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Sudden death in unsuspected rheumatic carditis
566
AXERICAN
HEART JOURNAL
evidences of acute nephritis; acute fulminating illness (sepsis, pneumonia, subacute bacterial endoearditis) ; low-grade infections; and nervousness in mild ehorea minor. In order that the advantage gained by the early diagnosis and treatment may be realized to the fullest extent, the physician who is called on to care far children should be thoroughly familiar with t,he various and diverse manifestations of rheumatic fever. AUTIIOR. Quinlan, J. T.: 2: 693, 1942.
Sudden Death in Unsuspected
Rheumatic
Casditis.
Brit.
M,
J.
A case of rheumatic carditis occurring in an apparently heaithy infant, age 3 years, 8 months, is recorded. The post-mortem examination of the heart showed general enlargement as well as rheumatic mitral and tricuspid valvulitis. The finding of characteristic Aschoff bodies was accepted as proof of the rheumatic nature of the infection, and the other components of the microscopic picture provided additional evidence in support of this conclusion. MCCULLOVH.
Roberts, J. E., and Lisa, J. R.: The Keart in Pulmonary Tuberculosis: A ClinicoPathological. Study of 100 Autopsied Patients. Am. Rev. Tuberc. 47: 253, 1943. The findings in a clinico-pathological study of the heart in 100 cases of active pulmonary tuberculosis are presented. Demonstrable myocardial lesions were present in sixty-nine. They consisted of tuberculous myocarditis in ten, acute rheumatic myocarditis in one, hschoff body-like lesions in nine, acute interstitial myocarditis in fifty, and acute miliary infarctions in eleven. Combinations of the lesions were found in thirteen. Healed rheumatic valvulitis was found in five, sclerotic lesions of the mitral and aortic valves in twenty, acute valvular endocarditis in two, and syphilitic aortic valvulitis in two. There were three instances each of tuberculous, chronic adhesive, and acute nontuberculous pericarditis. Tuberculous myocarditis was more frequent in the adults than in the children. Nontuberculous pulmonary infections appeared to be a significant factor in the causation of the interstitial myoMiliary infarctions occurred predominantly in the hypertrophied hearts, oarditis. in hearts with severe coronary arteriosclerosis, and in the later decades of life. The conception of a small heart in tuberculosis was not substantiated. Right ventricular hypertrophy was very uncommon. Mensuration of the ventricular wall appeared to be an unreliable criterion for hypertrophy; the microseopieal appearance of the myocardial fibers appeared more accurate. A moderate or severe disproportion between pulse rate and height of temperature was suggestive of myocardial disease. Murmurs due to organic valvular lesions were fairly common. Functional murmurs The conception that hypertension and active tuberculosis are were uncommon. Electrocardiographic tracings frequently revealed incompatible was not borne out. significant observations. While the present series is too small to permit definite conclusions about many c,ontroversial points, it is the belief of the authors that more attention paid to the cardiovascular system in the tuberculous individual will result in a more accurate estimation of existing cardiac damage. AUTHORS.
Suzman, S. :
Tuberculous
Pericardial
Effusion,
Bit.
Reart
5. 5: 19, 1943.
It is suggested that in any obscure A case of tuberculous pericarditis is described. case of pericardial effusion, especially where this is large, tuberculosis should be thought of as a possible diagnosis, and that this is still more likely if tapping has to be repeated.
AXERICAN
HEART JOURNAL
evidences of acute nephritis; acute fulminating illness (sepsis, pneumonia, subacute bacterial endoearditis) ; low-grade infections; and nervousness in mild ehorea minor. In order that the advantage gained by the early diagnosis and treatment may be realized to the fullest extent, the physician who is called on to care far children should be thoroughly familiar with t,he various and diverse manifestations of rheumatic fever. AUTIIOR. Quinlan, J. T.: 2: 693, 1942.
Sudden Death in Unsuspected
Rheumatic
Casditis.
Brit.
M,
J.
A case of rheumatic carditis occurring in an apparently heaithy infant, age 3 years, 8 months, is recorded. The post-mortem examination of the heart showed general enlargement as well as rheumatic mitral and tricuspid valvulitis. The finding of characteristic Aschoff bodies was accepted as proof of the rheumatic nature of the infection, and the other components of the microscopic picture provided additional evidence in support of this conclusion. MCCULLOVH.
Roberts, J. E., and Lisa, J. R.: The Keart in Pulmonary Tuberculosis: A ClinicoPathological. Study of 100 Autopsied Patients. Am. Rev. Tuberc. 47: 253, 1943. The findings in a clinico-pathological study of the heart in 100 cases of active pulmonary tuberculosis are presented. Demonstrable myocardial lesions were present in sixty-nine. They consisted of tuberculous myocarditis in ten, acute rheumatic myocarditis in one, hschoff body-like lesions in nine, acute interstitial myocarditis in fifty, and acute miliary infarctions in eleven. Combinations of the lesions were found in thirteen. Healed rheumatic valvulitis was found in five, sclerotic lesions of the mitral and aortic valves in twenty, acute valvular endocarditis in two, and syphilitic aortic valvulitis in two. There were three instances each of tuberculous, chronic adhesive, and acute nontuberculous pericarditis. Tuberculous myocarditis was more frequent in the adults than in the children. Nontuberculous pulmonary infections appeared to be a significant factor in the causation of the interstitial myoMiliary infarctions occurred predominantly in the hypertrophied hearts, oarditis. in hearts with severe coronary arteriosclerosis, and in the later decades of life. The conception of a small heart in tuberculosis was not substantiated. Right ventricular hypertrophy was very uncommon. Mensuration of the ventricular wall appeared to be an unreliable criterion for hypertrophy; the microseopieal appearance of the myocardial fibers appeared more accurate. A moderate or severe disproportion between pulse rate and height of temperature was suggestive of myocardial disease. Murmurs due to organic valvular lesions were fairly common. Functional murmurs The conception that hypertension and active tuberculosis are were uncommon. Electrocardiographic tracings frequently revealed incompatible was not borne out. significant observations. While the present series is too small to permit definite conclusions about many c,ontroversial points, it is the belief of the authors that more attention paid to the cardiovascular system in the tuberculous individual will result in a more accurate estimation of existing cardiac damage. AUTHORS.
Suzman, S. :
Tuberculous
Pericardial
Effusion,
Bit.
Reart
5. 5: 19, 1943.
It is suggested that in any obscure A case of tuberculous pericarditis is described. case of pericardial effusion, especially where this is large, tuberculosis should be thought of as a possible diagnosis, and that this is still more likely if tapping has to be repeated.