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Practical clinical coronary angiography
713
Abstracts PRACTICAL CLINICAL CORONARY ANGIOGRAPHY. Dacid Littmnnn, M.D., F.A.C.C., Frenk Crowley, M.D. and D&d Dunn, M.D. V. A. Hospital, West Roxbury, Mass.
Visualization of the coronary arteries in the live subject can now be performed quickly, safely and with a minimum of discomfort. A specially formed polyethylene catheter is inserted into the root of the aorta by means of It is pera modiliration of the Seldinger technic. cutaneously introduced through an area of local anesthesia over the right femoral artery. Radiopaque contrast substanc? is precisely injected into the coronary sinuses and rapid serial radiographs are obtained. Cardiac slowing is effected by bilateral carotid artery compression. Fifty-five sub.jects have been studied by this method during the past year. With few exceptions, they were men with suspected coronary or rheumatic heart disease. A ft.\\, had congenital anomalies. A majority of the coronary angio$rams made by this method were of diagnostic quahty and only ten were considered inadequate. The unidentified angiograms were scparately read and compared with the clinical pattern as Excellent correladetermined by conventional means. tion was obtained. With one or two exceptions coronary vascular abnormalities were apparent in all patients with arteriosclerotic heart disease while none was detectcsd in the few normal subjects and in patients with valvular or congfmital disease. The vascular bed was undrrstandably prominent and, at times, tortuous in the prescncr of ventricular hypertrophy. Intrinsic coronary abnormalities included non-filling of a vessel on repeated injections despite good opacification of the corresponding sinus. However, this did not OCCIII‘ in the absence of unusual tortuosity and ramification of the remaining vessels. In some instances extraordinary multiplication and branching was noted and intcrprcted as evidence of collateral development. Occasionally, a veritable cascade of fine vessels was seen emanating from (or acing to) an area of large vessel obstruction. Localized blocks were seen and an occasional instance of small aneurysmal dilatations. Moth-l-atcn areas of incomplete occlusion were also not(.d. There \vr‘t‘c‘ no important reactions to the procedure and no deaths. As a result of these studies several patirnts wt’rt‘ operated upon for relief of the symptoms of In each instance the radiocoronary inadequacy. graphic findings were confirmed. Direct blood vessel surgery was not attempted when the angiograms revealed diffuse disease. RE,.ATI”E YSMAL
MITRAL
PULMONARY
INSUFFICIENCY EDEMA.
AS A FACTOR
Aldo
A.
F.A.C.C., Aldo Jacono, M.D. and M.D. The Chicago Medical School,
IN PAROX-
Luisada, M.D., Marvin K@lan, Chicago,
pulmonary interpreted ciency, atrium
edema as the
developed. This systolic plateau, result of “relative” mitral insuffi-
further raised the (and of the pulmonary
mean pressure of the left vessels) above the threshold
of transudation. It is postulated that this valvular insufficiency was caused by extreme dilatation of the left ventricle and represented an important factor in the mechanism of pulmonary edema. CHLOROTHIAZIDE BLIND
M.D.
Rosenber,q, Brooklyn,
FOR
ANGINA
Monte Malach,
STUDY.
Kings
PECI‘ORIS.
M.D.
County
A
DOUBLE
and Rrnjumin :I. Hospital Ccntrr,
N. Y.
A one-year study of the effect of therapy with chlorothiazide and a placebo on twenty-four patients with angina pectoris without apparent congrstivc heart failure was undertaken. Neither the patient nor the physician was aware of whether a placebo or chlorothiazide was being administered. :it thr end of six months patients who received placebo therapy were switched to chlorothiazide therapy and vicr versa. The rationale for this therapy was to evaluate the effect of a diuretic agent for the abolition of latent congestive heart failure in patients with angina pectoris. Of the twenty-four patients who were given chlorothiazide in doses of one 250 mg. tablrt twice daily, fifteen (60 Fer cent) noted moderate to marked improvement of angina pectoris, with less daily or weekly sublingual nitroglycerine required ; exercise tolerance was increased in thirteen (54 per cent) ; hypertension was reduced to normctension in nine (38 per ccmt 1; and a weight reduction was effected in nine (38 per cent). The electrocardiogram, hallistocardiogram and pulse rates were not notably affected. I.eg cramps wcrc noted in three, headaches and vertigo in two and a skin rash in one. No electrolyte abnormalities wcrt‘ drtccted by serum studies. Of the twenty patients given a placebo, which was physically like the chlorothiazidc, in doses of one tablet twice daily, a moderate to marked improvement was noted in six (30 per cent); exercise tolcrancc was increased in eight (40 per cent); hypertension was reduced to normotension in seven (35 per cent): and a wciqht reduction was effected in ten (50 per cent). The clrctrocardiogram, hallistocardiogram and pulse ratcx were not affected. Leg cramps, headaches, vrrtigo and bursitis of the left shoulder were noted in one each. liesults of elcctrolytc studies on the srrtun remained normal. The results indicate some slight improvcmcnt in angina pectoris with chlorothiazide when patients under identical conditions were given the drug or a like placrho. A similar study is now under way with hydrochlorothiazide.
Ill.
The pressure curves from the pulmonary artery, left atrium and left ventricle (or aorta) were studied in scvcntren dogs following stimulation of the central nervous system through intracisternal injection of veratrine. The systolic pressures of the aorta and left The diastolic ventriclr rose to extremely high levels. prrssures of the left ventricle rose in all experiments in which pulmonary edema developed. However, the level of the diastolic pressure was often not sufficiently raised to cause edema. A typical plateau pattern was observed in the lrft atrium of all dogs in which
A STUDY
OF
MALES.
of Western Can.
G.
17,000
ELECTROCARDIOGRAMS
TV. Manning, Ontario,
Victoria
M.D.,
IN HEALTHY,
FIT
University London, Ontario,
F.A.C.C.
Hospital,
The electrocardiograms of 17,000 healthy, fit, young (eighteen to twenty-four years of age) male candidates for Aircrew Training with the Royal Canadian Airforce have been studied. Abnormalities were found in 4 per cent of these subjects which, following further clinical and electrocardiographic studies, was reduced to less than 0.5 per cent considered as unfit for Aircrew Training.
Abstracts PRACTICAL CLINICAL CORONARY ANGIOGRAPHY. Dacid Littmnnn, M.D., F.A.C.C., Frenk Crowley, M.D. and D&d Dunn, M.D. V. A. Hospital, West Roxbury, Mass.
Visualization of the coronary arteries in the live subject can now be performed quickly, safely and with a minimum of discomfort. A specially formed polyethylene catheter is inserted into the root of the aorta by means of It is pera modiliration of the Seldinger technic. cutaneously introduced through an area of local anesthesia over the right femoral artery. Radiopaque contrast substanc? is precisely injected into the coronary sinuses and rapid serial radiographs are obtained. Cardiac slowing is effected by bilateral carotid artery compression. Fifty-five sub.jects have been studied by this method during the past year. With few exceptions, they were men with suspected coronary or rheumatic heart disease. A ft.\\, had congenital anomalies. A majority of the coronary angio$rams made by this method were of diagnostic quahty and only ten were considered inadequate. The unidentified angiograms were scparately read and compared with the clinical pattern as Excellent correladetermined by conventional means. tion was obtained. With one or two exceptions coronary vascular abnormalities were apparent in all patients with arteriosclerotic heart disease while none was detectcsd in the few normal subjects and in patients with valvular or congfmital disease. The vascular bed was undrrstandably prominent and, at times, tortuous in the prescncr of ventricular hypertrophy. Intrinsic coronary abnormalities included non-filling of a vessel on repeated injections despite good opacification of the corresponding sinus. However, this did not OCCIII‘ in the absence of unusual tortuosity and ramification of the remaining vessels. In some instances extraordinary multiplication and branching was noted and intcrprcted as evidence of collateral development. Occasionally, a veritable cascade of fine vessels was seen emanating from (or acing to) an area of large vessel obstruction. Localized blocks were seen and an occasional instance of small aneurysmal dilatations. Moth-l-atcn areas of incomplete occlusion were also not(.d. There \vr‘t‘c‘ no important reactions to the procedure and no deaths. As a result of these studies several patirnts wt’rt‘ operated upon for relief of the symptoms of In each instance the radiocoronary inadequacy. graphic findings were confirmed. Direct blood vessel surgery was not attempted when the angiograms revealed diffuse disease. RE,.ATI”E YSMAL
MITRAL
PULMONARY
INSUFFICIENCY EDEMA.
AS A FACTOR
Aldo
A.
F.A.C.C., Aldo Jacono, M.D. and M.D. The Chicago Medical School,
IN PAROX-
Luisada, M.D., Marvin K@lan, Chicago,
pulmonary interpreted ciency, atrium
edema as the
developed. This systolic plateau, result of “relative” mitral insuffi-
further raised the (and of the pulmonary
mean pressure of the left vessels) above the threshold
of transudation. It is postulated that this valvular insufficiency was caused by extreme dilatation of the left ventricle and represented an important factor in the mechanism of pulmonary edema. CHLOROTHIAZIDE BLIND
M.D.
Rosenber,q, Brooklyn,
FOR
ANGINA
Monte Malach,
STUDY.
Kings
PECI‘ORIS.
M.D.
County
A
DOUBLE
and Rrnjumin :I. Hospital Ccntrr,
N. Y.
A one-year study of the effect of therapy with chlorothiazide and a placebo on twenty-four patients with angina pectoris without apparent congrstivc heart failure was undertaken. Neither the patient nor the physician was aware of whether a placebo or chlorothiazide was being administered. :it thr end of six months patients who received placebo therapy were switched to chlorothiazide therapy and vicr versa. The rationale for this therapy was to evaluate the effect of a diuretic agent for the abolition of latent congestive heart failure in patients with angina pectoris. Of the twenty-four patients who were given chlorothiazide in doses of one 250 mg. tablrt twice daily, fifteen (60 Fer cent) noted moderate to marked improvement of angina pectoris, with less daily or weekly sublingual nitroglycerine required ; exercise tolerance was increased in thirteen (54 per cent) ; hypertension was reduced to normctension in nine (38 per ccmt 1; and a weight reduction was effected in nine (38 per cent). The electrocardiogram, hallistocardiogram and pulse rates were not notably affected. I.eg cramps wcrc noted in three, headaches and vertigo in two and a skin rash in one. No electrolyte abnormalities wcrt‘ drtccted by serum studies. Of the twenty patients given a placebo, which was physically like the chlorothiazidc, in doses of one tablet twice daily, a moderate to marked improvement was noted in six (30 per cent); exercise tolcrancc was increased in eight (40 per cent); hypertension was reduced to normotension in seven (35 per cent): and a wciqht reduction was effected in ten (50 per cent). The clrctrocardiogram, hallistocardiogram and pulse ratcx were not affected. Leg cramps, headaches, vrrtigo and bursitis of the left shoulder were noted in one each. liesults of elcctrolytc studies on the srrtun remained normal. The results indicate some slight improvcmcnt in angina pectoris with chlorothiazide when patients under identical conditions were given the drug or a like placrho. A similar study is now under way with hydrochlorothiazide.
Ill.
The pressure curves from the pulmonary artery, left atrium and left ventricle (or aorta) were studied in scvcntren dogs following stimulation of the central nervous system through intracisternal injection of veratrine. The systolic pressures of the aorta and left The diastolic ventriclr rose to extremely high levels. prrssures of the left ventricle rose in all experiments in which pulmonary edema developed. However, the level of the diastolic pressure was often not sufficiently raised to cause edema. A typical plateau pattern was observed in the lrft atrium of all dogs in which
A STUDY
OF
MALES.
of Western Can.
G.
17,000
ELECTROCARDIOGRAMS
TV. Manning, Ontario,
Victoria
M.D.,
IN HEALTHY,
FIT
University London, Ontario,
F.A.C.C.
Hospital,
The electrocardiograms of 17,000 healthy, fit, young (eighteen to twenty-four years of age) male candidates for Aircrew Training with the Royal Canadian Airforce have been studied. Abnormalities were found in 4 per cent of these subjects which, following further clinical and electrocardiographic studies, was reduced to less than 0.5 per cent considered as unfit for Aircrew Training.