Mechanism of auricular flutter and fibrillation

ARSTRACTS,

THIRD

INTER-AMERICAN

CARDIOLOGICAL

CONGRESS

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3. All but one case showed extreme wasting with generalized atrophy. Major clinical diagnoses included neoplasms, chronic infections, and degenet-.Itive and metabolic diseases. 4. Important factors in production of emaciation were prolonged illness, bedfastness, fever, surgical procedures, radiation, and gastrointestinal dysfunction. 5. Clinically the atrophic heart was small or of normal size, quiet, inactive, with a faint apical or precordial short systolic murmur in 25 per cent of the cases. 6. Characteristic electrocardiograms showed progressive diminution of vnltage of I’, QRS, T wave, and prolongation of Q-T intervals. 7. Blood pressure fell in 76.4 per cent of cases; normotension to Ion- Ic\.~ls. and hypertension to normal or hypotensive levels. 8. The small heart was able to bear its load, as shown b>- the low incidenc.c of clinical heart failure. Only three patients had clinical and pathological V\ idence of heart failure and they had concomitant organic heart disease. THE

RECIPROCAL ACTION OF WATER, SODIUM, XND RESISTANT CARDIAC EDEMA-F. R. SCHEMM, M.D.,

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Cardiac edema in advanced disease which was resistant to more usual messures was cleared in 80 per cent of 322 instances by the institution of a regimcan which included a large intake of water, a moderate restriction of sodium, and small amounts of acid. In 160 instances edema did not clear with only two of the three factors of the regimen in force until the third factor was added; this was noted in from fifty to sixty instances for each of the three factors. In these observations water was given in amounts of from 1,500 to 8,000 C.C. dail,., sodium was restricted to from zero to 1,200 mg. dailv, and acids were given a.s diet OI drugs, including ammonium chloride by vein, >n amounts the equivalent of from zero to 16 Cm. of ammonium chloride dail?,. From these observations, it seems apparent that each factor of the regime has its limitations as well as uses and the importance of their reciprocal action emerges. The most severe restriction of sodium alone, the most extreme forcing of water alone, the heaviest doses of acid alone, or the combination of an>- two of these, may leave untouched a resistant edema which is capable of responding dramatically to the reciprocal action of all three factors, even when each is chnforced to a much less drastic degree. MECHANISM OF AURICULAR FLUTTER D. SCHERF, M.D., NEW YORK, N. Y.

AND

FIBRILLATJOS.

Published in full, Am. Heart J. 36:241, 1948 THE EFFECT OF ERGOTAMINE CARDIOGRAM-D. SCHERF, \-ORK, N. Y.

PREPARATIONS ON THE M.D., AND 11. SCHLACFIMAN,

ELECTROM.D.,

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It has been claimed that the injection of ergotamine tartrate prevented the occurrence of postural inversion of the T waves (Nordenfelt) and that inverted T waves which may occur in the supine position in the emotionally tense individual or in neurocirculatory asthenia may be normalized by this drug (Wenchkos). Both authors suggested that ergotamine tartrate could be utilized to differentiate a “functionally” inverted T wave from an inversion caused It>, organic disease. Twelve patients studied by us showed significant changes in the T waves on assuming the erect position. When the experiment was repeated after the intravenous injection of ergotamine tartrate, the positional inversion of the