison with data compiled on 600 hearts from men by White and associates has been included.
The Diffuse Vascular Lesion of So-Called "Thrombotic Thrombocytopenic Purpura"
Authors: MARCH HAROLD W.
Published: June 2012

"Thrombotic thrombocytopenic purpura" is a thrombocytopenic, hemolytic disease with occlusive mounds in the arterioles and capillaries. These mounds have been popularly supposed to represent bland platelet thrombi. In recent years observations have been forthcoming in favor of a primary vascular lesion as the anatomic basis of the disease. This paper places special emphasis on the latter proposition, and pathologic material is presented to demonstrate how such a lesion probably evolves.
The Value of the Atrial Electrokymogram in the Diagnosis of Mitral Regurgitation
Authors: FLEISCHNER FELIX G. , ABELMANN WALTER H. , BUKA ROBERT
Published: June 2012

The difficulty of correct clinical assessment of the functional state of the diseased mitral valve has prompted this re-evaluation of the atrial electrokymogram in 15 patients with rheumatic mitral disease. By means of a technic stressing careful placing of the pick-up device and recording from multiple locations along the left atrial border, a pattern characteristic of mitral regurgitation could be demonstrated. In general, the electrokymographic predictions correlated well with the operative findings.
Ventricular Function
Authors: SARNOFF STANLEY J. , CASE ROBERT B. , BERGLUND ERIK , SARNOFF L. CHARLOTTE
Published: June 2012

The cardiovascular effects of a new, long-acting, sympathomimetic amine, Aramine, are described. Cardiac output, aortic pressure, coronary flow, and ventricular stroke work rise while atrial pressures fall. A sustained increase in myocardial contractility is produced and the myocardium does not require more coronary flow per unit of ventricular work after its administration. The circulatory effects of ventricular failure produced by restricting coronary flow are reversed by the drug. The authors seriously question the premise that the ideal agent for the management of cardiogenic shock should act solely on the peripheral vascular bed.
Inhibition of Cholesterol-Induced Coronary Atherogenesis in the Egg-Producing Hen
Authors: STAMLER JEREMIAH , PICK RUTH , KATZ LOUIS N.
Published: June 2012

Mature egg-producing hens, intact or after oviduct ligation, are markedly resistant to cholesterol-induced coronary atherogenesis. This inhibition of coronary atherosclerosis is apparently effected by the endogenous estrogen secretion of these female birds.
Studies on the Control of Hypertension by Hyphex
Authors: SCHROEDER HENRY A. , MORROW JOHN D. , PERRY H. MITCHELL
Published: June 2012

One hundred and six patients in malignant stages of hypertension were treated with continuous oral hexamethonium chloride and 1-hydrazinophthalazine. The courses of ten uremic individuals were unaffected. Twenty-eight discontinued therapy, three of whom survived two months. Sixty-eight nonuremic patients continued treatment and 54 are alive 15 to 36 months later; 17 who were azotemic have lived two to three years. Of the 14 who died, only three succumbed to hypertensive complications. Forty-six of the living patients have returned to full activity. Apparently the malignant stage of hypertension is reversible by drugs properly used to lower blood pressure and no longer need be the rapidly fatal disease that it has been in the past.
The Correction of Electrolyte Deficits in Cardiovascular-Renal Disease
Authors: SCHEMM F. R. , CÁMARA A. A.
Published: June 2012

In this discussion of some of the points that have interested us in the correction of electrolyte deficits in cardiovascular-renal disease, we briefly reviewed the salt-losing syndrome in terminal nephritics and in hypertensives with advanced renal damage, and incidentally delved into the concepts of edema formation as we discussed its opposite mechanism. We found ourselves drawn into a discussion of potassium metabolism in the process, touching on the subject of "potassium losers." Next in the panorama of this multifaceted problem came the management of edematous patients who developed hyponatremia on the diuretic egimen (without losing their edema) or who became mercurial fast in "midstream"; i.e., after losing about half their edema. Under such dire circumstances, we showed how sodium chloride might be used to good advantage.

The promising use of corticotropin (ACTH) in hopelessly resistant cases of cardiac edema or in near-terminal severe cases of myocardial insufficiency, with incidental correction of a coexisting hyponatremia (accomplished without the use of sodium supplements) was described. Finally, we discussed in detail our use mainly of
hypotonic
solutions of sodium salts in correcting
concentration
as well as
pattern
and
volume
disturbances of the extracellular fluid in cardiovascular-renal patients who develop serious gastrointestinal and surgical complications. We emphasized that in such patients we have obtained the best end results with mainly hypotonic and isotonic, rather than hypertonic salt solutions. With this form of electrolyte replacement therapy, we have seen more floating on water and less drowning in brine!
Comparison of Indirect and Direct Methods of Measuring Arterial Blood Pressure
Authors: VAN BERGEN FREDERICK H. , WEATHERHEAD D. STUART , TRELOAR ALAN E. , DOBKIN ALLAN B. , BUCKLEY JOSEPH J.
Published: June 2012

Direct and indirect determinations of blood pressure have been recorded in 70 human subjects. Statistical analysis of the results is presented. A frequent discrepancy between direct and indirect readings is evident with the drift of the latter falling increasingly below the direct measurement as blood pressure rises. The greatest discrepancy is found in the young hypertensive subject and the possible clinical implications of this finding are discussed. An attempt is made to explain some of the factors contributing to the variable error by which auscultatory readings underestimate the true intraarterial pressure.
Serum Lipid and Fat Tolerance Studies in Normal, Obese and Atherosclerotic Subjects
Authors: POMERANZE JULIUS , BEINFIELD WILLIAM H. , CHESSIN MAX
Published: June 2012

Fat tolerance tests demonstrated elevated and prolonged postprandial lipemia in markedly obese, hypercholesteremic, and atherosclerotic subjects when compared with normal individuals. An improvement of this abnormal fat tolerance was achieved following rigid fat restriction in hypercholesteremic and atherosclerotic subjects and following weight reduction in the extremely obese. An inferential relationship is suggested between extreme obesity and atherosclerosis.
Pathology of the Pulmonary Vascular Tree
Authors: SMITH ROGER C. , BURCHELL HOWARD B. , EDWARDS JESSE E.
Published: June 2012

Previous studies in this series demonstrated structural changes in the pulmonary vascular bed as the result of mitral valvular disease and other cardiac disorders. The present study demonstrates changes in the lungs as the result of chronic left ventricular failure; these changes were like those produced by mitral stenosis. The most pronounced disturbance was medial hypertrophy. The exact mechanism is not known, but it probably is related to increased pulmonary venous pressure.
Treatment of Hypertension with Reserpine,with Reserpine in Combination with Pentapyrrolidinium,and with Reserpine in Combination with Veratrum Alkaloids
Authors: DOYLE A. E. , MCQUEEN E. G. , SMIRK F. H.
Published: June 2012

The treatment of hypertension with reserpine is described. When used alone it produced adequatefalls of blood pressure in ten out of forty patients. The combination of reserpine with veratrum did not increase the hypotensive effects of reserpine alone. The combination of reserpine with pentapyrrolidinium increases the effectiveness of the pentapyrrolidinium and lessens its parasympathetic side effects. The combination of reserpine and pentapyrrolidinium is regarded as the best therapeutic regime for severe hypertension. Some mild cases of hypertension may be managed with reserpine alone.
Right Ventricular Hypertrophy
Authors: WALKER ISOM C. , SCOTT RALPH C. , HELM ROBERT A.
Published: June 2012

Twelve cases whose electrocardiograms fulfilled at least one criterion of Sokolow and Lyon for right ventricular hypertrophy were examined at autopsy. Eight of the 12 demonstrated right ventricular hypertrophy anatomically. Eleven of the 12 cases had diseases usually associated with increased pressure in the right ventricle and pulmonary artery and with increased total pulmonary resistance. It is likely that factors other than muscle mass contribute significantly to the electrocardiographic pattern of right ventricular hypertrophy.
Corticotropin (ACTH) in Heart Disease: Its Paradoxical Effect on Sodium Excretion in Resistant Congestive Failure
Authors: CÁMARA AUGUSTO A. , SCHEMM FERDINAND R.
Published: June 2012

Since the spring of 1952 we have undertaken a clinical trial of corticotropin in 21 cardiac patients with resistant edema. Of these, there were eight with arteriosclerotic, eight with chronic rheumatic, and three with hypertensive heart disease, while two had cor pulmonale. Beneficial results were obtained in 17, or 81 per cent of the cases. These consisted of a spontaneous diuresis either during corticotropin administration or after its withdrawal, or an alteration of response to mercurials, the patients subsequently responding favorably, whereas they had previously been completely refractory to the mercurial diuretics.
Chronic Effusive Pericarditis
Authors: CONTRO S. , DE GIULI G. , RAGAZZINI F.
Published: June 2012

An unusual case of chronic pericarditis with effusion, lasting at least four years, in an asymptomatic child, is presented. The literature on the subject is reviewed. Attention is drawn to the fact that such cases exist, and should be considered when one is confronted with a case of cardiac enlargement of obscure etiology.
Evidence for Increased Serum Glutamic Oxalacetic Transaminase (SGO-T) Activity Following Graded Myocardial Infarcts in Dogs
Authors: NYDICK IRWIN , WRóBLEWSKI FELIX , LADUE JOHN S.
Published: June 2012

Elevation in serum concentration of the enzyme, glutamic oxalacetic transaminase, (SGO-T), is an accurate index of myocardial infarction in dogs. The enzyme rises in a rough proportion to the extent of myocardial necrosis. The test is a sensitive guide to myocardial injury. Infarcts less than 1 Gm. in weight result in a significant alteration in serum concentration of the enzyme. Concentrations of the enzyme in infarcted muscle are markedly lower than in normal muscle, suggesting that seepage through damaged cells causes the rise in serum concentration. Experimental and clinical myocardial injury result in similar abnormalities.
Lumbar Sympathectomy in the Treatment of Hypertensive Ischemic Ulcers of the Leg (Martorell's Syndrome)
Authors: PALOU J.
Published: June 2012

Hypertensive ischemic ulcer (Martorell's syndrome) is an infrequent complication of hypertensive disease. The ulcers appear on the leg as necrotic areas. The pathogenesis is described as ischemia resulting in local gangrene due to obliterating lesions in the arterioles. Actual pathological sections were studied which showed hyaline degeneration between the endothelium and internal elastic lamina, and these changes are similar to those found in other localities in hypertensive patients. Lumbar sympathectomy results in healing of the ulcers.
The Role of Pulmonary Hypertension and Thromboembolism in the Production of Pulmonary Arteriosclerosis
Authors: O'NEAL ROBERT M. , THOMAS WILBUR A.
Published: June 2012

Thromboembolism and pulmonary hypertension have been assessed as factors in the production of pulmonary arteriosclerosis. A study was made of autopsy records and tissue sections from 59 cases of congenital heart disease with anomalies permitting shunting of blood from the systemic to the pulmonary circulation and 31 cases of pulmonary stenosis with septal defect. Pulmonary arteriosclerosis was found to be common and of equal frequency in the two groups of cases, indicating that hypertension is not a necessary factor. There was a close correlation between the presence of pulmonary arterial thrombi and pulmonary arteriosclerosis.
Echinococcus Disease of the Left Ventricle
Authors: CANABAL EDUARDO JOAQUÍN , AGUIRRE CÉSAR V. , DIGHIERO JORGE , PURCALLAS JOAQUÍN , BALDOMIR JOSÉ M. , SUZACQ CARLOS V.
Published: June 2012

The subject of echinococcus disease of the left ventricle is discussed from the clinical, radiologic, and electrocardiographic point of view. Up to the present very few cases of this condition have been reported in the world literature. In most instances the diagnosis has been made by postmortem examination. The diagnostic criteria presented in this paper may be helpful in the recognition of this disease which, if treated by surgery, may be another form of "reversible" heart disease.
Costophrenic Septal Lines in Pulmonary Venous Hypertension
Authors: BRUWER ANDRÉ J. , ELLIS F. HENRY , KIRKLIN JOHN W.
Published: June 2012

On the thoracic roentgenograms of patients with mitral stenosis, costophrenic septal lines are frequently seen. These lines are a sign of pulmonary venous hypertension. They were not seen in a representative group of patients with pulmonary arterial hypertension but without pulmonary venous hypertension.
Dynamic Comparison of Current Ballistocardiographic Methods
Authors: TALBOT SAMUEL A. , HARRISON W. KIRBY
Published: June 2012

Part I dealt with dynamic arrangements (Dock, Smith, Walter, Nickerson, Burger, v. Wittern) which could be treated approximately as single masses in the lower frequency range. It was shown that in addition to the cardiovascular forces sought, other undesired forces from the support were mixed in, seriously altering the record: especially for components in the important 4 to 8 cycles per second region. Second, emphasis was laid on the several meanings that could be assigned the displacement, velocity and acceleration (DVA) records, according to what dynamic aspect (motion, momentum or force) of the cardiovascular action they were
referred.
It was explained that all direct-body and stiff-bed ballistocardiographic records were "compound", as they could not be referred to any one of these dynamical quantities.

In part II, we will discuss the platform methods in detail, showing how the platform mass comes into the record. The arguments for and limitations of the various platform methods are considered, including the "shin-platform" and the very light pendular platforms now being tried.
Arteriosclerosis in the Intramural and Extramural Portions of Coronary Arteries in the Human Heart
Authors: EDWARDS JOSEPH C. , BURNSIDES CHARLES , SWARM RICHARD L. , LANSING A. I.
Published: June 2012

Fifteen instances of intramural coronary arteries were observed in the dissection of 276 human hearts at consecutive unselected autopsies. All but 2 of these 15 had severe atheromata and narrowing of the lumina. It was thought important to determine whether or not the covering of the artery by cardiac muscle for a major part of its course protected the artery from atherosclerosis. From our data, one may assume that those portions surrounded by heart muscle were not protected from atherosclerotic process which occurred there as well as in extramural portions of the same arteries and in other entirely extramural coronary arteries.
Pyretotherapy and Subcutaneous Hexamethonium in the Treatment of Severe and Malignant Hypertension
Authors: THOMSEN PABLO , ORTÚZAR RAMÓN , GOÑI FERNANDO , ESPÍLDORA-LUQUE CRISTOBAL , VIAL LEÓN
Published: June 2012

The permanent lowering of arterial pressure in cases of malignant and severe hypertension is of paramount importance. A new treatment that combines subcutaneous administration of hexamethonium with fever therapy produced by intravenous injections of bacterial vaccine is described. Reduction of blood pressure to normal levels and improvement of eye grounds, electrocardiogram, heart condition and subjective symptoms were obtained. The basis for these effects could be the potentiation of the action of hexamethonium produced by the induced fever.
A Study of the Spatial Vectorcardiogram in Subjects with Anterior Myocardial Infarction
Authors: BURCH G. E. , HORAN LEO , CRONVICH J. A.
Published: June 2012

In 20 subjects with anterior myocardial infarction the early portions of the QRS sÊ-loop were directed away from the area of infarction. Deformities that occurred in later portions of the QRS sÊ-loop were compatible with loss of electric force produced by depolarization of areas activated late in the phase of depolarization. This observation is of significance because electrocardiograms, as conventionally recorded and interpreted, fail to detect infarcts located in areas of the heart that are depolarized late and that would not be expected to deform the early portions of the QRS complex sÊ-loop.
Effect of Pregnancy on the Course of Heart Disease
Authors: MILLER MARY M. , METCALFE JAMES
Published: June 2012

One hundred and six patients have been restudied three and one-half to 5 years (average 4.1 years) after they were observed with pregnancy and heart disease at the Boston Lying-in Hospital.

This re-evaluation indicated that the altered circulatory dynamics of pregnancy may temporarily decrease functional capacity. However, no permanent change in degree of heart disease could be directly attributed to the pregnancy for which these patients were followed in 1950 and 1951.
Thromboembolic Complications Following So-called "Good Risk" Cases of Myocardial Infarction
Authors: DE FRANCISCO ADOLFO , WRIGHT IRVING S.
Published: June 2012

Thromboembolic complications frequently occur following myocardial infarction. Following the general acceptance of anticoagulant therapy for the treatment of myocardial infarction, there have been some authors who have recommended that this therapy be withheld from "mild cases," unless they develop thromboembolic complications. It is the belief of the present authors that this is not justified unless there are contraindications for anticoagulant treatment, provided that proper facilities are available. Summaries of experience with 14 so-called "good risk" cases of myocardial infarction who developed a total of 18 certain and 4 probable thromboembolic complications are presented. As a result, there were 4 major amputations in 3 patients, 1 of whom died. Other complications are discussed in detail.
Posthypothermic Circulatory Failure
Authors: BLAIR EMIL , MONTGOMERY A. VERNON , SWAN HENRY
Published: June 2012

Certain aspects of cardiovascular function were studied in dogs that were cooled to 30 C. without ventilatory assistance, and rapidly rewarmed in warm water. While in the hypothermic state, the animals appeared to make an adequate cardiovascular adjustment to the lowered body temperature. Upon rewarming, however, each animal incurred an acute circulatory collapse, which was characterized by a low cardiac output, diminished ventricular work, hypotension, hyperpnea, and increased arteriovenous oxygen difference. It is uncertain whether this circulatory failure is central or peripheral in origin.
Significance of Abnormal Phase II Response to Valsalva Maneuver in Cardiac Patients
Authors: BURROUGHS ROBERT W. , BRUCE ROBERT A.
Published: June 2012

Abnormal responses to a standardized Valsalva maneuver have been proposed as additional criteria for heart failure. The present study was undertaken to determine the variability of these responses in normal subjects as well as frequency of abnormal responses in cardiac patients. Only phase II responses could be considered reliable for this purpose. Discrepancies between phase II responses were observed in relation to other criteria.
The Effect of Beta Sitosterol on the Serum Lipids of Young Men with Arteriosclerotic Heart Disease
Authors: FARQUHAR JOHN W. , SMITH RALPH E. , DEMPSEY MARY E.
Published: June 2012

Previous studies in human beings on unrestricted diets have indicated that the plant sterols (beta or gamma sitosterol) cause decreases in serum cholesterol. In this study, 15 young men with previous myocardial infarction were given 12 to 18 Gm./day of beta sitosterol with resultant sustained reductions of serum cholesterol and beta lipoprotein lipid. Lipoprotein lipid fractionation was performed by paper electrophoresis. These changes occurred irrespective of initial serum cholesterol or content of diet. Control observations of the effects of diet, weight maintenance, and the inclusion of placebos brought about increased confidence that the changes were due to the administered sitosterol.
Hypertensive Pulmonary Vascular Disease
Authors: HEATH DONALD , WHITAKER WILLIAM
Published: June 2012

Patients with pulmonary artery blood pressures that are chronically elevated to levels of the order of the systemic blood pressures, form a distinct clinicopathologic entity. This condition may complicate a ventricular septal defect, Eisenmenger's complex, patent ductus arteriosus, atrial septal defect, and mitral stenosis, and it may occur as idiopathic pulmonary hypertension. The clinical picture is dominated by symptoms and signs characteristic of pulmonary hypertension, which often mask underlying cardiac anomalies, and definitive pathologic changes occur in the pulmonary vasculature. The term hypertensive pulmonary vascular disease is therefore suggested for this distinct group of patients.
Splenorenal Arterial Anastomoses
Authors: HURWITT ELLIOTT S. , SEIDENBERG BERNARD , HAIMOVICI HENRY , ABELSON DONALD S.
Published: June 2012

A splenorenal arterial anastomosis may be life-saving or result in renal salvage under a variety of circumstances. These may include thrombosis or aneurysm of the aorta, and obstruction, injury, aneurysm, or anomalies of the renal artery. The successful construction of a left splenorenal arterial anastomosis in a patient with ascending thrombosis of the abdominal aorta is presented.
The Electrocardiogram in Infarction of the Lateral Wall of the Left Ventricle
Authors: DUNN WILLIAM J. , EDWARDS JESSE E. , PRUITT RAYMOND D.
Published: June 2012

This reappraisal of the electrocardiographic manifestations of infarction of the lateral wall of the left ventricle is based on data acquired by simple and conventional technics. Categories of cases have been determined by the age of the infarct and the distribution of the lesion with respect to the circumference of the left ventricular wall and its epicardial and endocardial boundaries. Significant data have been presented in the form of illustrative diagrams and reproductions. The results do not establish a simple pattern common to all cases of infarction of the lateral wall; they do illustrate the varied yet limited electrocardiographic consequences of such lesions.
Cardiotoxic Effects of Hypercatecholemia in Renal Insufficiency
Authors: RAAB W. , LEPESCHKIN E. , STARCHESKA Y. K. , GIGEE W.
Published: June 2012

Renal insufficiency is regularly accompanied by an increase of the total catecholamines of the blood. Adrenolytic drugs, which inactivate circulating catecholamines, temporarily improve the abnormal S-T segments and T waves in patients with renal insufficiency but not in hypertensive patients without renal complications. It is suggested that in renal insufficiency, the retained circulating catecholamines damage cardiac metabolism and function. In agreement with previous observations, the behavior of the "left ventricular strain pattern" was relatively independent of the blood pressure level.
Graphic Registration of Cardiac Thrills in Acquired and Congenital Heart Disease
Authors: LEVINSON DAVID C. , MEEHAN JOHN P. , SCHWARTZ LEONARD H. , GRIFFITH GEORGE C.
Published: June 2012

A method is described for the graphic registration of cardiac thrills. A thrill is defined as a chest wall vibration of sufficient intensity to be recognized by tactile sensation.
Hemodynamic and Clinical Appraisal of Coarctation Four to Seven Years after Resection and End-to-End Anastomosis of the Aorta
Authors: WRIGHT J. LEO , BURCHELL HOWARD B. , WOOD EARL H. , HINES EDGAR A. , CLAGETT O. THERON
Published: June 2012

This study was undertaken to ascertain whether coarctation of the aorta produces permanent hemodynamic abnormalities that may persist despite resection and end-to-end anastomosis. The results of studies in 10 patients 4 to 7 years after operation are compared to those obtained before and immediately after operation. The most significant finding was continued decrease in residual coarctation, in addition to dramatic immediate postoperative improvement in the degree of circulatory impairment.
Widespread and Sudden Occlusion of the Small Arteries of the Hands and Feet
Authors: JEPSON R. P.
Published: June 2012

This paper analyzes the syndrome of symmetrical digital gangrene that results from various pathologic processes. If a group of such patients is closely studied, it is apparent that among those who have suffered a sudden and widespread occlusion of the small arteries of the hands and feet some may be grouped apart by reason of the single nature of the attack and the good prognosis. Eleven such examples seen by the author are described and their differential diagnosis, causation, and treatment discussed.
Prevention of Rheumatic Fever and Bacterial Endocarditis Through Control of Streptococcal Infections
Authors: Rammelkamp Charles H.
Published: June 2012

This article is the second revision of the American Heart Association statement on the prevention of rheumatic fever issued January 1953. This statement was prepared by the Committee on Prevention of Rheumatic Fever and Bacterial Endocarditis appointed by the Council on Rheumatic Fever and Congenital Heart Disease of the American Heart Association. The committee is cognizant of the fact that no recommendations of any group can be final at this time. The present approach may not be the eventual solution of the problem of preventing rheumatic fever. Revisions and changes will be made as new knowledge may indicate.
XIII. Prognostic Significance of Negative U Waves in the Electrocardiogram in Hypertension
Authors: KEMP ROBERT L. , SURAWICZ BORYS , BETTINGER JOHN C. , GOTTLIEB HARRY , BELLET SAMUEL
Published: June 2012

Negative U waves were found in 23 per cent of 287 electrocardiograms of hypertensive patients. The group of patients with negative U waves showed higher average diastolic and mean blood pressures, more advanced congestive heart failure, a higher incidence of marked cardiomegaly and uremia, more serious cerebrovascular complications, and a higher mortality than the group with positive U waves.

Normal heart size, normal electrocardiographic patterns, and absence of evidence of renal impairment or congestive heart failure occurred more commonly in the group with positive U waves. Negative U waves were found in 43 per cent of 114 cases of "left ventricular strain" pattern in hypertensive patients.

In the presence of "left ventricular strain" pattern, the patients with negative U waves had more advanced congestive heart failure, a higher incidence of marked cardiomegaly and uremia, and a higher mortality than the patients with positive or isoelectric U waves.

A concept has been advanced that in the evolution of the "left ventricular strain" pattern, the inversion of the U wave is a late event that follows the inversion of the T wave by a certain time lag. In the few cases in which an inverted U wave followed a positive T wave, the morbidity and mortality were very high.

A negative U wave constituted the only abnormal finding in 1 case.
Failure of Alpha-Phenylbutyrate and Beta-Phenylvalerate in Treatment of Hypercholesterolemia
Authors: FREDRICKSON DONALD S. , STEINBERG DANIEL
Published: June 2012

Sodium alpha-phenylbutyrate and sodium beta-phenyl-n-valerate have been administered to a carefully controlled group of hypercholesterolemic patients. Prior reports that these compounds are effective in the treatment of hypercholesterolemia are not confirmed. Two patients developed toxic reactions requiring cessation of treatment. The ineffectiveness of these drugs, despite their inhibitory effect on the synthesis of cholesterol from acetate, is discussed in terms of recent biochemical information concerning their site of action.
Assay of Anti-Anginal Agents
Authors: COLE SEYMOUR L. , KAYE HARRY , GRIFFITH GEORGE C.
Published: June 2012

The measure of an anti-anginal agent is its ability to decrease chest pain. Because of the subjective character of pain, extreme care is necessary in choosing patients upon whom anti-anginal medication is to be tested. We have used the double-blind technic and an initial control period to neutralize the many extraneous mental and physical factors, such as bias or the patient-physician relationship itself, that might interfere with an accurate appraisal. This study shows, in addition, that proper evaluation of an anti-anginal agent requires that its effect be measured against multiple control periods without medication throughout the various phases of angina pectoris.
Effect of Protamine on Alimentary Lipemia
Authors: DAY ALLAN J. , WILKINSON GWENDOLINE K. , GILMORE HUGH R. , SCHWARTZ COLIN J. , Peters J. A.
Published: June 2012

The effect of protamine on the serum lipids during alimentary lipemia was investigated in normal male students and this effect was compared with that in atherosclerotic and in nonatherosclerotic men of the same age group. In the student group protamine produced a highly significant increase in the total fatty acid level, whereas in the 2 older groups no significant change occurred. These results were interpreted as demonstrating that circulating heparin exerts a physiologic effect on fat turnover in the young individual, an effect that is reduced with aging. It is suggested that the lowered fat tolerance known to occur with aging is the result of deficiency of circulating heparin.
Reversible Cardiopulmonary Syndrome with Extreme Obesity
Authors: ESTES E. HARVEY , SIEKER H. O. , MCINTOSH H. D. , KELSER G. A.
Published: June 2012

A syndrome consisting of obesity, somnolence, cyanosis, periodic breathing, and polycythemia, with congestive heart failure has been observed in 6 patients. The effect of weight reduction and the mechanisms responsible for the symptoms and signs are discussed.
Effect of
Rauwolfa serpentina
and Reserpine on the Blood Pressure in Essential Hypertension
Authors: SHELDON MURRAY B. , KOTTE J. HAROLD
Published: June 2012

A 2-year double-blind study of 18 ambulatory patients treated with
Rauwolfia serpentina
and reserpine is presented, with a statistical evaluation by the method of analysis of variance.
Amyloidosis of the Aorta
Authors: MACMAHON H. EDWARD , COTÉ ROGER
Published: June 2012

A review of the literature would suggest that amyloid deposition into the intima of the aorta is an unusual finding. An opportunity to study this condition in a patient with primary amyloidosis is the basis for this report. The suggestion is made that factors responsible for this may involve mechanisms similar to those that participate in the pathogenesis of atherosclerosis.
Stimulation of Interarterial Coronary Anastomoses by Experimental Acute Coronary Occlusion
Authors: PAUL MILTON H. , NORMAN LEONA R. , ZOLL PAUL M. , BLUMGART HERRMAN L.
Published: June 2012

"Hence it sometimes happens that, when the lumen of some artery has been too long obstructed or ligated, the blood busies itself in opening a wider channel for its passage in this vessel, must drive and buffet all the more into the next ones, until it has considerably dilated them to give itself room."

The development of interarterial coronary anastomoses may exert a profound influence on the clinical course of angina pectoris, coronary failure, and acute myocardial infarction. Earlier studies have shown that marked narrowing of a coronary artery produces rich intercoronary anastomotic communications. The present study is designed to determine whether acute occlusion of a coronary artery in a previously normal heart also leads to the development of a collateral circulation and what length of time is necessary to establish such a collateral circulation.
The Natural History of Rheumatic Heart Disease in the Third, Fourth, and Fifth Decades of Life
Authors: WILSON MAY G. , LIM WAN NGO
Published: June 2012

The object of this study is to provide information on the natural course of rheumatic heart disease in the third, fourth, and fifth decades of life. It is concerned with 757 out of 1,042 children under observation during the years 1916 to 1956 who reached the age of 20 or more years. The major manifestations of rheumatic fever experienced by these patients from the onset of the disease is related to the degree of residual cardiac damage. Survival to successive ages was analyzed with respect to sex, type of valvular lesion, and degree of cardiac enlargement.
Intracardiac Phonocardiography in Man
Authors: LEWIS DAVID H. , DEITZ GEORGE W. , WALLACE JOHN D. , BROWN JAMES R.
Published: June 2012

This paper describes a new method for the detection of sound from within the heart in man. It employs the technic and equipment of underwater listening developed and used by the Navy in antisubmarine warfare. Records are shown to illustrate the localization of heart sound production to an extent not possible by phonocardiograms from the chest wall. The technic has proved helpful in the evaluation of patients with valvular and congenital heart disease.
Arteriovenous Fistula of the Splenic Vessels Producing Ascites
Authors: CASSEL WILLIAM G. , SPITTEL JOHN A. , ELLIS F. HENRY , BRUWER ANDREÉ J.
Published: June 2012

Arteriovenous fistula involving the portal vein or its tributaries is a rare condition that in some cases can be treated successfully by surgery if it is recognized. The clinical manifestations and diagnostic criteria are presented.
Comparison of Four Orthogonal Systems of Vectorcardiography
Authors: LANGNER PAUL H. , OKADA ROBERT H. , MOORE SAMUEL R. , FIES HARRY L.
Published: June 2012

Four orthogonal systems of vectorcardiography that are considered to be more accurate than the tetrahedron and cube systems were compared. In a large majority of subjects the records made with each of the 4 systems were similar. However, in 5 of 60 subjects in whom the Z lead was studied, dissimilarities were found that were considered to be significant. The possible reasons for these dissimilarities are discussed. Comparative normalization data for the systems were obtained in the living human subject, based upon comparison of wave forms.
Patent Ductus Arteriosus in Association with Pulmonic Stenosis
Authors: HEINER DOUGLAS C. , NADAS ALEXANDER S.
Published: June 2012

A review was made of patients recently seen at the Children's Medical Center, Boston, who qualified for the diagnosis of patent ductus arteriosus associated with pulmonic stenosis. Six such patients were observed. The cardiac findings were distinctive, allowing for presumptive diagnosis without catheterization in the majority of instances. Noncardiac congenital anomalies of a particular type were found to be a part of the clinical profile. This finding plus certain epidemiologic evidence suggests the possibility of a common etiologic factor.
Coronary Arteriovenous Fistula
Authors: STEINBERG ISRAEL , BALDWIN JANET S. , DOTTER CHARLES T.
Published: June 2012

Angiocardiography and physical findings established the diagnosis of a coronary arteriovenous aneurysm in a 6-year-old asymptomatic schoolgirl. During the 7 years that have ensued, her heart size, electrocardiogram, and general condition have remained normal. Review of the literature discloses 13 autopsy-proved coronary artery fistulas and 8 cases wherein the diagnosis was established by exploratory thoracotomy or cardiac catheterization. The data indicate a wide variation in the clinical significance of the lesion and lead to the conclusion that management is best established on an individual basis.
Physical Factors in the Progression of Stenotic Vascular Lesions
Authors: RODBARD SIMON
Published: June 2012

An explanation of the progression of stenotic lesions was sought in animal experiments. After surgical decrease of the lumen of arteries, progressive ingrowth of fibrous connective tissue led to the development of stenosis with changes in the artery that resembled those of coarctation. These changes are explained by the action of local blood pressures. Phenomena such as progressive stenosis, valvulogenesis, patterns of lipid infiltration, medial hypertrophy, thinning, and cystic change are discussed in terms of the concepts derived from these studies.
Effect of Smoking on the Cardiovascular System of Man
Authors: ROTH GRACE M. , SHICK RICHARD M.
Published: June 2012

In normal subjects smoking or the injection of nicotine produces transient vascular effects on the heart and blood vessels. Apparently tobacco angina or tobacco heart is a clinical entity. Abnormal vascular responses after smoking in normal subjects may be due to hypersensitivity to nicotine, such as occurs in tobacco heart, or to the effect of nicotine on a vascular system demonstrated to be hyperreactive by the cold pressor test.

Tobacco is one of the most prominent contributing factors in thromboangiitis obliterans, as thromboangiitis is rarely found in nonsmokers.

The question as to whether the effects of smoking are due to sudden increased work of the heart or constriction of the coronary artery has stimulated a great amount of research. There is evidence to support both theories.

The findings of abnormal ballistocardiograms before and after smoking in the offspring of hypertensive parents and after smoking in the offspring of parents with coronary heart disease are highly important.

Statistically coronary artery disease seems to occur more frequently and at an earlier age in the person who smokes much than in the nonsmoker. Likewise, the mortality rate is higher among younger persons with coronary disease who are smokers than among those who are nonsmokers.
Heredity, Environment, and Serum Cholesterol
Authors: SCHAEFER LOUIS E. , ADLERSBERG DAVID , STEINBERG ARTHUR G.
Published: June 2012

Serum cholesterol levels of 1,236 healthy persons, including 775 members of 201 families, were analyzed in the investigation of the genetic control of serum cholesterol. It was concluded that there is an important genetic component in the determination of this level in healthy persons, that the gene is probably not sex-linked, and that environmental factors seem to play a lesser role.
Electrolyte and Water Excretion in Arterial Hypertension
Authors: HOLLANDER WILLIAM , JUDSON WALTER E.
Published: June 2012

The increased capacity of hypertensive subjects to excrete sodium is frequently reduced by effective antihypertensive drug treatment. This reduction in sodium excretion is not necessarily associated with changes in renal hemodynamic function or resting sodium excretion. It appears to result from an alteration in renal tubular activity. The findings suggest that the arterial pressure per se may operate to control sodium excretion. They also are consistent with the hypothesis that certain disturbances in sodium excretion in arterial hypertension may be the result and not necessarily the cause of an elevated blood pressure.
An Evaluation of Blood Nitrate Levels
Authors: BERRY JOHN W. , ROACH THOMAS C.
Published: June 2012

The lack of a suitable objective yardstick to measure the effect of anti-anginal drugs has led to confusion in their clinical evaluation. A method of quantitating the nitrate level in the serum has furnished a means of correlating the subjective relief with this group of drugs. Representative samplings of serum from noncardiac and cardiac patients were analyzed to establish control nitrate levels. The cardiac patients were selected for their good responses to nitroglycerin and pentaerythritol tetranitrate. A good subjective response to the drugs correlated with the increased blood nitrate levels.
Congenital Aortic Stenosis
Authors: MORROW ANDREW G. , SHARP EDWARD H. , BRAUNWALD EUGENE
Published: June 2012

Ten years ago congenital aortic stenosis was generally considered to be uncommon and seldom to carry a grave prognosis. The severity of obstruction of left ventricular outflow could not be directly assessed and suitable surgical procedures for its correction were not available. The changing concepts in respect to this malformation are reflected in the series of 30 patients described. The lesion was found to be relatively common and frequently serious. The severity and site of obstruction could be precisely evaluated and a physiologic basis was provided for the selection of patients for operation providing direct exposure of the aortic valve.
Theory and Practice in Acute Venous Thrombosis
Authors: WESSLER STANFORD , DEYKIN DANIEL
Published: June 2012

The purpose of this review has been to outline the basis for proposing, and the details for implementing, a rational and consistent plan of therapy for the management of acute venous thrombosis. We have interpreted the entity of venous thrombosis as representing a common, frequently systemic disease, clinically manifest by focal intravascular coagulation. Concerning this disease, the specific etiology is unknown, the diagnostic criteria are crude and unsatisfactory, and although the clinical course is usually benign and self limited it may be unpredictably recurrent and fatal. We have also inferred that the difficulties in statistically validating any specific therapeutic measure are, for the present, extremely great, and that this problem will not be significantly lessened until an accurate test for thrombosis is devised.

To construct a workable frame of reference for the clinical management of venous thrombosis within the limits of our present knowledge, we have formulated the concept of the temporary thrombotic state. Treatment is based upon the neutralization of hypercoagulability by anticoagulant drugs and upon a reduction of venous stasis by the removal of immobilization and a decrease in the size of the peripheral venous pool by elastic support. Various aspects of this therapeutic approach are described in detail and illustrated by selected case studies.
Anomalous Atrioventricular Excitation (Wolff-Parkinson-White Syndrome)
Authors: WOLFF LOUIS
Published: June 2012

An opportunity to study the mechanism in pre-excitation was provided by 3 patients with unusual features: coexistence of right bundle-branch block and pre-excitation, occurrence of 2 types of anomalous ventricular complex, and simultaneous occurrence of pre-excitation and varying grades of atrioventricular block (first degree to complete). The conclusion was reached that a functioning structural atrioventricular neuromuscular bypass is present in these cases.
Time and Concentration Components of Indicator-Dilution Curves Recorded Following Central Injections of Dye in Normal Human Subjects
Authors: CARTER STEFAN A. , C. SWAN H. J. , WOOD EARL H.
Published: June 2012

Indicator-dilution curves were recorded by oximeters at the ears and the right radial artery following the injection of Evans blue (T 1824) into the superior vena cava and pulmonary arteries of 37 subjects who had no evidence of cardiovascular disease. The variability and ranges of various time and concentration components of these dilution curves are presented. These values can be used as standards of reference in the interpretation of abnormal dilution curves. Some of the factors responsible for the variability of these values in healthy subjects are assessed and discussed.