128. The Graham-Steell murmur associated with mitral stenosis: An objective evaluation

132

College

proof

of a specific

suggests means

arrhythmia.

.4nalysis

that the electrocardiogram for the clear-cut

dia from

flutter

existence

of such

separation

in certain

cases

a division.

The

systole with block is offered

of the data

does not provide

a

Heart

Variation

and

questions

expiratory

flow rate, helium

term

atria1

the

tachyfor such

in the

The

split

difficulty

second

heart

in perceiving

cardiovascular dominant

the low frequency

vibrations

In contrast,

and sounds occurring

appear

as separate

giving

low frequencies

of band-pass

filters

analyzed

rapidly

isolation

heart

acoustic

disturbances,

of each

sound

possible

of small time intervals.

ear.

The

beat-to-beat changes

too small technic

variation

permitted

and narrowing

individuals

the

precise

and,

cycle.

analysis

cases,

of the

The

with

mechanism

between

of

between

beats

in a

single individual. Function

Patients,

ARTHUR

EDWIN

M.D. and FRANKLIN Fifty-six

WEISS, M.A., HEINZ SIMON, M.D., Newark,

consecutive

studied

prior

in an attempt

postoperative tive

in Elderly

ROTHFELD,

BERNSTEIN,M.D., F.A.c.c.,MAXWELL

NER, M.D., GERALD

cedures

Studies

L.

evaluation

patients

to elective to predict

older general

KLAUSGELBAND,

N. J. than

128.

The

Mitral

65 years

complications.

consisted

of a careful

pro-

prevent

Preoperahistory

and

that in 4 cases with arterial all

In

developed

elderly

patients,

pulmonary and roentgen

pulmonary

complications

procedures.

by

pulmonary

to clinical

to restore

(2)

An

pulmonary

appropriate

attempt

function

to

prior

to

therapy

(3) The pulmonary

Graham-Steell

Stenosis:

RUNCO,

function

and objective

labora-

evaluation

Murmur

An Objective

Associated

Evaluation,

M.D., HUSSEIN VAHABZADEH,

with

VINCENT

M.D., HUGH

S.

LEVIN, M.D. and RICHARD W. BOOTH, M.D., F.A.c.c., Omaha,

Nebr. experience

indicates

mitral

stenosis

aortic

regurgitation

favoring

a

sufficiency however,

artery

of clinical

or isolated

15 patients

findings

consistent

right

mitral

stenosis

heart

evaluated

by:

from

the

a

outflow method

false

valve

distortion.

Aortic

pul-

(1)

intra-

pulmonary tract,

for from

(2)

a

pulmonic

withdrawal

insufficiency

of

to con-

catheterization,

timed

obviates

Objective

with

left

tine-angiographic

induced

has not,

was

ventricular

using

in-

lesion

In addition

phonocardiography and

evidence

Pulmonic

with the diagnosis

insufficiency. and

with have

evaluated.

studied

right

evaluated

murmurs

as a coexisting

valvulography which

regardless

insufficiency

cardiac

most patients

diastolic murmur.

pulmonic

ventional

that

basal

been adequately

relative manic

and

Graham-Steel1

We have

modified

surgical

and possibly

pulmonary

M.D.,

both

of such therapy.

and clinical

Cardiopulmonary

Surgical

and

in

function

tory may aid in the selection

Past

by the

of splitting

of the split varied

in some

as a

separated

to be detected

in the width

in the respiratory

widening

surgery.

In some persons,

roentgen similar

in group

predicting

elective

split

re-

postopera-

pulmonary

surgical

systoles

of the onset

vibrations

in

general values

of the split sound was recorded

intervals

after

optimal

tech-

The

in 15 of the 18 patients

is superior

heart

as two separate

permitting

of two or more isolated

by time human

recorded

(1)

testing

be made

The

and identification

was

each component composite

subjects.

function

should

split second sounds

normal

was

of

were

one or more

value except

evaluation

and amplificathe inscription

of the split second

and eighty-two

sound

measurement

A series

con-

or both.

I and in only 4 of the 18 in group II. No one test was of

Conclusions:

occurring

phonocardiographic

14

However,

tests were abnormal

Of

studies, I) de-

clinical,

findings

postoperatively.

for a series of consecutive

in

preoperative

problems

which de-

function

(group

II) had an uneventful

electrocardiographic groups.

Six pa-

complications

atelectasis

desaturation,

variation

nic. One hundred

decay

18 (group The

of these

pulmonary

oxygen

transients.

this high-frequency

and

arterial

exercise.

the pulmonary

Eighteen

of pneumonia,

tive course.

and

all the preoperative

has

permits

sound was recorded

to surgery.

maining

tests

maximal time, resid-

ratio

and after

to perform

postoperative

sisting

equilibration

capacity

the 50 who completed 36 came

function

capacity,

they were too ill or uncooperative.

events. An instrument

entities.

respiratory

tests because

exceptional

multiple

were

before

will

as discrete

sounds as separate

in

sufficient

vibrations

allowing

127.

oxygen

in quick succession

tion of the high frequencies

second

them

and records

sounds

pre-

resides

based on these observations,

cardiovascular

timed,

may overlap

high-frequency acoustic

the

The

sounds

sounds

blend.

were

closely

phenomena.

rapidly

using

lung

veloped

but

of heart

so that individual

been devised,

M.D. and

demonstrates

separate,

content

Second

N. Y.

sound

acoustic

energy

duration

Split

of vital

ual volume/total saturation

electrocardiogram.

pulmonary

determination

STUART WARREN ROSNER,

Sound,

routine and

including

as a designation

SIMON RODBARD, M.D.,Buffalo,

The

examination,

roentgenogram

tients were unable

Beat-to-Beat

letes

physical chest

of atria1 tachycar-

tracings. *126.

News

technic catheter-

regurgitation

was

by aortic valvulography. evidence

of pulmonic

THE AMERICANJOURNAL

insufficiency

was

OFCARDIOLOGY

College found in only

1 patient.

both intracardiac valvulography. pulmonic tion.

This

Fourteen,

insufficiency,

Inusual

murmur

including

transmission

of

These

studies

one

the

with

mitral

stenosis valve

confirm

the occasional with

hypertension,

regurgitation

but

mitral

in-

existence

stenosis

further

is the usual source

The surgical

American varying

regurgita-

as semilunar

and security

ported

stress

of

and pul-

of the survey

men,

aged

40 to 69, who

was observed

that

aortic

of the basal diastolic

implications

will be discussed.

field showed was

more

Vectorcardiogram

duction,

in

The QRS

conduction,

tients

with

minor

degrees

can

than

and

in our

paroxysmal

presented.

The

experience

QRS

probability

patients

130.

was found

for prevalence

electrocardiograms in

of instances

is nondiagnostic, the

infarction. when

dis-

Myocardial

Tex.

one of the most common

in

instances

is helpful

in

is posterior infarction

is suggested

but is not suspected

the latter instance

the vectorcardiogram

firm myocardial

normalcy.

Illustrative

by the

clinically.

In

will often con-

and

electrocardio-

Emotional

ease:

Survey

of

Occupational F.A.c.c.,

and

12,000

Professional

Island,

scrutiny

stress is an important of coronary a “high 000

fat”

diet.

practice

Questionnaires JANUARY 1964

Heart Men

Disin

I. RUSSEK,

14

M.D.,

N. Y.

was

given

trigger

the

hypothesis

variable

Questionnaires

dentists

and

were

attorneys

or in selected occupational were also forwarded

that

in the etiology subsisting sent

on

to lO,-

engaged

in

specialties.

to 2,000

security

ELIAS

is due

case

presented

compression

One

of our patients association

systolic Cardiac

pressures.

be easily

of

is one who has slight widenductus

heart

missed

before.

for there

of the thoracic

with

may

cardiac

on the impingement

with this The

third

are no cardiac

only by incidental syndrome

arteriosus.

disease

reported

is straightening

of severity

An angio-

the extent

of the great vessels.

had a patent

type may

degrees

marked

with a mild systolic murmur.

has not been

this

with

valve closure.

and kinking

syndrome

that

The short-

and a pulmonic

in delineating

of congenital

appears

no heart disease

classifications.

normal

ing of the heart silhouette The

on x-ray examina-

diameter

with loud pulmonary revealed

a

of the

has an extremely

chest

was striking

described

to a develop-

of the great vessels.

has three

The second type of patient

pendent

SAADI,

diameter

although

corms enlargement

there

T.

spine which causes

by cardiomegaly

anteroposterior

chamber

findings

the diet is

the most recently

disease,

syndrome

catheterization

These

when

Syndrome,

tion and by heart murmurs

pulmonary

rela-

of reported

stress is an important

of the thoracic

It is characterized

x-ray

present

spine

films.

It

in many

manifestations

de-

of the sternovertebral

space. 133.

heart disease in populations

physicians,

general

Coronary

HENRY

Categories,

Staten

Further

Stress

stress.

heart and torsion and/or kinking

ened

rates

of the anteroposterior

The

security

Ohio.

which is discovered

grams are shown. *131.

anomaly

of the

fat.

back syndrome,

findings;

vectorcardiograms

Back

those

heart disease

among

in atherogenesis

of pseudoheart

cardiogram

but not shown in the electrocardiogram,

electrocardiogram

Straight cause

murmur

may be diagnostic

infarction

Straight

most severe

in which the electrocardiogram

posterior

132.

factor

high in animal

M.D., Youngstown,

exists.

M.D. and THOMAS

This is true both when posterior

is suspected and

Austin,

vectorcardiogram

accelerating

mental

WPW)

and occupational

ad-

in each

No consistent

the view that emotional

compression

is suggested.

Posterior

the vectorcardiogram

support

are

of minor

as frequent

tionship

but

cases

times

to analysts.

of rc-

with

practice

Coronary

as compared

have

mechanism

GRETCHEN H. RUNGE,

a number

pa-

which

(incomplete

paroxysmal

M. RUNGE, M.D., F.A.c.c.,

which

Illustrative of the existence

Vectorcardiogram

Infarction,

While

disorders conduction

conduction

with

orders but normal

in

some

in the vectorcardiogram,

of anornalous

in some

accurately

aberrations

mechanism

of aberrant

be demonstrated

more

minor

twice

rates

to increase

two to three for survey.

to

A striking

prevalence

disease

Stock

to North

are subject

stress. General

rates

York

refer

stress.

traders

relatively

displays

electrocardiogram

not in the electrocardiogram. degrees

Con-

Austin,Texas.

vectorcardiogram the

Aberrant

H. RUNGE, M.D. and THOMAS M.

GRETCHEN

RUNCE. M.D.,F.A.c.c.,

than

Occult

for

heart

selected

hypertension 129.

of occupational

coronary

specialists

on the Sew

results

degrees

tendency

analysts

The

vance in occupational

insufficiency

murmur.

the aortic

traders

Exchange.

in one case.

pulmonic monary

b)

and pulmonic

had proven

was misinterpreted

competence

was demonstrated

phonocardiography

133

Ne\vs

by

Acute

Experimental

Pericardotomy,

F.A.c.c.,

Heart

PETER

F.

Failure

Relieved

SALISBURY,

M.D.,

CECIL E. CROSS. M.D. and P. ANDRE RIEBEN,

M.s., Burbank, In about duced

with

stant

and

Calif. 40 dogs, a method

perfused

main coronary

“acute

heart

failure”

that kept cardiac the

separately

artery at low pressure

was pro-

output

con-

cannulated

left

from a reservoir.