161. The hemodynamic and metabolic effects of hypothermia and extracorporeal circulation in experimental acute coronary occlusion

142

College

foramen

ovale

dynamic

is practically

and clinical

Failure

to realize

nous fistula

a

mandatory

manifestation that

nant

systemic

*159. Adult

Murmurs

Using

Tape

Murmurs

in the

of Childhood

Recording

F. WEAVER,

WALT

Innocent

Phonocardiog-

M.D. and COLIN H. M.

WALKER, M.D., Denver. With the exception feld et al.

(1962),

childhood

murmurs

One

hundred

female,

56 male)

as children, years

following

patient

to reported

were found

to have

point

intercostal

young

a cardiac

in timing

The tape recorded

play back

lated almost exactly It is concluded

murmur.

of the value

with position,

incidence

the auscultatory

sounds and murmurs viewing

corre-

ejection

mur-

of murmurs

for use in heart

Analysis

heard

technic

in the

accurately

by neck.

reflected

such systems would appear

disease

Caused

is supported

by

screening

programs.

Gram-Negative

Micro-

of 169 Cases, MAX H. WEIL,

HERBERT

SHUBIN, M.D., F.A.C.C.

and

MAJORIE BIDDLE, PH.D.,Los Angeles. Between

1956 and 1960,

Los Angeles

County

by gram-negative the clinical and

frequently infection pelvic tion

course

manifestations

Hospital enteric

was complicated of shock.

in the elderly

to shock

was

at the

In

169

occurred

with a urinary

catheterization

manipulation.

Special

in patients

patients

pressor

agents,

tract

diabetes

was

shock

mellitus.

seemingly

However,

used

in

The

and

Experimental

Acute

was found clinical

effect

vaso-

on mortalit)

beneficial

effects

amounts

conjunction

state

by

were

of corticos-

with

judicious

amine.

The Hemodynamic

Hypothermia

was 82 per

improved

pharmacologic

of vasopressor

and Metabolic

Extracorporeal Coronary

Effects of

Circulation

Occlusion,

in

FRANK

M.

WEISER, M.D., LEONARD REICH, M.D., JACOB ZIMMERMAN, M.D. and BERNARD M. WAGNER. M.D.. New York. Sixty-one groups

animal

designed

performed C.);

ligation

experiments,

to separate

divided

major

by bloodstream

2.

sham

ligation

cooling and

and sham hypothermia; with

subsequent

hypothermia

4. ligation

prolonged

hypothermia

using

blood

ular weight

dextran

parameters

heart

included rate

pressure

(HR),

(MAP),

homologous

3.

and hypo-

rewarming

5. ligation

The

five were

hypothermia;

body temperature;

group

into

variables,

: Group 1. coronary artery ligation followed

in 30 minutes

thermia

predisposi-

with

were

fully stabilize

or other

on

tests, survival

alone was 20 per cent with

but no favorable

when

(24%) most

was

was demonstrated.

caused

by hypotension

Shock

patients

found

patients

in that order. “correctly”

high mortality

with diabetes

of the

(30°

had bacteremia

organisms.

who had urethral

or perineal

692 adult

anti-

chloram-

improved. due to bacteremia

in patients

161.

in patients

to be

administered

A disproportionately

teroids

clammy

was associated

and tetracycline,

were

and that due to bacteremia

observed

characteristic

most effective

proved

the basis of the in vitro sensitivity

cent.

and for a

cold

isolated

The

testing

streptomycin

antibiotics

amounts

findings.

systolic

auscultation

findings,

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

respiration

in the adult and the recent emphasis

this tape recording

organisms:

were all

were vibra-

with the stethoscopic

of arterial

Shock

and at

was readily

They

and oscilloscopic

organism

mortality.

by in vitro

When

a the

were observed.

frequent

the highest

biotics phenicol,

was in the third

that innocent

murs are common

160.

1

They were grade l/6 to 3/6 in inten-

and exercise.

were

subsequently,

with

though

100 patients

and 8.5%

survivors

No cardiac

area or neck in 10%

appropriately

suitable

most

In

those who succumbed.

leucopenia

features;

with

wounds.

anteceded

with shock was Eschuichia coli. Proteus

Mortality

tory in character.

Since

skin and leucocytosis

significantly

sity. varying

the high

(44

The

among

and

adults

left

to mid-systolic

on audio

dry skin clinical

prior

The shock state persisted

period

murmurs

of

hospitalization,

16 or more

the apex in 1 To of the cases. The murmur early

of cases of

patients

characteristically

early

or vascular

of cases.

shock during

event

shorter

in 460/o, in the first or second

in 24%

among

of 2.3 days among

intensity

in the neck

majority

or infected

onset of shock by 16 hours.

space

in the aortic

for the pregcomplication

but the incidence

for an average

of maximal

in 31%,

audible

manipulative

life.

of 170/l 00 mm. Hg. all

catheters

adult

had innocent

experience

(LIS)

The

primarily

those who developed

Warm

evaluation.

had a blood pressure

urinary

of innocent

into

re-examined

initial

indwelling

studies

were found in these patients,

Contrary

LIS

their

Except

unusual

shock was higher in men. admission,

slightly

selected

therefore

an

in women,

to hospital

by Marion-

extended

all of whom

were

abnormalities

The

few follow-up

randomly

occurred

bacterial

report

of the recent have

disease. was

Only one third of the cases of shock occurred

Cardiovascular

(a 16 Year Follow-up

raphy),

this

shock

the age of 35 years.

bacteremia

as cyanotic

form of heart failure.

Innocent

or hepatobiliary

woman,

under

arteriove-

may present

heart disease can cause fatal delay in recognizing correctable

mellitus

hemo-

of the disease.

massive

in the newborn

News

to

and sham

or low molec-

for pump priming. measured

dye-dilution stroke systemic

or calculated cardiac

volume vascular

(SV),

in each

output mean

resistance

(CO). aortic (SVR),

THE AMERICANJOURNAL OF CARDIOLOGY

College left

vc~ntrirular

work

(L\‘W).

pH,

transaminase,

SGP-transaminase,

genasr

electrocardiogram

(LDH),

gram.

All parameters

state.

30 minutes

upon reaching Ligation marked (to

followed

35% S\-.

dynamic

MAP

creased

greatly

quirements, marked in

increase

h1.4P

No or

in-

resulted LDH

total

body

and

CO:

of decreased

was applied. following

and potentially and heart with

a

re-

concomitant

and a moderate

in a relative

ligabene-

oxygen

increase

patients

with Laennec’s

volvement

catheterization.

Organic

Repolarization

myocardial

The myocardial

Coatrsville,

Disease,

year,

which

number

characterized

of structural

Instead

of viewing

of the value

responses

and the administration

drugs such as organic it was possible

nitrates selected

patients

repolarization cardiac

permitted

10 patients

the

lesion. their

and

tartrate,

the abnormal

The

and

T

of 15

not

of a of

a

electrocardiographic

separation T

into two groups: wave

pattern

*164.

Agents

Patients

with

In

was

at

flow

and

The

was

10 patients

on

circulation

the

rate,

rest

and

during

ergometer

by

redosthe

myodefect

&Adrenergic

Hypertension

and after

and

administration agent, were

01

was studied. cardiac

out-

determined

exercise about

8

the influence

pressure,

consumption

and Heart

S\.. Sweden.

hypertension

blocking blood

or

disease

of a peroral

standardized

before

but bc-

Individuals

arterial

intraarterial

oxygen

on

myocardial

metabolic

of

Normal

a P-adrenergic

and

the

and

positive on exercise.

liberated

cardiovascular

put

rest

myocardial

Influence in

with

without

en-

in both groups.

Arterial

subjects

was a

more

both diminished

LARS WERK~? M.D., GGteborg

Disease,

or

cirrhosis.

a myocardial

Hemodynamic

Blocking

was negative TheI,?

both

and became

phosphate

to be present

Heart

vasoactive

were

Apparently

nethalide.

postural

representation

seems

to

the past year were apdisorder

abnormal

were

for such

electrocardiograms

during

of an

appraisal

of certain that

this

blood

of

both at rest and

Laennec’s

on exercise.

was negative

Inorganic

in

related

to exercise,

the electrocardiographic

J.4NU.ARY 1964

factors

and ergotamine

to demonstrate

waves in randomly schizophrenic

studies

could be responsible

On the basis of a clinical

electrocardiographic

psychogenic

aid,

whether

cardium.

collateral

of the patients.

disorder

abnormalities.

since

as a diagnostic

of

electrocardio-

are present

as a repudiation

potential

leads. This cir-

impressive

to determine

the psychiatric

of

by the presence

coronary

oxygen

balances

of one

increased

consumption

blood flow,

on exercise.

with

was

was decreased

redox-potential balance

patients

normal

a

to encounter

disease

paradox

undertaken

Veterans

heart

electrocardiogram

features

it is usual

T waves in multiple

only a minority

structural

came

is particularly

evidences

parenlly

at the Coatesville

large

are

grossly abnormal cumstance

change

The

Hospital,

disproportionately

seeming

exercise. oxygen

Administration grams

MARTIN H. WENKOS, M.D.,

index

Myocardial

posilive

myocardial index

Pa.

In any calendar

more

The

with primar).

Coronary

were positive

were

exercise.

and myocardial

normal.

and pyruvate

glucose,

dehydrogenase,

and pyruvate

the cardiac

insinus

and coronar)

patients

on esercise.

were

cardiac

Demonstrable

that in alcoholic

and

cardiac

dioxide,

lactic

lactate

myo-

of coronary

arterial

oxygen extraction

In

Without

without

carbon

aldolase,

disease,

consumption

in

oxygen,

at rest and normal

exercise.

primary

both at rest and following

myocardial

in effective

Disturbances

\T~~~~~~

dysfunction

by means

dehydrogenase,

zymes.

Patients

Heart

for

malic dehydrogenase,

lactate

cirrhosis

Simultaneous

samples

diminution

with

hepatic

were studied

and became

Ventricular

dys-

JOSE RIBEIIAMA, M.D.,

patients

without

results indicate

perfusion.

Schizophrenic

alcoholic

disease

determined

induced

autonomic

Cardiomyopathies,

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

Chronic

vein

in-

Alcoholic

cardial

isocitrate

possibility

to the associated

it was

Mich.

negative

162.

In

to the level

changes

cardi-

in 5 patients

CLYDE Wr7. M.D. and RAPHAEL RAI.CON. M.D., Detroit,

The hemo-

The

WENDT,

the

in SVR

results

coronary

All

a

*163. E.

1, but less than that observed

with survival

LVW

(175’%).

SGO-transaminase,

hypothermia,

Diminishing

and

arrhythmias

when hypothermia

Moderate

in a

to hypothermia.

acid-base

in group

tion. is compatible ficial.

prior

3, suggesting

tissue necrosis

(35%)

in SVR

of significant

at these temperatures. creased

CO

(group 4) returned and

and

resulted

merely

undescribed

and

synergia.

in LVW/minute

moderately.

electrolyte,

incidence

in group

and

decreased

postligation

dtmonstrable

decrease

increase

measurements

present

at hour intervals

the result of a hitherto

in schizophrenia,

ascribable

of the experiment.

value)

progressive

opathy

in the control

by hypothermia

progressive

of control

marked HR.

postligation,

seemingly

SGO-

dehydro-

and vectorcardio-

were measured

the conclusion

and

pCO*,

lactic

News

at

on a bicycle

one week’s

treat-

ment. The changes

administration

of nethalide

at rest in the normal

tensive

patients,

cardiac

output

during

treatment

heart rate? brachial and left ventricular than

did not cause any

sub,jects.

before.

In the hyper-

arterial

pressure,

work were lower During

the

same