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The normal blood supply of the node of Tawara, the bundle of His and its branches
SELECTED
275
ABSTRACTS
Wintrobe, M. M., Alcayaga, R., Humphreys, S., and Follis, R. H., Jr.: ElectraBUll. cardiographic Changes Associated With Thiamine Deficiency in Pigs. Johns
Hopkins
Hosp.
72:
169,
1943.
Thiamine deficiency is associated with pronounced electrocardiographic changes in the pig. These include bradycardia and prolonged P-R interval as well as second degree auriculoventricular block, abnormalities in the P waves, inversion of T,, nodal auriculoventricular dissociation, complete block and ventricular premature beats, with ectopic ventricular rhythm, and auricular fibrillation.
Inanition alone may cause bradycardia but thiamine deficiency appeared to cause It is cona greater degree of slowing than could be accounted for by inanition. cluded that, in the thiamine-deficient pig, bradycardia is attributable to the vitamin Evidence iu presented which deficiency rather than, or in addition to, inanition. indicates that the bradycardia as wrll as certain other signs are the result of vagal overaction. The electrocardiographic changes are probably in metabolism which is caused by lack of thiamine.
the
expression
of the
disturbance AUTHORS.
Dressler, W. : A Case of Myocardial Infarction Masked by Bundle Branch Block but Revealed by Occasional Premature Ventricular Beats. Am. .T. M. SC. 206: 361,
1943.
A case is reported in which myocardial infarction was associated with left bundle branch block. Significant electrocardiographic changes suggestive of myocardial infarction were absent in the regular beats but were displayed by premature beats of ventricular origin. ~kl'l'H0R.
Lascano, E. F.: The Normal Blood Supply of the Node of Tawara, of His and Its Branches. Rev. argent. de cardiol. 10: 23, 1943. By has
means
of injecting the coronaries in the human heart:
with
a colored
gelatin
mixture
The Bundle the following
been shown
The first posterior perforating or ramus septi fibrosi of Hass, is the main artery t,o both the bundle of His and Tawara’s node; it anastomoses with others, including quite frequently the one which supplies the sinoauricular node. In so far as the blood supply to the right branch of the bundle is concerned, this can be divided into three parts, The first is supplied by an anastomotie plexus derived from terminal branches of Tamus septi fibrosi, the second posterior perforating (ramus aepti ventriculorum superior of Hass), ramus cristae supraventricularis (which runs in the portion of the cardiac muscle so named), and the first anterior perforating arteries. The second part is supplied by- the artery to the ansiform band or Gross’ ramus limbi dextri, a series of arterioles arising from the plexus supplying the first portion, collaterals of other anterior perforating, and collaterals of posterior perforating arteries. All these vessels anastomose with one another. The third part is supplied by nutrient arteries of the nonspecific myocardium further on than the anterior papillary muscle, which also freely anastomose with one another. Similarly,
the left branch of the bundle of His may be divided, in so far as its is concerned, into three parts. The first portion is supplied by a plexus of anastomoses formed by the following: terminal branches of the ramus sapti fibrosi, terminal branches of ramus septi ventrieulorum superior, terminal branches
blood supply
276
ABIERICdN
HE:\RT
JOURNAL
of ramus cristae supraventricularis, termin;~l branches of special ing which was manifest in 50 per cent of the specimens and which pose denominating ra.mus limbi sinistri, the r,emaining 50 per cent multiple small arterioles. 1‘11~ second part, spreading over the parts of the interventricular septum, is supplied by other anterior forating arteries which anastomose with one another profusely. supplied by arteries of the nonspecific estraseptal myocardium nnastomose with one anc~tllcr.
anterior perf oratthe authors probeing supplied by middle and fower and posterior perThe third part is which also freely
By means of improvements in the classic techniques of investigating coronary circulation and performing various experiments, it was possible to demonstrate Ilefinitelp and clearly that, not only (10 the nrteries intrusted with the blood supply to the node (l’awara ‘s) ( buntlle of His. and its branches, :nmstomow with one another, but that, thescl same vessels tlo so witlr the nutrient arteries of the nonspecific ‘I’hcrc~ arteries shoul~l be considered as mere1.v main arteries and not myocardium. terminal vessels to the abovemrmetl node. bundle, ant1 its branches. The :umstomosrs have a diameter of roughly 50 microns, and, from the abundant number of vessels involved, it, can be deduced that these anastomoses plny an important Enncti~m. Both the main arteries node, the bundle of His, excitability.
and the anastomoses and its branches, run
concerned in the supply to ‘I’a~ara’s in the same direction a.’ the WV:IW of ~kJ’PHOR.
Jaleski, T. C., and Morrison, E. T.: Congenital Heart Block: Cases in Healthy Adults. Am. J. M. SC. 206: 440. 1943.
A Study of TWO
Two cases of congenital heart block are reported. The Arst case, which has been studied for four years, is it healthy adult who has no cardiac symptoms and no other apparent anomalies. The s:ec*ond case, which has been followed from birth, has fmd no cardiac symptoms except for some syncopal attacks. This case is of particular interest in that the patient ha. q had two normal pregnancies \vithout any serious enrdiac disturbance. 3 UI’HOR9 5 .
Luisada, A. A., and Mautner, H.: and Extra Sounds of the Heart.
Experimental Exp.
l&led.
Studies on Functional & 8urg.
Murmurs
1: ,“SP. 1943.
Experimental studies have been made on heart sounds and murrnur~ of animals with simultaneous registration of the electrocardiogram and the phonocardiogram. Different drugs have been injected, the vagur nerve stimulatetl, and other procedures also tried in order to produce extra sounds and murmurs. Analysis of the records has sfrown the following results: A systolic murmur is Prooften present in marked tachycsrdia, independently from pressure conditions. longation of the heart sounds because of bundle branch block may simulate murmurs. Extra sounds, causing the appearance of gallop rhythm, occur in certain experimental conditions where vagus stimulation is accompanied by increased conDuring heart block two loud sounds may follow a tractility of the myocardium. blocked auricular contraction. A prolonged auricular sound and also a prolonged third sound may be observed in some experimental conditions. Sometimes they may Possible explanations are attain sue11 length as to become real functional rumbles. Unexplained extra sounds we*e observed exceptionally, and are discussed discussed. in the text. AUTHORS.
275
ABSTRACTS
Wintrobe, M. M., Alcayaga, R., Humphreys, S., and Follis, R. H., Jr.: ElectraBUll. cardiographic Changes Associated With Thiamine Deficiency in Pigs. Johns
Hopkins
Hosp.
72:
169,
1943.
Thiamine deficiency is associated with pronounced electrocardiographic changes in the pig. These include bradycardia and prolonged P-R interval as well as second degree auriculoventricular block, abnormalities in the P waves, inversion of T,, nodal auriculoventricular dissociation, complete block and ventricular premature beats, with ectopic ventricular rhythm, and auricular fibrillation.
Inanition alone may cause bradycardia but thiamine deficiency appeared to cause It is cona greater degree of slowing than could be accounted for by inanition. cluded that, in the thiamine-deficient pig, bradycardia is attributable to the vitamin Evidence iu presented which deficiency rather than, or in addition to, inanition. indicates that the bradycardia as wrll as certain other signs are the result of vagal overaction. The electrocardiographic changes are probably in metabolism which is caused by lack of thiamine.
the
expression
of the
disturbance AUTHORS.
Dressler, W. : A Case of Myocardial Infarction Masked by Bundle Branch Block but Revealed by Occasional Premature Ventricular Beats. Am. .T. M. SC. 206: 361,
1943.
A case is reported in which myocardial infarction was associated with left bundle branch block. Significant electrocardiographic changes suggestive of myocardial infarction were absent in the regular beats but were displayed by premature beats of ventricular origin. ~kl'l'H0R.
Lascano, E. F.: The Normal Blood Supply of the Node of Tawara, of His and Its Branches. Rev. argent. de cardiol. 10: 23, 1943. By has
means
of injecting the coronaries in the human heart:
with
a colored
gelatin
mixture
The Bundle the following
been shown
The first posterior perforating or ramus septi fibrosi of Hass, is the main artery t,o both the bundle of His and Tawara’s node; it anastomoses with others, including quite frequently the one which supplies the sinoauricular node. In so far as the blood supply to the right branch of the bundle is concerned, this can be divided into three parts, The first is supplied by an anastomotie plexus derived from terminal branches of Tamus septi fibrosi, the second posterior perforating (ramus aepti ventriculorum superior of Hass), ramus cristae supraventricularis (which runs in the portion of the cardiac muscle so named), and the first anterior perforating arteries. The second part is supplied by- the artery to the ansiform band or Gross’ ramus limbi dextri, a series of arterioles arising from the plexus supplying the first portion, collaterals of other anterior perforating, and collaterals of posterior perforating arteries. All these vessels anastomose with one another. The third part is supplied by nutrient arteries of the nonspecific myocardium further on than the anterior papillary muscle, which also freely anastomose with one another. Similarly,
the left branch of the bundle of His may be divided, in so far as its is concerned, into three parts. The first portion is supplied by a plexus of anastomoses formed by the following: terminal branches of the ramus sapti fibrosi, terminal branches of ramus septi ventrieulorum superior, terminal branches
blood supply
276
ABIERICdN
HE:\RT
JOURNAL
of ramus cristae supraventricularis, termin;~l branches of special ing which was manifest in 50 per cent of the specimens and which pose denominating ra.mus limbi sinistri, the r,emaining 50 per cent multiple small arterioles. 1‘11~ second part, spreading over the parts of the interventricular septum, is supplied by other anterior forating arteries which anastomose with one another profusely. supplied by arteries of the nonspecific estraseptal myocardium nnastomose with one anc~tllcr.
anterior perf oratthe authors probeing supplied by middle and fower and posterior perThe third part is which also freely
By means of improvements in the classic techniques of investigating coronary circulation and performing various experiments, it was possible to demonstrate Ilefinitelp and clearly that, not only (10 the nrteries intrusted with the blood supply to the node (l’awara ‘s) ( buntlle of His. and its branches, :nmstomow with one another, but that, thescl same vessels tlo so witlr the nutrient arteries of the nonspecific ‘I’hcrc~ arteries shoul~l be considered as mere1.v main arteries and not myocardium. terminal vessels to the abovemrmetl node. bundle, ant1 its branches. The :umstomosrs have a diameter of roughly 50 microns, and, from the abundant number of vessels involved, it, can be deduced that these anastomoses plny an important Enncti~m. Both the main arteries node, the bundle of His, excitability.
and the anastomoses and its branches, run
concerned in the supply to ‘I’a~ara’s in the same direction a.’ the WV:IW of ~kJ’PHOR.
Jaleski, T. C., and Morrison, E. T.: Congenital Heart Block: Cases in Healthy Adults. Am. J. M. SC. 206: 440. 1943.
A Study of TWO
Two cases of congenital heart block are reported. The Arst case, which has been studied for four years, is it healthy adult who has no cardiac symptoms and no other apparent anomalies. The s:ec*ond case, which has been followed from birth, has fmd no cardiac symptoms except for some syncopal attacks. This case is of particular interest in that the patient ha. q had two normal pregnancies \vithout any serious enrdiac disturbance. 3 UI’HOR9 5 .
Luisada, A. A., and Mautner, H.: and Extra Sounds of the Heart.
Experimental Exp.
l&led.
Studies on Functional & 8urg.
Murmurs
1: ,“SP. 1943.
Experimental studies have been made on heart sounds and murrnur~ of animals with simultaneous registration of the electrocardiogram and the phonocardiogram. Different drugs have been injected, the vagur nerve stimulatetl, and other procedures also tried in order to produce extra sounds and murmurs. Analysis of the records has sfrown the following results: A systolic murmur is Prooften present in marked tachycsrdia, independently from pressure conditions. longation of the heart sounds because of bundle branch block may simulate murmurs. Extra sounds, causing the appearance of gallop rhythm, occur in certain experimental conditions where vagus stimulation is accompanied by increased conDuring heart block two loud sounds may follow a tractility of the myocardium. blocked auricular contraction. A prolonged auricular sound and also a prolonged third sound may be observed in some experimental conditions. Sometimes they may Possible explanations are attain sue11 length as to become real functional rumbles. Unexplained extra sounds we*e observed exceptionally, and are discussed discussed. in the text. AUTHORS.