bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinicopathologic Correlations
Authors: CARTER JOHN B. , SETHI SURENDRA , LEE GERALD B. , EDWARDS JESSE E. 
Published: June 2012

Among the various anatomic classes of aortic valvular insufficiency is that associated with prolapse of one or several cusps of the valve. A number of etiologic factors come into play, including intrinsic weakness or excessive cuspid tissue, trauma, infection, inadequate support of the aorta as in certain ventricular septal defects, and loss of commissural support from laceration of the ascending aorta. The latter condition may result from trauma, cystic medial necrosis, inflammation, or hypertension. The lacerated aorta may either be associated with typical dissecting aneurysm or there may be little intramural dissection of blood.
In some instances wherein prolapse of one or more cusps causes aortic insufficiency, the functional disturbance may be overcome by correcting the basic problem while preserving the natural aortic valve.
Prevention of Rheumatic Fever
Authors: DENNY FLOYD W. , AYOUB ELIA M. , DILLON HUGH C. , DISNEY FRANK A. , KAPLAN EDWARD L. , MOODY MAX D. , PATERSON PHILIP Y. , TARANTA ANGELO 
Published: June 2012

Rheumatic fever is a recurrent disease which frequently can be prevented. Infection with group A streptococci precipitates both initial and recurrent attacks; therefore, prevention of rheumatic fever and rheumatic heart disease depends upon the control of streptococcal infections. This may be accomplished by (1) prevention of streptococcal injections in rheumatic subjects, and (2) early and adequate treatment of streptococcal infections in all individuals.
Bacterial endocarditis may result from dental and other surgical procedures in patients with rheumatic or congenital heart disease. When such procedures are undertaken, these patients should be protected by administration of antibiotics in therapeutic doses.
Hemodynamic Effects of Angiotensin in Normal and Environmentally Stressed Monkeys
Authors: FORSYTH RALPH P. , HOFFBRAND BARRY I. , MELMON KENNETH L. 
Published: June 2012

Simultaneous regional blood flow and resistance measurements were made in 21 organs in 11 supine unanesthetized rhesus monkeys before and during two different doses of intravenously infused angiotensin II or saline. Systemic arterial pressure and total peripheral resistance significantly increased at both infusion rates in the six experimental monkeys, compared with changes in five control monkeys; cardiac output decreased at the high dose level. Among major organs, the kidneys, skin, liver (hepatic artery), and mesentery had reductions in the fraction of cardiac output they received and, thus, the greatst increase in resistance and decrease in blood flow. No organ had a significant increase in its blood flow; however, skeletal muscle and bone were normally perfused due to increases in the fraction of cardiac output they received.
Four other monkeys received continuous intravenous angiotensin infusions at initially subpressor rates for periods of 26 to 30 days. There were steady increases of systemic arterial blood pressure due to a rise in total peripheral resistance which reached a plateau in about 5 days. Avoidance schedules or other environmental stresses in these angiotensin-infused monkeys produced much more marked pressor episodes than those which occur in noninfused monkeys. These observations support the hypothesis that small amounts of angiotensin can potentiate sympathetic mediated vasomotor activity.
Diagnostic Import of QRS Notching in High-Frequency Electrocardiograms of Living Subjects with Heart Disease
Authors: FLOWERS NANCY C. , HORAN LEO G. 
Published: June 2012

In a 10-month period 92 patients have been studied for the occurrence of high-frequency notching in orthogonal electrocardiographic leads X, Y, and Z obtained by high-frequency, high-speed techniques. The same patients were studied radiographically with barium, with routine electrocardiograms, hemodynamically at cardiac catheterization and, in many instances, with left ventricular angiograms. Sixty-nine patients had not had cardiac surgery prior to recording and had normal duration of ventricular activation. These patients were placed into groups which included those with no ventricular enlargement, isolated right ventricular enlargement, isolated left ventricular enlargement, and biventricular enlargement.
The patients with no ventricular enlargement had a mean of 2.9 notches and never exceeded a total notch count of 6. Those with single ventricular enlargement had a mean of between 5 and 6, while those with biventricular enlargement frequently exceeded 6 notches and had a mean of 8.6. The differences were statistically significant.
We concluded, then, that notch count correlates well with the dynamic evidence of ventricular enlargement in a living population. Since the effect is additive, biventricular enlargement elevates the counts sufficiently to remove the overlap with normal seen in groups with univentricular enlargement.
Pathologic Changes in Aortic-Coronary Arterial Saphenous Vein Grafts
Authors: VLODAVER ZEEV , EDWARDS JESSE E. 
Published: June 2012

This is a pathologic study of segments of saphenous vein used as a graft between the aorta and a coronary artery in the surgical treatment of coronary atherosclerosis. Except for an occasional case with thrombotic occlusion of the graft, no lesions were observed in grafts which had been in place for less than 1 month. In each of two grafts in place for 1 month, mild fibrous thickening of the intima was present. Eight grafts which had been in place for 3½ months or longer consistently showed lesions, either organized thrombi (two grafts) or intimal fibrotic proliferative lesion (six grafts). In this group, five of the six grafts with intimal fibrous proliferation showed near or complete occlusion of the lumen.
The intimal fibrous proliferative lesion appears primarily to be a response to arterial pressure within the segment of vein. Obstructive atherosclerosis in the artery beyond the anastomosis with the graft may favor the development of the intimal lesion. The intimal lesion may progress rapidly according to the data in one of the cases. In this, patency of the graft demonstrated angiographically 3½ months after the operation was followed by near-complete occlusion of the lumen by the proliferative lesion 3 weeks following demonstration of patency.
Incidence of Myocardial Infarction and Sudden Death from Coronary Heart Disease in Nashville, Tennessee
Authors: HAGSTROM RUTH M. , FEDERSPIEL CHARLES F. , HO YAW CHIN 
Published: June 2012

The incidence rates for myocardial infarction and sudden death attributable to coronary heart disease for adults between the ages of 35 and 74 years for black and white populations were studied in Nashville, Tennessee, for a l-year period, July 1, 1967 to June 30, 1968. The overall incidence rate for myocardial infarction was 3.42 and for sudden coronary death, 1.55 per 1,000 population. The male-to-female ratio for the white population for myocardial infarction was 3:1, and for the black population 2:1. Similar male-to-female ratios were found for those dying suddenly for both races. However, both black males and females died suddenly at a higher rate than did the white.
Over half of the sudden deaths occurred within a 2-hour period after onset of symptoms. Fifty-two percent were dead on arrival at a hospital, 31% died at home, and 6% in a public place. Only 4% had either no contact with a source of medical care or had negative disease histories prior to sudden death. Thus, it would seem possible in further studies to identify a group of individuals at high risk of sudden death from coronary heart disease.
Role of Echocardiography in Diagnostic and Hemodynamic Assessment of Hypertrophic Subaortic Stenosis
Authors: SHAH PRAVIN M. , GRAMIAK RAYMOND , ADELMAN ALLAN G. , WIGLE E. DOUGLAS 
Published: June 2012

An abnormal sharp anterior motion of the anterior mitral leaflet has been previously described as a diagnostic abnormality in hypertrophic subacute stenosis (HSS). The present prospective study explored the diagnostic sensitivity and specificity of this finding in 26 patients studied without knowledge of clinical diagnosis. When the abnormality observed was complete and persistent, a correct diagnosis of HSS was made in every case. In the absence of systolic abnormality at rest and on provocation, the diagnosis of HSS could be excluded. When the abnormality was small and inconstant (nine patients) two thirds of the patients were shown to have a latent or labile form of outflow obstruction whereas the remaining third had no evidence of HSS.
In an extended part of the study on 31 patients with known HSS, comparisons of resting pressure gradients across left ventricular outflow tract were made with the echocardiographic findings at rest. Those with persistently abnormal mitral valve movement had an average pressure gradient of 78 mm Hg, those with inconstant abnormality had an average gradient of 24 mm Hg, and those with no resting abnormality had no gradients at rest.
Ethyl Alcohol and the Heart
Authors: REGAN TIMOTHY J. 
Published: June 2012

Since a significant fraction of the population are heavy consumers of ethanol, and recent postmortem studies suggest that most alcoholics have some degree of cardiac abnormality, elucidation of the basis for alcoholic cardiomyopathy is of some importance. Intoxicating amounts of ethanol depress ventricular function acutely and effect leakage of myocardial cell components.
On the basis of studies in three animal species and in man, it would appear that the cumulative effects of chronic ethanol intake can, without evident malnutrition, depress ventricular function and produce metabolic and morphologic abnormalities of the myocardium before clinical manifestations. Progression of the disease to produce heart failure, arrhythmias, or thromboembolism, separately or in combination, occurs under multiple circumstances that are not clearly defined. These would appear to include the cumulative effects without superimposed factors, an intensified drinking episode, simultaneous exposure to trace metals in excess, and occasional specific nutritional deficiency or superimposed infection. The low incidence of nutritional complications such as cirrhosis, peripheral neuritis, and delirium tremens associated with cardiomyopathy supports the view that the cardiac abnormality is commonly not dependent on malnutrition. Finally, clinical data indicate that cessation of alcohol intake will reverse the disease or interrupt its progression in many patients. Anticoagulant therapy is recommended at least during the early recovery stage.
Coronary Arteries in Fatal Acute Myocardial Infarction
Authors: ROBERTS WILLIAM C. 
Published: June 2012

The coronary arteries are diffusely involved by atherosclerotic plaques in fatal acute myocardial infarction (AMI). The degree of luminal narrowing may vary but plaques are present in practically every millimeter of extramural coronary artery. Usually the lumens of at least two of the three major coronary arteries are narrowed > 75% by old plaques in patients who die suddenly (< 6 hours) from cardiac disease with or without myocardial necrosis. Coronary thrombi occur in about 10% of patients who die suddenly or in whom necrosis is limited to the left ventricular subendocardium, and in about 50% of patients with transmural myocardial necrosis. Coronary thrombi usually indicate the presence of shock or congestive heart failure or both during the development of myocardial necrosis. The infrequency of coronary thrombi in patients dying suddenly of cardiac disease and in those with transmural necrosis who never have shock or congestive heart failure suggests that the thrombi may be consequences rather than causes of AMI.
Although it may not precipitate AMI, coronary thrombosis may still be the underlying cause of the atherosclerosis. The finding of fibrin deposits in old atherosclerotic plaques and the findings of atherosclerotic-type lesions (cholesterol clefts, foam cells, pultaceous debris, calcific deposits) in organized known thrombi (as in the left atrium in mitral stenosis) suggest a strong relationship between thrombosis and atherosclerosis.
Coronary arterial emboli are not rare; they are located in distal portions of the coronary tree and are present in the small epicardial branches as well as in intramural coronary arteries. In contrast, coronary thrombi are located in proximal portions of major extramural vessels, are infrequent in the small epicardial branches, and are absent in intramural coronary arteries. Coronary atherosclerosis is limited to the extramural coronary arteries and spares the intramural coronary arteries.
Primary Dissecting Aneurysm of Coronary Artery
Authors: CLAUDON DAVID G. , CLAUDON DANN B. , EDWARDS JESSE E. 
Published: June 2012

Primary dissecting aneurysm of a coronary artery is a rare form of acute coronary arterial obstruction.
A review of 24 cases, including two observed by the authors, indicates that this condition tends to occur (1) in the young adult, (2) in the female more commonly than the male, and (3) relatively commonly in the postpartum state.
The clinical manifestations take the form either of sudden death or acute myocardial infarction. In the latter situation, there is the potential for overcoming the coronary arterial obstruction by a surgical bypass procedure.
Ultrasoundcardiographic Studies of the Mitral Valve Region in Young Infants with Mitral Atresia, Mitral Stenosis, Hypoplasia of the Left Ventricle, and Cor Triatriatum
Authors: LUNDSTRÖM NILS-RUNE 
Published: June 2012

Reflected ultrasound has been used for investigation of the mitral valve region in early infancy. The material consists of two patients with mitral atresia, three patients with mitral stenosis and aortic valvular atresia, five patients with mitral and aortic valvular stenosis, one patient with cor triatriatum, and one patient with severe degree of aortic valvular stenosis with a normal mitral valve. The results are compared with ultrasoundcardiographic findings in ten infants without heart disease. A specific abnormal echo was obtained in cases with mitral atresia and cor triatriatum. The patients with a combination of mitral and aortic valvular lesions could be separated into two groups by means of ultrasoundcardiography. This separation reflected the functional state of the left ventricle based on the degree of mitral stenosis and hypoplasia of the left ventricle.
This noninvasive technic has been found useful as a complementary method for the investigation of the mitral valve region. It can even be performed in seriously ill infants.
Nonparoxysmal Junctional Tachycardia Complicating Acute Myocardial Infarction
Authors: KONECKE LEE L. , KNOEBEL SUZANNE B. 
Published: June 2012

Twenty-one instances of nonparoxysmal junctional tachycardia (NPJT) were observed in 203 consecutive patients with acute myocardial infarction. The arrhythmia complicated both anterior and inferior wall infarction and was associated with an ominous prognosis, particularly in patients with anteror wall infarction.
The NPJT is probably a manifestation of the severity of the lesion. The exact mechanisms of the enhanced A-V junctional activity remain obscure. The possible role of increased levels of epinephrine and norepinephrine and localized increases of potassium in the A-V junction from adjacent necrotic myocardium is suggested.
Blood-Gas Changes and Pulmonary Hemodynamics following Acute Myocardial Infarction
Authors: FILLMORE SIDNEY J. , GUIMARÃES ARMENIO C. , SCHEIDT STEPHEN S. , KILLIP THOMAS 
Published: June 2012

Arterial and mixed venous oxygen tensions were measured in 24 patients following acute myocardial infarction while they were breathing air and 100% oxygen. Total venous admixture and the right-to-left shunt during 100% oxygen breathing were calculated. These data were related to the pulmonary arterial diastolic pressure, the cardiac index, and the central blood volume.
Patients with myocardial infarction that was not complicated by congestive failure had blood gases, pulmonary shunts, and pulmonary arterial diastolic pressures comparable to control patients who were at rest in bed.
When congestive failure complicated myocardial infarction, arterial blood oxygen tension was lower, pulmonary shunting was increased, and the pulmonary arterial diastolic pressure was elevated. Cardiac index and central blood volume were usually normal.
The present data quantitate the contribution of anatomic shunting to the hypoxemia observed in myocardial infarction. Hypoxemia and increased anatomic shunting are closely correlated to the degree of elevation of pulmonary arterial diastolic pressure. The interrelationships of arterial hypoxemia, venous admixture, arterial-alveolar oxygen gradient, and pulmonary arterial diastolic pressure suggest that pulmonary venous congestion is an important determinant of the hypoxemia and shunting observed in patients with acute myocardial infarction.
Arrhythmias following Cardiac Valve Replacement
Authors: SMITH ROGER , GROSSMAN WILLIAM , JOHNSON LEWIS , SEGAL HERMAN , COLLINS JOHN , DALEN JAMES 
Published: June 2012

A prospective study of 50 consecutive patients undergoing cardiac valve replacement was designed to determine the incidence, types, and predisposing factors to postoperative arrhythmias. Patients were monitored continuously for the first 7 days following surgery.
Thirty-seven patients (74%) experienced a total of 66 episodes of arrhythmia. Supra-ventricualr arrhythmias were the most common (43 of 66; 65%). The most frequent specific arrhythmia was atrial fibrillation (21 of 66; 32%). Arrhythmias occurred 77% of the time within the first 48 hours of surgery.
Of 25 factors evaluated preoperatively in each patient, only two were found to predispose to postoperative arrhythmias. These were: (1) previous cardiac surgery; and (2) elevated blood urea nitrogen.
There were four hospital deaths, representinig a hospital mortality of 8%. No deaths were due to a primary arrhythmia.
It is concluded that whereas arrhythmias are a very common complication of cardiac valve replacement, early detection and treatment has lessened their significance as a cause of postoperative mortality and morbidity.
Preexcitation and Tachycardias in Wolff-Parkinson-White Syndrome, Type B
Authors: LISTER JOHN W. , WORTHINGTON FRANCIS X. , GENTSCH THOMAS O. , SWENSON JOHN A. , NATHAN DAVID A. , GOSSELIN ARTHUR J. 
Published: June 2012

Electrophysiologic events in a 52-year-old man with Wolff-Parkinson-White (W-P-W) syndrome, type B, recurrent supraventricular tachycardias, and coronary artery disease were studied during cardiac catheterization and at open-heart surgery.
During cardiac catheterization reciprocal tachycardias were repeatedly initiated by premature atrial beats and terminated by rapid right atrial pacing. Our results confirm that the tachycardia usually seen in the W-P-W syndrome is reciprocal tachycardias with orthograde conduction to the ventricles through the normal atrioventricular conduction system and retrograde conduction to the atria via the Kent bundle.
The epicardial surface of the ventricles was "mapped" at surgery. The earliest site of excitation was the posterior base of the left ventricle near the crux of the heart. Kent bundle conduction was temporarily ablated with lidocaine (Xylocaine) hydrochloride.
This is the first case of W-P-W syndrome, type B, in which the anomalous A-V bundle entered the left ventricle. Our results indicate that the analysis of the electrocardiogram in localizing an abnormal A-V connection cannot be relied upon completely.
Type IV Hyperlipoproteinemia in a Consanguinous Family
Authors: AMIDI MORTEZA 
Published: June 2012

The involvement of all five offspring of consanguinous and hypertriglyceridemic parents (first cousins) is reported.
Three sons and two daughters of this family have increased triglycerides, normal cholesterol, and normal or slightly increased phospholipids. Mother and elder daughter have abnormal glucose tolerance. Father and mother are hypertensive; father had recent development of myocardial infarction and gout. The two elder sons had myocardial infarction and repeated bouts of angina. All three male offspring of this family have gout and are being treated with xanthinoxidase inhibitor (allopurinol). Planar xanthoma was present in one son with myocardial infarction. No chylomicronemia was noted. The response to diet and Atromid-S was satisfactory.
Effects of Treatment on Morbidity in Hypertension
Authors:   VETERANS ADMINISTRATION COOPERATIVE STUDY GROUP ON ANTIHYPERTENSIVE AGENTS
Published: June 2012

Additional data are presented from the Veterans Administration Cooperative Study with respect to the 194 control and 186 treated male patients with initial diastolic blood pressures averaging 90-114 mm Hg. Attack rates and effectiveness of treatment were examined with respect to the following risk factors present at entry: (1) cardiovascular-renal (CVR) abnormalities, the prevalence of which was higher than in the general population of hypertensive patients; (2) diastolic blood pressure; and (3) age. Both attack rates and effectiveness of treatment increased directly with the number of these risk factors present at entry. Age and presence of CVR abnormalities at entry appeared to strongly influence subsequent attack rates, whereas entry level of blood pressure had a relatively smaller effect on attack rates. On the other hand, "effectiveness of treatment" appeared to be most influenced by the initial level of blood pressure. Patients with prerandomization diastolic blood pressure in the range of 90 to 104 mm Hg derived relatively little benefit from treatment unless they had CVR abnormalities at entry or were over 50 years of age. A longer period of follow-up would be needed to assess the value of treatment in the lower risk subgroups.
With respect to side effects, the incidence of mild hypokalemia, hyperuricemia, and elevated fasting blood sugar was significantly higher in the treated group. These and other side effects should be weighed against the benefit to be expected from treating hypertensive patients at low risk.