- Email: [email protected]
Coronary artery disease in women under the age of forty
SELECTED
n 7.5
ABSTRACTS
circulation time, venous pressure, vital capacity, and teleroentgenogram of the chest, were macle. Thirty of this carefully studied group of patients are kno\vn to be still alive, but only b-vent\-seven of the original group of forty-seven w’ere available for comparative study and symptomar it appraisal. Of this number, sixteen have remained asymptomatic, three admitted to mild syniptoms of cardiac failure on careful questioning, and eight presented frank evidences of ntyocardiwl insufficiency such as exertional and/or paroxysmal nocturnal dyspnea. Of the sixteen who :~re asymptomatic, ten are 60 years of age or older, while the remaining six range in age from 4.1 to 59 years. Most of these asymptomatic patients are still working. Of the eight who complained of dyspnea, two are 60 and 71 years of age, respectively, whereas the remainder range in age from 35 to 57 years. In the symptomatic and asymptomatic groups, aortic insufficiency has been known to be present for approximately the same length of time, that is, for five to twelve years, with an average of 7.6 years. Compensation has been restored by treatment with digitalis in nine of the symptomatic group. The symptomatic phase in this group has varied from tao to fourteen years, with an average of 5.6 years. Nine of the total number of surviving patients h.td been in congestive heart failure three to nine years previously and had responded very \vell IO digitalis. All the patients included in this study had received continuous antisyphilitic t hera;~) with bismuth and arsenicals for approximately four years. Abnormal widening of the aorta did not appear to be a factor affecting the prognosis, whereas a low diastolic blood pressure was recorded in only two of those who have survived the five year follow-up period. The intensity of the murmur did not seem to bear any relationship to the ulrimate outcome, since a loud diastolic murmur was frequently heard in those who had remained asymptomatic while the murmur was soft in many who had always been symptomatic. It is the conclusion of the authors that of all the tests available, the circulation time and the diasic,lic. blood pressure probably offer the best index of prognosis in syphilitic acrtic insufficiency. \\‘r,sukt: Melvin.
J. P., Jr.:
Post-partal
Heart
Disease.
Ann.
Int.
Med.
27596
(Oct.j,
IS.
1947.
Four female Negro patients, two of whom were 21 years of age and the other two 31 and 3.! years of age, developed congestive heart failure during the postpartum interval, shortly after the uncomplicated delivery of their respective infants. There was no history of antecedent rheuma t it infection nor syphilis in the entire group and serologic tests were uniformly negative. In cdl cases, the diet appeared to be adequate throughout pregnancy and there were no stigmata of nutritional deficiency which could be detected in the physical examination. Temporary etevat ions of the diastolic blood pressure were noted in all cases during the phase of cardiac decompensati(.n. Ectopic rhythms were not present. The only adventitious cardiac sounds consisted of transient systolic murmurs and protodiastolic gallop rhythms. Teleroentgenograms of the chest in a11 instances revealed definite cardiac enlargement, which disappeared following restoration of cardiac compensation. Low-grade fever was present in one case but the cause for the pyrexia was ne\ er established in spite of repeated blood cultures. In all four instances, uneventful recovery from the congestive heart failure followed bed rest, diuresis, and digitalis, whereas no benefit seemed to result from the administration of concentrates of vitamin B complex. The author considers that the clinical findings in these cases confirm prev-ious concepts that reversible disease of the heart, directly incidental to pregnancy, may be a definite clinical entity.
Underdahl, of Forty.
L. O., and Smith, L. L.: Proc. Staff Meet., Mayo
Coronary Artery Clin. 22:479 (Oct.
Disease in Women 15), 1947.
Under
the
Age
The authors studied the records of 95,000 women under the age of 40 years who were seen during the eleven-year period, 1935 through 1945, and found a total of twenty-seven patients in whom there was no reasonable doubt of the diagnosis of coronary disease. The ratio is, therefore, one case of coronary artery disease in every 3,500 patients. This series included cases of coronary sclerosis with angina pectoris and coronary sclerosis with myocardial infarction. The criteria for diagnosis are the same for coronary disease in women under the age of 40 years as in any other group. In this series, there was only one patient who had diabetes.
676
XMERIC~N
There were seven patients who had questionable infarction. Of these seven the hospital and another died five weeks had coronary sclerosis with angina pectoris. myocardial infarctions, but the diagnosis
HEXKT
JOURNAL
definite myocardial infarction and two others who had patients, two died suddenly while under observation in after returning home. The remaining twenty patients Two of these had a history which suggested previous could not be proved.
Of the twenty-seven patients, only one was under the age of 35 years. Thirteen of the twenty-seven patients had varying degrees of obesity. Seventeen of the patients (63 per cent) had varying degrees of hypertension. Of the five patients who were of normal weight and had infarction, four had hypertension; the fifth had neither obesity, hypertension, nor hyperlipemia. Of fourteen patients who had blood fat determinations, eight showed elevation and six had normal values. The results of this study confirm the age of 40 years is very rare.
previous
impressions
that
coronary
disease
in women
under BELLET.
Lewis,
L. A., and Page phoretic Technique) Renal Hypertension.
I. II.: Changes’ in the Plasma of Patients With Hypertension J. Exper. Med. 86:185 (Aug.),
Protein Pattern and Dogs 1947.
(Tiselius ElectroWith Experimental
Employing the Tiselius electrophoretic technique, the author studied the plasma protein pattern of ten patients with essential hypertension, sixteen patients with malignant hypertension, that of six dogs before and after the development of hypertension induced by wrapping both The sixteen kidneys in silk, and that of three dogs in which the spleen was wrapped in silk. patients with malignant hypertension were classified according to the severity of the disease into mild, moderate, and severe cases. The proteins studied were albumin, alpha, beta, and gamma globulin, and fibrinogen. The plasma portein pattern of the patients with uncomplicated essential hypertension showed only slight variations from the normal. In those with severe malignant hypertension, the fibrinoThese changes were less gen and beta globulin were usually elevated and the albumin increased. In the dogs with experimental hypermarked in less severe cases of malignant hypertension. tension, the gamma globulin level was greatly elevated, and in one dog with the malignant hyperIt is concluded that eletension syndrome, beta globulin and fibrinogen were also increased. vation of beta globulin seems in some manner to be associated with the occurrence of severe vascular disease. MERANZE. Miale,
J. B.: Characteristic Lupus Erythematosus).
Urinary Findings in Visceral Angiitis. Am. J. Clin. Path. 17:820 (Oct.), 1947.
(Periarteritis
Nodosa,
Urinary findings in three cases of visceral angiitis (periarteritis nodosa, lupus erythematosus) are listed. These consist of erythrocytes and erythrocytic casts, waxy casts, fatty casts, broad casts, and “oval fat bodies.” This urinary picture has been described so seldom in acute glomerulonephritis that it is considered presumptive evidence of the presence of visceral angiitis These findings disappear with remission of the disease. in the acute phases. MERASZE. Jones, J. C.: Complications Surg. 16:305 (Aug.), 1947.
of the
Surgery
of Patent
Ductus
Arteriosus.
,J. Thoracic
Jones discusses the types of morbidity and mortality incident to the operative management of sixty-one consecutive patients with patent ductus arteriosus. In none of the patients was there a preoperative bacterial endarteritis. In fifty-three patients the ductus was ligated and in eight it was completely divided and sutured. Two deaths occurred. One occurred during operation when a massive hemorrhage from the ductus necessitated division and suture; cardiac arrest developed and resuscitation was unsuccessful. The second death occurred forty-eight days
n 7.5
ABSTRACTS
circulation time, venous pressure, vital capacity, and teleroentgenogram of the chest, were macle. Thirty of this carefully studied group of patients are kno\vn to be still alive, but only b-vent\-seven of the original group of forty-seven w’ere available for comparative study and symptomar it appraisal. Of this number, sixteen have remained asymptomatic, three admitted to mild syniptoms of cardiac failure on careful questioning, and eight presented frank evidences of ntyocardiwl insufficiency such as exertional and/or paroxysmal nocturnal dyspnea. Of the sixteen who :~re asymptomatic, ten are 60 years of age or older, while the remaining six range in age from 4.1 to 59 years. Most of these asymptomatic patients are still working. Of the eight who complained of dyspnea, two are 60 and 71 years of age, respectively, whereas the remainder range in age from 35 to 57 years. In the symptomatic and asymptomatic groups, aortic insufficiency has been known to be present for approximately the same length of time, that is, for five to twelve years, with an average of 7.6 years. Compensation has been restored by treatment with digitalis in nine of the symptomatic group. The symptomatic phase in this group has varied from tao to fourteen years, with an average of 5.6 years. Nine of the total number of surviving patients h.td been in congestive heart failure three to nine years previously and had responded very \vell IO digitalis. All the patients included in this study had received continuous antisyphilitic t hera;~) with bismuth and arsenicals for approximately four years. Abnormal widening of the aorta did not appear to be a factor affecting the prognosis, whereas a low diastolic blood pressure was recorded in only two of those who have survived the five year follow-up period. The intensity of the murmur did not seem to bear any relationship to the ulrimate outcome, since a loud diastolic murmur was frequently heard in those who had remained asymptomatic while the murmur was soft in many who had always been symptomatic. It is the conclusion of the authors that of all the tests available, the circulation time and the diasic,lic. blood pressure probably offer the best index of prognosis in syphilitic acrtic insufficiency. \\‘r,sukt: Melvin.
J. P., Jr.:
Post-partal
Heart
Disease.
Ann.
Int.
Med.
27596
(Oct.j,
IS.
1947.
Four female Negro patients, two of whom were 21 years of age and the other two 31 and 3.! years of age, developed congestive heart failure during the postpartum interval, shortly after the uncomplicated delivery of their respective infants. There was no history of antecedent rheuma t it infection nor syphilis in the entire group and serologic tests were uniformly negative. In cdl cases, the diet appeared to be adequate throughout pregnancy and there were no stigmata of nutritional deficiency which could be detected in the physical examination. Temporary etevat ions of the diastolic blood pressure were noted in all cases during the phase of cardiac decompensati(.n. Ectopic rhythms were not present. The only adventitious cardiac sounds consisted of transient systolic murmurs and protodiastolic gallop rhythms. Teleroentgenograms of the chest in a11 instances revealed definite cardiac enlargement, which disappeared following restoration of cardiac compensation. Low-grade fever was present in one case but the cause for the pyrexia was ne\ er established in spite of repeated blood cultures. In all four instances, uneventful recovery from the congestive heart failure followed bed rest, diuresis, and digitalis, whereas no benefit seemed to result from the administration of concentrates of vitamin B complex. The author considers that the clinical findings in these cases confirm prev-ious concepts that reversible disease of the heart, directly incidental to pregnancy, may be a definite clinical entity.
Underdahl, of Forty.
L. O., and Smith, L. L.: Proc. Staff Meet., Mayo
Coronary Artery Clin. 22:479 (Oct.
Disease in Women 15), 1947.
Under
the
Age
The authors studied the records of 95,000 women under the age of 40 years who were seen during the eleven-year period, 1935 through 1945, and found a total of twenty-seven patients in whom there was no reasonable doubt of the diagnosis of coronary disease. The ratio is, therefore, one case of coronary artery disease in every 3,500 patients. This series included cases of coronary sclerosis with angina pectoris and coronary sclerosis with myocardial infarction. The criteria for diagnosis are the same for coronary disease in women under the age of 40 years as in any other group. In this series, there was only one patient who had diabetes.
676
XMERIC~N
There were seven patients who had questionable infarction. Of these seven the hospital and another died five weeks had coronary sclerosis with angina pectoris. myocardial infarctions, but the diagnosis
HEXKT
JOURNAL
definite myocardial infarction and two others who had patients, two died suddenly while under observation in after returning home. The remaining twenty patients Two of these had a history which suggested previous could not be proved.
Of the twenty-seven patients, only one was under the age of 35 years. Thirteen of the twenty-seven patients had varying degrees of obesity. Seventeen of the patients (63 per cent) had varying degrees of hypertension. Of the five patients who were of normal weight and had infarction, four had hypertension; the fifth had neither obesity, hypertension, nor hyperlipemia. Of fourteen patients who had blood fat determinations, eight showed elevation and six had normal values. The results of this study confirm the age of 40 years is very rare.
previous
impressions
that
coronary
disease
in women
under BELLET.
Lewis,
L. A., and Page phoretic Technique) Renal Hypertension.
I. II.: Changes’ in the Plasma of Patients With Hypertension J. Exper. Med. 86:185 (Aug.),
Protein Pattern and Dogs 1947.
(Tiselius ElectroWith Experimental
Employing the Tiselius electrophoretic technique, the author studied the plasma protein pattern of ten patients with essential hypertension, sixteen patients with malignant hypertension, that of six dogs before and after the development of hypertension induced by wrapping both The sixteen kidneys in silk, and that of three dogs in which the spleen was wrapped in silk. patients with malignant hypertension were classified according to the severity of the disease into mild, moderate, and severe cases. The proteins studied were albumin, alpha, beta, and gamma globulin, and fibrinogen. The plasma portein pattern of the patients with uncomplicated essential hypertension showed only slight variations from the normal. In those with severe malignant hypertension, the fibrinoThese changes were less gen and beta globulin were usually elevated and the albumin increased. In the dogs with experimental hypermarked in less severe cases of malignant hypertension. tension, the gamma globulin level was greatly elevated, and in one dog with the malignant hyperIt is concluded that eletension syndrome, beta globulin and fibrinogen were also increased. vation of beta globulin seems in some manner to be associated with the occurrence of severe vascular disease. MERANZE. Miale,
J. B.: Characteristic Lupus Erythematosus).
Urinary Findings in Visceral Angiitis. Am. J. Clin. Path. 17:820 (Oct.), 1947.
(Periarteritis
Nodosa,
Urinary findings in three cases of visceral angiitis (periarteritis nodosa, lupus erythematosus) are listed. These consist of erythrocytes and erythrocytic casts, waxy casts, fatty casts, broad casts, and “oval fat bodies.” This urinary picture has been described so seldom in acute glomerulonephritis that it is considered presumptive evidence of the presence of visceral angiitis These findings disappear with remission of the disease. in the acute phases. MERASZE. Jones, J. C.: Complications Surg. 16:305 (Aug.), 1947.
of the
Surgery
of Patent
Ductus
Arteriosus.
,J. Thoracic
Jones discusses the types of morbidity and mortality incident to the operative management of sixty-one consecutive patients with patent ductus arteriosus. In none of the patients was there a preoperative bacterial endarteritis. In fifty-three patients the ductus was ligated and in eight it was completely divided and sutured. Two deaths occurred. One occurred during operation when a massive hemorrhage from the ductus necessitated division and suture; cardiac arrest developed and resuscitation was unsuccessful. The second death occurred forty-eight days