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Studies on the velocity of blood flow. XIII. The circulatory response to thyrotoxicosis
297
ABSTRACTS
the
The administration potassium content
of potassium of the muscle.
&basic
phosphate
was
followed
by
a rise
in
Blumgart, Herrman on the Velocity Comparison J. Clin. Invest.
I.,.; Gargill, Samuel L.; and Gilligan, Dorothy Rourke: StUdieS of Blood Flow. XIV. The Cfrculation in Myxedema with a of the Velocity of Blood Flow in Myxedema and Thyrot.@xicosis. 9: 91, 1930.
Sixteen series of measurements were made in 7 patients with myxedema in order to correlate the clinical manifestations with changes in the velocity of blood flow, ven.ous and arterial pressures, basal metabolic rate, pulse rate, plasma volume, respiratory minute volume and vital capacity of the lungs. In each patient measurements when the basal metabolic rate was low were compared with subsequent measurements when the basal metabolic rate had been elevated to normal by appropriate doses of thyroid gland by mouth. The plasma volume per kilogram of body weight was low and tended to increase on administration of thyroid gland. The pulse rate was low and bore a rough relatiouship to the basal metabolic As the metabolism rose, the pulse rate approached normal. The venous rate. pressure was within the normal limits of normal in all 7 patients. The vital capacity of the lungs was strikingly diminished in all subjects in the absence of any signs of congestive heart failure and did not show significant change The extent of diminution in the vital capacity was not closely following treatment. related to the degree of lowering in the basal metabolic rate. The respiratory minute volume was decreased before treatment and always rose significantly as the basal metabolic rate increased. The velocity of blood flow was strikingly slow in every subject and corresponded closely with the degree to which the metabolic rate was lowered. After taking thyroid gland by mouth, the rise in the metabolic rate and the increase in the velocity of blood flow to normal took place simultaneously and closely paralleled each other. The slowing of blood flow in myxedema was almost as great as that observed in patients with rheumatic valvular heart disease with auricular fibrillation and symptoms and signs of congestive failure. None of the myxedematous patients showed clinical evidences of cardiovascular disease. The great increase in velocity of blood flow and the consequent increased cardiac work that occurs when the basal metabolic rate is raised to normal affords a rational explanation of the clinical manifestations of cardiac insufficiency which occur not infrequently following thyroid gland therapy in myxedema. The changes in the pulse rate, basal metabolic rate and velocity of blood flow in myxedema are compared to those previously reported in thyrotoxicosis. The comparison indicates that the increased velocity of blood flow in thyrotoxicosis results from the increa.sed basal metabolic rate rather than from a specific toxic effect on the heart. The findings emphasize the close interrelation between blood flow and metabolism and throw additional light on the degree, manner, and results of changes in the circulation associated with increased and decreased metabolic rates.
Blnmgart, Herrman L., Gargill, Samuel L., and Gilligan, Dorothy Ronrke: Stud&s on the Velocity of Blood Flow. XIII. The Circulatory Response to Thyrotoxico&.
J. Clin.
Invest.
9:
69, 1930.
Twenty-seven series of measurements thyrotoxieosis in order to correlate the velocity of blood flow through the lungs,
were made in clinical manifestations the basal metabolic
thirteen patients with with changes in the rate, pulse rate, venous
298
THE
AMERI(‘AN
IIEART
JOTJRNAL
and arterial pressures and vital capacity of the lungs. Measurements the basal mctnbolic rate was elevated were compared with subsequent when the rat,c was reduced.
made when measurrmentn
There was a geuernl but inexact relation bet,ween the degree of elevation of the pulse rate and the increase in the basal metabolic rate. No significant deviations ‘from the normal were observed in the venous blood pressure before or after treatment. Diminution in the vital capacity of the lungs was an inconstant finding. With a decrease in the basal met:tbolic rate, the vital capacity of the lungs tended to increase. The velocity of the hlood flow was strikingly increased so that the pulmonary circulation time was the fastest yet rerordtd in man. The increase in velocity of blood flow through the lungs was proportional to the degree of elevation in the basal mctaholir rate. This emphasixcs the strain under which the heart labors in thprotoxicosis. In nine patients with tllyrotoxicosis but without circulatory failure, the basal metabolic rate averaged 33 per cent above the normal, while the velocity of blood flow through the lungs averaged 83 prr cent short the uormal. In 4 thyrotoxic patients with similar basal metabolic rates but with cardiovascular disease, the vrlocity of blood flow was slightly slower. The fact that the latter group of patients experienced dyspncn on slight exertion emphasizes the close interdependence of the circulatory-respiratory-metabolic mecLanism. When the basal metabolic rate was lowered by the administration of compound solution of iodine or by operation, the y-rlocity of blood flow was corrcspoudingl,v slowed.
Morton, John J., and Scott, W. J. Merle: The Measurement of Sympathetic Vasoconstrictor Activity in the Lower Extremities. J. Clin. Invest. 9: 235, 1930. The importance of deciding whcthrr a given peripheral vascular disease is due to vxsospnsm, occlusion of the lumen, or a combination of the two is recognized. Spinal anesthesia is offered as n test which will simplify the differentiation of these elements in the lower extremities. By its use the vasoconstrictor activity can be accurately measured by the rise in tho surface temperature of the feet. The test is simplr, safr, rapid, rind localized to the part under study. Under individuals extremities.
inhalation and offrr
anesthesia a possibility
surface for
temperatures a simplr test
for
show rapid vascular
changes in normal lesions of the upper
Brown, George E.: Observations on the Surface Capillaries in Man Foliowing Cervicothoracic Sympathetic Ganglionectomy. .T. Clin. Invest. 9: 115, 1930. Quantitative studies on the capillaries of the skin of human beings have been Nine made both before and a,fter ceruicothoracic sympathetic ganglionectomy. cases of advanced Raynnud’s disease, four eases of rasomator forms of scleroderma, four cases of primary scleroderma, two cases of thromboangiitis obliterans, and one case of arthritis of the hands hare been studied. The operation did not cause dilatation of the capillaries (the usual physiological effect) in any case. On the contrary, there were consistent narrowing of the dilated atonic capillaries in Rapnaud’s disease and an increase in the number of visible capillaries. This could be explained on the basis of a diminished concentrstion of a theoretical chemical dilator substance in the tissues. Following sympathetic ganglionectomy forms of scleroderma, there was definite The number of open capillaries for
in eight eases of vasomotor and primary reduction in the caliber of the capillaries. each square millimeter of skin increased.
ABSTRACTS
the
The administration potassium content
of potassium of the muscle.
&basic
phosphate
was
followed
by
a rise
in
Blumgart, Herrman on the Velocity Comparison J. Clin. Invest.
I.,.; Gargill, Samuel L.; and Gilligan, Dorothy Rourke: StUdieS of Blood Flow. XIV. The Cfrculation in Myxedema with a of the Velocity of Blood Flow in Myxedema and Thyrot.@xicosis. 9: 91, 1930.
Sixteen series of measurements were made in 7 patients with myxedema in order to correlate the clinical manifestations with changes in the velocity of blood flow, ven.ous and arterial pressures, basal metabolic rate, pulse rate, plasma volume, respiratory minute volume and vital capacity of the lungs. In each patient measurements when the basal metabolic rate was low were compared with subsequent measurements when the basal metabolic rate had been elevated to normal by appropriate doses of thyroid gland by mouth. The plasma volume per kilogram of body weight was low and tended to increase on administration of thyroid gland. The pulse rate was low and bore a rough relatiouship to the basal metabolic As the metabolism rose, the pulse rate approached normal. The venous rate. pressure was within the normal limits of normal in all 7 patients. The vital capacity of the lungs was strikingly diminished in all subjects in the absence of any signs of congestive heart failure and did not show significant change The extent of diminution in the vital capacity was not closely following treatment. related to the degree of lowering in the basal metabolic rate. The respiratory minute volume was decreased before treatment and always rose significantly as the basal metabolic rate increased. The velocity of blood flow was strikingly slow in every subject and corresponded closely with the degree to which the metabolic rate was lowered. After taking thyroid gland by mouth, the rise in the metabolic rate and the increase in the velocity of blood flow to normal took place simultaneously and closely paralleled each other. The slowing of blood flow in myxedema was almost as great as that observed in patients with rheumatic valvular heart disease with auricular fibrillation and symptoms and signs of congestive failure. None of the myxedematous patients showed clinical evidences of cardiovascular disease. The great increase in velocity of blood flow and the consequent increased cardiac work that occurs when the basal metabolic rate is raised to normal affords a rational explanation of the clinical manifestations of cardiac insufficiency which occur not infrequently following thyroid gland therapy in myxedema. The changes in the pulse rate, basal metabolic rate and velocity of blood flow in myxedema are compared to those previously reported in thyrotoxicosis. The comparison indicates that the increased velocity of blood flow in thyrotoxicosis results from the increa.sed basal metabolic rate rather than from a specific toxic effect on the heart. The findings emphasize the close interrelation between blood flow and metabolism and throw additional light on the degree, manner, and results of changes in the circulation associated with increased and decreased metabolic rates.
Blnmgart, Herrman L., Gargill, Samuel L., and Gilligan, Dorothy Ronrke: Stud&s on the Velocity of Blood Flow. XIII. The Circulatory Response to Thyrotoxico&.
J. Clin.
Invest.
9:
69, 1930.
Twenty-seven series of measurements thyrotoxieosis in order to correlate the velocity of blood flow through the lungs,
were made in clinical manifestations the basal metabolic
thirteen patients with with changes in the rate, pulse rate, venous
298
THE
AMERI(‘AN
IIEART
JOTJRNAL
and arterial pressures and vital capacity of the lungs. Measurements the basal mctnbolic rate was elevated were compared with subsequent when the rat,c was reduced.
made when measurrmentn
There was a geuernl but inexact relation bet,ween the degree of elevation of the pulse rate and the increase in the basal metabolic rate. No significant deviations ‘from the normal were observed in the venous blood pressure before or after treatment. Diminution in the vital capacity of the lungs was an inconstant finding. With a decrease in the basal met:tbolic rate, the vital capacity of the lungs tended to increase. The velocity of the hlood flow was strikingly increased so that the pulmonary circulation time was the fastest yet rerordtd in man. The increase in velocity of blood flow through the lungs was proportional to the degree of elevation in the basal mctaholir rate. This emphasixcs the strain under which the heart labors in thprotoxicosis. In nine patients with tllyrotoxicosis but without circulatory failure, the basal metabolic rate averaged 33 per cent above the normal, while the velocity of blood flow through the lungs averaged 83 prr cent short the uormal. In 4 thyrotoxic patients with similar basal metabolic rates but with cardiovascular disease, the vrlocity of blood flow was slightly slower. The fact that the latter group of patients experienced dyspncn on slight exertion emphasizes the close interdependence of the circulatory-respiratory-metabolic mecLanism. When the basal metabolic rate was lowered by the administration of compound solution of iodine or by operation, the y-rlocity of blood flow was corrcspoudingl,v slowed.
Morton, John J., and Scott, W. J. Merle: The Measurement of Sympathetic Vasoconstrictor Activity in the Lower Extremities. J. Clin. Invest. 9: 235, 1930. The importance of deciding whcthrr a given peripheral vascular disease is due to vxsospnsm, occlusion of the lumen, or a combination of the two is recognized. Spinal anesthesia is offered as n test which will simplify the differentiation of these elements in the lower extremities. By its use the vasoconstrictor activity can be accurately measured by the rise in tho surface temperature of the feet. The test is simplr, safr, rapid, rind localized to the part under study. Under individuals extremities.
inhalation and offrr
anesthesia a possibility
surface for
temperatures a simplr test
for
show rapid vascular
changes in normal lesions of the upper
Brown, George E.: Observations on the Surface Capillaries in Man Foliowing Cervicothoracic Sympathetic Ganglionectomy. .T. Clin. Invest. 9: 115, 1930. Quantitative studies on the capillaries of the skin of human beings have been Nine made both before and a,fter ceruicothoracic sympathetic ganglionectomy. cases of advanced Raynnud’s disease, four eases of rasomator forms of scleroderma, four cases of primary scleroderma, two cases of thromboangiitis obliterans, and one case of arthritis of the hands hare been studied. The operation did not cause dilatation of the capillaries (the usual physiological effect) in any case. On the contrary, there were consistent narrowing of the dilated atonic capillaries in Rapnaud’s disease and an increase in the number of visible capillaries. This could be explained on the basis of a diminished concentrstion of a theoretical chemical dilator substance in the tissues. Following sympathetic ganglionectomy forms of scleroderma, there was definite The number of open capillaries for
in eight eases of vasomotor and primary reduction in the caliber of the capillaries. each square millimeter of skin increased.