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The effect of sodium salicylate on the normal human electrocardiogram
THE
EFFECT
OF SODIUM SALICYLATE ON THE II1 lMt\X ELE~~TRO~Al~DIOQRA~~f
xORW&
w
ITHIK recent years the etrctrocardiograp1~ has been used a great deal in the study of the effwt. of rhmatic fcvw on the heart muscle,‘* ‘* 3* + r, MICI by this method it. has hew shown that. it is frequently possible t.o detect evidenw of myocardial damage long before such damage can be recognized clinically. Some e.linicians” have even gauged prognosis with the aid of the cteetroc*ardiograph. In view of the almost. universal WC of salicy1at.r during rheumatic fever the question has been raised as to wht?ther some of the eteotrocardiographic chaJigt~s found ill that diseaw nlipht not 1)~ tluc! to the drug rather than to thth disease itxclf. ‘l’hc following study. therefore, has been undertaken to ascertain the* t+l’ectx of the salieylates on the ~?lc~~trt,cardiograIii of normal hwrts. I!efore entering in detail upon the nwthotl pursrird it will he \vPtl lo rcvim tlrcb vlertrocardiographic clin~igt~s rwortlrcl in rtieuniatie ftwr. Protongation of flir P-R intrruat. from a niwct depressioii of conduction that is barely notiwabtt~ in thtb c~tectro~ai,diograln to dropped beats; partial ant1 town twuptt~tr heart-block ; iitterstions in the heart rhythm, as for example. sinus srrhyvthmiil. sino-aurictutar block, wdat rhythm, premafurc beat.s, paroxysmal twh,veartlia. aurieular fibrillation and flutter; and finally cthanges in thr contour of thr QRS group and the S-T transition int.rrral ;--all thtw haw hwn n&d in acute’ rhcumatie. fever. l:sinp these criteria, l~t~tl~scl~iltt. Saks and l&man” found t.he heart involwtl iu (3 out nf 65 cases of rhcwuat.ic fewr. It is believed that. the cchangrs iti thr S-T interval, i.t*., the riw i m-m! rarely the fall) of t.lie H-T or S-T segaic& directly from t.llth last stroke of the R- or S-WIW, respc~~tirclg, without the usual S-T isoelectric level, is the most coiiiwni ctiailgtt ii1 rheumatic ferw and for this reason psrfiwlw attention has bcwi paitl to this interval.
In this study the* l~tsa Followett wix to giv4’ sotliuin salieyta to t.o normal human cont.rots atit to watc4~ for the above mentioned changes in the elect.rocarttiopraJn. 11anztik7 states t.lie full therapeutic dose of sodium saticytatc: to hr I5 grams, i.fl., “25 grains. In normal subjects this is cwret.ed in about stwaty-eight hours. The toxic clinical dose (i.e., until gastric a.ntt autlitory disturbances supervene)
-.z.Y
.-z
P ii 4
I
k
1 s-l
1
.\I.tS'I'l:li
2io 480 'Jo0 1080 1320 1440 lb80
Gr. (:r. Gr. Or. fir. Gr. Gr.
and T-Waves, and the S-T segment remainctl practically unchanged. Perhaps most significant of all, the forms of’ the T-wave and the contour of the B-T or S-T segrtlc?ats were absolutely ~maltcred, as may be seen from the accompanying illustrations. These important findings in condunction with the P-R measurements, itldicate that sotlium salicylate has no effect on the normal human clcctrocardiolrram and does not account for any of the electrocardiographic changes noted in rhcumatic fever. SUXBIARY Considering the well-known efiCect’ of acute rheumatic fever oil tlic heart muscle, and also considerin g the fact that the electrocardioseraphic changes in rheumatic fever have become of considerable iuiortance, it seemed important to study the effect of salicylates on the electrocardiogram of normal persons. Thirteen individuals, twelve men and one woman, were chosen. These were fairly normal persons who had no disease which affectetl the heart. Electrocardiographic records were taken before and aftcl the administration of sodium salicylate. The salicylate was given by mouth ancl by rectum, or when gastric complaints were present, b> rectum alone, until signs of salicylism appeared. In studying these records it is seen that sodium salicylate produced no effect on the pulse rate. The auriculoventricular conduction time, the form and amplitude of the QRS group, and the contour of the R-T or 8-T segment were unaltered; the l’- and T-waves similarly were not affectecl. The elcrt~ocflrrl,io!jl.~l~~~ tkercforc is ,not changed ly sotliur~~ scrZ,ic!jlate, and there is no evidence that t,he drug has any effect on the normal heart muscle. Tn rheumatic fever elect,rocardiographic changes are almost invariably present. As sodium salicylate has been s1Iow11 to cause no changes in the electrocardiograms of normal persons, the drug cannot be held responsible for the changes which are found in individuals with this tlisease. The electrocardiographic cahauges enumerated by various aut’hors in rheumatic fever are not the result of salicylatc therap!-, but are tlue to heart muscle disease which is present in spite of the use of the salicylates. I wish to express my sincere thanks to Dr. of this work and for his helpful suggestions.
L. A. Conner
for
his kind
super17isiou
REFEBENC’ES
IParkinson, Gosw, and Gunson: Quart. Jour. Med., 1919-20, xiii, 363. “Cohn and Swift: Jour. Exper. Med., 1924, xxix, 1. :
Medicine,
EFFECT
OF SODIUM SALICYLATE ON THE II1 lMt\X ELE~~TRO~Al~DIOQRA~~f
xORW&
w
ITHIK recent years the etrctrocardiograp1~ has been used a great deal in the study of the effwt. of rhmatic fcvw on the heart muscle,‘* ‘* 3* + r, MICI by this method it. has hew shown that. it is frequently possible t.o detect evidenw of myocardial damage long before such damage can be recognized clinically. Some e.linicians” have even gauged prognosis with the aid of the cteetroc*ardiograph. In view of the almost. universal WC of salicy1at.r during rheumatic fever the question has been raised as to wht?ther some of the eteotrocardiographic chaJigt~s found ill that diseaw nlipht not 1)~ tluc! to the drug rather than to thth disease itxclf. ‘l’hc following study. therefore, has been undertaken to ascertain the* t+l’ectx of the salieylates on the ~?lc~~trt,cardiograIii of normal hwrts. I!efore entering in detail upon the nwthotl pursrird it will he \vPtl lo rcvim tlrcb vlertrocardiographic clin~igt~s rwortlrcl in rtieuniatie ftwr. Protongation of flir P-R intrruat. from a niwct depressioii of conduction that is barely notiwabtt~ in thtb c~tectro~ai,diograln to dropped beats; partial ant1 town twuptt~tr heart-block ; iitterstions in the heart rhythm, as for example. sinus srrhyvthmiil. sino-aurictutar block, wdat rhythm, premafurc beat.s, paroxysmal twh,veartlia. aurieular fibrillation and flutter; and finally cthanges in thr contour of thr QRS group and the S-T transition int.rrral ;--all thtw haw hwn n&d in acute’ rhcumatie. fever. l:sinp these criteria, l~t~tl~scl~iltt. Saks and l&man” found t.he heart involwtl iu (3 out nf 65 cases of rhcwuat.ic fewr. It is believed that. the cchangrs iti thr S-T interval, i.t*., the riw i m-m! rarely the fall) of t.lie H-T or S-T segaic& directly from t.llth last stroke of the R- or S-WIW, respc~~tirclg, without the usual S-T isoelectric level, is the most coiiiwni ctiailgtt ii1 rheumatic ferw and for this reason psrfiwlw attention has bcwi paitl to this interval.
In this study the* l~tsa Followett wix to giv4’ sotliuin salieyta to t.o normal human cont.rots atit to watc4~ for the above mentioned changes in the elect.rocarttiopraJn. 11anztik7 states t.lie full therapeutic dose of sodium saticytatc: to hr I5 grams, i.fl., “25 grains. In normal subjects this is cwret.ed in about stwaty-eight hours. The toxic clinical dose (i.e., until gastric a.ntt autlitory disturbances supervene)
-.z.Y
.-z
P ii 4
I
k
1 s-l
1
.\I.tS'I'l:li
2io 480 'Jo0 1080 1320 1440 lb80
Gr. (:r. Gr. Or. fir. Gr. Gr.
and T-Waves, and the S-T segment remainctl practically unchanged. Perhaps most significant of all, the forms of’ the T-wave and the contour of the B-T or S-T segrtlc?ats were absolutely ~maltcred, as may be seen from the accompanying illustrations. These important findings in condunction with the P-R measurements, itldicate that sotlium salicylate has no effect on the normal human clcctrocardiolrram and does not account for any of the electrocardiographic changes noted in rhcumatic fever. SUXBIARY Considering the well-known efiCect’ of acute rheumatic fever oil tlic heart muscle, and also considerin g the fact that the electrocardioseraphic changes in rheumatic fever have become of considerable iuiortance, it seemed important to study the effect of salicylates on the electrocardiogram of normal persons. Thirteen individuals, twelve men and one woman, were chosen. These were fairly normal persons who had no disease which affectetl the heart. Electrocardiographic records were taken before and aftcl the administration of sodium salicylate. The salicylate was given by mouth ancl by rectum, or when gastric complaints were present, b> rectum alone, until signs of salicylism appeared. In studying these records it is seen that sodium salicylate produced no effect on the pulse rate. The auriculoventricular conduction time, the form and amplitude of the QRS group, and the contour of the R-T or 8-T segment were unaltered; the l’- and T-waves similarly were not affectecl. The elcrt~ocflrrl,io!jl.~l~~~ tkercforc is ,not changed ly sotliur~~ scrZ,ic!jlate, and there is no evidence that t,he drug has any effect on the normal heart muscle. Tn rheumatic fever elect,rocardiographic changes are almost invariably present. As sodium salicylate has been s1Iow11 to cause no changes in the electrocardiograms of normal persons, the drug cannot be held responsible for the changes which are found in individuals with this tlisease. The electrocardiographic cahauges enumerated by various aut’hors in rheumatic fever are not the result of salicylatc therap!-, but are tlue to heart muscle disease which is present in spite of the use of the salicylates. I wish to express my sincere thanks to Dr. of this work and for his helpful suggestions.
L. A. Conner
for
his kind
super17isiou
REFEBENC’ES
IParkinson, Gosw, and Gunson: Quart. Jour. Med., 1919-20, xiii, 363. “Cohn and Swift: Jour. Exper. Med., 1924, xxix, 1. :
Medicine,