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Characteristic feature of the exercise BCG in coronary artery disease
463
Abstracts and no heart parison with
disease. duration
All these were sorted for comof life, the chi squares being Abnormalities of Mandelbaum.
calculated by Mr. E. ballisto form were most clearly associated with duration of life, the more abnormal the record the shorter the Reduced exercise duration, and chi square equal to 69. tolerance was next, 38. Cardiac enlargement next, with 26. Heart disease compared with no heart disease None of the other was nest with a chi square of 24. measurements was significantly related to duration of It should be noted that ballife by the chi square test. closely related to mortality in our listo amplitude, study of originally healthy persons and with the records normal in form, was not significantly related to it in this study of patients most of whom had abnormal rec\Yhm the ballisto is abnormal in form its ords. amplitude has much less clinical meaning than when the form is normal. EFFEC.TS OF ShlOKlNC AND OF NITROGLYCERINE ON 3 PATIENTS WITII CORONARY HEART DISEASE, AS JUDGED BY
SIMULTANEOUS
RECORDS
RALLISTOCARDIOGRAM
AND
Hanson. M.D., Department University of Pennsylvania,
OF PULSE
ULTRA-LOW
FREQUENCY
DERIVATIVE.
of Therapeutic Philadelphia, Pa.
William Research.
This investigation was prompted by two possible difficulties with the smoking test as used for the detection of incipient coronary heart disease. The test was devised whrn high frequency tables and shin bar instruments were in use, and it has been suggested that when improved ultra-low frequency instruments were used, abnormal reactions to nicotine were not detected. Also. there has been the fear that nicotine, long known to cause tremor of the peripheral muscles in some cases, might be introducing artifacts into the ballistocardiogram which wcrc being intrrprrted as cardiac abnormalities. Though the series is not extensive enough to permit judgment of the frequency of abnormal reactions when one used ultra-low frequency ballistocardiogram, there is no doubt that abnormal reactions to smoking can be dctcctrd by this instrument. Since both ballistocardiogram and pulse derivative are altered: the abnormality seen after smoking cannot be attributed to tremor of periphrral muscles; thr heart is advrsely affected, as has gemrally been belie\-rd. I~H*RACTI%RISTIC: CORONARY
~*TLJRE
ARTERY
Hun Z.WI,I.Jr. . .Johns
DISEASE.
Hopkins
OF
THE
EXERC*SE
A. T&bat and Hospital, Baltimore, S.
wx
IN
IV. k-. Md.
Superficial c xamination I and manual measurements of records sugc-st that subjects with proved uncomplicated coronary artery disease (CAD), have ULF-BCG patterns which differ characteristically from the normal. Other differences occur in exercise. Furthermore, the individual CAD patient shows characteristic changes in form in exercise against his own record at rest, in a way differing from those changes with exercise of normal patients. This latter approach avoids comparing the CAD records with their range of patterns, against the normals with their range of patterns. Specifically, comparing records of a group of 10 proved CAD patients against 10 normal patients with a wide range of ages, the following features characterize the subjects with CAD: (1) Their amplitude in all measured features (peaks and slopes) is considerably less, both before and after exercise. (2) Their G to I amplitude is smaller than appears in the normal range, SEPTEMBER
1962
both before and after exercise. (3) Their H, I and J amplitudes change less with exercise than do those of normal patients. (4) Their respiratory variations are (5) The accentuated less by exercise than in normals. I wave decreases in width at the base by 30 to 50 per cent after exercis?. but in normals only 10 to 20 per ctmt. Comparing an individual CAD patient’s records before and after exercise, the above features all appear. R.ALLISTOCARDIOGRAPHIC ACTIVE
AND
INACTIVE
Di Maw, M.D., House, Irvington,
FINDINGS
IN
RHEUMATIC
and Sidnq N. Y.
CHII.DREN
WITH
Rod@ V. .tl.D., Irvinqton
FEVER.
R. Arbcit,
Ballistocardiographic findings in children with active Corand inactive rheumatic fever were analyzed. relations were made between the number and degrech of ballistocardiographic abnormalities and the presence of valvular involvement. No BCG abnormalities were found when thr rhcumatic process was inactive and there was no valvular involvement. Progressively increasing percentages cf abnormal BCC’s were found when the heart was cnlarqed, or the valves damaged or carditis was prcxscnt. No normal BCG’s were found when valvular invol\,r*I‘,~. t and rheumatic activity were simultanrous. TlIE HIGH BODY
Lenov
EARLY
DIAGNOSIS
FRCQUENCY
OF
MYOCARQIAI.
(ACCELERATION)
BALLISTOCARDIOGR.+PHY.
Hill Hospital,
New York,
INI’kRCTION
HEAD-I;4
K>T
,%‘ahum .J. I1Kcr, N. Y.
R,’
DIR’:<: 1’
.tf. Il.,
Previous reports by the author have strcsscd: (i j The acceleration tracing in direct boLl!; ballistocartiiography may render the qualitative aberrations more readily detectable; (2) the cutoff b&w avrraz;c natural body frequency may advantageously prcclutlc~ its attenuation by lower frequencies: (3) H, -may rc; rvscnt the most significant component r-eflccting orq:nr.ic disease; (4) suspending brcathin:_ in midinspiraticn artefactual clur to may counteract dctrrioration “splanchnic pooling”; (5) thr importance c,f heart sound correlation for accurate wax-c notation. The characteristic alterations found in myocardi; 1 inf.lrction arc: (1) HI- a single small notcll on the ascending limb of J. (2) Bifid dissociation of HI into its HR-HI, components of diminished amplitude. (3, These may mrrqr with the peak of an accrntuated .I,: which brcomcs thr main initial tlownstrokc forming deep sr<:mmtation of .J. (4) J may appear cithc~r hypcr- 01 unaltered in confi,curation, or present hypokinrtic, deep JII-JI, segmentation of diminished amplitudr. A hyperkinetic J in early infarction in the younqcr individual is of particular interest. (5) :\ccvntl.ation of I-l,,. at the apparent expense of H,. Thr present report co\-ers 19 patients ranging from 30 to 78 years of age and from the hyposthcnic to the obese, with particular importance ,qiven to the diagnosis This of myocardial infarction in its rarliest phase. was confirmed simultaneously or subsrqucntly by electrocardiography or other clinical laboratory methods. In 14, the initial electrocardiogram was nonspecific. In 4. the sc‘rum transwith subsequent alteration in 4. In 2, with aminase was the only confirmatory test. negative electrocardiograms and continuing to ambulate, death was sudden within 3 months. Of the 15 who lived, all ballistocardiograms returned to within normal limits, during or shortly after convalescrnce.
Abstracts and no heart parison with
disease. duration
All these were sorted for comof life, the chi squares being Abnormalities of Mandelbaum.
calculated by Mr. E. ballisto form were most clearly associated with duration of life, the more abnormal the record the shorter the Reduced exercise duration, and chi square equal to 69. tolerance was next, 38. Cardiac enlargement next, with 26. Heart disease compared with no heart disease None of the other was nest with a chi square of 24. measurements was significantly related to duration of It should be noted that ballife by the chi square test. closely related to mortality in our listo amplitude, study of originally healthy persons and with the records normal in form, was not significantly related to it in this study of patients most of whom had abnormal rec\Yhm the ballisto is abnormal in form its ords. amplitude has much less clinical meaning than when the form is normal. EFFEC.TS OF ShlOKlNC AND OF NITROGLYCERINE ON 3 PATIENTS WITII CORONARY HEART DISEASE, AS JUDGED BY
SIMULTANEOUS
RECORDS
RALLISTOCARDIOGRAM
AND
Hanson. M.D., Department University of Pennsylvania,
OF PULSE
ULTRA-LOW
FREQUENCY
DERIVATIVE.
of Therapeutic Philadelphia, Pa.
William Research.
This investigation was prompted by two possible difficulties with the smoking test as used for the detection of incipient coronary heart disease. The test was devised whrn high frequency tables and shin bar instruments were in use, and it has been suggested that when improved ultra-low frequency instruments were used, abnormal reactions to nicotine were not detected. Also. there has been the fear that nicotine, long known to cause tremor of the peripheral muscles in some cases, might be introducing artifacts into the ballistocardiogram which wcrc being intrrprrted as cardiac abnormalities. Though the series is not extensive enough to permit judgment of the frequency of abnormal reactions when one used ultra-low frequency ballistocardiogram, there is no doubt that abnormal reactions to smoking can be dctcctrd by this instrument. Since both ballistocardiogram and pulse derivative are altered: the abnormality seen after smoking cannot be attributed to tremor of periphrral muscles; thr heart is advrsely affected, as has gemrally been belie\-rd. I~H*RACTI%RISTIC: CORONARY
~*TLJRE
ARTERY
Hun Z.WI,I.Jr. . .Johns
DISEASE.
Hopkins
OF
THE
EXERC*SE
A. T&bat and Hospital, Baltimore, S.
wx
IN
IV. k-. Md.
Superficial c xamination I and manual measurements of records sugc-st that subjects with proved uncomplicated coronary artery disease (CAD), have ULF-BCG patterns which differ characteristically from the normal. Other differences occur in exercise. Furthermore, the individual CAD patient shows characteristic changes in form in exercise against his own record at rest, in a way differing from those changes with exercise of normal patients. This latter approach avoids comparing the CAD records with their range of patterns, against the normals with their range of patterns. Specifically, comparing records of a group of 10 proved CAD patients against 10 normal patients with a wide range of ages, the following features characterize the subjects with CAD: (1) Their amplitude in all measured features (peaks and slopes) is considerably less, both before and after exercise. (2) Their G to I amplitude is smaller than appears in the normal range, SEPTEMBER
1962
both before and after exercise. (3) Their H, I and J amplitudes change less with exercise than do those of normal patients. (4) Their respiratory variations are (5) The accentuated less by exercise than in normals. I wave decreases in width at the base by 30 to 50 per cent after exercis?. but in normals only 10 to 20 per ctmt. Comparing an individual CAD patient’s records before and after exercise, the above features all appear. R.ALLISTOCARDIOGRAPHIC ACTIVE
AND
INACTIVE
Di Maw, M.D., House, Irvington,
FINDINGS
IN
RHEUMATIC
and Sidnq N. Y.
CHII.DREN
WITH
Rod@ V. .tl.D., Irvinqton
FEVER.
R. Arbcit,
Ballistocardiographic findings in children with active Corand inactive rheumatic fever were analyzed. relations were made between the number and degrech of ballistocardiographic abnormalities and the presence of valvular involvement. No BCG abnormalities were found when thr rhcumatic process was inactive and there was no valvular involvement. Progressively increasing percentages cf abnormal BCC’s were found when the heart was cnlarqed, or the valves damaged or carditis was prcxscnt. No normal BCG’s were found when valvular invol\,r*I‘,~. t and rheumatic activity were simultanrous. TlIE HIGH BODY
Lenov
EARLY
DIAGNOSIS
FRCQUENCY
OF
MYOCARQIAI.
(ACCELERATION)
BALLISTOCARDIOGR.+PHY.
Hill Hospital,
New York,
INI’kRCTION
HEAD-I;4
K>T
,%‘ahum .J. I1Kcr, N. Y.
R,’
DIR’:<: 1’
.tf. Il.,
Previous reports by the author have strcsscd: (i j The acceleration tracing in direct boLl!; ballistocartiiography may render the qualitative aberrations more readily detectable; (2) the cutoff b&w avrraz;c natural body frequency may advantageously prcclutlc~ its attenuation by lower frequencies: (3) H, -may rc; rvscnt the most significant component r-eflccting orq:nr.ic disease; (4) suspending brcathin:_ in midinspiraticn artefactual clur to may counteract dctrrioration “splanchnic pooling”; (5) thr importance c,f heart sound correlation for accurate wax-c notation. The characteristic alterations found in myocardi; 1 inf.lrction arc: (1) HI- a single small notcll on the ascending limb of J. (2) Bifid dissociation of HI into its HR-HI, components of diminished amplitude. (3, These may mrrqr with the peak of an accrntuated .I,: which brcomcs thr main initial tlownstrokc forming deep sr<:mmtation of .J. (4) J may appear cithc~r hypcr- 01 unaltered in confi,curation, or present hypokinrtic, deep JII-JI, segmentation of diminished amplitudr. A hyperkinetic J in early infarction in the younqcr individual is of particular interest. (5) :\ccvntl.ation of I-l,,. at the apparent expense of H,. Thr present report co\-ers 19 patients ranging from 30 to 78 years of age and from the hyposthcnic to the obese, with particular importance ,qiven to the diagnosis This of myocardial infarction in its rarliest phase. was confirmed simultaneously or subsrqucntly by electrocardiography or other clinical laboratory methods. In 14, the initial electrocardiogram was nonspecific. In 4. the sc‘rum transwith subsequent alteration in 4. In 2, with aminase was the only confirmatory test. negative electrocardiograms and continuing to ambulate, death was sudden within 3 months. Of the 15 who lived, all ballistocardiograms returned to within normal limits, during or shortly after convalescrnce.