- Email: [email protected]
Certain aspects of syphilitic cardiac disease
AUSTIZACTS
715
9
Treatment depends on the etiology in the particular case. In cases due to coronary disease every endeavor should be made to prevent undue strain on the heart until satisfactory anastomoscs hare had time to form and to supply the The ireatment of a paroxysm is necessary but of myocardium with sufficient blood. less importance than its prevention. Angina is a danger signal, a sign of some harmful activity, and if we make the patient insensitive to his discomforts he will soon kill himself. For this reason surgical treatment wide satisfactory to relieve pain should not be resorted to csccpt in extreme cases.
McEachern, Donald, and Rake, Geoffrey: A Stutly of the Morbid Anatomy of Hearts from Patients Dying with Hyperthyroidism. Hull. Johns Ho11. Hosp. 48:
273,
1931.
This study has been made on all the cases of llvl)ertlt?-roidisrlt coming to autopsy in the Johns Hopkins Hospital since its opening in 18X9. Thirty-seven cases were evidence that hyperthyroidism existed. Ten found in which thrrc was conclusive Twenty-five cases were discarded because tissues or sections were not available. control cases were selected accordiug to age for each of the six decades in which These 150 cases were chosen consecuthe cases of hyperthyroidism were scattered. tively from the autopsy records. Fourteen hearts of the total series showed no changes of the kind or degree not to be- found in the control groups of similar age or which are not well recognized as occurring in general autopsy material in the absence of specific heart disease. In eight instances moderate perivaseular or intermuscular fibrosis or small round cell infiltration was found. Similar changes were also encountered among the control cases though less frequently. Conspicuous alterations were found in five instances; in three of which there was coexistent heart disease. Cardiac hypcrtrophy was noted in 16 of the 07 cases. No relationship could be established between the coincidence of auricular fibriIIation or the duration of hyperthyroidism aud the ultimate findings in the heart. Congestive heart failure occurred in fire of the six cases that presented coexisting organic heart disease. The authors bclierc that from this evidence it is impossible to ascribe the cardiac phenomena to structural ehangcs in the muscle. It is pointed out that the heart from hyperthyroid animals continued to beat whrn isolated at a much faster rate than similar preparations from normal animals. Emphasis is placed on the dcsirability of studying the problem from tlrc xicwpoint OP metabolic and functional alterations in the myocardium.
Carter, Edward P., and Baker, Benjamin Cardiac Disease. Bull. Johns Hopkins
M., Jr.: Hosp. 48:
Aspects of Syphilitic
Certain 315,
1931.
The authors have undertaken a study of the eases of syphilitic aortic disease, aortitis, aortic insufficiency either alone or combined with aneurysm and of aneurysm alone, admitted to the wards of the Johns Hopkins Hospital since 1910 at which time the Wassermann test came into accepted use. They hare completed a detailed analysis of the first 100 cases. This has been supplemented by the pathological findings in those cases that came to autopsy. Their determinations are based chiefly on this series together with certain additional clinical material including statistical figures of the remaining cases of the entire series of 567. They have found the increased incidence of syphilis in colored patients, being about three times more frequent in colored males than in white males. They bclirre that every individual having a syphilitic infection is a potential subject of cardiovascular disease. What constitutes the predisposing factor which determines tile peculiar arterial inversion with the ultimate involvement of the aortic ring or the dcvelopmcnt of an aneurysm is not clearly understood.
:trtcry rw:11ws a similar The question as to why the rorom~ry satisfactorily answered. The Wassermann reaction was positive in an extremely high Latent period from the day of the primary l&on to tile first two extremes jective symptoms was fifteen years and five months; It was and thirty-nine years. Various symptoms are diseusscd. fibrillation was entirely absent in this series of ICIO cases. patients is discussed and an extensive bibliography is included
Raab, W.: sential
Central Hypertension.
In decerebrate obtained:
Vasemotor Arch.
cats
with
the
Irritability. Jnt. Med. vagi
47:
cut,
the
Contribution 727, 1931. following
to
fate
has
not
been
percentage of (‘Rs(‘s. appearance of subbeing three years noted that auricular Treatment of thesc in the article. the
experimental
Problem
results
of Es
were
1. There was a strong increase of the arterial blood pressure for a period np to two hours by the continuous perfusion of the brain stem with blood containing abnormally high amounts of lactic acid. 2. Hyperirritability of the vasomotor centers resulted under the influence of a shortage of oxygen or perfusion with lactic acid, or with the injection of lactic arid into the suboccipital cavity. The inhalation of carbon dioxide causes a considerably greater rise and the hyperventilation a greater fall in blood pressure under these conditions than occur under normal conditions. 3. Sensitive stimuli cause higher rises of blood pressure during the conditions mentioned than they do normally. 4. The effect of epinephrine is considerably weakened and inverted during the lack of oxygen; it is scarcely altered during perfusion with lactic acid. 5. Acetic acid increases the irritability of the vasomotor center in the same way as lactic acid; alkali gives irregular effects. 6. These experimental results correspond to the following characteristic features of essential hypertension : (1) High blood pressure ; (2) hypersensitivity to the inhalation of rarbou dioxide (abnormal incrrase of blood pressure) and to hyperventilation (abnormal fall of blood pressure) ; (3) hypersensitivity to peripheral sensitive stimuli; and (1) weakened or inverted effect of epinephrine. 7. The conclusion was reached that the symptoms of essential hypertension can be considered due to the local need of oxygen and the accumulation of lactic acid within the vasomotor centers of the brain stem as a consequence of local circulatory disturbances. The actual lercl of the blood pressure in hypertension would accordingly be composed of the sum of the stimulus through lactic acid plus the pathologically increased responses to the stimulus of the normal carbon dioxide tension of the blood and of different kiuds of sensitive and emotional stimuli.
David, and Pratt, Essential Hypertension.
Ayman,
Joseph H.: Arch.
Int.
Nature Med.
of the Symptoms 47:
Associated
with
67.5, 1931.
The possibility of a psychic origin for the early symptoms associated with essential hypertension was suggested by the clinical experiments of one of the authors. This idea was further encouraged by an earlier study in which 82 per cent of 40 hypertensive patients were definitely relieved of their symptoms by suggestion. Added support for this opinion was afforded by the widespread belief that as in psychoneuroses, the greater relief from the symptoms of which hypertensive patients complain may be obtained by the removal of worries, fears and other disturbances in the psychic sphere. The cause of this similarity, the problem of the relation of the symptoms presented by hypertensive patients to t,hose observed in the psychoneuroses, seemed worthy of study.
715
9
Treatment depends on the etiology in the particular case. In cases due to coronary disease every endeavor should be made to prevent undue strain on the heart until satisfactory anastomoscs hare had time to form and to supply the The ireatment of a paroxysm is necessary but of myocardium with sufficient blood. less importance than its prevention. Angina is a danger signal, a sign of some harmful activity, and if we make the patient insensitive to his discomforts he will soon kill himself. For this reason surgical treatment wide satisfactory to relieve pain should not be resorted to csccpt in extreme cases.
McEachern, Donald, and Rake, Geoffrey: A Stutly of the Morbid Anatomy of Hearts from Patients Dying with Hyperthyroidism. Hull. Johns Ho11. Hosp. 48:
273,
1931.
This study has been made on all the cases of llvl)ertlt?-roidisrlt coming to autopsy in the Johns Hopkins Hospital since its opening in 18X9. Thirty-seven cases were evidence that hyperthyroidism existed. Ten found in which thrrc was conclusive Twenty-five cases were discarded because tissues or sections were not available. control cases were selected accordiug to age for each of the six decades in which These 150 cases were chosen consecuthe cases of hyperthyroidism were scattered. tively from the autopsy records. Fourteen hearts of the total series showed no changes of the kind or degree not to be- found in the control groups of similar age or which are not well recognized as occurring in general autopsy material in the absence of specific heart disease. In eight instances moderate perivaseular or intermuscular fibrosis or small round cell infiltration was found. Similar changes were also encountered among the control cases though less frequently. Conspicuous alterations were found in five instances; in three of which there was coexistent heart disease. Cardiac hypcrtrophy was noted in 16 of the 07 cases. No relationship could be established between the coincidence of auricular fibriIIation or the duration of hyperthyroidism aud the ultimate findings in the heart. Congestive heart failure occurred in fire of the six cases that presented coexisting organic heart disease. The authors bclierc that from this evidence it is impossible to ascribe the cardiac phenomena to structural ehangcs in the muscle. It is pointed out that the heart from hyperthyroid animals continued to beat whrn isolated at a much faster rate than similar preparations from normal animals. Emphasis is placed on the dcsirability of studying the problem from tlrc xicwpoint OP metabolic and functional alterations in the myocardium.
Carter, Edward P., and Baker, Benjamin Cardiac Disease. Bull. Johns Hopkins
M., Jr.: Hosp. 48:
Aspects of Syphilitic
Certain 315,
1931.
The authors have undertaken a study of the eases of syphilitic aortic disease, aortitis, aortic insufficiency either alone or combined with aneurysm and of aneurysm alone, admitted to the wards of the Johns Hopkins Hospital since 1910 at which time the Wassermann test came into accepted use. They hare completed a detailed analysis of the first 100 cases. This has been supplemented by the pathological findings in those cases that came to autopsy. Their determinations are based chiefly on this series together with certain additional clinical material including statistical figures of the remaining cases of the entire series of 567. They have found the increased incidence of syphilis in colored patients, being about three times more frequent in colored males than in white males. They bclirre that every individual having a syphilitic infection is a potential subject of cardiovascular disease. What constitutes the predisposing factor which determines tile peculiar arterial inversion with the ultimate involvement of the aortic ring or the dcvelopmcnt of an aneurysm is not clearly understood.
:trtcry rw:11ws a similar The question as to why the rorom~ry satisfactorily answered. The Wassermann reaction was positive in an extremely high Latent period from the day of the primary l&on to tile first two extremes jective symptoms was fifteen years and five months; It was and thirty-nine years. Various symptoms are diseusscd. fibrillation was entirely absent in this series of ICIO cases. patients is discussed and an extensive bibliography is included
Raab, W.: sential
Central Hypertension.
In decerebrate obtained:
Vasemotor Arch.
cats
with
the
Irritability. Jnt. Med. vagi
47:
cut,
the
Contribution 727, 1931. following
to
fate
has
not
been
percentage of (‘Rs(‘s. appearance of subbeing three years noted that auricular Treatment of thesc in the article. the
experimental
Problem
results
of Es
were
1. There was a strong increase of the arterial blood pressure for a period np to two hours by the continuous perfusion of the brain stem with blood containing abnormally high amounts of lactic acid. 2. Hyperirritability of the vasomotor centers resulted under the influence of a shortage of oxygen or perfusion with lactic acid, or with the injection of lactic arid into the suboccipital cavity. The inhalation of carbon dioxide causes a considerably greater rise and the hyperventilation a greater fall in blood pressure under these conditions than occur under normal conditions. 3. Sensitive stimuli cause higher rises of blood pressure during the conditions mentioned than they do normally. 4. The effect of epinephrine is considerably weakened and inverted during the lack of oxygen; it is scarcely altered during perfusion with lactic acid. 5. Acetic acid increases the irritability of the vasomotor center in the same way as lactic acid; alkali gives irregular effects. 6. These experimental results correspond to the following characteristic features of essential hypertension : (1) High blood pressure ; (2) hypersensitivity to the inhalation of rarbou dioxide (abnormal incrrase of blood pressure) and to hyperventilation (abnormal fall of blood pressure) ; (3) hypersensitivity to peripheral sensitive stimuli; and (1) weakened or inverted effect of epinephrine. 7. The conclusion was reached that the symptoms of essential hypertension can be considered due to the local need of oxygen and the accumulation of lactic acid within the vasomotor centers of the brain stem as a consequence of local circulatory disturbances. The actual lercl of the blood pressure in hypertension would accordingly be composed of the sum of the stimulus through lactic acid plus the pathologically increased responses to the stimulus of the normal carbon dioxide tension of the blood and of different kiuds of sensitive and emotional stimuli.
David, and Pratt, Essential Hypertension.
Ayman,
Joseph H.: Arch.
Int.
Nature Med.
of the Symptoms 47:
Associated
with
67.5, 1931.
The possibility of a psychic origin for the early symptoms associated with essential hypertension was suggested by the clinical experiments of one of the authors. This idea was further encouraged by an earlier study in which 82 per cent of 40 hypertensive patients were definitely relieved of their symptoms by suggestion. Added support for this opinion was afforded by the widespread belief that as in psychoneuroses, the greater relief from the symptoms of which hypertensive patients complain may be obtained by the removal of worries, fears and other disturbances in the psychic sphere. The cause of this similarity, the problem of the relation of the symptoms presented by hypertensive patients to t,hose observed in the psychoneuroses, seemed worthy of study.