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Considerations on a rare case of dextrocardia (Isolated dextrocardia with inversion of the chambers)
300
AMEKICAN
Galli,
F.:
Considerations
Inversion
of
the
on
a Hare
HEART
Case
Cuore
Chambers).
of
JOIJRNAI.
Dextrocardia
e circolaz.
30:13
(Isolated
(No.
Dextrocardia
With
12), 1946.
‘l‘he published cases of dextrocardia are reviewed and it is noted that when this congenital anomaly is isolated and not associated with inversion of other viscera, the cardiac chambers arc usually in a position similar to that of a normal heart, but displaced to the right. A case is reported in which there was an isolated dextrocardia but the chambers were a mirror image of the normal. It is, therefore, the sixth published case of this rare anomal>.. The patient was an 1%year-old girl who complained of exertional dyspnea and palpitation. The heart was centrally placed, and there was an “apical” systolic murmur over the right side of the heart, transmitted to both the right axilla and the fourth left interspace. The spleen and liver were in normal position. A chest film revealed a “mirror-like” image of the heart, with the esophagus at the right of the spine but the stomach in the normal position. The general shape of the heart was rounded; the retrocardiac space was reduced. The right (actually the left) auricle was somewhat enlarged. The electrocardiogram showed a typical mirror-image appearance in Lead I; Lead II showed an inverted T wave. The author attributes the electrocardiographic conduction system in relation to the electrodes. valve defect. Kramer,
Milton
L.,
Arteriovenous
and Fistula.
Kahn,
J. W.:
Arch.
Int.
The
Med.
The
Effect
78:28
changes to inversion in the position of the final diagnosis was dextrocardia with mitral I,r~Is:\o \. of
(July),
iitropine
on
the
Branham
Sign
in
1946.
The phenomena of the Branham sign, which consists of the slowing of the pulse rate upon temporary obliteration of the arteriovenous fistula, suggests that it is due to a reflex arc in which the vagus nerve is the efferent pathway. Although patients with the larger fistulas show the most striking changes in pulse rate, the Branham phenomenon is also observed in patients with small fistulas. The authors studied the effects of atropine on the elimination of the Branham phenomenon in patients with arteriovenous fistula. The heart rate, pupillary changes, and dryness of the mouth were utilized as evidence of atropinization. In nine of the ten cases thus studied, there was considerable fall in the pulse rate on obliteration of the fistula prior to atropinization, but the slowing failed to appear following administration of atropine. The changes in the blood pressure usually associated with obliteration of the fistula, namely, rise in diastolic pressure and reduction of pulse pressure, were not influenced by atropine. BEI,I.I’T.
Chenoweth,
Pharmacol.
M.
B.:
& Exper.
The
Cardiovascular
Therap.
87:41
Actions
(Aug.),
of
2,3-dimercaptopopanol
(B.4L
I.
J
1946.
BAL exerts its most important systemic actions on the central nervous and cardiovascular systems. Because of the presence of a pronounced circulator>effect, a detailed investigation OJ its action was made. BAL administered to cats intravenously resulted in a fall of the systemic and pulmonary arterial and venous pressures and in a rise of the portal pressure. When administered in very small repeated intravenous doses or by pericutaneous application, BAL caused a rise in blood pressure. There was a marked rise in the peripheral resistance of the limb vessel:. during the period of falling blood pressure but none in the vessels of the liver or splanchnic areah. Electrocardiograms (Lead II) were obtained in three rate were slight. Decrease in the voltage of the R wave, the S-T segment, occasional ectopic beats, brief periods of of the T wave were observed at different times in the three
anesthetized cats. Changes in heart deepening of the S wave, elevation of ventricular tachycardia, and lowering cats.
Following the administration of BAL, the hematocrit reading was increased, while at the same time the concentration of injected dye in the blood was reduced. This paradoxical result is probably due to the loss of the dye from the blood stream. Blood volume, calculated on the basis of the hematocrit readings, was found to decrease by 30 per cent, whereas in the calculations
AMEKICAN
Galli,
F.:
Considerations
Inversion
of
the
on
a Hare
HEART
Case
Cuore
Chambers).
of
JOIJRNAI.
Dextrocardia
e circolaz.
30:13
(Isolated
(No.
Dextrocardia
With
12), 1946.
‘l‘he published cases of dextrocardia are reviewed and it is noted that when this congenital anomaly is isolated and not associated with inversion of other viscera, the cardiac chambers arc usually in a position similar to that of a normal heart, but displaced to the right. A case is reported in which there was an isolated dextrocardia but the chambers were a mirror image of the normal. It is, therefore, the sixth published case of this rare anomal>.. The patient was an 1%year-old girl who complained of exertional dyspnea and palpitation. The heart was centrally placed, and there was an “apical” systolic murmur over the right side of the heart, transmitted to both the right axilla and the fourth left interspace. The spleen and liver were in normal position. A chest film revealed a “mirror-like” image of the heart, with the esophagus at the right of the spine but the stomach in the normal position. The general shape of the heart was rounded; the retrocardiac space was reduced. The right (actually the left) auricle was somewhat enlarged. The electrocardiogram showed a typical mirror-image appearance in Lead I; Lead II showed an inverted T wave. The author attributes the electrocardiographic conduction system in relation to the electrodes. valve defect. Kramer,
Milton
L.,
Arteriovenous
and Fistula.
Kahn,
J. W.:
Arch.
Int.
The
Med.
The
Effect
78:28
changes to inversion in the position of the final diagnosis was dextrocardia with mitral I,r~Is:\o \. of
(July),
iitropine
on
the
Branham
Sign
in
1946.
The phenomena of the Branham sign, which consists of the slowing of the pulse rate upon temporary obliteration of the arteriovenous fistula, suggests that it is due to a reflex arc in which the vagus nerve is the efferent pathway. Although patients with the larger fistulas show the most striking changes in pulse rate, the Branham phenomenon is also observed in patients with small fistulas. The authors studied the effects of atropine on the elimination of the Branham phenomenon in patients with arteriovenous fistula. The heart rate, pupillary changes, and dryness of the mouth were utilized as evidence of atropinization. In nine of the ten cases thus studied, there was considerable fall in the pulse rate on obliteration of the fistula prior to atropinization, but the slowing failed to appear following administration of atropine. The changes in the blood pressure usually associated with obliteration of the fistula, namely, rise in diastolic pressure and reduction of pulse pressure, were not influenced by atropine. BEI,I.I’T.
Chenoweth,
Pharmacol.
M.
B.:
& Exper.
The
Cardiovascular
Therap.
87:41
Actions
(Aug.),
of
2,3-dimercaptopopanol
(B.4L
I.
J
1946.
BAL exerts its most important systemic actions on the central nervous and cardiovascular systems. Because of the presence of a pronounced circulator>effect, a detailed investigation OJ its action was made. BAL administered to cats intravenously resulted in a fall of the systemic and pulmonary arterial and venous pressures and in a rise of the portal pressure. When administered in very small repeated intravenous doses or by pericutaneous application, BAL caused a rise in blood pressure. There was a marked rise in the peripheral resistance of the limb vessel:. during the period of falling blood pressure but none in the vessels of the liver or splanchnic areah. Electrocardiograms (Lead II) were obtained in three rate were slight. Decrease in the voltage of the R wave, the S-T segment, occasional ectopic beats, brief periods of of the T wave were observed at different times in the three
anesthetized cats. Changes in heart deepening of the S wave, elevation of ventricular tachycardia, and lowering cats.
Following the administration of BAL, the hematocrit reading was increased, while at the same time the concentration of injected dye in the blood was reduced. This paradoxical result is probably due to the loss of the dye from the blood stream. Blood volume, calculated on the basis of the hematocrit readings, was found to decrease by 30 per cent, whereas in the calculations