New York Heart Association

Society NEW YORK Heart Committee

Transactions HEART

A~SSOCIATION

of the New York Tuberculosis

and Health Association

The annual scientific meeting of the Scar York Comnrittee on Cardiac Clinms was held at the New York Acatlemp of Medicine in Xew York City on April 2% 1936. The following are abstracts of papers presented or read by title:

The Precordial and

Harry

Lead in Children. L. Jaffe,

X.D.

(Mount

Arthur Sinai

XI. Master, Hoqlital).

31.D.:

Simou

Dack,

M.D.,

ABSTRACT

A preliminary report on chest leads in normal children has been made. Anterior chest leads were studied in seven positions in seventy-one normal children of from two to fifteen years of age. The active electrode was moved across the fourfh or fifth interspace from the right of the sternum to beyond the apex of the heart. The was small, usually inverted and often following data were obtained : The P-wave absent. The Q-wave, alway-s present, varied from ? to 22 mm., increasing as the electrode approached the apex. The R-wave also varied from 2 to 22 mm., but diminished near the apex. Notching and slurring of the QRS were common. The R-T transition was never elevated or depressed over 1 mm. An upright or diphasic T-wave to the left of the sternum, abnormal in adults, occurred in 60 per cent of the children. It was most frequent over the sternum, the incid.ence decreasing as the apex was approached as we11 as with increasing age. No correlation was found between the shape of the heart or axis deviation and the presence of upright T-maves. An upright T-wave in the precordial lead in chiidren is not to be considered a sign of cardiac involvement.

Studies of the Circulation

in Affections

of the Precordium.

M.D., Norman F. Crane, M.D., ant1 John Cornell University Medical College).

R. Dcitrick,

RJD.

Haroll J. Stewart, (Scvv York Hospital,

ABSTRACT

Studies of the circulat,ion bnve been made in patients exhibiting lesions of the pericardium, three sugering from chronic constrictive pericarditis, and a fourth exhibiting recurrent pericardial effusion. Observations were made of cardiac output by the acetylene method (three samples being taken), of arm-to-tongue circulation time (decholin), of venous pressure (direct method), of blood pressure, of heart rate, of cardiac size (x-ray). Electrocardiograms together with electrical axis shifts were also recorded. All observations were made with patients in a basal metabolic state. In those with constrictive pericarditis it was found that the cardiac output was less and the circulation time longer. than in normal individuals; the venous pressure was elevated. The heart was not large in these patients, and the elec trical axis of the electrocardiogram was relatively fixed. In the patient with recurring effusion after removal of the fluid (1,000 cc. to 1,500 C.C. was removed every three to four weeks), edema of the face, dyspnea, pleural 241

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The Effect of Potential Variations of the Distant Electrode Electrocardiogram. (‘harks E. ~GJ~~~I~J~JI, M.D., and Bertha Turk

Vuirersity

(~‘ollegc

of Alerliciue,

Dellr\

ue Hnrpital

Kwler.

z1.D.

(Sew

1.

Transient Ventricular Fibrillation: Its Clinical and Graphic ing Established Auriculoventricular Dissociation. Silltier (Montrtiorc

on the Precordial

Manifestations

Dur-

I-‘. s,~hr\-artz,

Iv 3.

Hospital). ABsTI;.~\C’r

(‘orrelatell olxxwations of tlie elinieal iInN graphic manifestations of syncopal seizures in six patients with A-V dissociation reveal that, a elinieal diagnosis of the cxrrliae mechanism responsil~le for tlww seizures nmy lw made from a knowle~lgc of the following: A. The pretilrrillatory mechanism. Tlris is clmracterizetl ‘1s an awelrration of the basic ventricular rate. This acceleration may he eft’rettvl through (a) a simple and progressive shortening of the interventricular periods ; (1)) a strplike progression of lroth auricles and ventricles; (c) the interposition of a single estrxsystole changing a slower rhythm to a faster one; (tl ,I recurrent short runs of taeliycarllia arising in an eetopic forus of the ventricles an(l alternating with the perio& of heart-lrlock ; (e) a taehyxystolc in which a rapit auricnlar rate keeps pact witli a rapid ventricular rate ; and tinall> (f) the rentricular rate may be incrensetl hy isolated premxturc beats of the wntrieles which would appe:.ir in rapid succession and accelerate the heart before the wrcliar mrehanism reqronsihlr for ryncope set in. H. The postfihril~atory ntechanism which follows the revival of the Ireart. This is cliaractrriztvl by a progressive arcelcration of an intermediarv itliovrntricular rhythm, SO that, if the heart rate following an :tt,txck of synropc is noted to increase in this manner, it is fair to assume that the perio~l of symope wliielt antwe~lwl tllis mechanism was the result of rentrieular fibrillation.

SOCIETY

A Correlative Hospital).

Study

of the Cardiac

TRANSA~!TIONS

Outline.

Bernard

‘t-25

S. Epstein,

M.D.

(Nontefiore

ABSTRACT

The cardiac contour was studied in taent.y-eight post-mortem cases. Observations were made with the heart in situ. Preexutions were taken ‘to reduce cardiac displacement to the minimum. The left horder of the normal heart consists of the arch of the aorta, the pulmonary artery and in some cases, a small portion of the conus pulmonalis, and the left ventricle. The right ventricle appears on the right border only in ewes with marked right ventricular enlargement. The left auricle rarely appears on the left border. The left auricular appendage may he border forming, hut is of little significance. Iln unusual case in which a dilated left auricle appears on the left border of the heart is described. The mode of origin of the pulmonary artery from the corns pulmonalis varies considerably. It is horizontal in the transverse type of heart, and vertical in the “drop” type of heart. Enlargement of the left ventricle may rotate the heart clockwise, thereby deviating an otherwise normal left auricle to the right.