Parasystole with fixed coupling

College

128 aortic

obstruction.

arately.

100GA, of aortic

CO.

\\‘hen AP the

postcmbolic

obstruction.

greater

.4P and CP diminished

was maintained

extent,

CO,

level

obtained

Cl: and hfE

and LV lactate

cular

resistance

onary

that

for periods

acute myocardial left ventricular quately may

the

with cardioaenic

cor-

performance

in

with shock. The increased

needs produced coronary

are met ade-

flow. This

hcmodynamic

shock

of vas-

up to 1 hr. increases

infarction

by the increased

to a

diminished

increase

myocardial

oxygen

improve

improved

to

below this level.

mechanical

flow and improves

than

prior

production

more than \vhen AP \vas maintained It is concluded

mod-

at greater

status

unresponsive

technic

of patients

to conventional

versity

of Colorado

‘I‘he

purpose

Medical

of this

perience

with

a severe

form

pulmonic

valve

the latter

Center,

report

21 cases

being

Denver,

is to review

of pseudotruncus

of tetralogy atresia

fect. ‘I‘he age range

of Fallot

extended

from

our

ex-

arteriosus, consisting

of

septal

de-

and a ventricular

the oldest

Colo.

1 wk. to 36 yr.,

recorded

patient

with this

lesion. Because

of the characteristic

diagnosis

of this entity

In the presence physical

sign

anastomoses. patients,

murmur

murmur

(76y0),

second

sound

Other

studies

revealed

were

findings

along the left sternal

in the area of the pulmonary ular, irregular collateral

(lOO’%),

in-

border

and an ejec-

bronchial by

present

in 41%

fluoroscopy.

A

of cases.

ventricle

and

to delineate

and nod-

which

may

right

aortic

the

from septal

is usually

re-

blood vessels arising

and

M.D.

Hospital

A variable

are alive. Although

age, as evidenced

death

by 6 deaths

is not uncom-

over yr.).

2 yr. of age

(average

age

RICHARD

Plea.

M.D., Llichael

Center,

c.ollpling

usually

regarded

svstolic

mechanism.

Chicago.

Ho\\ever.

for constant

of parac;ystolic

Reese

ectopic feature

three

beats

is

JI” a para-

conditions

may

constant

cou-

or almost

beats.

LANGEN-

Ill.

of prcmatllrr

as an essential

be responsible pling

Coupling,

AI.FRI:D

and Medical

Examples

of each variety

will be presented. 1. Actually, petted

variations

inant

and

of the

the impulses

can

of the dom-

parasystolic

the dominant

center.

the

the interval constant,

constant;

to the next

a constant

dominant

ectopic

rhythm.

beat,

i.e.!

will tend

and all conduc-

dominant

beat

the parapacemaker,

beat

will remain

the interval

betlveen

and the last beat

the coupling

to become

tem-

develops,

the dominant

and at the same time:

the premature

however,

for. lvhenever

discharges

cx-

can reach

t\vo rhythms

the rate of both pacemakers impulse

be

If,

pacemaker

pacemaker,

between

tion times remain systolic

coupling protection

of a parasystolic

relation

provided

tolic

in

only if there is mutual

of the

of the parasys-

fixed

(“forced

cou-

pling”).

2. Ifsubthreshold supernormal will limit short, mature

stimuli

phase

effective

of the cycle

beats

with

during a

its short

to the parasystolic

portion

ectopic

become

of excitability,

responses

early

only

duration

impulses

and

result

minor

to a

in pre-

variations

of

their coupling. 3. If, by chance

or by the design of an experiment,

the rates of two independent pacemakers coupling

and mutually

are in a simple of all premature

spite of complete Refsum’s

numerical beats

independence

Syndrome:

Interesting

protected

relation.

may

be

fixed

present

in

of the two rhythms.

A Neurological

Cardiovascular

Disease

with

Manifestations,

H.

DANIEL LEWIS, JR.,M.D.,HARRY H. WHITE, M.D. and MARVIN DUNN, M.D., University of Kansas Medical

Center,

Heredopathia syndrome) trait

and

limitation athy

an

ataxia.

neurogenic

frequently hearing

a chronic

associated

weakness

is not unusual

among

polyneuroplimbs

distally

without

with

with

primarily

retinitis concentric

accompanied

protein

loss, icthyosis

abnormalities

and

of the

fluid

recessive

atypical

It is usually

cerebrospinal facial

an

blindness paresis

(Refsum’s

autosomal

by

night

progressive

and

relatives.

as

Kan.

of the field of vision,

thalmoplegia,

death

polyneuritiformis

with

and cerebellar

graphic

City,

is characterized

with

cytosis,

Kansas atactica

is inherited

pigmentosa

increased

lived to 36 yr. of age, and there are

subjects

9.7 yr., range 2-20

was

is nec-

interventricular

2 yr. of age, long term survival

mon, as 1 patient

arch

to outflow

injection

the collateral

at an early

due to

be demon-

Angiocardiography

aortic

from the aorta. Twelve of the 21 patients

9 surviving

concavity

segment

the obstruction

A retrograde

occur

arterial

arteries

essary to demonstrate right

a striking

shadows in the lung parenchyma

strated

before

physical

who

(43%).

Radiographic

may

murmur

in only 4 patients

cluded a systolic

quired

differentiat-

was found in 80y0 of our

of age.

the

at the bedside.

continuous

3 months

tion click

the

chest due to bronchopulmonary

absent

a single

picture,

the cardinal

is a diffuse,

This

being

clinical

can be made

of cyanosis,

heard over the entire

defect.

with Fixed

DOKF,

poral

Pseudotruncus Arteriosus, ROBERT T. LAFARGUE, M.D.,JOHN H. K. VOGEL, M.D.,RAY PRYOR, M.D. and S. ~:ILBERTBLOUNT, JR.,M.D.,F.A.c.c., Uni-

below

Parasystole

and reset

therapy.

ing

News

ptosis,

transverse

by pleoophsmile,

and electrocardio-

ofconduction.

these patients

Sudden and their

First degree heart block is the most common THE

AMERICAN

JOURNAL

OF CARDIOLOGY