bluuebunny/crossref_metadata_2025 huggingface dataset:
Serum, Atrial, and Urinary Digoxin Levels During Cardiopulmonary Bypass in Children
Authors: KRASULA RICHARD W. , HASTREITER ALOIS R. , LEVITSKY SIDNEY , YANAGI RUTH , SOYKA LESTER F.
Published: June 2012

Serum, urine, and tissue samples were collected from 42 children undergoing open-heart surgery and analyzed for digoxin by radioimmunoassay. Of these, 24 had been digitalized prophylactically (RECENT) and 18 had been receiving maintenance therapy (MAINT) for one month or longer. Twenty-five percent of the RECENT patients exhibited arrhythmias during the postoperative period as compared to none in the MAINT group. Serum digoxin levels were equivalent in the two groups throughout the study. Although no change in tissue digoxin concentrations occurred during bypass, right atrial appendage concentrations were significantly higher in the RECENT group (109
vs
62 ng/g;
P
< 0.001). This high atrial digoxin concentration presumably resulted from the large doses used for initial digitalization, and concomitant with postoperative hypokalemia and myocardial metabolic changes secondary to perfusion, may have been responsible for the high incidence of arrhythmias in the RECENT group. Both digoxin and creatinine excretion were depressed following bypass. The amount of biotransformation of digoxin was 2-59.
Propranolol in the Treatment of Acute Myocardial Infarction
Authors: MUELLER HILTRUD S. , AYRES STEPHEN M. , RELIGA ANNA , EVANS ROBERT G.
Published: June 2012

Improvement of myocardial oxygenation is a major goal in the treatment of ischemic heart disease. Propranolol, 0.1 mg/kg intravenously, was administered to 20 patients in the acute state of myocardial infarction without clinical evidence of left ventricular failure. The most important hemodynamic response was a substantial decrease in myocardial contractility. This was reflected by a fall i cardiac index (average of 0.6 L/min/M
2
,
P
< 0.001) and of arterial mean pressure (average of 16 mm Hg,
P
< 0.001) with little change in systemic vascular resistance. Decrease in cardiac index was due mainly to decrease in stroke volume. Heart rate, not strikingly increased at the control state in the majority of patients, decreased an average of 7 beats/min (
P
< 0.001). Pulmonary wedge pressure rose an average of 2 mm Hg (
P
< 0.05). It remained unchanged or decreased in three patients. These varying but small changes in wedge pressure in the presence of decreased contractility may be related to improved left ventricular compliance, produced by propranolol. Propranolol markedly improved myocardial metabolism. Arterial - coronary sinus oxygen difference decreased an average of 0.72 ml/100 ml (
P
< 0.001); coronary sinus oxygen tension increased an average of 2 mm Hg. Myocardial lactate production shifted to extraction (average of -8% to 14%) or the rate of lactate extraction increased (average of 20% to 29%). Coronary blood flow decreased an average of 13 ml/100 g/min (
P
< 0.001). Both decrease in mean aortic pressure and decrease in myocardial oxygen requirements probably contributed to the fall in coronary blood flow. The finding, that myocardial metabolism improved, suggests that reduction in myocardial oxygen demand outweighed the decrease in coronary blood flow. None of the 20 patients developed left ventricular failure or other complications related to beta-adrenergic blockade. Severe chest pain, unresponsive to conventional therapy in four patients, was relieved by propranolol.

These findings demonstrate that acutely administered propranolol improves myocardial oxygenation in patients with uncomplicated acute infarction without endangering perfusion of other vital organs.
Pre- and Postoperative Rest and Exercise Hemodynamics in Children with Pulmonary Stenosis
Authors: STONE FREDERIC M. , BESSINGER F. BLANTON , LUCAS RUSSELL V. , MOLLER JAMES H.
Published: June 2012

Twenty children with pulmonary valvular stenosis were studied by cardiac catheterization both at rest and during submaximal supine exercise, prior to and following pulmonary valvotomy. The resting and exercise states were comparable preoperatively and postoperatively since cardiac output, heart rate, A - V O
2
difference and oxygen consumption were similar. Evidence of improved cardiac function was found postoperatively.

Both the rest and the exercise right ventricular end-diastolic pressure (RVEDP) decreased significantly following pulmonary valvotomy. Preoperatively, 12 of 20 patients showed an increase in RVEDP with exercise; in six of these there was a simultaneous fall in stroke index, indicating impaired myocardial function. No patient showed this response postoperatively.

This indicates that although altered cardiac function can be demonstrated in some children with pulmonary valvular stenosis, it is reversible by pulmonary valvotomy. This is in contrast to studies in adults, and suggests that a factor in the natural history of pulmonary valvular stenosis is the impact of chronically elevated afterload on the right ventricle. Hemodynamic measurements made during exercise provide a useful means of assessing patients with pulmonary stenosis before and after pulmonary valvotomy.
Necropsy Studies in Myocardial Infarction with Minimal or No Coronary Luminal Reduction Due to Atherosclerosis
Authors: ELIOT R. S. , BAROLDI G. , LEONE A.
Published: June 2012

A postmortem study was conducted on the hearts of 10 patients who died with a typical clinical picture of acute myocardial infarction within 25 days of onset of symptoms. The coronary arterial systems of the patients revealed minimal or no luminal reduction due to coronary atherosclerosis or other cause. These cases contribute to the understanding of the pathogenesis of acute myocardial infarction in that they document the presence of typical acute myocardial infarction in the absence of chronic or acute coronary arterial obstruction. They further suggest that the hearts of those dying of typical myocardial infarction show minimal or no coronary disease in approximately 7% when studied as described.
Echocardiographic Features of Congestive Cardiomyopathy Compared with Normal Subjects and Patients with Coronary Artery Disease
Authors: CORYA BETTY C. , FEIGENBAUM HARVEY , RASMUSSEN SUSAN , BLACK MARY J.
Published: June 2012

Echocardiograms of ten patients with congestive cardiomyopathy were compared to those of three groups of patients: (1) 17 with no catheterization or angiographic evidence of cardiac disease; (2) 19 with 75% or greater obstruction of one or more coronary arteries (CAD); and (3) 8 with previous myocardial infarction and congestive heart failure (CAD-CHF). Echocardiographic values of interest included the left ventricular internal dimension at end-diastole/body surface area (LVIDd index), the amplitudes of the left septal echo (LSa) and posterior endocardial echo (ENa), LSa + ENa, and the maximum rate of rise of the posterior endocardial echo ([See Equation in PDF File]). Septal and posterior wall thicknesses were measured and the presence or absence of pericardial effusion and abnormal mitral valve closure were observed. All of the left ventricular measurements were significantly different when comparing the cardiomyopathy group with the normal and CAD groups. Differentiating cardiomyopathy from the CAD-CHF group was far more difficult with the only highly significant difference being the LSa + ENa (
P
< 0.001). Only one cardiomyopathy patient and one CAD-CHF patient had a sum of LSa + ENa overlapping the other group.

These results are consistent with the diffuse disease usually seen in congestive cardiomyopathy and the segmental nature of coronary artery disease in which some area of the left ventricle moves well even in the presence of congestive heart failure.
The Effect of Isometric Exercise on the Left Ventricular Volume in Normal Man
Authors: STEFADOUROS MILTIADIS A. , GROSSMAN WILLIAM , SHAHAWY MAHFOUZ EL , WITHAM A. CALHOUN
Published: June 2012

The effect of isometric handgrip exercise (IHG) on left ventricular (LV) size and performance was studied noninvasively on 15 normal subjects at rest and at the end of 3 min of IHG at 50% of maximum contraction. Left ventricular internal diameter was measured at end-diastole and end-systole on LV echograms, the indirect carotid pulse was recorded, and blood pressure measured by sphygmomanometry. Using the cube formula, LV end-diastolic (EDVI) and end-systolic (ESVI) volume indices were computed, and stroke (SI) and cardiac (CI) indices were derived. Mean blood pressure (BPm) and systemic vascular resistance (SVR) were calculated from these data by a technique previously described. In comparison to values at rest, IHG resulted in a significant (
P
< 0.01) rise in CI (3.5 ± 0.2 to 4.4 ± 0.3 L/min/m
2
), BPm (87 ± 2 to 120 ± 4 mm Hg) and heart rate (79 ± 3 to 97 ± 4 beats/min). The product (SI x BPm), used as an index of LV stroke work, increased substantially (52 ± 3 to 74 ± 4 gm-m/m
2
). No significant change was noted in EDVI (60 ± 4 to 62 ± 3 ml/m
2
), SI (44 ± 2 to 46 ± 2 ml/m
2
), and SVR (1209 ± 69 to 1275 ± 63 dynes/sec/cm
–5
).

Thus normal hearts responded to IHG by increasing CI through tachycardia and pumping the same SI against increased afterload, without utilizing diastolic volume reserves. These data support the hypothesis that isometric muscular exercise leads to an augmentation of LV myocardial contractility in normal man.
Electrophysiological Delineation of the Specialized A-V Conduction System in Patients with Congenital Heart Disease
Authors: KRONGRAD EHUD , MALM JAMES R. , BOWMAN FREDERICK O. , HOFFMAN BRIAN F. , WALDO ALBERT L.
Published: June 2012

The course of the distal His bundle and the right bundle branch was electrophysiologically delineated during open heart surgery in nine patients with tetralogy of Fallot and in six other patients with various forms of congenital heart disease. In patients with tetralogy of Fallot, right bundle branch electrograms were usually recorded up to 25 mm from the plane of the tricuspid valve annulus and only rarely beyond this site, indicating that the electrical activity in the right bundle branch was isolated from right ventricular myocardium to a site 25 mm away from the tricuspid annulus in the patients studied. In one patient with right bundle branch block pattern on the electrocardiogram induced by a ventriculotomy, the right bundle branch was traced to the Purkinje fiber-ventricular muscle junction, supporting the observation that a right bundle branch block pattern induced by ventriculotomy does not indicate that injury to the proximal part of the right bundle branch occurred.

In five patients with various forms of congenital heart disease we did not record electrical activity from the distal His and right bundle branch. The anatomic and functional reasons for this failure are discussed. In one patient with a common ventricle, the identification of the specialized atrioventricular (A-V) conduction system allowed for total surgical correction of this anomaly without injury to the conduction system. The electrophysiological delineation of the specialized atrioventricular conduction system is suggested for all patients undergoing open heart surgery who have complicated congenital heart disease on which no data are available regarding the exact location of the specialized atrioventricular conduction system, for patients with unusual ventricular anatomy, and for patients in whom the hemodynamic and angiographic studies do not correlate well with the electrocardiogram.
Augmentation of Electrical Alternans with Lowering of the Heart Rate in Massive Pericardial Effusion
Authors: COKKINOS DENNIS V. , KELESIDES CONSTANTINE , SIATERLIS JOHN , HALIMOS EVANGELOS
Published: June 2012

A patient with massive pericardial effusion and electrical alternans was studied. Intravenous administration of 8 mg practolol produced a decrease in heart rate from 120 to 87 beats/min, with increase of the alternans. The postulation that tachycardia is necessary for the appearance of electrical alternans in cardiac tamponade cannot be supported from this finding.
The George E. Brown Memorial Lecture
Authors: WRIGHT IRVING S.
Published: June 2012

The present knowledge regarding the pathogenesis of thrombosis is reviewed. New conceptions and technics involving physical principles are outlined. Hitherto unemphasized aspects of thrombosis are discussed. The present status of anticoagulant therapy is summarized. The effects of other factors on the action of anticoagulants are considered.
An Evaluation of Replacement Fluids in Laboratory Animals following Control Hemorrhage
Authors: MORRISON A. ERVINE , LUNDY JOHN S. , ESSEX HIRAM E.
Published: June 2012

Solutions of Dextran Ph, Plasmoid, Periston and isotonic saline were compared with serum albumin and whole blood to determine the efficacy of the former as blood substitutes. Rats, guinea pigs and dogs were used as experimental animals. Dextran Ph, Plasmoid and Periston were found to be less satisfactory than whole blood, since 50 to 80 per cent of the rats and guinea pigs survived following their use compared with 100 per cent survival when whole blood was given. There was, however, 100 per cent mortality of the animals when a blood substitute was not given.
Serum Cholinesterase Activity and Arterial Blood Pressure
Authors: VORHAUS LOUIS J.
Published: June 2012

Conflicting data have appeared in the literature regarding serum cholinesterase and blood pressure. The studies reported here were undertaken to establish or refute the existence of a direct relationship between these two factors. Two types of studies were performed. First, serum cholinesterase activity was measured in 63 unselected hypertensive patients. Second, a selected group of seven hypertensive patients and three healthy subjects was studied with a variety of drugs known to influence either blood pressure or serum cholinesterase. Results indicate that no direct relationship exists between blood pressure and serum cholinesterase and that fluctuations in these two factors occur independently of each other.
Abdominal Aortic Aneurysm with Rupture into the Inferior Vena Cava
Authors: VIAR WILLIAM N. , LOMBARDO THOMAS A.
Published: June 2012

A patient is presented with an arteriosclerotic abdominal aneurysm that ruptured into the inferior vena cava. Clinically, the picture was that of a peripheral arteriovenous communication with heart failure of the "high-output" type. Intestinal bleeding occurred as a result of venous engorgement and hemorrhagic colitis.
The Henry Jackson Memorial Lecture
Authors: WIGGERS CARL J.
Published: June 2012

This lecture reviewed selected types of experiments carried out in our laboratory which are relevant to the interpretation of clinical disorders. From an analysis of ventricular pressure pulses, inferences were drawn as to basic determinants of cardiac performance in experimental conditions simulating those which arise clinically. The analysis included alterations in ventricular contraction patterns produced by pericardial effusion, hypervolemia, oligemia, arterial hypertension of peripheral origin and that due to coarctation of the aorta, aortic and pulmonary stenosis, idioventricular rhythms, ventricular alternation, coronary occlusion and myocardial ischemia, aortic regurgitation, and mitral insufficiency.
Comparison of the Circulatory Effects of Epinephrine and Norepinephrine
Authors: WAKIM KHALIL G. , ESSEX HIRAM E.
Published: June 2012

A comparison was made of the circulatory effects of
l
-epinephrine and
l
-norepinephrine when various doses were given either intravenously or intra-arterially into anesthetized animals. No significant difference was found between the effects of identical doses of the two drugs on the arterial blood pressure, heart rate and blood flow. The intensity and duration of effect of either drug varied roughly with the dose given.
Pressor Substances in Arterial Hypertension
Authors: DAVIES DEAN F. , OLSEN NORMAN S. , SCHROEDER HENRY A.
Published: June 2012

Pherentasin is the only pressor substance found in blood of hypertensive patients which is not found in normal blood. This study defines its unit and compares its concentration with diastolic blood pressure level, type of hypertension, and age of patients. Lack of correlation between blood pressure level and pherentasin content suggests considerable variation in the amount of depressor substances in these patients. Chemical studies of pherentasin and its partial, tentative formula are discussed. Demonstration of the existence of an additional pressor fraction from blood which is volatile in alkaline solution is described.
Effect of Athyroid State on Vascular Reactivity and Arterial Pressure in Neurogenic and Renal Hypertensive Dogs
Authors: MCCUBBIN JAMES W. , PAGE IRVINE H.
Published: June 2012

Since vascular responsiveness to adrenaline, noradrenaline, renin and angiotonin is reduced by suppression of thyroidal function in normotensive dogs, it was a possibility that in neurogenic and renal hypertensive animals suppression of thyroidal function might be associated with decrease in arterial pressure. This possibility was not confirmed, hypertension persisting unaltered in both groups of hypertensive animals over long periods of observation. Changes in vascular reactivity were slight in comparison with those associated with the athyroid state in normotensive dogs.
The Relationship of Serum Lipoproteins to Atherosclerosis in the Cholesterol-Fed Alloxanized Rabbit
Authors: PIERCE FRANK T.
Published: June 2012

The alloxanized rabbit fed cholesterol develops extreme hyperlipemia and hypercholesteremia and yet develops a lesser degree of atherosclerosis than does the normal animal fed cholesterol. The concentrations of the S
f
12-30 and S
f
20-30 classes of lipoproteins correlate well with atherosclerosis as finally observed in the alloxanized rabbit, whereas both free and total serum cholesterol correlate negatively with atherosclerosis. In the alloxan-diabetic rabbit, the serum cholesterol is principally carried in the S
f
80-100 and greater classes of lipoproteins, and a metabolic block in the conversion of these lipoproteins to those of S
f
40 and less can be demonstrated.
Effect of Potassium Administration on (1) Peripheral Vascular Reactivity and (2) Blood Pressure of the Potassium-Deficient Rat
Authors: FRIEDMAN MEYER , FREED S. CHARLES , ROSENMAN RAY H.
Published: June 2012

One hour after administration of potassium chloride to potassium-deficient rats, the depressed peripheral vascular response to pressor substances was significantly elevated. Administration of potassium chloride to potassium-deficient rats also returned to higher levels the lowered blood pressure of previously normotensive, as well as hypertensive rats. It appears that the depressor effect of potassium deprivation is due to the loss of peripheral vascular reactivity, both of which are rapidly restored by potassium administration specifically.
Hepatic Circulation in Cirrhosis of the Liver
Authors: BRADLEY S. E. , INGELFINGER F. J. , BRADLEY G. P.
Published: June 2012

The hepatic blood flow (EHBF) was estimated by the bromsulfalein method in 39 cirrhotic patients. In 91 normal subjects hepatic blood flow averaged 1530 ml. per minute, and in the cirrhotics, hepatic blood flow averaged 1090 ml. per minute. In association with this highly significant reduction in blood flow, hepatic arteriovenous oxygen difference increased and bromsulfalein extraction fell. These findings indicate that hepatic blood flow tends to decrease more than oxidative metabolism of residual functional cells, so that relative ischemia and hypoxia of active liver tissue develop in cirrhotic disease.
The Effect of Posture on Hypertension Induced by Sympathomimetic Amines in Man
Authors: M.D. A. LITTMAN , GUNNAR R. M. , GROSSMAN M. I. , CASAS R.
Published: June 2012

After atropine the hypertension induced by Arterenol in man is abolished by tilting to the vertical position. This does not occur with equipressor doses of Arterenol or with atropine alone. Arterenol and atropine in combination could not be shown to have a blocking action at sympathetic ganglions in animal experiments, nor was there blockade of the carotid sinus reflex pathways. The failure to maintain Arterenol-induced hypertension after atropine was thus unexplained. Further experiments on the clinical implications of this phenomenon were performed.
The Q Wave in Precordial Electrocardiograms Overlying the Hypertrophied Right Ventricle: Intracavity Leads
Authors: FOWLER NOBLE O. , WESTCOTT RICHARD N. , SCOTT RALPH C.
Published: June 2012

Right ventricular cavity electrocardiograms were obtained in six subjects having qR patterns in V leads made from precordial sites overlying the hypertrophied right ventricle. Four of the six, unlike control subjects, had no initial R wave in the right ventricular cavity; one had only a questionable initial R wave. Simultaneous intracavity and precordial electrocardiograms suggested that the initial Q wave over the hypertrophied right ventricle is due to abnormal depolarization of the interventricular septum, and that the large R wave over the hypertrophied right ventricle is the result of delay in activation of the free wall of that chamber.
Rupture of an Aortic Aneurysm into the Pulmonary Artery
Authors: CARTER CURTIS H. , AGOSTAS WILLIAM N. , SYDENSTRICKER V. P.
Published: June 2012

A case report of rupture of an aortic aneurysm with antemortem diagnosis and a brief review of the common clinical findings in this syndrome are presented. The case reported was studied by cardiac catheterization which, it is felt, confirmed the clinical diagnosis. Postmortem findings are given and a drawing and photograph of the specimen is shown.
Studies in Experimental Pericardial Tamponade
Authors: METCALFE JAMES , WOODBURY JOHN W. , RICHARDS VICTOR , BURWELL C. SIDNEY
Published: June 2012

As intrapericardial pressure is increased by the introduction of saline into the pericardial cavity, cardiac output falls. Intravascular pressures, arterial and venous, pulmonary as well as systemic, approach the same value. This equalization of intravascular pressure is due to the decreasing ability of the heart to maintain normal distribution of blood within the vessels.
Vasodilator Effects of a Substance Present in Normal Human Urine in Comparison with the Effect of Methacholine and Sodium Nitrite
Authors: GREEN HAROLD D. , LITTLE J. MAXWELL , GADDY CLIFFORD G. , FRANKLIN LEWIS T. , WAYNE HOWARD H.
Published: June 2012

This paper presents a method for bioassay of vasotropic substances. Data on the accuracy of the method are presented in terms of the response to repeated injections of methacholine. Some of the factors affecting the response to methacholine are analyzed. The peripheral vasodilator effect of a nondialyzable substance present in human urine is demonstrated and the effectiveness of this substance is related to that of methacholine.
The Factors Influencing the Circulation Time
Authors: LEE PEARCE MORTON , LEWIS ALVIN E. , KAPLAN MELVIN R.
Published: June 2012

A mathematical analysis of the relationship of cardiac output and heart-lung blood volume to observed circulation time is presented. The theoretic conclusions are substantiated by an experiment in which it is shown that diluting the amount of indicator used prolongs the observed circulation time through the heart and lungs.
Tissue Clearance as a Measure of Nutritive Blood Flow and the Effect of Lumbar Sympathetic Block upon Such Measures in Calf Muscle
Authors: RAPAPORT SAMUEL I. , SAUL ALBERT , HYMAN CHESTER , MORTON M. E.
Published: June 2012

This paper reports the effect of procedures known to alter local blood flow upon the rate of removal of locally injected Na
24
and I
131
. An evaluation of this clearance method as a measure of nutritive blood flow is made. A second purpose is to report the lack of effect upon clearance from calf muscle of lumbar sympathetic block, and to discuss its therapeutic implications.
Changes in Exeretion of Intestinal Cholesterol and Sterol Digitonides in Hyper- and Hypothyroidism
Authors: FRIEDMAN MEYER , BYERS SANFORD O. , ROSENMAN RAY H.
Published: June 2012

The fecal output of cholesterol and of noncholesterol sterols was determined in hyper- and hypo-thyroid rats, and in a group of control animals. The intestinal excretion of cholesterol and of total digitonin-precipitable sterols was found to be considerably increased in the hyperthyroid, and considerably decreased in the hypothyroid animals. The relationship of these findings to the altered plasmal cholesterol content occurring in deranged thyroid states is discussed.
Intra-arterial Histamine in the Treatment of Occlusive Peripheral Arterial Disease
Authors: DIXON JOHN A. , SCOTT W. J. MERLE , EPSTEIN MARVIN A.
Published: June 2012

Intra-arterial histamine was found to increase significantly the walking tolerance of a small series of cases of obliterative peripheral arterial disease with intermittent claudication. Physiologic determinations during injection show tachycardia, increased cardiac output, increased stroke volume and increased homolateral femoral arteriovenous oxygen difference. The similarity of these results to those caused by arteriovenous fistulas is noted.
Indications for Bishydroxycoumarin (Dicumarol) in Acute Myocardial Infarction
Authors: RUSSEK HENRY I. , ZOHMAN BURTON L. , DOERNER ALEXANDER A. , RUSSEK ALLEN S. , WHITE LAVERE G.
Published: June 2012

Many physicians find it difficult to decide whether or not a patient sustaining a mild episode of acute myocardial infarction should be treated with anticoagulant drugs. The Committee for the Evaluation of Anticoagulants in the Treatment of Coronary Occlusion with Myocardial Infarction (American Heart Association) has recommended the employment of such therapy in patients with this disease, unless contraindications to anticoagulant therapy exist. Data are presented to show that in "good risk" patients treated conservatively without anticoagulants, the mortality rate and incidence of thromboembolism are strikingly low. Consequently, even the maximum benefit theoretically obtainable from the employment of dicumarol in these cases is not sufficient to justify the hazard entailed in its use. It is therefore recommended that anticoagulants be employed only in the more serious attacks of the disease.
Congenital Aneurysmal Defect of the Membranous Portion of the Ventricular Septum
Authors: CLARK RICHARD J. , WHITE PAUL D.
Published: June 2012

A case of congenital aneurysmal defect of the ventricular septum is reported which appears to be unique in that this lesion was the only significant finding at autopsy. The patient had evidence of auriculoventricular block for a period of 26 years, at first partial and then complete. She succumbed at the age of 47 to a series of Adams-Stokes attacks which were demonstrated to be set off by paroxysmal ventricular flutter followed by ventricular tachycardia and ventricular standstill. Pertinent literature is briefly reviewed.
Revascularization of the Heart
Authors: HAHN RICHARD S. , BECK CLAUDE S.
Published: June 2012

This report on revascularization of the heart is based on work done in this laboratory in the period from Sept. 1, 1949 to Sept. 1, 1951. A brief description of the operation is given. After the operation was done an attempt was made to shift the inflow from the coronary arteries to the graft from the aorta. An attempt was made to occlude all coronary arteries. Four hundred operations were done on 100 dogs. Data on mortality and infarcts are given in this paper.
Dynamic Responses of the Right Ventricle following Extensive Damage by Cauterization
Authors: KAGAN ABRAHAM
Published: June 2012

Previous observations that major destruction of the right ventricular walls causes but slight changes in venous and arterial pressures were confirmed. Furthermore, additional observations indicated that the compensatory reaction of the damaged ventricle to stress is diminished surprisingly little. The results are considered evidence that the cauterization procedure and others of a similar nature do not produce right heart failure and, therefore, would not be expected to cause venous congestion. The subsidiary muscular mechanism which maintains the right ventricular pump remains enigmatic; but evidence is submitted that the damaged right ventricle is regulated independently of the left.
Clinical Evaluation of 1-Hydrazinophthalazin (C-5968) in Hypertension
Authors: JOHNSON ROBERT L. , FREIS EDWARD D. , SCHNAPER HAROLD W.
Published: June 2012

Single oral doses of 1-hydrazinophthalazine frequently lowered blood pressure particularly diastolic pressure in hypertensive patients. Prolonged therapy was less successful, apparently as a result of development of tolerance or side effects. The best long-term results were obtained when l-hydrazinophthalazine was alternated with hexamethonium.
Cation Exchange Resin in the Treatment of Congestive Heart Failure
Authors: KLINGENSMITH W. C. , ELKINTON J. R.
Published: June 2012

Thirty-four edematous cardiac patients who were being treated with cation exchange resin were studied for its long term effectiveness and for clinical and chemical complications. In 23 of 27 patients the resin was effective in terms of mobilizing edema fluid previously refractory to other forms of treatment, of partial or complete substitution for mercurial diuretics, and of permitting a slight increase in the salt content of the diet. Gastrointestinal intolerance was the chief clinical complication but prevented therapy in only five patients. Chemical complications of sodium depletion, potassium depletion or excess, and severe chloride acidosis were not seen.
The Use of Crystalline Visammin in the Treatment of Angina Pectoris
Authors: NALEFSKI L. A. , RUDY W. B. , GILBERT N. C.
Published: June 2012

The high incidence of unpleasant side effects following the use of crude preparations of khellin in the treatment of angina pectoris has limited its clinical use. It was felt that if this vasodilator drug were prepared free of resins, chromones and other plant impurities, it might then be used more extensively in the treatment of coronary insufficiency. Currently, a crystalline preparation of high purity has become available. A series of patients with angina pectoris were studied using this preparation. A Starr ballistocardiograph was interjected into our study in an attempt to obtain objective evidence of any effect this drug might have on the mechanical action of the heart.
The Low Frequency Velocity Measurement Ballistocardiograph
Authors: SMITH J. E. , BRYAN SAMUEL
Published: June 2012

The velocity measurement ballistocardiograph is described which has filter circuits to eliminate body tremor components. Small adjustable condensers are utilized on the input and output of the filter section to vary the frequency response of the circuit and thus create a sharper cut-off for occasional cases with high amplitude body tremor. The input and output condenser values are not above 5 mfd. in either section. By utilizing this type of circuitry, the lack of wave distortion makes it feasible to measure the ratios of wave amplitudes. The timing device makes it practical to time wave segments from the peak of the R wave, and a single channel recorder can be utilized. Normal standards are described and deviations from normal in coronary artery disease are discussed. The low frequency, velocity measurement ballistocardiograph is easily adaptable for routine office use.
Thrombocytic Acroangiothrombosis
Authors: TACKET HALL S. , JONES RUSSELL S.
Published: June 2012

Two additional cases of a syndrome characterized by arthralgia, fever, anemia, thrombocytopenia, hemorrhagic manifestations, and thromboses of arterioles and capillaries are presented. Pathologic description is given in some detail. Resemblances to certain other processes, including the rickettsial diseases, "vascular collagen" diseases and other conditions are pointed out. Deficiencies in knowledge of the entity are emphasized and a plea is made for continued efforts to define precisely the natural history of the syndrome.
Nitroglycerin to Unmask Reversible Asynergy Correlation with Post Coronary Bypass Ventriculography
Authors: HELFANT RICHARD H. , PINE ROGELIO , MEISTER STEVEN G. , FELDMAN MICHAEL S. , TROUT ROBERT G. , BANKA VIDYA S.
Published: June 2012

The value of nitroglycerin in determining the potential reversibility of asynergy was examined in 35 patients with coronary heart disease. Ventriculograms performed at rest and after sublingual nitroglycerin were analyzed for (1) location of asynergy relative to distribution of the 3 major coronary arteries and (2) severity of asynergy. Of the 41 hypokinetic zones, 30(73%) improved following nitroglycerin. Of 28 akinetic zones, 16 (57%) improved (7 of the 16 segments becoming normal) following nitroglycerin. None of 7 dyskinetic zones showed change following nitroglycerin. Twelve patients were restudied following coronary bypass surgery. There was an excellent over-all correlation between the segments that responded to nitroglycerin and bypass surgery in those segments with open grafts. Eighteen segments which improved following nitroglycerin had patent postoperative grafts, and in 15 segments there was a corresponding improvement following bypass surgery. Two segments which were unresponsive to nitroglycerin preoperatively had patent postoperative bypass grafts. Neither segment improved despite graft patency. In summary, sublingual nitroglycerin is useful in unmasking residual contractile ability in asynergic zones. A positive response to nitroglycerin appears to be predictive of corresponding beneficial effect from a coronary bypass graft. The data strongly suggest that the use of nitroglycerin to determine residual contractile ability may be of considerable value in better defining the potential risks and benefits of coronary bypass surgery.
Effect of Procaine Amide, Quinidine, and Ajmaline in the Wolff-Parkinson-White Syndrome
Authors: WELLENS HEIN J.J. , DURRER DIRK
Published: June 2012

Using the single test stimulus method, atrioventricular (A-V) conduction, ventriculo-atrial conduction, the refractory period of right atrium and right ventricle, and the mechanism of tachycardia were studied in 16 patients with the Wolff-Parkinson-White syndrome. The same studies were repeated at least four times during the hour following intra-atrial administration of 10 mg procaine amide/kg body weight (six patients), 4 mg quinidine gluconate/kg body weight (six patients), or 50 mg ajmaline (four patients).

Following procaine amide the refractory period of the accessory pathway increased in all patients, with temporary complete block of the accessory pathway in four patients. There was an increase in H-V interval during antegrade conduction through the A-V node-His pathway. The effective refractory period of the A-V node showed no appreciable change. In three of four patients tachycardia could not be produced by pacing in contrast to the pacing effect found prior to procaine amide.

Quinidine gluconate increased the refractory period of the accessory pathway in four patients, causing temporary complete block in two patients. The H-V interval increased in three patients. The refractory period of the A-V node showed no change in three patients, lengthened in one, and shortened in the other two. Quinidine gluconate prevented pacing-induced initiation of tachycardia in two out of four patients.

Ajmaline
*
increased the refractory period of the accessory pathway in all four patients, with temporary complete block in three patients. The H-V interval also lengthened. No change was observed in the refractory period of the A-V node. Ajmaline prevented initiation of tachycardia in one out of two patients. In the other patient tachycardias could still be initiated despite disappearance of pre-excitation during atrial pacing.

In one patient in each group tachycardia could be produced during pacing following drug administration where no tachycardia could be produced under control conditions. In two patients re-entry in the A-V node during ventricular pacing caused this phenomenon. In the other patient administration of the drug prevented atrial re-entry during atrial pacing. This re-entrant beat had previously created refractoriness in the atrial part of the tachycardia pathway. The changes following procaine amide, quinidine gluconate, and ajmaline were clearly short term; their effects disappeared after one hour in 15 of the 16 patients studied.
A Comparison of Regional Blood Flow and Oxygen Utilization During Dynamic Forearm Exercise in Normal Subjects and Patients with Congestive Heart Failure
Authors: ZELIS ROBERT , LONGHURST JOHN , CAPONE ROBERT J. , MASON DEAN T. , Kleckner Robert
Published: June 2012

Patients with severe congestive heart failure (CHF) have been found to have a diminished response to the metabolic arteriolar dilator stimulus of ischemia. In order to evaluate a more physiologic stimulus and the possible metabolic consequences of this vascular abnormality, 22 normal subjects (N) and seven patients with severe CHF performed rhythmic forearm exercise by squeezing a rubber bulb to 25, 50, or 100 mm Hg for 5 sec, four times/min, for 5 min. During the last half of the 10 sec relaxation phases, forearm blood flow (FBF) was measured plethysmographically. Not only was FBF reduced at rest in CHF (CHF:2.00 ± 0.31; N: 3.10 ± 0.27 ml/min·100 ml,
P
< 0.02) but it was reduced at each level of exercise as well (CHF: 4.05 ± 0.71, 5.57 ± 0.71, 6.68 ± 3.09; N: 7.10 ± 0.76, 11.15 ± 1.24, 20.32 ± 1.93 ml/min·100 ml,
P
< 0.01). Forearm oxygen extraction, calculated from brachial venous and systemic arterial blood, was consistently increased in CHF and was sufficient to maintain a normal forearm oxygen consumption at rest (CHF: 0.14 ± 0.04; N: 0.12 ± 0.01 ml O
2
/min · 100 ml,
P
< 0.5). During exercise the calculated index of oxygen consumption was reduced at all levels of exercise (CHF: 0.30 ± 0.04, 0.48 ± 0.09, 0.54 ± 0.14; N: 0.51 ± 0.05, 0.89 ± 0.08, 1.63 ± 0.13 ml O
2
/min · 100 ml,
P
< 0.01). These differences persisted despite alpha-adrenergic blockade with phentolamine and suppression of skin flow in N by epinephrine iontophoresis. Therefore, at comparable levels of dynamic forearm exercise patients with CHF have an inadequate arteriolar dilation and their augmented oxygen extraction is not sufficient to prevent them from shifting more completely to anaerobic metabolism.
Accelerated Junctional Escape
Authors: KNOEBEL SUZANNE B. , FISCH CHARLES
Published: June 2012

During the routine interpretation of electrocardiograms, 49 cases of spontaneously occurring accelerated, or borderline accelerated, junctional escape complexes (escape intervals of 1200 ± 20 msec) were encountered. Forty-seven of the 49 patients whose cardiograms demonstrated the accelerated junctional escapes had the clinical setting recognized to be associated with the more protracted accelerated junctional rhythm, nonparoxysmal junctional tachycardia. In addition, five patients demonstrated nonparoxysmal junctional tachycardia immediately preceding or subsequent to the cardiograms demonstrating accelerated junctional escape. It is suggested, therefore, that the two arrhythmias, i.e., accelerated junctional escape and nonparoxysmal junctional tachycardia, may be of similar clinical significance.

The determinants of the length of the manifest escape interval could be assessed in those cases where two or more junctional escape complexes occurred in sequence, allowing the true interectopic interval to be ascertained. The dominant role of the rate of atrioventricular conduction and the sequence of ventricular and junctional activation in determining the length of the manifest escape interval was apparent.
Tetralogy of Fallot with Absent Pulmonary Valve
Authors: LAKIER JEFFREY B. , STANGER PAUL , HEYMANN MICHAEL A. , HOFFMAN JULIEN I. E. , RUDOLPH ABRAHAM M.
Published: June 2012

Absent or hypoplastic pulmonary valve is an uncommon condition usually associated with a ventricular septal defect and an obstructive pulmonary valve ring. Secondary abnormalities involving the pulmonary arteries and major bronchi are common, and many result in severe pulmonary complications. Eight patients with absent pulmonary valve, ventricular septal defect and obstructed pulmonary valve ring are herein described. The clinical features, cardiac catheterization, cineangiographic and postmortem findings are presented. Possible fetal hemodynamics and their influences are discussed, as are postnatal hemodynamics and their clinical consequences. Patients with this combination of lesions have been regarded as having a very poor prognosis, and recent publications have advocated early surgical intervention; however, most published series are small, and only 106 cases have been documented. These cases have been reviewed for clinical and anatomic features as well as an overview of prognosis and results of surgical intervention.
Criss-Cross Atrioventricular Relationships Producing Paradoxical Atrioventricular Concordance or Discordance
Authors: ANDERSON ROBERT H. , SHINEBOURNE ELLIOT A. , GERLIS LEON M.
Published: June 2012

Two cases are described in which the systemic and pulmonary blood streams cross at atrioventricular level. One was examined pathologically, the other was diagnosed at cardiac catheterization by angiography. Both possessed situs solitus, but in one heart the right atrium was connected to a morphologic right ventricle on the left, whereas in the other it was connected to a left-sided morphologic left ventricle. In both cases transposition of the great arteries was present. The cases have been interpreted as representing rotation of embryonic d- and l-bulboventricular loops following septation.

In attempting to describe these heart difficulties in terminology were encountered which were partially overcome by combining the concepts of concordant and discordant atrioventricular relationships with those of transposition and malposition. However, to give an accurate interpretation of the hearts, it proved necessary to include a term indicating rotation of the bulboventricular loop following septation. Thus the hearts were described as situs solitus, discordant (d-rotated) loop with d-transposition, and situs solitus, concordant (l-rotated) loop with l-transposition.
Echocardiographic Evaluation of the Bjork-Shiley Prosthetic Valve
Authors: DOUGLAS JOHN E. , WILLIAMS G. DOYNE
Published: June 2012

The
in vitro
and
in vivo
echocardiographic characteristics of the Bjork-Shiley tilting disc prosthetic valve are described. Optimal position of transducer and valve for detecting maximal disc excursion occurs when the ultrasound beam is perpendicular to the maximally opened disc. This alignment may vary from patient to patient requiring individualization by the echocardiographer. Rotation of the inner valve annulus at the time of surgery, when physiologically feasible, can facilitate optimal valve and ultrasound transducer alignment for serial postoperative evaluations of valve function.
An Improved Method for Echographic Detection of Left Atrial Enlargement
Authors: BROWN OWEN R. , HARRISON DONALD C. , POPP RICHARD L.
Published: June 2012

Echographic dimensions of the aortic root and left atrium were compared in 170 patients in order to assess dilation of the left atrium with reference to the relatively nondistensible fibrous aortic root. In 50 patients without cause for left atrial or aortic enlargement, the ratio of left atrial/aortic root dimension was 0.87-1.11. In 80 patients with known cause for left atrial enlargement, the left atrial/aortic root ratio was ≥ 1.17. In 40 patients with isolated aortic valve disease, dilation of both the aortic root and the left atrium resulted in a left atrial/aortic root dimension ratio < 1.17 in some patients. Despite this consideration, the comparison of left atrial and aortic root dimension appears to be as specific as, and more sensitive than, previously proposed methods for the evaluation of left atrial enlargement.
Accuracy of a Continuous Real-Time ECG Dysrhythmia Monitoring System
Authors: YANOWITZ FRANK , KINIAS PLATO , RAWLING DAVID , FOZZARD HARRY A.
Published: June 2012

The accuracy of QRS detection and premature ventricular beat (PVB) recognition by an on-line computer system was evaluated in a prospective study. Long-term studies in six cardiac patients and short term studies in thirty revealed a QRS detection accuracy of 99%. PVB accuracy was tested in twenty-eight patients for a total time of 415 minutes. About 10% of the heart beats in this group were recognized as PVBs by the cardiologist; 90% of these were correctly identified by the computer system. False positive PVBs were less than 1% of the PVBs. The major types of PVBs missed were fusion beats and late PVBs. Some were unrecognized because of coincident excessive movement artifact. The computer system appeared to be sufficiently reliable to warrant further clinical studies.
A Method for Evaluating Computer Programs for Electrocardiographic Interpretation
Authors: BAILEY JAMES J. , ITSCOITZ SAMUEL B. , HIRSHFELD JOHN W. , GRAUER LEONARD E. , HORTON MARTHA R.
Published: June 2012

A method for evaluating computer programs for electrocardiographic interpretation is described. This method allows a clinician to judge the usefulness of a program for his specific setting and needs. The method requires a significant proportion and variety of abnormal tracings, the application of specific fixed criteria, and the separation of disagreements between the computer program and the clinician into those resulting from criteria differences and those resulting from programming errors, viz., pattern recognition failures, mismeasurements, and/or deficient program logic. When applied to the experimental IBM program 1971, staff cardiologists found essential agreement with the program's results in 76% of 1150 unselected tracings. Clinically significant disagreements based strictly on the application of different criteria occurred in 20% of the tracings, whereas disagreements based on program errors were found in only 4%. Although this program requires some system of human overview and quality checking, its potential for clinical implementation is worthy of consideration.
Effects of Maintenance Digoxin Therapy on Systolic Time Intervals and Serum Digoxin Concentrations
Authors: CARLINER NATHAN H. , GILBERT CHARLES A. , PRUITT ALBERT W. , GOLDBERG LEON I.
Published: June 2012

Systolic time intervals (STI) and serum digoxin concentrations (SDC) were measured in eight patients with compensated atherosclerotic and/or hypertensive heart disease who received oral digoxin 0.25 mg/day or 0.5 mg/day for alternate two-week periods without a loading dose. Control data were obtained both before and after the four weeks of treatment. After 13 days treatment with digoxin, 0.5 mg/day, there was a significant decrease in total electromechanical systole corrected for heart rate (QS
2
i), pre-ejection period (PEP), pre-ejection period corrected for heart rate (PEP
1
) and PEP/left ventricular ejection time (LVET). After the thirteenth dose of 0.25 mg/day there was significant shortening of PEP
1
and PEP/LVET. Shortening of QS
2
i correlated significantly with SDC 24 hours after the thirteenth dose of 0.5 mg. These data suggest that after 13 days of treatment with 0.25 and 0.5 mg/day of digoxin, a positive inotropic effect occurs as reflected by STI shortening. A greater effect was recorded with the 0.5 mg dose.