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Comparison of simultaneous indirect (auscultatory) and direct (intra-arterial) measurements of arterial pressure in man
SELECTED
evenly to a base to 300 oscillations
line with an amplitude per mnute.
5i:l
ABSTRACTS
of
8 to 10 mm.
and
a frequency
of
131
With progressive asphyxia of the heart, the rate may be lowered to 90 1”‘~ minute. The QR8 complexes are continuous with each other so that the T waver are totally absent. This mechanism may be considered as one of ventricular flutter. The second type consists of irregular oscillations averaging 130 to Nl per minute and varying in amplitude from 3 to 18 mm. in height. They differ in shape, size and form as well as frequency, duration and amplitude from record to record and moment to moment. Periodic waxing and waning of the height of the oscillations may be present and occasionally alternation of the ventricular complexes may be seen. They may persist as long as 6 minutes at one time and as many ah ::(11) periods have been recorded in one patient during 24 hours. Transient ventricular flutter and fibrillation may be ended by a single premature beat of the ventricles, a succession of these, or a run of ventricular taclyartlk A postundulatory pause, however, invariably precedes recovery. The auricles maintain their regular rate and rhythm during ventricular fibrillation except in the longer periods when they may be slowed with an irregular rat(l and at times stand still because of asphyxia. Except for the frequency and duration and its unusual iransient, recurrent and reversible nature associated with profound clinical disturbances, the fibrillary process in man is identical with that in animals. dI;THOK.
Sprague, H. B.: Syphilitic Aortitis With Aortic Regurgitation: An Electrocardiographic and Autopsy Survey at the Massachusetts General Hospital. p. 1W-l. A series of 22 cases of syphilitic aortitis with aortic. regurgitation autopsietl at the Massachusetts General Hospital from 1926 to 1941 has been analyzed with reference to the electrocardiographic findings. The absence of left axis deviation in the electrocardiogram suggests a complication beyond simple aortic dilatation wit11 involvement of aortic cusps and separation of their commissures. Conditions r+ sulting in acute, or chronically mild strain on the left ventricle, or conditions rt’sulting in an additional strain on the right ventricle appear to be largely responsible for the appearance of a normal electrical axis or a right axis deviation. In cases with bundle branch block, high degrees of coronary obstruction may hn present, particularly of the right coronary orifice. Rut in one ease without coronary narrowing, a large aneurysm pressing on and finally perforating into the pulmonary artery was found at autopsy. It is suggested that the electrical axis of the electrocardiogram is of more use than the S-T and T segments in indicating complications of syphilitic aortitis. The results of this study afford another example of the fact that the extent of disease and the presence of complications are often of more importance than an etiologic factor alone in the production of alterations in the electrocardiogram. ii7:THOW.
Steele, J. M.: (Intra-Arterial)
Comparison of Simultaneous Measurements of Arterial
Indirect (Auscultatory) and Direct Pressure in Man. p. 1042.
Concerning the comparison of simultaneous measurements obtained by direct intra-arterial manometry ant1 1,~ intlirect in 39 indivi(luals, it may be sa.id that: Hg. the this
Systolic pressure In the present direct pressure difference.
was underestimated study, the indirect in the radial artery.
in indirert measurement pressure in the brachial This procedure may
of arterial aus{-ultxtory
pressure
techniquta
hy about 10 men. was compared with account for half of
574
AMERICAN
In auscultatory technique curate measure of diastolic estimated diastolic pressure its
The indirect convenience
auscultatory and simplieityi
HEART
JOURNAL
the disappearance of sound proved to be a more acpressure than the sudden muffling. The former overby 8.8 mm. Hg, the latter by I&$ than one. method of estimating arterial pressure is, considering ‘an unusually accurate bedside method. AUTHOR.
Sussman, M. L., and Dack,,S.: The Roentgenkymogram III. Cases With Normal Electrocardiogram. p. 1064.
in Myocardial
Infarction.
A detailed analysis is presented of I8 cases of ,coronary occlusion in which the electrocardiogram returned to normal but ventricular contraction, demon,,/ abnormal strated roentgehkymographically, persist@. This indicates the importance of the latter examination in cases in which symptoms of coronary disease or occlusion are present but other object.ive confirmation ‘is lacking. AUTHORS.
Wechsler, I. S., and Bender, teritis Nodosa. p. 1071.
M. B.:
The Neurological
Manifestations
of Periar-
Seven cases of periarteritis nodosa with neurological manifestations are described. The most characteristic nerve disorder in this disease is involvement of single or multiple peripheral nerves in the extremities. The nerves are usually affected individually and at different times. Signs of central nervous system involvement are also present but are never striking, chiefly because gross lesions of the brain or spinal cord in periarteritis nodosa a,re uncommon. Renal damage and associated arterial hypertension may explain some of the symptoms of brain involvement in periarteritis nodosa. AUTHORS.
White, Paul D., and Blumgart, II. L.: .Cessation of Repeated Pulmonary Infarction and of Congestive Failure After Termination of Auricular Fibrillation by Quinidine Therapy. p. 1095. Dr. B. S. Oppenheimer, in 1922, in his paper on “Results with Quinidine in Heart Disease, ’ ’ described his experience with two patients who, during the course of aurieular fibrillation, had hemiplegia due to emboli. Both, subsequently responded to quinidine by a change to sinus rhythm without suffering from a recurrence of symptoms of embolism, either during or after the treatment. In further development of this same theme, we have herewith reported two patients in whom the administration of quinidine with consequent return to normal rhythm was undertaken despite generally accepted contraindications. This was folwith cessation of pulmonary embolism lowed by abrupt and striking improvement, in Case 1 and of congestive failure in Case 2. In Case 1 the improvement has In Case 2 quinidine was probably life-saving at persisted to the time of writing. t,be moment, the patient surviving nearly three years before eventual death from his circulatory disease. AUTHORS.
Wilson, F. N.: Concerning the Form of the QRS Deflections cardiogram in Bundle Branch Block. p. 1110.
of the Electro-
Multiple unipolar precordial leads have been employed in a large series of cases in which bundle branch block was thought to be present. In the vast majority of instances the use of such leads made it possible to determine whether bundle branch
evenly to a base to 300 oscillations
line with an amplitude per mnute.
5i:l
ABSTRACTS
of
8 to 10 mm.
and
a frequency
of
131
With progressive asphyxia of the heart, the rate may be lowered to 90 1”‘~ minute. The QR8 complexes are continuous with each other so that the T waver are totally absent. This mechanism may be considered as one of ventricular flutter. The second type consists of irregular oscillations averaging 130 to Nl per minute and varying in amplitude from 3 to 18 mm. in height. They differ in shape, size and form as well as frequency, duration and amplitude from record to record and moment to moment. Periodic waxing and waning of the height of the oscillations may be present and occasionally alternation of the ventricular complexes may be seen. They may persist as long as 6 minutes at one time and as many ah ::(11) periods have been recorded in one patient during 24 hours. Transient ventricular flutter and fibrillation may be ended by a single premature beat of the ventricles, a succession of these, or a run of ventricular taclyartlk A postundulatory pause, however, invariably precedes recovery. The auricles maintain their regular rate and rhythm during ventricular fibrillation except in the longer periods when they may be slowed with an irregular rat(l and at times stand still because of asphyxia. Except for the frequency and duration and its unusual iransient, recurrent and reversible nature associated with profound clinical disturbances, the fibrillary process in man is identical with that in animals. dI;THOK.
Sprague, H. B.: Syphilitic Aortitis With Aortic Regurgitation: An Electrocardiographic and Autopsy Survey at the Massachusetts General Hospital. p. 1W-l. A series of 22 cases of syphilitic aortitis with aortic. regurgitation autopsietl at the Massachusetts General Hospital from 1926 to 1941 has been analyzed with reference to the electrocardiographic findings. The absence of left axis deviation in the electrocardiogram suggests a complication beyond simple aortic dilatation wit11 involvement of aortic cusps and separation of their commissures. Conditions r+ sulting in acute, or chronically mild strain on the left ventricle, or conditions rt’sulting in an additional strain on the right ventricle appear to be largely responsible for the appearance of a normal electrical axis or a right axis deviation. In cases with bundle branch block, high degrees of coronary obstruction may hn present, particularly of the right coronary orifice. Rut in one ease without coronary narrowing, a large aneurysm pressing on and finally perforating into the pulmonary artery was found at autopsy. It is suggested that the electrical axis of the electrocardiogram is of more use than the S-T and T segments in indicating complications of syphilitic aortitis. The results of this study afford another example of the fact that the extent of disease and the presence of complications are often of more importance than an etiologic factor alone in the production of alterations in the electrocardiogram. ii7:THOW.
Steele, J. M.: (Intra-Arterial)
Comparison of Simultaneous Measurements of Arterial
Indirect (Auscultatory) and Direct Pressure in Man. p. 1042.
Concerning the comparison of simultaneous measurements obtained by direct intra-arterial manometry ant1 1,~ intlirect in 39 indivi(luals, it may be sa.id that: Hg. the this
Systolic pressure In the present direct pressure difference.
was underestimated study, the indirect in the radial artery.
in indirert measurement pressure in the brachial This procedure may
of arterial aus{-ultxtory
pressure
techniquta
hy about 10 men. was compared with account for half of
574
AMERICAN
In auscultatory technique curate measure of diastolic estimated diastolic pressure its
The indirect convenience
auscultatory and simplieityi
HEART
JOURNAL
the disappearance of sound proved to be a more acpressure than the sudden muffling. The former overby 8.8 mm. Hg, the latter by I&$ than one. method of estimating arterial pressure is, considering ‘an unusually accurate bedside method. AUTHOR.
Sussman, M. L., and Dack,,S.: The Roentgenkymogram III. Cases With Normal Electrocardiogram. p. 1064.
in Myocardial
Infarction.
A detailed analysis is presented of I8 cases of ,coronary occlusion in which the electrocardiogram returned to normal but ventricular contraction, demon,,/ abnormal strated roentgehkymographically, persist@. This indicates the importance of the latter examination in cases in which symptoms of coronary disease or occlusion are present but other object.ive confirmation ‘is lacking. AUTHORS.
Wechsler, I. S., and Bender, teritis Nodosa. p. 1071.
M. B.:
The Neurological
Manifestations
of Periar-
Seven cases of periarteritis nodosa with neurological manifestations are described. The most characteristic nerve disorder in this disease is involvement of single or multiple peripheral nerves in the extremities. The nerves are usually affected individually and at different times. Signs of central nervous system involvement are also present but are never striking, chiefly because gross lesions of the brain or spinal cord in periarteritis nodosa a,re uncommon. Renal damage and associated arterial hypertension may explain some of the symptoms of brain involvement in periarteritis nodosa. AUTHORS.
White, Paul D., and Blumgart, II. L.: .Cessation of Repeated Pulmonary Infarction and of Congestive Failure After Termination of Auricular Fibrillation by Quinidine Therapy. p. 1095. Dr. B. S. Oppenheimer, in 1922, in his paper on “Results with Quinidine in Heart Disease, ’ ’ described his experience with two patients who, during the course of aurieular fibrillation, had hemiplegia due to emboli. Both, subsequently responded to quinidine by a change to sinus rhythm without suffering from a recurrence of symptoms of embolism, either during or after the treatment. In further development of this same theme, we have herewith reported two patients in whom the administration of quinidine with consequent return to normal rhythm was undertaken despite generally accepted contraindications. This was folwith cessation of pulmonary embolism lowed by abrupt and striking improvement, in Case 1 and of congestive failure in Case 2. In Case 1 the improvement has In Case 2 quinidine was probably life-saving at persisted to the time of writing. t,be moment, the patient surviving nearly three years before eventual death from his circulatory disease. AUTHORS.
Wilson, F. N.: Concerning the Form of the QRS Deflections cardiogram in Bundle Branch Block. p. 1110.
of the Electro-
Multiple unipolar precordial leads have been employed in a large series of cases in which bundle branch block was thought to be present. In the vast majority of instances the use of such leads made it possible to determine whether bundle branch