The effect of spinal deformities on the heart

The effect of spinal deformities on the heart

862 THE AMER.JCAX HISART ,JOPR?iAL been matle in our knowledge of this discasxuccpt for axis deviation in six instances, thl, c~l~~c~trocarcllog~...

162KB Sizes 1 Downloads 60 Views

862

THE

AMER.JCAX

HISART

,JOPR?iAL

been matle in our knowledge of this discas<,. Ifc (lixeuss:cs the early ideas that prcvailcd among- the workers in the I;nglish schools at the time the author came under the influcr1c.c of Dr. Cheadle. He also discusses tho present conception of the disease, outlining briefly the various factors that contribute to its ineidencc. The main interest in the article centers in the fact that it represents the reflc~tions of one who himself contributed a great deal to the subject and who was constantly in contact with other workers who have played important parts in atlvancing our knowledge of this condition.

Bohning, Anne, and Katz, Louis N.: of Patients With Recent Coronary cal

Electrocardiograms of protracted

Unusual Changes in the Electrocardiograms Occlusion. A. J-. M. SC. 186: 3, 103::.

arc presented of ten patients or transient coronary occlusion

The most sign&ant findings in cases in the form of the S-T segment and the or an inversion. The most significant whether it be in an upward or in a usually show a rapid change in contour Not all curves in recent coronary cases Parkinson and Bedford.

of

having recent

a clinical origin.

history

typi-

of recent coronary occlusion are changes T-wave: either an elevation, a depression fact is that a definite change is present, downward direction. 8uccessivc records in the early stages of coronary occlusion. can be fitted into the T1 and Tz4 types of

Attention is drawn to a large, upright, sharply peaked T-wave whose limbs and shoulders are symmetrical and have their convexity pointing downward and toward each other, associated with an isoelectric or negative S-T interval having a “hump” pointing clown. It is different from the nonspecific, tall T-wave. This large upright T-wave is most commonly found in Leads II and III of the Ti type and is as diagnostic a feature of the coronary occlusion type of curve as the inThe authors have verted cove-shaped T-wave of which it is the inverse image. designated this characteristic as the upright coronary T-vvave.

Edeiken, 186:

Joseph : 99,

The Effect

of Spinal

Deformities

on the Heart.

A.

J. hl.

SC.

1933.

Spinal deformities, especially scoliosis and kyphoscoliosis have a profound cffeet upon the lungs, and the effect upon the heart is probably secondary to the Kinking or twisting of the groat vessels as the result of latter in most cases. displacement of the heart may be responsible for certain cardiac signs and symptoms. Most patients with kyphoscoliosis and severe grades However, of right-sided disturbance of cardiac function. many being restricted in activity because of dyspnea cyanotic and a few show edema of the legs. According patients die of a pulmonary complication. Kyphoscoliosis heart. The shape The of right thorax Pure right-sided. causing cases. area to

causes marked and position

of

changes in the the heart vary

of scoliosis have signs they may live for years, on exertion. Some arc to the literature most

size, shape considerably

and position from case

of to

the cast.

aorta tends to follow the spine in spite of the deformity. In two cases kyphoscoliosis observed postmortem, the aorta coursed directly across the to reach the spine. scoliosis due to organic disease is relatively uncommon and is usually In the lat.ter, the heart is displaced and often rotated to the left, it to appear “mitralized. ” The aortic knob appears very sharp in some Left scoliosis causes the heart to become centrally placed and the aortic appear widened. The aortic diameter, however, is not increased.

Three of the four cases of kyphosis included in this study presented cardiac complaints but there were complicating factors in each case sufficient to account for the symptoms. In pure kyphosis the antcropostcrior transrcrse diameter ratio tends to be greater t.han normal. Two lransrcrsc

cases of lordosis ~liametrr ratio

prcscnt~~~l no cardiac sytllptonis. was smaller than normal in both,

The

antcro~,optrril,t,

b>xuccpt for axis deviation in six instances, thl, c~l~~c~trocarcllog~alIl was normal 20 of 21 cases of spinal deformity. Two of the four abnormal electrocardiograms were in patients with hyperthyroidism and hyljcrtension. The infrequcnc? of axis deviation despite displacement and rotation of the heart is probably du(~ t.o the opposing effects of rotation around longitu(lina1 and nnteropostrrior asp.

in

Nylin, Gustav: Scandinavica,

Clinical Tests of the Supplement 52, 10.13.

The object of this investigation after graduated work, the oxygen pressure and pulse rat?, according

Function

of

the

Heart.

was to Ilctermine brforc consumption, minute voluntc to a preliminary report.

Tbe increase in osygcn consumption as a prrcentage a fixed amount of work on t,hc stairs varies within fairly individuals and is indcprntlcnt of body weight, provided physiological limits.

Arta

and at fixed of the hpart.

hlvrlica

times bloocl

of the resting value aftcI narrow limits in hea1th.v that the latter is within

In dccompensatcII heart tlisc,axc patients anll casts of dccompcnsatcrl hypcrtonia, this increase is consistently greater than in the, healthy casts, so that it seems to be a rcliahle measure of pronounee(1 heart insuficiency, though this is at the same tirnca as the insufficiency yiclglb more doubtful with borclerlinc casts. to treatment, a reduction of the oxygen consumption after work oftctn sets in. In spite of the paucity of the material, the author believes that the function test according to this methotl is of practical value in judging as to the prcsencll or otherwise of hrart insufficiency, especially in cxscs of heart neurosis, hypertonia and obesity. The increase in ventilation after work is a far less reliahlc mra~ur(l nf thcb dceompcnsation than the increase in oxygen consumption. The pulse rate, utilization and standard metabolism, are increased in many decompensated heart disoasc and hypcrtonia cases during rest, hut, on the other hand, the minute volume, the minute rolumc/m? body surface, and the systolic output, are rcducctl. Determinations of these functions of the circulation cannot be used, hnwr,vrr, as a method of functional heart diagnosis, as the ralucs for healthy and dccompensated cases partly overlap. The systolic output/m2 body surface in the considerably re(luced, so that its determination of the functions mcntioncd in paragraph 4.

derompensated is of grcatcr

The utilization, i.e., the oxygen absorption amount of work, returns more quickly to the than in severe decompensation casts.

cases appears to bc importanrc than that

per liter of blood, after resting value in healthy

a flxcd ptsrsons

The return of the systolic blood pressure and pulse rate to the resting value, after a fixed amount of work, is slower in decompensation cases than in healthy Owing to the fact that the distribution of the values for hralthy pcrpersons. sons and decompensation eases partly overlaps, determinations of thcsc functions severally cannot be nscd as measures of hrart insufficiency. The rwnsatrd

return cases.

of

the

T,il,jestrand-Zander’s

product

is

retarllcd

in

the

clcnom-