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Childhood mortality from rheumatic fever and heart diseases
SELECTED Gold,
H., Modell, W., Kwit, N. J., Comparison and Otto, H. L.: Intravenous Injection in Man.
307
ABSTRACTS
Shanc, S. J., Dayrit, C., Kramer, M. L., Zahm, of Ouabain With Strophanthidin-3-Acetate & Exper. Therap. 94:39 (Sept.), J. Ph armacol.
W., by 1948
One milligram of strophanthidin+acetate (one of the synthetic esters of strophanthidin) and 0.5 mg. ouabain were diluted to 10 cc. and administered intravenously to patients with auricular fibrillation and clinical evidence of congestive heart failure. Each patient was given both drugs at different times so that individual variations in response could be controlled. None of the eight patients studied had received any digitalis compounds for at least three weeks prior to the test. Slowing of the ventricular rate was used as an objective sign of digitalization. Both drugs showed rapid effects. With strophanthidin-3-acetate, 70 per cent of the maximum ventricular slowing was seen within five minutes and the maximum slowing occurred within ten minutes. The ventricular rate returned to its preinjection level in four hours or less. With ouabain, 50 per cent of the maximum slowing was evident within ten minutes and the maximum effect occurred within one to two hours. The ventricular rate did not return to its preinjection level for thirty-six hours. No toxic effects were noted with either drug. There was improvement in the clinical picture coincident with the slowing of the ventricular rate. The transitory, extremely rapid, and moderately short duration of action of strophanthidin -3-acetate suggests that it might be of therapeutic value in acute cardiac emergencies, such as paroxysmal pulmonary edema, and in some of the paroxysmal tachycardias. Its relatively short duration of action would decrease the danger of prolonged toxic reactions in patients receiving digitalis compounds. GODFREY. Donovan,
G. E.:
Modern
Phonocardiography.
Lancet
6524:401
(Sept.
ll),
1948.
The modern practice is to record the heart sounds linearly, stethoscopically, or logarithmically. The author describes a phonoelectrocardioscope which permits the direct, instantaneous, simultaneous, and constant viewing of a pair of cardiac phenomena such as the phonocardiogram and electrocardiogram. The phonocardiogram represents amplified heart sounds recorded logarithmically. The instrument consists of a double-channel electronic valve amplifying unit with frequency control, intensity control, tone-compensated volume control, a double-beam cathode ray oscilloscope, and a long-persistent fluorescent screen. If permanent records are desired, photographs can be taken of one traverse of the cathode-ray spots on the screen. Several still photographs of the fluorescent screen are demonstrated as examples. The author suggests that many of the inaudible vibrations which can be recorded (such as the four components to the first and second heart sounds) may eventually prove to have almoit as much clinical significance as have the cardiac sounds and murmurs. WAGNER. Wolff,
G.: Bureau
Childhood Mortality Pub. 322, Washington,
From Rheumatic D. C., 1948.
Fever
and
Heart
Diseases.
Child.
In a statistical study of death rates in the United States during the years 1939 to 1941, it was found that at least 12,000 deaths were caused by acute rheumatic fever and its sequelae in childhood. Among the nonwhite children with ages ranging from 5 to 19 years, there were 16.6 deaths reported per 100,000 population; among white children the death rate was 11.1 per 100,000. With increasing age in both sexes and racial groups, there was a distinct increase in the death rate for rheumatic heart disease. The nonwhite group consistently had a higher mortality rate than the white group. This suggests that adverse social and economic conditions are important factors. When analyzed by geographic divisions, these race differences were most significant in the Middle Atlantic States, but in the Mountain State division, higher death rates were observed for white children, as compared with nonwhite children. No consistent sex differences in mortality rates were seen, except in the group between the ages of IS to 19 years. In this age group the nonwhite females showed a distinctly higher rate than nonwhite males, while in the white group the rate for females was lower than for males.
308
AMERICAN
In general, the mortality Pacific Coast States. In the children in all age groups.
HEAHT
JOURNAL
rate is highest in the Middle Atlantic States Mountain Division, the rate was exceptionally
and high
lowest iu the for the white
The range of the crude rate for mortality from acute rheumatic fever plus diseases of the heart ranged from 5.3 in Vermont to 22.4 in Utah; the average for the United States was 11.7 per 100,000. WAIFE. Luisada, Left
A., and Ventricle
Twenty patients cardiography. The oblique positions.
Fleischner, in Myocardial
F.
G.: Studies Infarction.
of Fluorocardiography: Acta cardiol. 308 (No.
with old or recent myocardial infarctions were studied graphic study was made in the posteroanterior position
Tracings 4), 1948.
of the
by means of fluoroand in both anterior
Several abnormalies of ventricular systole and diastole were recognized. Among these, lack of pulsation and inverted pulsation (paradoxical pulsation) in a circumscribed area were considered as the most significant findings, the former, pointing to an area of “local paralysis”: the latter, to a “dynamic aneurysm” of the ventricular wall. Evaluations of the dynamic results of such abnormalities are given. The reasons for suggesting the two new terms are discussed. Correlation of the findings with electrocardiographic per cent. In general, the area presenting an abnormality extensive than indicated by the electrocardiogram. The findings confirm those of previous greater exactitude and broader applicability kymography are given.
data revealed a coincidence of contraction was found
roentgenkymographic of fluorocardiography
of about 90 to be more
studies. The reasons for a in comparison with roentgenAUTHORS.
Bechgaard, dinav.
I’. : I’aroxysmal 132:9 (No. l), 1948.
Ventrieular
Fibrillation
With
Heeovery.
Acta
med.
Scan-
Twenty-five cases with electrocardiograms showing transient ventricular fibrillation are cited from the literature. All of the patients had severe heart disease, usually with A-V dissociation. ,411 but three died shortly after the fibrillation was recorded. Two patients were able to return to work and the author adds the report of a third instance. A SO-year-old man with a history of rheumatic fever at the age of 28 had fainting fits for several years, then a six-months’ remission, following which he developed nocturnal palpitation and spells of dyspnea with a decreased diurnal exercise tolerance. He then had several fits consisting of sudden disappearance of the pulse, cyanosis, focal convulsions, and hyperpnea, with the return of an irregular pulse which then became regular. ,4n electrocardiogram was normal five days before the attacks, with a P-Q interval of 0.20 second. During two attacks, however, ventricular fibrillation was recorded and in a third the entire electrocardiograph sequence of (1) ventricular flutter-fibrillation for 125 seconds, (2) asystole for 1.4 seconds, (3) A-V dissociation with variable ventricular complexes and an auricular rate of 100 per minute, (4) a prolonged P-Q interval, and (5) a normal tracing six minutes after the attack. Strophanthus, 0.25 mg., was given twice at four-hour intervals with cessation of the attacks during one night. Three attacks occurred the next morning but with another 0.50 mg. of strophanthus, together with digitalis for more prolonged action, no more attacks occurred. There The patient was able to return were no evidences of a cardiac lesion aside from the arrhythmia. to work and an electrocardiogram was normal six months after discharge. He had only one questionable attack in the thirteen months following hospitalization but dropped dead at the end of this period. Necropsy showed slight, nonstenosing coronary grams, but no other abnormalities, gross or microscopic. was therefore unknown.
atheroma The
and a heart which cause of the disturbance
weighed 330 of rhythm SAGEN.
H., Modell, W., Kwit, N. J., Comparison and Otto, H. L.: Intravenous Injection in Man.
307
ABSTRACTS
Shanc, S. J., Dayrit, C., Kramer, M. L., Zahm, of Ouabain With Strophanthidin-3-Acetate & Exper. Therap. 94:39 (Sept.), J. Ph armacol.
W., by 1948
One milligram of strophanthidin+acetate (one of the synthetic esters of strophanthidin) and 0.5 mg. ouabain were diluted to 10 cc. and administered intravenously to patients with auricular fibrillation and clinical evidence of congestive heart failure. Each patient was given both drugs at different times so that individual variations in response could be controlled. None of the eight patients studied had received any digitalis compounds for at least three weeks prior to the test. Slowing of the ventricular rate was used as an objective sign of digitalization. Both drugs showed rapid effects. With strophanthidin-3-acetate, 70 per cent of the maximum ventricular slowing was seen within five minutes and the maximum slowing occurred within ten minutes. The ventricular rate returned to its preinjection level in four hours or less. With ouabain, 50 per cent of the maximum slowing was evident within ten minutes and the maximum effect occurred within one to two hours. The ventricular rate did not return to its preinjection level for thirty-six hours. No toxic effects were noted with either drug. There was improvement in the clinical picture coincident with the slowing of the ventricular rate. The transitory, extremely rapid, and moderately short duration of action of strophanthidin -3-acetate suggests that it might be of therapeutic value in acute cardiac emergencies, such as paroxysmal pulmonary edema, and in some of the paroxysmal tachycardias. Its relatively short duration of action would decrease the danger of prolonged toxic reactions in patients receiving digitalis compounds. GODFREY. Donovan,
G. E.:
Modern
Phonocardiography.
Lancet
6524:401
(Sept.
ll),
1948.
The modern practice is to record the heart sounds linearly, stethoscopically, or logarithmically. The author describes a phonoelectrocardioscope which permits the direct, instantaneous, simultaneous, and constant viewing of a pair of cardiac phenomena such as the phonocardiogram and electrocardiogram. The phonocardiogram represents amplified heart sounds recorded logarithmically. The instrument consists of a double-channel electronic valve amplifying unit with frequency control, intensity control, tone-compensated volume control, a double-beam cathode ray oscilloscope, and a long-persistent fluorescent screen. If permanent records are desired, photographs can be taken of one traverse of the cathode-ray spots on the screen. Several still photographs of the fluorescent screen are demonstrated as examples. The author suggests that many of the inaudible vibrations which can be recorded (such as the four components to the first and second heart sounds) may eventually prove to have almoit as much clinical significance as have the cardiac sounds and murmurs. WAGNER. Wolff,
G.: Bureau
Childhood Mortality Pub. 322, Washington,
From Rheumatic D. C., 1948.
Fever
and
Heart
Diseases.
Child.
In a statistical study of death rates in the United States during the years 1939 to 1941, it was found that at least 12,000 deaths were caused by acute rheumatic fever and its sequelae in childhood. Among the nonwhite children with ages ranging from 5 to 19 years, there were 16.6 deaths reported per 100,000 population; among white children the death rate was 11.1 per 100,000. With increasing age in both sexes and racial groups, there was a distinct increase in the death rate for rheumatic heart disease. The nonwhite group consistently had a higher mortality rate than the white group. This suggests that adverse social and economic conditions are important factors. When analyzed by geographic divisions, these race differences were most significant in the Middle Atlantic States, but in the Mountain State division, higher death rates were observed for white children, as compared with nonwhite children. No consistent sex differences in mortality rates were seen, except in the group between the ages of IS to 19 years. In this age group the nonwhite females showed a distinctly higher rate than nonwhite males, while in the white group the rate for females was lower than for males.
308
AMERICAN
In general, the mortality Pacific Coast States. In the children in all age groups.
HEAHT
JOURNAL
rate is highest in the Middle Atlantic States Mountain Division, the rate was exceptionally
and high
lowest iu the for the white
The range of the crude rate for mortality from acute rheumatic fever plus diseases of the heart ranged from 5.3 in Vermont to 22.4 in Utah; the average for the United States was 11.7 per 100,000. WAIFE. Luisada, Left
A., and Ventricle
Twenty patients cardiography. The oblique positions.
Fleischner, in Myocardial
F.
G.: Studies Infarction.
of Fluorocardiography: Acta cardiol. 308 (No.
with old or recent myocardial infarctions were studied graphic study was made in the posteroanterior position
Tracings 4), 1948.
of the
by means of fluoroand in both anterior
Several abnormalies of ventricular systole and diastole were recognized. Among these, lack of pulsation and inverted pulsation (paradoxical pulsation) in a circumscribed area were considered as the most significant findings, the former, pointing to an area of “local paralysis”: the latter, to a “dynamic aneurysm” of the ventricular wall. Evaluations of the dynamic results of such abnormalities are given. The reasons for suggesting the two new terms are discussed. Correlation of the findings with electrocardiographic per cent. In general, the area presenting an abnormality extensive than indicated by the electrocardiogram. The findings confirm those of previous greater exactitude and broader applicability kymography are given.
data revealed a coincidence of contraction was found
roentgenkymographic of fluorocardiography
of about 90 to be more
studies. The reasons for a in comparison with roentgenAUTHORS.
Bechgaard, dinav.
I’. : I’aroxysmal 132:9 (No. l), 1948.
Ventrieular
Fibrillation
With
Heeovery.
Acta
med.
Scan-
Twenty-five cases with electrocardiograms showing transient ventricular fibrillation are cited from the literature. All of the patients had severe heart disease, usually with A-V dissociation. ,411 but three died shortly after the fibrillation was recorded. Two patients were able to return to work and the author adds the report of a third instance. A SO-year-old man with a history of rheumatic fever at the age of 28 had fainting fits for several years, then a six-months’ remission, following which he developed nocturnal palpitation and spells of dyspnea with a decreased diurnal exercise tolerance. He then had several fits consisting of sudden disappearance of the pulse, cyanosis, focal convulsions, and hyperpnea, with the return of an irregular pulse which then became regular. ,4n electrocardiogram was normal five days before the attacks, with a P-Q interval of 0.20 second. During two attacks, however, ventricular fibrillation was recorded and in a third the entire electrocardiograph sequence of (1) ventricular flutter-fibrillation for 125 seconds, (2) asystole for 1.4 seconds, (3) A-V dissociation with variable ventricular complexes and an auricular rate of 100 per minute, (4) a prolonged P-Q interval, and (5) a normal tracing six minutes after the attack. Strophanthus, 0.25 mg., was given twice at four-hour intervals with cessation of the attacks during one night. Three attacks occurred the next morning but with another 0.50 mg. of strophanthus, together with digitalis for more prolonged action, no more attacks occurred. There The patient was able to return were no evidences of a cardiac lesion aside from the arrhythmia. to work and an electrocardiogram was normal six months after discharge. He had only one questionable attack in the thirteen months following hospitalization but dropped dead at the end of this period. Necropsy showed slight, nonstenosing coronary grams, but no other abnormalities, gross or microscopic. was therefore unknown.
atheroma The
and a heart which cause of the disturbance
weighed 330 of rhythm SAGEN.