bluuebunny/crossref_metadata_2025 huggingface dataset:
Muscular Subaortic Stenosis
Authors: FLAMM M. D. , HARRISON DONALD C. , HANCOCK E. W.
Published: June 2012

Eleven patients with muscular subaortic stenosis were studied by use of combined right and transatrial septal left heart catheterization. A variety of stimulating maneuvers were performed to induce or increase the functional outflow tract obstruction; 150 µg/kg of propranolol was administered intravenously, and the stimulating maneuvers were repeated. Outflow obstruction was latent (present only with stimulation) in four patients, labile (present intermittently at rest) in five patients, and persistent and severe in two patients. Propranolol abolished or significantly decreased the spontaneous variations in outflow obstruction occurring at rest, during the enhanced gradient in the post-exercise state, and during variations induced by isoproterenol infusion. The outflow obstruction induced by inhalation of amyl nitrite, the Valsalva maneuver, and premature ventricular contractions was only inconsistently prevented. Long-term oral propranolol therapy has been of significant symptomatic benefit in all the patients with latent or labile outflow obstruction and is considered the treatment of choice in these groups. In one patient with persistent outflow obstruction, an increase in symptoms occurred when oral propranolol was administered, and the drug was discontinued. Evidence is presented to support the concept of a cycle of obstruction and hypertrophy in the natural history of this disease. This vicious cycle might be prevented by propranolol.
The Electrocardiogram in Duchenne Progressive Muscular Dystrophy
Authors: SLUCKA CECYLIA
Published: June 2012

Interpretation of the electrocardiogram in the Duchenne form of progressive muscular dystrophy (PMD) is still debated in the literature. The group studied consisted of 106 patients with the Duchenne type of PMD, aged 3 to 29 years. The duration of the disease varied from a few months to 15 years. One hundred one patients had abnormal electrocardiograms. These were of four types: type a (64 cases) showed tall R waves in V
1
and deep Q waves in V
4-6
; type b (24 cases), RSr' and deep Q waves in V
5-6
; and type c (13 cases), polyphasic R waves in V
1
.

The view that the electrocardiographic abnormalities in Duchenne dystrophy are a manifestation of the dystrophic process in the myocardium is discussed. The authors' material, however, failed to support this view but did support the view that the electrocardiographic abnormalities have an heredofamilial character.
Factors Influencing the Restoration of Blood Flow Following Pulmonary Embolization as Determined by Angiography and Scanning
Authors: MURPHY MARVIN L. , BULLOCH ROBERT T.
Published: June 2012

Twenty-five patients with proven pulmonary emboli were followed for at least 20 weeks with serial scans and, in select cases, angiograms to determine the factors influencing the rate of resolution. Fifteen patients showed complete resolution at some time during the observation period. Five of these 15 patients experienced recurrent embolic episodes either before or after complete resolution. The remaining 10 patients included two who died of recurrent massive emboli, three who had recurrent episodes resulting in incomplete resolution, two who showed incomplete resolution at 20 weeks without recurrent emboli, and three who were lost to follow-up.

Twenty-one patients exhibited prompt resolution in single or multiple embolic episodes, and four experienced slow resolution.

Recurrent embolization is the most significant event in preventing restoration of blood flow. This is most likely to occur in the patient who presents with (1) an initial field defect in excess of 35%, (2) associated heart disease, and (3) peripheral thrombophlebitis and pulmonary emboli without other disease. These factors identified the patients susceptible to recurrent embolization in this study.
Catheter Technique for Recording His Bundle Activity in Man
Authors: SCHERLAG BENJAMIN J. , LAU SUN H. , HELFANT RICHARD H. , BERKOWITZ WALTER D. , STEIN EMANUEL , DAMATO ANTHONY N.
Published: June 2012

A technique for the routine recording of His bundle (H) activity in man using a bipolar or multipolar catheter is described. The recording catheter is inserted percutaneously, via the Seldinger method, into the right femoral vein and advanced fluoroscopically into the right atrium. Placement of the pre-formed curve at the catheter tip across the tricuspid valve in nine patients resulted in stable recordings of His bundle activity in successive cardiac cycles. Right atrial pacing resulted in progressive lengthening of the P-H interval with increasing frequency but the H to S-wave interval remained constant at all rates. Similar lengthening of the P-H interval was produced during atrial pacing when pressure was applied to the carotid sinus. The use of this recording technique in man will facilitate diagnostic interpretation of the electrocardiogram and can be used in various investigations of atrioventricular and intraventricular conduction in man.
A Study of Hemodynamics and Coronary Blood Flow in Man with Coronary Artery Disease
Authors: ROWE GEORGE G. , THOMSEN JAMES H. , STENLUND ROGER R. , MCKENNA DAVID H. , SIALER SALVADOR , CORLISS ROBERT J.
Published: June 2012

Coronary blood flow was measured by the nitrous oxide method, and cardiac output was measured by the Fick principle, in a series of 31 human subjects with the clinical diagnosis of angina pectoris. Coronary arteriography was carried out on the same subjects as a part of the same procedure, and the extent and severity of the coronary artery lesions was determined. A numerical value was assigned to the severity of the coronary artery disease, an attempt was made to correlate the severity of coronary artery disease with the measured coronary blood flow and with various hemodynamic parameters which traditionally describe the systemic and pulmonary circulation. There was no correlation between any of the parameters measured and the severity of coronary artery disease demonstrated by angiography. It is concluded, therefore, that the nitrous oxide method for measuring coronary blood flow is not helpful in separating subjects with normal coronary arteries from those with coronary artery disease, nor are resting hemodynamic observations helpful.

Maximum flow through the coronary arteries of the dog heart was measured by postmortem perfusion. This flow rate is sufficient to provide a considerable factor of safety as far as constriction of the major coronary arteries is concerned. If these data are extrapolated to the coronary vessels of man, it would seem that a very large "safety factor" exists, and this may explain why severe coronary disease is not revealed by studies of coronary blood flow.
Hemodynamic Effects of Hypovolemia in Normal Subjects and Patients with Congestive Heart Failure
Authors: MURRAY R. H. , THOMPSON L. J. , BOWERS J. A. , STEINMETZ E. F. , ALBRIGHT C. D.
Published: June 2012

Five young normal subjects (NS) and six middle-aged patients with chronic, low-output, congestive heart failure (HFP) were studied before and after 10 minutes of exposure to hypovolemia induced by negative pressure (30 mm Hg) applied to the lower body. ECG, respirometer, and catheters placed in the subclavian artery and superior vena cava permitted measurements of heart rate (HR), respiration rate, arterial and central venous pressures (CVP), and cardiac output (CO). In the group of NS, systemic vascular resistance (SVR) rose moderately, while CVP fell 4.3 mm Hg; CO, stroke volume (SV), stroke work (SW), and central blood volume (CBV) fell about 20%, whereas blood pressure and HR showed little change. In the group of HFP, control hemodynamic values were generally abnormal. In four patients the response to hypovolemia was similar to that of NS. Two patients with advanced heart failure showed no change or a rise in CO, SV, and SW in the face of a fall in CVP (3.1 and 3.7 mm Hg), no change or a fall in SVR, and a rise in CBV. It is concluded that HFP does not respond to hypovolemia in a consistent manner. Certain patients with advanced failure demonstrated abnormal responses to induced hypovolemia, the causes for which are complex.
Dynamic Changes in Left Ventricular Free Wall Thickness in the Human Heart
Authors: EBER LESLIE M. , GREENBERG HARVEY M. , COOKE JOHN M. , GORLIN RICHARD
Published: June 2012

Sufficient delineation of differences in density is often not achieved by standard x-ray cinematographic technic. As a result, when cineventriculography is used to study the shape and motion of the left ventricle, its free wall is often defined imprecisely, if at all. This problem has been overcome by utilization of a special color-coded, triple-emulsion cine film in place of the usual black and white film. The resulting photographic images permitted analysis of wall dynamics and measurement of wall thickness in different planes of the heart. Thickening of the normal wall during systole averaged between 70 and 106%, but with inconsistent nonuniform regional changes within this range. In the diseased left ventricle with localized areas of paradoxical expansion, markedly reduced if any thickening of the wall occurred during systole.
The Freon Test
Authors: AMPLATZ KURT , JEFFERY ROBERT F. , GOBEL FREDARICK L. , WANG YANG , GATHMAN GARY E. , MOLLER JAMES H. , LUCAS RUSSELL V.
Published: June 2012

A new, sensitive, qualitative technic is described for detecting small left-to-right and right-to-left circulatory shunts. Advantages over other sensitive shunt detection devices are: (1) the use of a readily available, nonradioactive, nonexplosive, nontoxic gas, namely Freon 22; (2) the ability to sample through standard cardiac catheters as small as 5F; (3) an immediate answer due to recording of the gas concentration in blood; and (4) extremely high sensitivity allowing the detection of the smallest left-to-right and right-to-left shunts.
Pathology of the Conduction System in Cardiac Rejection
Authors: BIEBER CHARLES P. , STINSON EDWARD B. , SHUMWAY NORMAN E.
Published: June 2012

Correlation of electrocardiographic abnormalities occurring postoperatively with lesions of the conduction system found at autopsy was done in 20 dogs which had received cardiac homografts. The incidence of arrhythmias closely paralleled the severity of rejection injury found within the heart and specifically within the conduction system. Severe pathological changes in the conduction system (grade D) were uniformly associated with arrhythmias. These disturbances, as well as decrease in electrocardiographic voltage, have consistent anatomic correlates in acute rejection of cardiac homografts and are of primary importance in the clinical diagnosis of acute rejection.
Salivary Sodium-Potassium Ratio and Plasma Renin Activity in Hypertension
Authors: ADLIN E. VICTOR , CHANNICK BERTRAM J. , MARKS ALLAN D.
Published: June 2012

The cause of the suppression of plasma renin activity (PRA) in many patients with essential hypertension and normal aldosterone excretion is unknown. Since mineralocorticoid excess can lower PRA, we attempted to evaluate the activity of salt-retaining hormones in these patients by measuring the salivary Na/K ratio. The median Na/K ratio in 20 hypertensive patients with suppressed PRA and normal or low aldosterone excretion was 0.71. This was significantly lower than the median of 1.38 in 29 normal subjects and the median of 1.05 in 15 hypertensive patients with normal PRA.

Excess dietary intake of salt is a possible cause of PRA suppression in these patients, but our findings indicate that high rather than low Na/K ratios would be expected if this were present. On the other hand, both the salivary electrolyte changes and the suppression of PRA are consistent with the hypothesis that mineralocorticoid excess is present in these patients, despite the failure to demonstrate elevated excretion of aldosterone.
Surgically Induced Atrioventricular Block as Treatment for Recurrent Atrial Tachycardia in Wolff-Parkinson-White Syndrome
Authors: EDMONDS JOHN H. , ELLISON ROBERT G. , CREWS THOMAS L.
Published: June 2012

In a 60-year-old male with WPW syndrome and recurrent PAT refractory to cardiac drugs, surgical creation of complete A-V block without cardiopulmonary bypass has prevented recurrence of the PAT. The findings in this case support the accessory conduction tissue theory as being responsible for WPW conduction in some patients and a circus re-entry movement as responsible for the recurring PAT.
Coarctation of the Aorta in Infants and Children
Authors: TAWES ROY L. , ABERDEEN EOIN , WATERSTON D. J. , CARTER R. E. BONHAM
Published: June 2012

The operative experience with 333 children (179 [54%] under one year of age) is reported. Associated cardiac anomalies were present in 75%. All those requiring operation before the age of one year had congestive heart failure. Early recognition of the failure of medical treatment and early operative correction are imperative if an avoidable fatal outcome is to be prevented. This study demonstrates that the operative mortality is small (2.8%) in patients over the age of six months, and that almost half of the very ill infants under six months of age can be saved by early operation.
Transposition of the Great Arteries with Ventricular Septal Defect
Authors: WALDHAUSEN JOHN A. , BORUCHOW I. , MILLER WILLIAM W. , RASHKIND WILLIAM J.
Published: June 2012

Infants with transposed great arteries need atrioseptostomy for adequate intracardiac mixing of the systemic and pulmonic circulations. Those with ventricular septal defect and pulmonary artery hypertension, with or without other associated lesions, usually require further surgical palliation.

Postseptostomy measurements of pulmonary artery pressures at systemic levels were obtained in ten infants with transposition of the great arteries and ventricular septal defects. Three had, in addition, patent ductus arteriosus, and two of these had aortic coarctation (one preductal with hypoplasia of the aortic arch). One had transposition of the great arteries, ventricular septal defect, and tricuspid atresia.

Four of the patients had surgical septectomy; the remaining seven had balloon atrioseptostomy. All had pulmonary artery banding; the three ductus arteriosus lesions were ligated; and both coarctations were repaired (one with reconstruction of the aortic arch). The only operative death was in one of the patients with transposition of the great arteries and ventricular septal defect only.

When the interatrial communication is adequate in patients with transposition, ventricular septal defect, and pulmonary artery hypertension, pulmonary vascular obstructive changes may be prevented by pulmonary artery banding and surgical correction of the associated lesions.
Subvalvar Pulmonary Obstruction Complicating the Postoperative Course of Balloon Atrial Septostomy in Transposition of the Great Arteries
Authors: TYNAN MICHAEL , CARR IAN , GRAHAM GERALD , CARTER R. E. BONHAM
Published: June 2012

The immediate results of balloon atrial septostomy performed on 41 infants with transposition of the great arteries have been presented. There were ten hospital deaths, nine of these occurring in infants with additional cardiac malformations; five of these ten infants had operations for the additional malformations. The results show that an adequate interatrial defect can be created by balloon atrial septostomy, and it is suggested that this technique is of particular value in infants under three months of age.

Increasing cyanosis following an initial improvement after septostomy was more frequently associated with subvalvar pulmonary obstruction than with inadequacy of the atrial septal defect. Catheterization of the pulmonary artery and angiocardiography are important in the diagnosis of subvalvar pulmonary obstruction.
Pregnancy and Open-Heart Surgery
Authors: ZITNIK RALPH S. , BRANDENBURG R. O. , SHELDON R. , WALLACE R. B.
Published: June 2012

During pregnancy, when surgically reparable heart disease can no longer be medically manged, open- or closed-heart surgery is the procedure of choice
without
prior therapeutic abortion. Cyanotic congenital heart disease in a pregnant patient when completely correctable surgically may be an indication for surgery in itself.

Available data suggest that pregnancy per se does not increase the maternal risk of heart surgery with use of extracorporeal circulation. Fetal mortality in our series was 33%.
Left Ventricular Function After Formation of Myocardial Tunnels Used for Internal Mammary Artery Implantation
Authors: ENRIGHT LEE P. , HANNAH HAMNER , REIS ROBERT L.
Published: June 2012

Left ventricular function curves and maximum dp/dt were determined at constant heart rate and aortic pressure in 20 dogs before and after the formation of myocardial tunnels used for internal mammary artery implantation. In five dogs, the internal mammary arteries were implanted in anterior and posterior myocardial tunnels developed by blunt dissection midway between endocardium and epicardium and extending one-half the ventricular length. In five dogs, tunnels of similar length and location were made with a scalpel. In ten additional dogs, myocardial infarction was produced by left anterior descending artery ligation six weeks prior to the time of study. Tunnels were created in these animals by blunt dissection and, after the inscription of function curves, the tunnels were enlarged with a scalpel. A repeat function curve was then inscribed. In 19 of the 20 animals, neither the creation of long myocardial tunnels nor the implantation of freely bleeding internal mammary arteries produced significant immediate alteration in the function of the normal or the functionally impaired myocardium.
Pressure in a Vascular Implant in the Myocardium During Systole
Authors: BAIRD RONALD J. , MANKTELOW RALPH T. , SHAH PRAKASH A.
Published: June 2012

The systolic pressure in the portion of an internal mammary artery which is within a myocardial tunnel may be much higher than aortic systolic pressure. The high pressure occurs in the distal portion of the tunnel and exists during the isovolumetric and ejection phases of myocardial systole. It occurs consistently in an implant which has passed initially into the inner half of the myocardium and inconsistently in more shallow implants. It is a result of systolic occlusion of the implant as it passes through different myocardial layers.

The presence of an implant-to-coronary pressure gradient during systole is probably another factor encouraging the formation of implant-to-coronary anastomoses and the subsequent flow through them.
Lymph Circulation in Congestive Heart Failure
Authors: WITTE MARLYS HEARST , DUMONT ALLAN E. , CLAUSS ROY H. , RADER BERTHA , LEVINE NORMAN , BREED ERNEST S.
Published: June 2012

The lymphatic circulation was evaluated after cannulation of the cervical thoracic duct in 12 patients with severe intractable congestive heart failure. After venting the distended duct, lymph flowed rapidly under increased pressure, and signs and symptoms of circulatory congestion were dramatically relieved. Dyspnea, orthopnea, anorexia, abdominal discomfort, distended neck veins, hepatomegaly, peripheral and scrotal edema, and ascites diminished or disappeared. Central venous pressure fell and armto-tongue circulation time decreased. In some patients arterial pressure, amplitude of peripheral pulses, central venous Po
2
, and urinary output rose further suggesting enhanced cardiac output. Considered together with previous observations in experimental animals, the findings indicate that elevated systemic venous pressure greatly increases formation of thoracic duct lymph but at the same time impedes the return of lymph into the great veins. While therapeutic drainage of lymph from the thoracic duct in patients with cardiac failure is limited, the capacity of the lymphatic system to transport excess capillary filtrate back to the blood stream constitutes a major control mechanism regulating the manifestations of this disorder.
The Cardiovascular Effect of Induced Controlled Anoxemia
Authors: SCARBOROUGH WILLIAM R. , PENNEYS RAYMOND , THOMAS CAROLINE B. , BAKER BENJAMIN M. , MASON ROBERT E. , Beser Jacob , Lore Salle A. , Saltzer Grace
Published: June 2012

Cardiovascular responses were studied by means of the ballistocardiograph and electrocardiograph in 16 normal subjects and 11 patients with suspected coronary artery disease before, during and after the induction of oximetrically controlled anoxemia. Progressive and significant increases occurred in cardiac output, pulse rate, left ventricular work, maximum cardiac force and pulse pressure during anoxemia in all of the normal subjects and in the 5 patients whose ballistocardiograms allowed the calculation of these variables. The increase in cardiac output resulted almost entirely from an acceleration of cardiac rate. In the normal subjects control ballistocardiograms were normal in form and remained normal throughout anoxemia. Of the patients, 1 with normal, 2 with borderline and 1 with abnormal ballistocardiograms became abnormal or more abnormal. Two of the patients had a positive electrocardiographic test for coronary insufficiency while the test was negative in all of the normal subjects.

The linear relationship between left ventricular work and arterial oxygen saturation suggests that when cardiovascular function is tested by means of anoxemic stress the level of arterial desaturation should be controllable. This is made possible by the use of a variable oxygen-nitrogen mixture and an oximeter.
Changes in Configuration of the Ventricular Chambers during the Cardiac Cycle
Authors: RUSHMER ROBERT F. , CRYSTAL DEAN K.
Published: June 2012

Cinefluorographic angiocardiography has been used to record the sequential changes in the size and shape of the right and left ventricular chambers and the external cardiac silhouette in dogs. Evidence is presented which indicates that (1) the left ventricle is usually filled more rapidly than it is emptied, (2) the diastolic size appears to remain remarkably constant during a major portion of the diastolic period and (3) residual blood remains within the ventricle at the end of systole.
The Diagnosis of Aortic Septal Defect by Retrograde Aortography
Authors: GASUL BENJAMIN M. , FELL EGBERT H. , CASAS RAUL
Published: June 2012

This rare congenital malformation is a round or oval opening between the ascending aorta and the main pulmonary artery above the semilunar valves. It is practically impossible to differentiate this malformation from a patent ductus arteriosus clinically because both malformations may present the same physical, fluoroscopic, roentgen and electrocardiographic findings. Even angiocardiography and cardiac catheterization do not differentiate these congenital malformations. The authors have studied 2 patients with aortic septal defects. One was operated at another clinic for a suspected patent ductus arteriosus, and the other case presented here was diagnosed by retrograde aortography.
Effects of Desoxycorticosterone Acetate on Cholesterolemia, Blood Pressure and Atherogenesis in Chicks
Authors: STAMLER J. , PICK R. , KATZ L. N. , Levinson E. , Johnson P. , Dudley M. , Bolene C.
Published: June 2012

Chronic exhibition of chicks to desoxycorticosterone acetate produces a slight but definite rise in blood pressure. This effect is increased by addition of salt to the diet. This regimen does not affect cholesterol levels and atherogenesis in the chick on ordinary mash. However, in the presence of a mildly atherogenic diet (0.25 per cent cholesterol) concomitant DCA exhibition increases the incidence and severity of atherosclerosis.
Interrelationships of Cardiac Output, Blood Pressure, and Peripheral Resistance during Normal Respiration in Normotensive and Hypertensive Individuals
Authors: WILLIAMS ARNOLD H. , GROPPER ARTHUR L.
Published: June 2012

The effects of normal respiration upon the heart, blood pressure, and peripheral circulation were studied in normotensive and hypertensive subjects. Changes of right and left ventricular output were measured by the ballistocardiogram and the pressure-pulse method of Remington, peripheral blood flow by plethysmographs. The central and peripheral changes were interrelated and evidence is presented that the latter are chiefly due to the effects of intrathoracic pressure upon cardiac filling.
The Dynamics of Eisenmenger's Complex
Authors: GOLDBERG H. , SILBER E. N. , GORDON A. , KATZ L. N.
Published: June 2012

Pulmonary venous blood and pulmonary venous pressure were obtained by catheterization technic in a case of Eisenmenger's complex with anomalous pulmonary venous drainage into the right auricle. This made possible measurement of the true total pulmonary vascular resistance and evaluation of a pulmonary factor in the cyanosis accompanying this anomaly. No evidence for inadequate oxygenation in the lungs was apparent, and it is concluded that the cyanosis in Eisenmenger's complex is due solely to venoarterial shunting.
The Nitroglycerin-Flicker Test
Authors: FOX ERNEST L. , WRIGHT IRVING S.
Published: June 2012

The nitroglycerin-flicker test, as suggested and modified by Krasno and Ivy, has been used to test normal individuals and patients with a variety of cardiovascular diseases. The hypothesis that this test would serve as an index of the presence of vascular disease or spasm elsewhere in the body than the retina was explored. These studies have failed to justify the drawing of conclusions based on the results of this test regarding the presence or absence of generalized vascular disease or of localized vascular disease or spasm elsewhere than the retinal vessels. It is concluded that the use of this test in mass surveys to detect cardiovascular disease is not justified.
The Unipolar Precordial and Extremity Electrocardiogram in Normal Infants and Children
Authors: ALIMURUNG MARIANO M. , JOSEPH LESTER G. , NADAS ALEXANDER S. , MASSELL BENEDICT F.
Published: June 2012

Information regarding the normal unipolar electrocardiogram in the young ages is very limited. This study furnishes data obtained from 521 normal infants and children from birth to 13 years, using the V chest leads and the aV limb leads. Four age groups were noted in the evolution of the newborn pattern into the adult pattern as mainly reflected by the configuration of the QRS complex in V
1
. Detailed analyses of the rest of the unipolar electrocardiogram disclosed other distinctive features both in wave patterns and voltages which differ significantly not only from adult findings but also among the various age groups noted.
Determinants of Cardiac Performance
Authors: WIGGERS CARL J.
Published: June 2012

Sequential experimental studies are reviewed which, when properly integrated, confirm the concept that the responses of the ventricles, however measured, are determined by the initial length of fibers, provided that the functional state of the myocardium is not altered. Some of the established factors are discussed which may obscure the evidence that this basic law is of importance under normal and pathologic conditions.
The Quantitative Electrokymograph
Authors: MORGAN RUSSELL H. , STURM RALPH E.
Published: June 2012

The quantitative electrokymograph has been developed in an effort to provide an instrument which will be easier to operate than the electrokymographic equipment currently available. In addition, provision has been made for the recording of both border-motion phenomena and densitometric changes within the heart and great vessels. In the design of the instrument, considerable attention has been directed toward the development of a means whereby electrokymographic tracings may be calibrated. Care has also been exercised in the instrument's design in order to provide a frequency response that is essentially flat from 0 to 40 cycles per second.
The Distribution of Body Fluids In Congestive Heart Failure
Authors: ELKINTON J. R. , SQUIRES R. D.
Published: June 2012

The pathogenesis of congestive heart failure is discussed. Experimental evidence is cited to support the thesis that abnormalities in the distribution of body fluids may affect circulatory and renal function, and hence may be a cause as well as an effect in the complex sequence of events leading to the congestive state. Emphasis is placed upon alterations in cellular metabolism which may lead to such disturbances in body fluids and so through various mechanisms, cellular, humoral, and circulatory, may modify the volume regulation of the body.
The Distribution of Body Fluids In Congestive Heart Failure
Authors: SQUIRES R. D. , SINGER R. B. , MOFFITT G. R. , ELKINTON J. R.
Published: June 2012

The distribution of values of serum concentrations of sodium, chloride, potassium, and total carbon dioxide were studied in a large group of patients with congestive heart failure, and compared with the values in a smaller group of normal subjects used as controls. The depression of sodium and chloride concentration, and the elevation of total carbon dioxide content were evaluated in terms of renal function and mercurial therapy. In 11 of the cases with high serum contents of total carbon dioxide the acid-base equilibrium was precisely defined by measurement of pH in cutaneous whole blood and calculation of the pressure of carbon dioxide and of the concentration of buffer base.
The Action of Several Cardiac Glycosides on Conduction Velocity and Ventricular Excitability in the Dog Heart
Authors: MOE GORDON K. , MÉNDEZ RAFAEL
Published: June 2012

The effects of digitoxin, ouabain, lanatoside C and K-strophanthoside on ventricular excitability and conducion velocity were studied. All agents caused an initial slight increase followed by a decrease of ventricular excitability, and depression of A-V and intraventricular conduction. Conduction, while depressed in the specialized tissue, was well maintained in the muscle itself until death of the heart. No significant qualitative differences between the glycosides were observed.
Experimental Arterial Disease
Authors: WARTMAN WILLIAM B. , JENNINGS ROBERT B. , HUDSON BRYAN
Published: June 2012

When emboli of rabbit blood measuring 0.5 mm. in average diameter were injected into the ear vein of healthy adult male rabbits, they either became adherent to the walls of the pulmonary arteries or impacted in them. In either case an acute arteritis accompanied by endothelial proliferation regularly occurred. This process was reversible in some instances but in others was followed by organization of emboli which resulted in eccentric fibroelastic thickening of the intima or formation of fibrous intravascular bridges. Fatty degeneration, calcification, hemorrhage, and atheroma were absent. The lesions were self-limited and healed. They were not progressive.
The Dissection of the Atrioventricular Node Bundle and Bundle Branches in the Human Heart
Authors: WIDRAN JERROLD , LEV MAURICE
Published: June 2012

The A-V node, bundle and bundle branches were grossly dissected in 41 human hearts. The method for this dissection is described. Given also are the sizes of the individual structures with advancing age. These structures grow more slowly than the remainder of the myocardium.
Circulation Time Determinations from the Right Ventricle
Authors: ZIEGLER ROBERT F.
Published: June 2012

The determination of the circulation time from the ventricle to the face using fluorescein and ultraviolet light eliminates all of the variable factors from the venous side of the circulation and gives evidence specifically of the presence or absence of an intraventricular right to left shunt. The most important clinical application is the differentiation of tetralogy of Fallot from pulmonary valvular stenosis with an intact ventricular septum, the first requiring a shunting type of operation and the second a pulmonary valvulotomy.
Focal Necrotizing Myocarditis without Interstitial Infiltration
Authors: BROWN MORTON G. , FIENBERG ROBERT , HOLZMAN DANIEL
Published: June 2012

Sudden death occurred in a patient considered to have a myocardial infarction. Detailed microscopic examination revealed a focal necrotizing myocarditis without interstitial infiltration. The original connective tissue framework without collagen in many of the areas where muscle fibers disappeared precludes the term myocardial fibrosis. A pathologic classification is suggested. No adequate etiologic agent could be found.
Sequential Alterations in Myocardial Lactate Metabolism, S-T Segments, and Left Ventricular Function During Angina Induced by Atrial Pacing
Authors: PARKER JOHN O. , CHIONG MIGUEL A. , WEST ROXROY O. , CASE ROBERT B.
Published: June 2012

Myocardial lactate metabolism was monitored before, during, and after a period of atrial pacing with a continuous automated sampling technic. The electrocardiogram was recorded, and left ventricular function was evaluated by relating left ventricular end-diastolic pressure to left ventricular stroke work. Seventeen of 21 patients with coronary artery disease experienced angina during pacing, and 13 of these showed lactate production by the myocardium during angina. The abnormalities in lactate metabolism developed early in the pacing period, along with S-T segment depression and impairment of left ventricular function, all of which usually occurred before the onset of pain. In the patients with angina, the mean lactate extraction was 14.1% during the control period and —15.1% during the pacing period. Abnormalities in myocardial lactate metabolism have been demonstrated with greater regularity during pacing-induced angina than during angina precipitated by exercise or isoproterenol. This investigation has demonstrated the sequences of changes in lactate metabolism during and after a period of angina and their relation to electrocardiographic and hemodynamic events.
Hemodynamic Studies in Chronic Uremia
Authors: DEL GRECO FRANCESCO , SIMON NORMAN M. , ROGUSKA JADWIGA , WALKER CHARLES
Published: June 2012

Hemodynamic functions and blood volume were observed in patients with chronic uremia. Thirty-one patients had clinical features of circulatory congestion and 37 did not. The degree of anemia and acidosis was comparable in both groups. However, creatinine clearance was significantly lower in patients with circulatory congestion. Both groups of patients had greater blood pressure, heart rate, plasma volume, and total peripheral resistance than normal. Resting cardiac output was abnormally decreased in 19% of the patients with circulatory congestion and in 14% of patients without features of circulatory congestion. There was no correlation between blood volume and blood pressure. Intravenous digitalization of seven of the patients with circulatory congestion produced clinical and hemodynamic improvement in only two. Hemodialysis effected an increase in cardiac output and a decrease in total peripheral resistance in six patients with congestion. In seven patients without circulatory congestion after dialysis there was a fall in plasma and blood volume, associated with a slight decrease in cardiac output. It is suggested that congestion of the circulation in chronic uremia results from a variety of hemodynamic, myocardial, and metabolic alterations, rather than from any single abnormality.
Use of the Ultrasonic Doppler Method for Timing of Valvular Movement
Authors: KOSTIS JOHN B. , FLEISCHMANN DIETRICH , BELLET SAMUEL
Published: June 2012

The ultrasonic Doppler method was employed to time the rapid movements (opening and closure) of the mitral and aortic valves. To exclude signals due to slowly moving structures (heart walls), the Doppler tracing was processed by a filter that eliminated low frequencies. Clear tracings containing two deflections, one due to the opening and the other to the closure of each valve, were obtained. The valvular origin of the deflections was verified by recordings simultaneous with intratardiac pressures in five dogs.

The ultrasonic Doppler tracing was found to be a satisfactory aid in the differentiation of various extra heart sounds in 24 patients. Thus, the second heart sound precedes, the third heart sound follows, and the opening snap is simultaneous with the signal due to mitral opening. The fourth heart sound is simultaneous with the atrial component of the unfiltered Doppler signal. Ejection clicks and systolic clicks are simultaneous with or follow the signal due to aortic opening.

Because of its simplicity and safety, this method used in conjunction with the phonocardiogram should prove helpful in distinguishing the opening snap, third and fourth heart sounds, and certain additional auscultatory phenomena.
The Atrioventricular Conduction System in Two Cases of Tricuspid Atresia
Authors: GULLER BARBARA , DUSHANE JAMES W. , TITUS JACK L.
Published: June 2012

The morphology of the atrioventricular (A-V) conduction system was studied by serial histologic section in two cases of tricuspid atresia type IB (without transposition of the great arteries, with subpulmonary stenosis). The A-V node was adjacent to the central fibrous body, and its location was indicated by a "dimple" in the floor of the right atrium. The left bundle branches originated unusually close to the nodal-bundle junction. The right bundle branch was markedly elongated in its course to the right septal endocardium. It was situated along the inferior aspect of the channel-like ventricular septal defect as it traversed the septum. The early origin of the left bundle branches and the markedly elongated course of the right bundle branch were such that, theoretically, abnormal spread of the activation wave might result.
Factors Related to ST-Segment Depression after Exercise in Middle-Aged Chinese Men
Authors: CHAING BENJAMIN N. , ALEXANDER E. RUSSELL , BRUCE ROBERT A. , THOMPSON DONOVAN J. , TING NONG
Published: June 2012

Ninety-four or 7% of 1,346 healthy middle-aged Chinese men who underwent a graded treadmill test of maximal exercise showed post-exercise ST-segment depression. Stepwise linear discriminant function analysis showed that the major factors associated with this response were systolic blood pressures at maximal exercise, age, and certain resting ECG abnormalities, and to a lesser extent, systolic and diastolic pressure at rest, resting heart rate, and cigarette smoking. Hypertensive subjects showed at least a fourfold increase of post-exercise ST depression as compared with age-matched normotensive controls. Since coronary atherosclerosis is rare among Chinese, the study is of particular interest in demonstrating some factors related to ST depression after maximal exercise, particularly the effect of higher systemic pressure, in a group of middle-aged Chinese men.
Relation of Plasma to Interstitial Fluid Volume in Essential Hypertension
Authors: TARAZI ROBERT C. , DUSTAN HARRIET P. , FROHLICH EDWARD D.
Published: June 2012

Extracellular water (radiobromine), plasma volume (radioiodinated human serum albumin), and peripheral plasma renin activity were measured simultaneously in men with uncomplicated, untreated essential hypertension and in normal subjects. The ratio of plasma volume to interstitial fluid volume (PV/IF) was significantly lower in hypertensive patients (0.194 vs. 0.223,
P
<0.001). This could not be explained only on the basis of the diminished plasma volume found in hypertensive patients (17.3 ml/cm of body height vs. 18.7 ml/cm,
P
<0.05), as three normal subjects with marked plasma volume contraction had normal PV/IF ratios (0.224). This disturbed ratio in hypertensives suggests, therefore, an abnormality in the mechanism regulating the distribution of extracellular water in essential hypertension. Peripheral plasma renin activity correlated inversely with plasma volume, but not with extracellular water volume, suggesting that these two indices of body fluid volume are not always functionally interchangeable.
Protein Content in Lymph and Edema Fluids in Congestive Heart Failure
Authors: WITTE CHARLES L. , WITTE MARLYS HEARST , DUMONT ALLAN E. , COLE WILLIAM R. , SMITH JOHN R.
Published: June 2012

Protein content of tissue fluid and lymph is not uniform and depends upon regional differences in capillary permeability modified by changes in capillary filtration pressure. Whereas increased pressure in freely permeable liver sinusoids promotes formation of excess liver and thoracic duct lymph and ascitic fluid high in protein, increased venous pressure in less permeable beds promotes formation of excess lymph and edema fluid progressively lower in protein content. To ascertain the influence of colloid osmotic (oncotic) and hydrostatic pressure on excess lymph and edema formation in congestive heart failure, a disorder characterized by generalized venous hypertension, protein content of lymph (thoracic duct, liver, and small intestine), intracavitary and peripheral edema fluid, and plasma were measured in 42 patients with cardiac failure. In "acute" heart failure, thoracic duct lymph and ascitic fluid have high protein content (85% and 68% of plasma protein respectively) and are derived primarily from the liver, but in "chronic" heart failure protein content of thoracic duct lymph and ascitic fluid are lowered (46% and 40% of plasma protein respectively) by lymph from extrahepatic sites. In both stages, pleural and leg edema fluid are comparatively low in protein content (26 to 44% and 3 to 8% of plasma protein respectively). In congestive heart failure, edema and intracavitary fluid form primarily in response to increased venous pressure which outside the liver is partially counterbalanced by increased effective plasma oncotic pressure.
Platelet Function and Myocardial Infarction
Authors: MUSTARD JAMES FRASER , PACKHAM MARIAN AITCHISON
Published: June 2012

Platelet thromboemboli may be important not only in the development of some forms of atherosclerosis and occlusive thrombi, but also in initiating disturbances of the microcirculation. The latter mechanism may be significant in those cardiac deaths that are not directly attributable to advanced atherosclerotic disease or occlusive thrombi in coronary arteries. In addition, it is possible that mural thrombi and atherosclerotic lesions may fragment and shower the microcirculation with emboli. Such a mechanism appears to occur in the cerebrovascular and renal circulations, and it seems unlikely that the myocardial tissue would be spared the effects of such a mechanism. Thus, in examining the relation between platelets, thrombosis, and the complications of vascular disease, it is important to emphasize that consideration must be given to platelet thromboemboli and disturbances of the microcirculation as well as to occlusive coronary artery thrombi.
The Role of Lipids in Acute Myocardial Infarction
Authors: FREDRICKSON DONALD S.
Published: June 2012

Plasma lipids and lipoproteins usually undergo several phasic changes following myocardial infarction. Within a few hours the free fatty acid (FFA) concentration rises precipitously and may not become normal for 2 days or more. During the first 1 to 3 days, there begins a significant decline in cholesterol and beta lipoproteins. After a possible early decline, the concentrations of very low density lipoproteins and triglycerides begin to climb within the first week and characteristically are considerably above the measured initial levels for weeks thereafter. Beta lipoprotein concentrations return slowly to initial values. The late return of lipids to supranormal levels is probably often an expression of abnormality present before infarction. Some of these oscillations in lipid and lipoprotein concentrations occur after other forms of trauma. Arguments are presented that the early alterations are not attributable to caloric deprivation or anticoagulants and the mechanisms involved are speculated upon.
The Value of Aggressive Therapy in the Hypertensive Patient with Azotemia
Authors: MROCZEK WILLIAM J. , DAVIDOV MICHAEL , GAVRILOVICH LILLIAN , FINNERTY FRANK A.
Published: June 2012

By giving diazoxide intravenously and furosemide orally the diastolic blood pressure was kept under 110 mm Hg and the urinary output over 1 L/day for a 2-week period in 25 hypertensive patients with azotemia. During the first 2 weeks of treatment three patients died. Although the 40% decrease in mean arterial pressure in the remaining patients was associated with immediate improvement in the cardiovascular status, for example, clearing of congestive heart failure and papilledema, there was a 19% average increase in BUN and 17% average increase in serum creatinine values. Three months later, however, maintenance of the reduced arterial pressure was associated with average reductions of 24 mg/100 ml in BUN and of 2.8 mg/100 ml in serum creatinine below control values. Each of the patients who remained on therapy continued to do well. Twenty-six months later six additional patients had died. In the remaining 16 patients the average mean arterial pressure was 117 mm Hg; papilledema had cleared; the average concentration of BUN was 22 mg/100 ml; the average serum creatinine was 1.8 mg/100 ml.
A Long-Time Study of the Blood Lipids of Two Students of Atherosclerosis
Authors: PAGE IRVINE H. , LEWIS LENA A.
Published: June 2012

A study of serum cholesterol and lipoproteins covering periods of 28 years in a male physician and 17 years in a female research worker showed relative constancy for the cholesterol levels and greater variability for the lipoproteins. Cholesterol was reduced sharply and temporarily just after each influenzal infection. In the male, the level of cholesterol was slightly above 300 mg/100 ml for more than 13 years. An extremely low cholesterol and high carbohydrate diet proved unacceptable. A more liberal, relatively low-saturated fat, low-cholesterol, and high polyunsaturated fatty acid diet with about 30% of the calories from fat, maintained the cholesterol level between 230 and 270 mg and has been followed with relish for a number of years. A myocardial infarction occurred 27 years after the study began. Clofibrate since then has reduced the cholesterol level further.

The female subject is in good health and maintains cholesterol levels slightly below 300 mg on a usual American diet. She is 10 years younger than the male. Her —S 40-70 lipoproteins have usually been well below the male subject's. Weight gain and lack of exercise seemed regularly to increase both levels.

The data are presented because we believe them to be accurate; their interpretation is for the reader. We hope he must wait for some time for the outcome of the study.
Dermatoglyphics in Congenital Heart Disease
Authors: ALTER MILTON , SCHULENBERG ROBERT
Published: June 2012

Dermatoglyphics form in utero during early gestation and may be influenced by genetic or environmental factors operating at that time. Since cardiac embryogenesis also occurs during early gestation, an analysis of dermatoglyphics in congenital heart disease (CHD) might reveal some types which are associated with aberrant dermatoglyphics.

Ten dermatoglyphic traits were analyzed in 225 individuals with CHD proved, in most instances, by extensive radiologic studies and at surgery. These traits were compared with dermatoglyphics in 200 normal control subjects. The analysis revealed that the atd angle was significantly increased in CHD. Except for endocardial fibroelastosis and atrioventricular canal, all subtypes of CHD had a wider atd angle than controls. In ventricular septal defect, patent ductus arteriosus, tetralogy of Fallot, and multiple cardiac defects, the increase was statistically significant. The present study confirms previous reports that the atd angle may be increased in CHD.