bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increased Sympathetic Nerve Activity Following Resection of Coarctation of the Thoracic Aorta
Authors: GOODALL MCC. , SEALY W. C. 
Published: June 2012

Twenty patients who underwent resection of the thoracic aorta and six patients operated on for hiatial hernia, patent ductus, mitral insufficiency, or A-V fistula were studied to determine whether there was an increase in sympatho-adrenal medullary activity following resection.
Daily 24-hour urine samples were collected from each patient and control, and outputs of noradrenaline (norepinephrine) and adrenaline (epinephrine) were determined. The preoperative outputs were similar in the coarctation group and the controls.
Postoperatively, however, although noradrenaline was elevated in both groups, it was elevated more in the coarctation group and remained elevated for a longer period than in the control subjects. Both the subjects with coarctation and the controls had marked increases in urinary output of adrenaline after operation. In the coarctation arctation group, however, the increase was greater and extended for a longer period.
The mechanism for increase in noradrenaline output seems to be directly related to the baroreceptors. After resection of aorta for coarctation, pressure in the proximal segment of the aorta decreases. The proximal baroreceptors then reduce their inhibitory influence on the bulbar vasomotor centers, and these centers, in order to compensate for the decreased proximal blood pressure, increase sympathetic nerve activity which is reflected by an increased release of noradrenaline.
The Hemodynamic Response to Chronic Anemia
Authors: DUKE MARTIN , ABELMANN WALTER H. 
Published: June 2012

To determine whether the hyperkinetic circulatory response to chronic anemia is obligatory and to assess its strength and potential reversibility, the hemodynamic state at rest was assessed (indicator-dilution method) in 24 patients with chronic anemia before and after certain interventions.
A comparison of cardiac output measured before and after treatment established the consistency of the hyperdynamic response to anemia. In the absence of convalescent data, this response might have been overlooked in some anemic patients whose cardiac output fell within the normal range. In the anemic state, cardiac output correlated negatively and significantly with age (r=-0.752). This relationship may account for the apparent absence of the hyperkinetic circulation in elderly, anemic patients.
In only the most anemic (hemoglobin, 3.8 g/100 ml) of six patients did inhalation of 100% oxygen lower cardiac output significantly.
In four patients, studied in both the supine and sitting posture, orthostatic stress was consistently accompanied by a decrease in central blood volume (7%) and an increase in total systemic resistance (64%), resulting in a reduction of both stroke index (28%) and cardiac index (23%).
Administration of methoxamine to seven anemic patients resulted in increases in mean arterial blood pressure (24%) and total systemic resistance (40%) in all and a decrease in cardiac output in all but one patient (mean, 20%).
Peripheral vasoconstriction induced by means of orthostatic stress or by a pressor amine thus effected an acute reversal of the high output state in chronic anemia. These observations suggest that redistribution of blood volume and vasodilatation play a dominant role in the hyperkinetic circulatory response to chronic anemia and indicate that this state is labile rather than fixed.
The Anatomic Basis for High-Frequency Components in the Electrocardiogram
Authors: FLOWERS NANCY C. , HORAN LEO G. , THOMAS J. R. , TOLLESON WILLIAM J. 
Published: June 2012

In a correlative study between selected body-surface potential recordings and anatomic findings, multilead sets of high-fidelity, high-speed records from 128 persons were studied in connection with the results of our detailed postmortem dissections of their hearts. Attention was focused on high-frequency components (notching and slurring of the expanded QRS) as described by Langner.
We found that (1) groups with ventricular enlargement without scarring were indistinguishable from groups with infarction on the basis of the number of high-frequency components; (2) both of these groups were clearly distinguishable from normal subjects on this basis alone; and (3) the high-frequency component count in the group with ventricular enlargement showed high negative correlation with age and high positive correlation with right and left ventricular weights.
These findings suggest that the appearance of high-frequency components in the vectorcardiogram or electrocardiogram may relate to the struggle between competing generator sites of ventricular enlargement as well as to the classic concept of shattering of the wave of activation on the shoals of infarction.
Hemodynamic Effects of Nitroglycerin, Propranolol, and Their Combination in Coronary Heart Disease
Authors: WIENER LESLIE , DWYER EDWARD M. , COX J. WILLIAM 
Published: June 2012

The hemodynamic effects of 10 mg of propranolol given intravenously (iv) were studied in 10 patients (group I) with coronary heart disease (CHD). These results were compared with the hemodynamic effects in a similar group of the nine (CHD) patients (group II) who were studied after administration of 0.6 mg of nitroglycerin and then after receiving 10 mg of propranolol iv with a second 0.6-mg dose of nitroglycerin. Measurements were obtained at rest and during exercise: before treatment, after nitroglycerin alone, after propranolol alone, and after nitroglycerin-propranolol in combination. Pretreatment exercise showed a 125% increase in mean pulmonary artery pressure (PAP) to 43 mm Hg and a 163% increase in left ventricular end-diastolic pressure (LVEDP) to 29 mm Hg. Nitroglycerin decreased PAP (–45%) and LVEDP (–66%); as did nitroglycerin-propranolol: PAP (–33%) and LVEDP (–38%). Nitroglycerin reduced tension-time index (TTI) –21%, and increased cardiac index (CI) +17%, heart rate (HR) +10%, left ventricular work index (LVWI) +11%, and left ventricular dp/dt (LV dp/dt) +22%. By contrast, nitroglycerin-propranolol reduced LVWI –14%, LV dp/dt –30%, TTI – 15%, and HR – 13% but did not significantly alter CI from pretreatment.
Propranolol increased PAP to 40 mm Hg, did not change LVEDP at 29 mm Hg and decreased stroke index (SI) 16%. Nitroglycerin-propranolol diminished PA and LVED pressure and increased SI 14%. Effects of propranolol alone and of nitroglycerin-propranolol on HR, TTI, and LV dp/dt were not significantly different.
Nitroglycerin-propranolol appears to have important advantages over nitroglycerin or propranolol alone. A reduction in HR, TTI, and LV dp/dt, determinants of myocardial oxygen consumption, concurrent with improved left ventricular function, demonstrates a beneficial synergistic hemodynamic action for nitroglycerin combined with propranolol.
Impaired Maximal Exercise Performance with Hypertensive Cardiovascular Disease
Authors: WONG HEE ONG , KASSER IRWIN S. , BRUCE ROBERT A. , Pettet Gladys , Hofer Verona 
Published: June 2012

Responses to a multistage treadmill test of maximal exercise were studied in 61 hypertensive patients: 13 had uncomplicated hypertension; 15 had associated retinopathy; 22 had left ventricular hypertrophy; and 11 also had coronary heart disease. Because of significant differences with aging normally, and differences in ages of these subgroups, responses were compared with those of normotensive persons matched for age and sex.
With only elevated blood pressure there was no impairment of exercise performance and no increase in S-T segment depression. With ventricular hypertrophy and particularly with retinopathy, maximal exercise duration was shortened. Prevalence of postexertional myocardial ischemia, manifested by S-T segment depression, was increased threefold in those with hypertrophy of the left ventricle.
Even greater impairment of exercise duration, maximal heart rate, and systolic pressure was observed in patients with coronary heart disease and hypertension. Prevalence of S-T segment depression was sevenfold greater.
This ECG manifestation of myocardial ischemia may represent either an augmented contractile force or a significantly restricted coronary blood supply to limit myocardial perfusion. Differences in duration of exercise and circulatory responses, particularly the product of maximal heart rate and maximal systolic pressure/100, indicate these variations in pathophysiological mechanisms.
Double-Outlet Right Ventricle with Transposed Great Arteries and Subpulmonary Ventricular Septal Defect
Authors: HIGHTOWER BILLY M. , BARCIA ALBERTO , BARGERON LIONEL M. , KIRKLIN JOHN W. 
Published: June 2012

The angiocardiographic findings and successful surgical treatment of three patients with double-outlet right ventricle, bilateral conus, transposition of the great arteries, subpulmonary ventricular septal defect, and pulmonary-mitral valve discontinuity are reported. The atria, viscera, and ventricles were normally located, and the aorta originated to the right and anterior to the pulmonary artery.
Surgical repair was accomplished by closure of the ventricular septal defect in such a way that left ventricular outflow was routed via a prosthetic tunnel to the pulmonary artery. Then systemic venous return was transposed intra-atrially by the Mustard technique.
All patients survived complete repair and have continued to improve over a period ranging from several months to 1 year after operation. In one patient complete heart block developed postoperatively, necessitating the insertion of a permanent electronic pacemaker. Details of the method of repair and preoperative studies are presented.
Direct Measurement of Instantaneous Coronary Blood Flow after Total Correction of Anomalous Left Coronary Artery
Authors: REIS ROBERT L. , COHEN LAWRENCE SOREL , MASON DEAN T. 
Published: June 2012

An anomalous left coronary artery was excised from the pulmonary artery and connected by a reversed segment of autogenous saphenous vein to the ascending aorta in a 20-year-old man. Before it was anastomosed to the aorta, retrograde flow of oxygenated blood from coronary artery to pulmonary artery occurred predominantly during diastole; the pressure in the left main coronary artery was 30/15 mm Hg and rose to systemic levels following occlusion of the coronary artery at its junction with the pulmonary artery. After transplantation to the aorta, the vessel was encircled with an electromagnetic flow probe and instantaneous left coronary artery blood flow was measured simultaneously with the pressures in the left ventricle and ascending aorta. The pattern of instantaneous coronary blood flow and its relation to ventricular and aortic pressure were similar to the pattern that has been observed in normal animals. Mean flow through the left coronary artery was 104 ml/min. Following operation, the left ventricular enddiastolic pressure decreased to normal levels and the anastomosis was proved to be patent.
Transplantation of the anomalous coronary artery to the systemic circulation restores normal coronary dynamics and may be preferable to simple ligation.
New Method to Delineate Myocardial Damage at Surgery
Authors: KAISER GERARD A. , WALDO ALBERT L. , HARRIS PAUL D. , BOWMAN FREDERICK O. , HOFFMAN BRIAN F. , MALM JAMES R. 
Published: June 2012

A technique is described for obtaining unipolar and bipolar ventricular electrograms at surgery.
The alterations in the form of the electrogram in various pathologic states are consistent, reliable, and reproducible.
The method has advantages over dye technique for delineating areas of damaged myocardium and has been used in a clinical series of 12 patients undergoing cardiac surgery.
Chronic Cardiac Compression (Chronic Constrictive Pericarditis)
Authors: CHAMBLISS J. R. , JARUSZEWSKI E. J. , BROFMAN B. L. , MARTIN J. F. , FEIL H. 
Published: June 2012

Sixty-one patients with chronic cardiac compression were studied critically, the largest series in the literature. All patients had pericardiectomy performed. The operative mortality was 18 per cent. Satisfactory result was obtained 72.1 per cent of the patients operated. Tuberculosis was the cause in 28.2 per cent. In most of the remaining cases the etiology was obscure. The symptoms, physical signs, and laboratory examinations are reported. The physiologic studies after operation demonstrate improved cardiac filling and emptying.
The importance of diagnosis and the desirability of pericardiectomy are stressed. With antibiotic therapy there is less risk in operating patients with active infection and the compression syndrome.
Cardiac Asthma
Authors: LOMBARDO THOMAS A. , HARRISON TINSLEY R. 
Published: June 2012

Cardiac asthma may be defined as the clinical syndrome induced by acute passive congestion and edema of the lungs. It occurs when the left side of the heart suffers from a sudden disproportion between work load and work capacity. It may result, therefore: (1) from disorders which cause rapid impairment of the myocardium, the load being constant (for example, myocardial infarction); (2) from disorders which suddenly increase the resistance or pressure load (such as paroxysmal hypertension consequent to an adrenal medullary tumor); (3) from disorders which markedly elevate the inflow or venous load without impairing the myocardium (such as strenuous exertion in a person with mitral stenosis); or (4) from a combination of these factors. The most common cause is increased venous return in a recumbent subject with left ventricular strain consequent to hypertension. Of the numerous conditions which may produce increased venous return, nocturnal reabsorption of extracellular fluid from dependent parts is probably the most common. The therapeutic implications are obvious.
Cardiac asthma must be differentiated from the various primary diseases of the lungs which cause paroxysms of wheezing or panting. The differentiation is usually readily made by simple clinical measures; in doubtful instances measurements of circulation time may be of crucial value.
The management of cardiac asthma involves chiefly three therapeutic principles: (1) Control of precipitating factors (and especially treatment of latent edema and control of nocturnal cough); (2) measures aimed at reducing the inflow load (sitting position, morphine, venesection, tourniquets on extremities, positive pressure breathing); (3) attempts to reduce the amount of residual blood in the left ventricle (rapid digitalization, use of oxygen, and aminophyllin).
A severe attack of cardiac asthma associated with rapidly developing pulmonary edema constitutes one of the commonest and gravest of all medical emergencies. There are few conditions in the broad domain of internal medicine in which prompt and energetic therapy, based on an understanding of the mechanism of the disorder, can produce such immediate and gratifying benefit.
Congenital Pulmonary Stenosis Resulting from Dysplasia of Valve
Authors: KORETZKY EMIL D. , MOLLER JAMES H. , KORNS MICHAEL E. , SCHWARTZ COLIN J. , EDWARDS JESSE E. 
Published: June 2012

A distinctive type of pulmonary valvular stenosis, termed "pulmonary valvular dysplasia," is described from six necropsies and 10 living children. The anatomic features of the stenotic pulmonary valve are unique in that there are three distinct cusps and no commissural fusion. The obstructive mechanism is related to markedly thickened, immobile cusps, characterized by the presence of disorganized myxomatous tissue.
Several clinical features tend to distinguish this form of pulmonary stenosis. In each of 16 patients studied, a pulmonary ejection murmur was present, but this was not associated with an ejection click. Other features suggestive of this type of pulmonary stenosis were slow body growth, abnormal facies, and a positive family history of pulmonary stenosis. The electrocardiogram showed a greater degree of right axis deviation than is found in most cases of dome-shaped pulmonary stenosis. Right ventriculography revealed distinctive features of the pulmonary valve which were characterized by lack of typical dome-shaped deformity and by the presence of thick cusps.
Experience with simple incision-valvulotomy was associated with a high (38%) operative mortality and significant residual stenosis in survivors. The suggested operative procedures include excision of a valve cusp, placement of a right ventricular outflow patch, or replacement of the pulmonary valve.
Delayed Onset of Hemolytic Anemia in a Child
Authors: MILLER B. LYNN , PEARSON HOWARD A. , WHEAT MYRON W. , WHITE ALVYN W. , SCHIEBLER GEROLD L. 
Published: June 2012

Severe intravascular hemolysis is described as a complication of implantation of an aortic Starr-Edwards ball-valve prosthesis and insertion of a Teflon patch in the ascending aorta in a 9-year-old boy with severe aortic valvar stenosis. This progressive hemolysis of delayed onset was the sole indicator of extreme degeneration of the silicone rubber ball of the prosthetic aortic valve, a potentially lethal condition requiring surgical intervention. The phonocardiographic signs of aortic ball variance were not present, and there was no overt valvar incompetence.
A lesser but noteworthy aspect in this case was the occurrence of an "aplastic crisis" superimposed on the severe hemolysis. This transient bone marrow, red cell aplasia, which was unrelated to drugs, precipitated an acutely severe anemia which accounted for the presenting symptoms of the patient and required transfusion.
Natural History of Transposition of the Great Arteries
Authors: LIEBMAN JEROME , CULLUM LAWRENCE , BELLOC NEDRA B. 
Published: June 2012

The natural history of transposition of the great arteries between 1957 and 1964 is presented based on a total of 742 cases. The area of study was the State of California and included 290 cases from 14 selected hospital centers. It is clear that in this era of more successful surgery, no such study will ever again be possible.
Of major importance has been a compilation of a life table so that present day cardiologists and surgeons, when evaluating whether surgery should be undertaken in a particular patient, can weigh the risk of the operative procedure against the expected number of years of life remaining if surgery is not done.
For the whole group the age of death was as follows: by 1 week, 28.7%; by 1 month, 51.6%; and by 1 year, 89.3%.
The average life expectancy at birth was 0.65 years; at 1 week of age, 0.87 years; at 1 month, 1.12 years; and at 1 year, 3.92 years.
Associated lesions had a marked effect on prognosis. The life tables presented tell a more complete story, and the pertinent data are presented in detail. (See longer summary at end of paper for further information.)
Electrocardiographic Findings in Cardiac Transplantation
Authors: SCHEUER JAMES , SHAVER JAMES A. , HARRIS BARRY C. , LEONARD JAMES J. , BAHNSON HENRY T. 
Published: June 2012

This paper outlines the electrocardiographic course of a 46-year-old recipient of a cardiac transplant in whom direct myocardial leads were implanted. There was one episode of decreased QRS voltage with an intraventricular conduction delay, suggestive of an acute immunologic rejection. On one occasion bradycardia occurred, and this was treated by ventricular pacing. There was also an episode of supraventricular tachycardia. Vagotonic maneuvers or agents would not have been appropriate treatment for this arrhythmia. In the presence of both donor and recipient P waves, the interpretation of some of the arrhythmias was difficult.
Since the QRS voltage is important in diagnosing early rejection, great care was taken in accurately standardizing the electrocardiogram and in reproducibly placing electrocardiographic leads. The myocardial leads were found to reflect voltage changes more clearly than surface leads. The presence of myocardial wires also proved convenient for pacing. The use of a right atrial recording electrode is recommended for the diagnosis of complex arrhythmias. This will permit more accurate identification of donor and recipient P waves.
Influence of Amyl Nitrite Inhalation on the Systolic Time Intervals in Normal Subjects and in Patients with Ischemic Heart Disease
Authors: SAWAYAMA TOSHITAMI , OCHIAI MASAKAZU , MARUMOTO SUSUMU , MATSUURA TOHRU , NIKI ISAO 
Published: June 2012

The systolic time intervals of the left ventricle in 30 patients with ischemic heart disease but without heart failure were compared with those of 30 normal individuals before and after inhalation of amyl nitrite by using polygraphic recordings.
In the normal subjects, following amyl nitrite, the ejection-time index was significantly prolonged, and the pre-ejection period and its index were significantly reduced, while the ejection time was not significantly shortened. The ischemic heart disease group, however, exhibited no significant changes in the ejection-time index, pre-ejection period, or its index, whereas the ejection time was significantly shortened.
These differences were not related to heart rate or diastolic blood pressure level but may be explained by a postulated lack of increase in stroke volume or in the contractility of the ischemic myocardium, or both, at the maximal effect of amyl nitrite.
The responses of the left ventricular systolic intervals to amyl nitrite may prove useful as a clinical test of latent ventricular functional impairment in subjects with ischemic heart disease.
Coarctation of the Aorta in Infancy
Authors: SINHA SACHCHIDA N. , KARDATZKE MERL L. , COLE ROGER B. , MUSTER ALEXANDER J. , WESSEL HANS U. , PAUL MILTON H. 
Published: June 2012

Material from 78 infants with coarctation and congestive heart failure during the first 6 months of life was reviewed. Three fourths of these infants had combined aortic lesions, that is, coarctation, a narrow constrictive zone of stenosis, and tubular hypoplasia of the transverse arch, a proximal, long, uniformly narrow segment.
It was the purpose of this study (1) to distinguish coarctation of the aorta from tubular hypoplasia by using pathologic and angiographic measurements, (2) to assess the relationship of these two entities and additional shunting cardiac defects with the occurrence of congestive heart failure in infancy, and (3) to evaluate the optimal therapeutic approach for symptomatic infants with coarctation.
It was found that (1) coarctation of the aorta as an isolated anomaly is a relatively uncommon cause of congestive heart failure in infancy. In contrast, coarctation associated with tubular hypoplasia of the transverse arch or with additional cardiac defects is frequently associated with severe congestive heart failure. It was found also (2) that surgical management is far more successful than medical management alone in symptomatic infants with coarctation of the aorta and associated significant cardiac defects.
Urinary Catecholamine Excretion in Myocardial Infarction
Authors: HAYASHI K. DAVID , MOSS ARTHUR J. , YU PAUL N. 
Published: June 2012

The catecholamine excretion rates in urine were studied in three groups of patients with acute myocardial infarction. Group I patients had no complications. Group II patients had minor complications. In groups I and II urine was obtained during the first night of the patient's admission. Group III patients had major complications, and urine was collected during one episode of complications. Catecholamines were measured by spectrophotofluorometric assay using the trihydroxyindole method.
A lack of elevation in basal catecholamine excretion in patients without complications and an elevated catecholamine excretion in those with complications suggest that myocardial necrosis or ischemia per se is not responsible for increased catecholamine excretion and that the increase in catecholamine excretion may reflect the presence of complicating factors.
Recurrent or persisting chest pain, pulmonary congestion or edema, and ventricular arrhythmias were almost always associated with elevated catecholamine excretion. Although in some cases a causal relationship of these complications with observed increase in catecholamine excretion is suggested, further study is required for a definitive conclusion.