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The four-lead electrocardiogram in coronary sclerosis
842
THE
AMERICAN
Graybiel, Ashton, and White, Contributions Ma’de During This
review
is introduced
Paul 1934. with
the
HEART
JOURNAL
Dislelases of the Heart: D.: Arch. Int. Med. 55: 842, 1935. following
A
Review
of
statements:
There has not been a major contribution to the knowledge of heart disease during 1934. Minor advances have been made, however, and some recent gains consolidated. This review does not include all that has been done; it suffices merely to indicate certain trends and to cite some of the more interesting publications. While a few of the reports seem more wonderful than probable, an especially critical attitude has been avoided because the newness of the work prevents conclusion. Bohning, A., Sclerosis.
and Am.
Katz, J. M.
L. N.: SC. 189:
The Four-Lead 833, 1935.
Electrocardiogranr
in
Coronary
A total of 508 electrocardiograms taken with a Lead IV have been analyzed and the data tabulated and summarized. Two hundred were from patients clinically diagnosed to have coronary sclerosis, 50 from patients suspected of having coronary sclerosis but without definite symptoms, 100 from patients with suspected cardiac disease, 25 from individuals with normal hearts, and 133 from patients known to have other types of organic heart disease. It was found that patients with coronary sclerosis showed more often than ‘any of the control groups. The abnormalities in Lead IV in the patients with coronary always associated with abnormal findings in the conventional deviations were usually more striking in Lead IV.
abnormalities
Patients with coronary petence showed abnormalities myoeardial incompetence.
of myocardial patients without
in Lead
IV
The sclerosis negative
sclerosis having in Lead IV
clinical evidence more often than
sclerosis were almost three leads, but the incomsuch
four major types of abnormal Lead IV found .in patients with coronary are described. They are the positive QR,S4 type (the most common), the QRS4 type, the positive and diphasic T4 type, and the deeply negative
T4 type. The value of Lead IV confirmed by postmortem
in determining examination
in
the status of the coronary circulation seven eases of coronary sclerosis.
was
Serial four-lead electrocardiograms were obtained in 56 of the 200 patients with coronary sclerosis covering a period of from four months to two years or more. Analysis of these records and, in addition, those obtained on patients with recent coronary occlusion and other conditions showed the value of serial electrocardiograms in evaluating the state of the coronary circulation. This is particularly important because of the paucity of precise clinical evidence in a large number of such patients. If records obtained in patients suffering from acute infectious processes, those taken on moribund patients, and those taken on patients given large doses of digitalis are excluded, then one can determine from serial four-lead electrocardiograms whether the coronary insufficiency is: (1) an acute transitory coronary ins&l. cieney, i.e., angina pectoris, nocturnal dyspnea, cardiac asthma, or its equivalent; (2) a subacute sclerotis wit,h myocardial infarction; (3) a chronic nonprogressive or (4) a chronic progressive coronary insufficiency. coronary insufficiency; This functional classification should prove as useful in evaluating the clinical course of the patients as the anatomical and etiological classifications. This study emphasizes the importance of taking serial four-lead electrocardiograms in all patients suspected of having coronary disease in estimating the degree of insufficiency of the coronary circulation and the rate of its progress.
THE
AMERICAN
Graybiel, Ashton, and White, Contributions Ma’de During This
review
is introduced
Paul 1934. with
the
HEART
JOURNAL
Dislelases of the Heart: D.: Arch. Int. Med. 55: 842, 1935. following
A
Review
of
statements:
There has not been a major contribution to the knowledge of heart disease during 1934. Minor advances have been made, however, and some recent gains consolidated. This review does not include all that has been done; it suffices merely to indicate certain trends and to cite some of the more interesting publications. While a few of the reports seem more wonderful than probable, an especially critical attitude has been avoided because the newness of the work prevents conclusion. Bohning, A., Sclerosis.
and Am.
Katz, J. M.
L. N.: SC. 189:
The Four-Lead 833, 1935.
Electrocardiogranr
in
Coronary
A total of 508 electrocardiograms taken with a Lead IV have been analyzed and the data tabulated and summarized. Two hundred were from patients clinically diagnosed to have coronary sclerosis, 50 from patients suspected of having coronary sclerosis but without definite symptoms, 100 from patients with suspected cardiac disease, 25 from individuals with normal hearts, and 133 from patients known to have other types of organic heart disease. It was found that patients with coronary sclerosis showed more often than ‘any of the control groups. The abnormalities in Lead IV in the patients with coronary always associated with abnormal findings in the conventional deviations were usually more striking in Lead IV.
abnormalities
Patients with coronary petence showed abnormalities myoeardial incompetence.
of myocardial patients without
in Lead
IV
The sclerosis negative
sclerosis having in Lead IV
clinical evidence more often than
sclerosis were almost three leads, but the incomsuch
four major types of abnormal Lead IV found .in patients with coronary are described. They are the positive QR,S4 type (the most common), the QRS4 type, the positive and diphasic T4 type, and the deeply negative
T4 type. The value of Lead IV confirmed by postmortem
in determining examination
in
the status of the coronary circulation seven eases of coronary sclerosis.
was
Serial four-lead electrocardiograms were obtained in 56 of the 200 patients with coronary sclerosis covering a period of from four months to two years or more. Analysis of these records and, in addition, those obtained on patients with recent coronary occlusion and other conditions showed the value of serial electrocardiograms in evaluating the state of the coronary circulation. This is particularly important because of the paucity of precise clinical evidence in a large number of such patients. If records obtained in patients suffering from acute infectious processes, those taken on moribund patients, and those taken on patients given large doses of digitalis are excluded, then one can determine from serial four-lead electrocardiograms whether the coronary insufficiency is: (1) an acute transitory coronary ins&l. cieney, i.e., angina pectoris, nocturnal dyspnea, cardiac asthma, or its equivalent; (2) a subacute sclerotis wit,h myocardial infarction; (3) a chronic nonprogressive or (4) a chronic progressive coronary insufficiency. coronary insufficiency; This functional classification should prove as useful in evaluating the clinical course of the patients as the anatomical and etiological classifications. This study emphasizes the importance of taking serial four-lead electrocardiograms in all patients suspected of having coronary disease in estimating the degree of insufficiency of the coronary circulation and the rate of its progress.