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Subacute myocardial infarction or necrosis
842
THE
AMERICAN
HEART
JOURNAL
The corollary may be equally true. Any patients with the Qypical pain of coronary insufficiency but no other suggestive clinical findings, even in the absence of changing T-waves in the electrocardiograms, must be considered as possible cases of coronary occlusion without myocardial infarction and treated accordingly. This means total bed rest for a week or ten days as a myocardial infarction might be developing. In these instances, clinical judgment is of much more importance than the electrocardiograr~~s. ilI:THORS.
Laufer, 236,
S. T.:
Subacute
Myocardial
Infarction
or Necrosis.
Canad. M. A. .J. 45:
1941.
Myocardial necrosis without typical symptoms or an acute onset, which can be detected by delayed electrocardiographic changes of coronary occlusion type, is described as a clinical entity under the title of subacute myocardial infarction or necrosis. The mechanism of its production and the clinical Aymptoms and signs, justifying it as an entity, are discussed. The symptoms are so atypical that the patient often continues his regular activities, to his own detriment. The delayed appearance of electrocardiographic changes are in accord with the clinical picture and may be discovered only accidentally some time later. The importance of a careful history in aiding the detection of cases of subacute myocardial infarction or necrosis is strongly stressed. A raised leucocyte count may be the only positive sign in the cases outlined. AUTHOR.
Klemperer, P., Pollack, A. D., and Baehr, G.: Erythematosus. Arch. Path. 32: 569, 1941.
Pathology
of Disseminated
Lupus
Disseminated lupus erythematosus is founded morphologically on a well-defined serie’s of alterations of the collagenous tissues. The characteristic organic changes, previously considered as heterogeneous, can now be understood as local manifestations of the widespread damage of collagen. Various concepts of lupus erythematosus as a disease with predominant localization in a single organ or as a diffuse disease of the peripheral circulation can be entertained no longer. AUTHOILS.
Wrenberg, H., and McCleary, J.: Rheumatic J. Obst. & Gynec. 41: 45, 1941.
Heart Disease in Pregnancy.
Am.
Three hundred forty-five cases of pregnancy complicated by rheumatic heart disease are reported. Seventy-seven cardiac failures occurred in this group, an incidence of 22.3 per cent. It is possible to foretell fairly accurately which patient with heart disease will fail unless adequate bed rest is enforced. Several prognostic aids are offered. The functional capacity of the heart in the nonpregnant state is of great importance, 83 per cent of the failures occurring in the badly incapacitated groups, 2B and 3, while only 17 per cent of the failures were in the comparatively well-functioning Classes I and 2A. An equally important aid is the patient ‘8 age; 42.6 per cent of the pregnancies in women over 30 years of age were complicated by cardiac failure as compared to 16.1 per cent in the group under 30. A third significant aid in prognosis is the presence or absence of a history of previous failure. Of those that decompensated before, 75 per cent had cardiac failure when pregnant as compared to a 14.1 per cent incidence of cardiac failure in the previously compensated group.
THE
AMERICAN
HEART
JOURNAL
The corollary may be equally true. Any patients with the Qypical pain of coronary insufficiency but no other suggestive clinical findings, even in the absence of changing T-waves in the electrocardiograms, must be considered as possible cases of coronary occlusion without myocardial infarction and treated accordingly. This means total bed rest for a week or ten days as a myocardial infarction might be developing. In these instances, clinical judgment is of much more importance than the electrocardiograr~~s. ilI:THORS.
Laufer, 236,
S. T.:
Subacute
Myocardial
Infarction
or Necrosis.
Canad. M. A. .J. 45:
1941.
Myocardial necrosis without typical symptoms or an acute onset, which can be detected by delayed electrocardiographic changes of coronary occlusion type, is described as a clinical entity under the title of subacute myocardial infarction or necrosis. The mechanism of its production and the clinical Aymptoms and signs, justifying it as an entity, are discussed. The symptoms are so atypical that the patient often continues his regular activities, to his own detriment. The delayed appearance of electrocardiographic changes are in accord with the clinical picture and may be discovered only accidentally some time later. The importance of a careful history in aiding the detection of cases of subacute myocardial infarction or necrosis is strongly stressed. A raised leucocyte count may be the only positive sign in the cases outlined. AUTHOR.
Klemperer, P., Pollack, A. D., and Baehr, G.: Erythematosus. Arch. Path. 32: 569, 1941.
Pathology
of Disseminated
Lupus
Disseminated lupus erythematosus is founded morphologically on a well-defined serie’s of alterations of the collagenous tissues. The characteristic organic changes, previously considered as heterogeneous, can now be understood as local manifestations of the widespread damage of collagen. Various concepts of lupus erythematosus as a disease with predominant localization in a single organ or as a diffuse disease of the peripheral circulation can be entertained no longer. AUTHOILS.
Wrenberg, H., and McCleary, J.: Rheumatic J. Obst. & Gynec. 41: 45, 1941.
Heart Disease in Pregnancy.
Am.
Three hundred forty-five cases of pregnancy complicated by rheumatic heart disease are reported. Seventy-seven cardiac failures occurred in this group, an incidence of 22.3 per cent. It is possible to foretell fairly accurately which patient with heart disease will fail unless adequate bed rest is enforced. Several prognostic aids are offered. The functional capacity of the heart in the nonpregnant state is of great importance, 83 per cent of the failures occurring in the badly incapacitated groups, 2B and 3, while only 17 per cent of the failures were in the comparatively well-functioning Classes I and 2A. An equally important aid is the patient ‘8 age; 42.6 per cent of the pregnancies in women over 30 years of age were complicated by cardiac failure as compared to 16.1 per cent in the group under 30. A third significant aid in prognosis is the presence or absence of a history of previous failure. Of those that decompensated before, 75 per cent had cardiac failure when pregnant as compared to a 14.1 per cent incidence of cardiac failure in the previously compensated group.