86. Continuous electrocardiographic monitoring in nocturnal angina

College News (Perkrate@)

on

Occlusion

of

Survival

Following

Coronary

Experimental GEORGE LUMB?

Arteries,

M.D. and LAWRENCX B.

HARDY,

B.A.,

an attack.

‘l‘hc

served

continuous

by

of sleep

Wilmington!

Each

Del. Collateral

circulation

narrowing

was studied following

to occlusion

Adequacy

was

mortem

of coronary

determined

arteriograms

Comparisons animals

pig was chosen, the

produced Thrcae

of

between

pentaerythritol

controls

artery

reIvas

groups

studied.

Survivors

left coronary four days:

(1)

Occlusion

(a) Fifty controls,

showed

artery.

good

5 showed

collaterals

6. no abnormalitirs.

(b) Thirty

(63.37;))

good collaterals

examined

for infarcts:

between

through

survived

gross infarcts,

the

more

7, patchy

treated,

than

fibrosis,

19 survivors

in survivors.

3, gross,

of

12 survivors

when perfused

Eighteen

The

48 hours

plastic constrictors.

left and right circulations

and

distribution

after

by hygroscopic artery.

post-

infarcts.

tetranitratc.

Occlusion

were

in pigs.

rates,

as its coronary

right coronary (2476).

arteries

assessment

made

human.

gradual

by survival

and

were

receiving

sembles

Twenty

3, patchy

were

fibrosis,

14,

no abnormalities. (2)

Occlusion

circumflex

of right

artery.

(12.59’0))

good

examined

for

Sixteen extensive, (3)

(a)

collaterals

Nine

were

Occlusion

hours.

Survivor

Twenty

in survivors.

left

Six

1,

were

gross.

(b)

for

infarcts:

1,

anterior

descending (5’%),

died

in less than

extensive

2 survived

Seven survived

artery. good col-

infarction.

(lo%),

48 (b)

good collaterals

more than 48 hours with

Results

indicate

collateral

gradual

occlusion

with

survival

in Groups

l(b)

vival

difference

there

was a tendency

48 hours. peared

significant

was noted

following

improvement

in

No significant

in Group

3(b),

for prolongation

In all groups between

development

and 2(b).

the extent

to be less in treated

the differences

animals.

the groups

sur-

although

of life beyond

Continuous

Angina,

lenging mrnt.

Perhaps

frequency served

with

problem with

nocturnal in diagnosis,

N. Y.

angina

which

these EGG

present

patients before,

a chaland treat-

is due to the inhave during

been

ob-

and aftcl

pain

of nocturnal

angina.

of increasing

patient

was

instance,

subsided

other

coronar)

awakened

the changes aftrr

1~)

rapidly

sublingual

continuous eye

nitro-

during

after

the oral

bedtime. more

The

effect

administration of

did seem

to prevent

they recurred reduce

the

to

angina

no recognizchlorothiazide

for some

it, Nylidrin”’ of

at the

insufficiency.

had

symptoms,

incidence

cleared

showed

coronary

attacks

despite

at

is considered

ECG

and meralluride

on his angina1

period and

of meperidinr

patient’s

changes

digitalis

attacks

occurs

His nocturnal

second

usual

Though

His

eye movement

apparently

infrequent.

monitoring

variant.”

a rapid

dreaming

elrctrocnceph-

movement

stages of sleep when dreaming

only

to

had and

“Prinzmetal

both

be relatively

able

who

the

most

time.

seemed

both

When

markedl)

nocturnal

and

effort angina in this patient. Case

histories

complexity for

of

of the

these

patients

nocturnal

related

more

angina

studies

during

angina

illustrated

the

syndrome

and

decubitus.

of the

patients

The

circulatory sleep

necessity

physiology

is further

of

emphasized

by these findings. 87. Further Cardiac

Studies

KARL KARLSON,

of Patients

with

JOSHUA LYNFIELD,

Fistulae,

H. BURI+

M.D.,

Coronary-

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

~c.D., R. R. TORRES,

M.D. and A. YAO, New York. additional

arterial

fistulae

chambers patients

cases

of children

communicating

was confirmed The

studies. third

case.

stenosis.

Both

patient,

has

severe

Selective has

demonstrated

arising

from a single

patients

an

with

anomaly

was entirely

unsuspected

fistula

may be masked

complicating through with

an

the right

were

infundibular

connection

(1) The cardiac

the has

diagnosis

and

operated

lesions. chambers

inter-

pulmonary and

aortog-

anomalous

branch

artery

which

right

ventriclr.

made

a

This

clinically. led

to

the

following

of a coronary

in the presence

uncomplicated heart

of the

an extraordinarily

fistulous

conclusions:

Two

angiocardiographic

coronary

patients

coronary

and the diagnosis

angiocardiography

raphy

of our

studied.

clinically,

by selective

aortographic

with

with the right cardiac

have been intensively were diagnosed

Study

pathogenesis

part of the difficulty

by continuous

JANUARY 1964

when

esting

MAURICE LUNGER, M.D. and

In each

(EEG)

occurred

upon.

Monitoring

the

ob-

a night

by at least five minutes

characteristic

patient

presented

for

Electrocardiographic

ARTHUR SHAPIRO, M.D., Brooklyn, Patients

One

alographic

apbeing

episodes

before

and

\v~rr each through

glycerin.

Explanation is presently

several

pain.

reversed,

of infarction

sought.

in Nocturnal

angina1

prcst,ntcd

monitoring

was precrdcd

insufficiency

Three

gross infarctions.

2 patients

of EC:G changes

cardiac

one survivor Nineteen

with

episode

the closely

(43.70/o), good collaterals

showed

treated,

survivors.

extensive, examined

of left

in survivor.

and

2 survivors

patchy fibrosis.

controls,

laterals

artery

controls.

in

5,

7 survivors

7, gross, 1,

(a) Twenty

coronary

Sixteen

infarcts:

treated,

in survivors.

86.

119

(2) fistula

arterial

of additional Although

flop

communi-sting

is from

left to right,