Idiopathic hypertrophy of the heart in infants

Idiopathic hypertrophy of the heart in infants

Society Transactions AMERICAN HEART ASSOCIATION YOURTH A N N U A L S C I E N T I F I C Jt~NE 12~ 1928 The fourth a n n u a l scientific s e s s i ...

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Society Transactions AMERICAN

HEART

ASSOCIATION

YOURTH A N N U A L S C I E N T I F I C Jt~NE 12~ 1928 The fourth

a n n u a l scientific s e s s i o n of t h e A m e r i c a n

tion was called to order shortly

tteart

Associa-

after two o'clock on Tuesday,

12, 1928, i n t h e B a l l R o o m o f t h e L e a m i n g t o n Minnesota,

SESSION

June

ttote], in M i n n e a p o l i s ,

as f o l l o w s :

The Chairman, Dm WILLI~I H. Rou~G Boston, Mass.--Ladies and gentlemen~ we have waited, I think, as long as we can for our president, Dr. James B. Herriek of Chicago, who was to begin the meeting. I am sorry there is not a larger attendance. Some of the speakers would like to have a lantern, and I believe that one is being brought from somewhere--I think in this city--so tlmt the first paper [ will eaI1 for is by Dr. Hurxthal. 1. DR. L ~ w ~ s M. tIu~xTt~AL, B o s t o n , M a s s . - - H e a r t

thyroidism.

Failure and

ttyper-

( F o r o r i g i n a l a r t i c l e s e e p a g e 403.)

2. DR. ROBERT H .

ttALS~V, N e w

York,

N. Y . - - O b s e r v a t i o n s

Mortality of tteart Disease in New York State.

(For

on the original

a r t i c l e s e e p a g e 94.) 3. DR. PAUL W .

E~IERSON, AND DR. IIY~IAN G~E~:N, B o s t o n ,

Mass.--

Idiopathic Hypertrophy of the Heart in Infants.* ]t would be better to designate the treme~dous increase ia the size of the heart described in the literature as ~'idiopathic hypertrophy" by the term, "hypertrol)hy of unknown etiology," but so few eases have been reported that for the present, to keep the literature on the subject accessible, we have retained the old name. Such enlarged hearts described by Howland in his classical article showe,l hypertrophy and nothing else except in two instances a very small open foramen ovule. He was of the opinion that it was unjustifiable to discard a ease as one of idiopathic hypertrophy merely because it showed likewise a shnple defect. The two kinds of cases, hypertrophy with simple defect and hypertrophy without~ are so similar clinically that one might, before post-nmrtem exanfination of the heart~ swear as go the correctness of a diagnosis, only to find that without a murmur, a simple defect such as a. foramen ovale, an open interventrieular septum or a patent duetus arteriosus would be present, or that with a murmur nothing would be shown except a hypertrophy. We believe that such eases of defects are worthy of reporting as purpose of emphasizing this class trophy of the heart without olher larged to from two and a half to

idiopathic hypertrophy which also have simple a class and we have five such eases. With the we are reporting six eases of idiopathic hyperdefect. In all of the cases the hearts were enfour times the normal size, and in all of them

*Abstract of paper read at the Fifth Annual Scientific Session of the American Heart Association in Minneapolis. 116

117

SOCIETY TRANSACTIONS

d y s p n e a a n d cyanosis were the m o s t common s~m~ptoms. The oldest p a t i e n t was t w e n t y - e i g h t m o n t h s of age. Seven died w i t h i n one week a f t e r a d m i s s i o n to the h o s p i t a l . W e could find no s a t i s f a c t o r y etiology for this disease b u t we s u s p e c t t h a t a possible a n d as y e t u n i n v e s t i g a t e d cause m a y be a congenital n a r r o w i n g of the capillary bed. There were eight autopsies.

4. Da. B. J. CLAWSON, M i n n e a p o l i s , dktm. ( S e e l i y o e a r d i t i s , page 5. DI%. I~OBERT L . B E N S O N ,

Minn.--Fibrosis

of the Myocar-

1.)

Portland, 0re.--Rupture

of the, Heart.

DISCUSSION T ~ E CHAm.MAX.--This h a s been a m o s t i n t e r e s t i n g g r o u p of speeches t h a t h a s been p r e s e n t e d this afternoon~ a n d I will a s k Dr. A l b e r t to open the discussion. DR. I:][EI#I~Y ALBEI~T, Des Moines, Iowa.--l~Ir. C h a i r m a n . F r o m t h e public h e a l t h point of v'iew~ which is the point of view in which I a m interested, it is very encouraging to note t h e v e r y g r e a t i n t e r e s t which is b e i n g m a n i f e s t e d in t h e s t u d y of h e a r t disease, n o t only b y t h e public a n d t h e m e d i c a l p r o f e s s i o n in genera% b u t also by special groups, such as is, f o r i n s t a n c e r e p r e s e n t e d b y this association. The public h a s become i n t e r e s t e d t h e p a s t few years, l a r g e l y because h e a r t disease is now t h e l e a d i n g c a u s e of d e a t h in this country, a n d m o r t a l i t y f r o m h e a r t disease also is, affd for some y e a r s h a s been, on the increase. On t h e other h a n d , t h e public h e a l t h official m e e t s with two g r e a t difficulties when it comes to h e a r t disease. F~,rst.--tteart disease is n o t a definite t h i n g like tuberculosis a n d t y p h o i d fever. }Ieart disease varies so widely in its n a t u r e a n d is p r o d u c e d b y such diverse causes, t h a t the p r o b l e m o f e v a l u a t i n g the hlfluenee or effect of the several f a c t o r s is a v e r y complex a n d difficult one. S e c o n d . - H e a r t disease does n o t p r e s e n t t h e u r g e n t call for i m m e d i a t e a t t e n t i o n t h a t we have in connection w i t h d i p h t h e r i a or scarlet fever or o t h e r r e a d i l y c o m m u n i c a b l e diseases. W h e ~ you have to w a i t t e n or fifteen y e a r s a f t e r t h e cause st:trted to act before the disease forces itself on your a t t e n t i o n , you can r e a d i l y a p p r e M a t e tha~ the b u s y h e a l t h officer is m u c h more likely to look a f t e r q u a r a n t i n a b l e diseases and the paying public is much more interested in having the health department protect them fronl da~igers hnmediately at hand. I was much interested this afternoon, especially in the reference made by ]Dr. Halsey of the importance of securing certain statistical data. I-Ie suggested that the cause of h e a r t disease be included on t h e d e a t h certificate. Now, I a g r e e with h i m t h a t it is very desirable to h a v e more definite d a t a t h a n we n o w get. We who are g a t h m ' i n g s t a t i s t i c s in s t a t e public h e a l t h d e p a r t m e n t s a r e i n t e r e s t e d in h a v i n g as definite d a t a as possible with r e f e r e n c e to t h e cause of diseas% b u t as f a r a s h e a r t disease is concerned, the cause is n o t susceptible of b e i n g g i v e n in as definite a f o r m as ir~ connection with m o s t other eonditions~ a n d c e r t a i n l y it is not as simple as would be implied b y simply dividing it into rheumatie~ syphilitic, a n d arteriosclerotic groups. W e m a y speak r a t h e r definitely with reference to the r h e u m a t i c a n d syphilitic f o r m s b u t when it comes to arteriosclerosis, we ha.re here to deal with a p a t h o l o g i c a l condition, or possibly as s u g g e s t e d b y some, with a n o r m a l s e n e s c e n t p r o c e s s - - r a t h e r t h a n a n etiological f a c t o r . W h e n it comes to a ease of arteriosclerosis we h a v e to deal w i t h m a n y factors~ some of which are as y e t b u t poorly u n d e r s t o o d . A year or so ago I delved into a certain speculative field. I g o t t h e n o t i o n t h a t more cases o f h e a r t disease were caused b y scarlet f e v e r t h a n it h a d been given credit for. Once h a v i n g decided upon t h a t notion I w a n t e d to g e t t h e d a t a to