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Tuberculous heart disease
466
AMERICAN
HEART
JOURNAL
The authors conclude that anticoagulant therapy is of great value in the prevention of thromboses of veins and arteries subsequent to trauma. However, with the possible exception of the superiority of heparin in the prevention of thrombosis of injured small arteries, the difference between the anticoagulants, heparin and Dicumarol, was not significant. LoRIX Elkin,
D. C., Cooper, F. W., Jr., Rohrer, R. H., Miller, W. B., Jr., Dennis E. W. : The Study of Peripheral Vascular Disease With Part I. Surg., Gynec. & Obst. 87:i (July), 1948.
Shea, I’. Radioactive
C.,
Jr., and Isotopes.
The authors utilized radioactive sodium 24 in the investigation of the circulation to the extremities. Two methods were studied. In one, 5 C.C. of the prepared solution was rapidly injected into an antecubital vein and the circulation time to the lower extremity was determined by noting the sudden rapid increase in the rate of count of the Geiger-Mueller detector placed posterior to each gastrocnemius muscle and at the ball of each foot. The figure obtained depended not only upon the flow of blood to the part but also upon the diffusion of sodium chIoride from the vessel into the extravascular spaces. The second method consisted of injecting the sodium directly into the gastrocnemius muscle and determining the rate of disappearance of the material as recorded on a detector placed behind the gastrocnemius muscle. The rate of removal depended upon the circulation through the nutrient capillaries. It is the authors’ opinion that with this procedure a means is at hand for determining the relative blood flow to the muscles, since the rapidity of removal of the sodium from this tissue is related to the volume of blood flow locally. ABRAMSON. Puddu, V., and Mussafia, Tests. Acta Cardiol.
A. : Considerations 2:140, 1947.
on the Electrocardiogram
During
Exercise
Depression of the RS-T segment during exercise in patients with coronary artery disease may be explained by a delay of endocardial repolarization. Occasional elevation of the RS-T segment must be assumed to be the result of a diffusion of the ischemic region toward the epicardial layers. Uprighting of a previously inverted T wave during the test is explained as the result of a balance between two regions, one of which is characterized by delay of repolarization at rest, the other by a normal resting condition which upon exercise becomes equally delayed. A temporary “normalization” of the record must result. HECHT. Segers,
M.
:
Interaction
Between
Auricles
and
Ventricles.
Acta
Cardiol.
2:335,
1947.
Three clinical examples are presented in which an interaction between auricles and ventricles could be demonstrated in the presence of complete A-V block. The presence of such interaction in the apparent absence of anatomical pathways may be seen (1) in synchronization of auricular and ventricular beats in instances of complete A-V block; (2) in shortening of P-P intervals in complete A-V bIock during the ventricular excitation; (3) in alteration of the contour of the P wave in complete block in auricular beats that follow the ventricular complex; (4) in auricular extrasystoles appearing in close relationship to the ventricular beats in A-V block; and (5) in an abnormal duration of the ventricular compensatory pause after ventricular extrasystoles. No physiological explanation has been attempted. HECHT. Wallgren,
A. :
Tuberculous
Deart
Disease.
Three cases of tuberculous pericarditis exudative and adhesive pericarditis following enlarged retrocardiac nodes. A left upper pericardial surface. In contrast to this, two friction rubs, enlarged cardiac shadows, and
.\rta
med.
Scandinnv.
(Suppl.)
196:132,
1947.
are reported. ‘I’hc lirst, an S-year-old bo),, died of fever, crythema nodosum, and a left hilar lesion with lobe caseous pneumonia was found adherent to the boys, 9 and 6 years of age, respectively, developed altered T waves one month after the onset of febrile
SELECTED
AHSTKACTS
4hi
primary tuberculosis of the lung. The cardiac signs persisted about three weeks and were accompanied by increased fever and further elevation of the sedimentation rate. There were no demonstrable cardiac sequellae except a change in the contour of the right auricular border in one ho);. This was attributed to a pericardial adhesion. No rheumatic manifestations were recorded in the past histories, nor did any appear for the duration of a three-year follow-up period after the pcricarditis. The author compares the situation in his latter two patients with acute “tuber-l.ulous-allergic” serofibrinous pleurisy on the basis of the brief course and good prognosis.
Graf,
W.. Moller, T., Srandinav. (Suppl.)
and Mannheimer, 196:167, 1947.
E.:
The
Continuous
.\cta
Murmur.
n~:d.
Phonocardiographic records in five frequency ranges were recorded simultaneously with Lead II of the electrocardiograph to demonstrate the characteristics and points of maximal intensity oi the main types of continuous murmurs: in patent ductus arteriosus, the thyroid murmur of G raves’ disease, arteriovenous aneurysm, the fontancl murmur of infants, and the venous huts 01 children. The murmur of patent ductus arteriosus began atjout 0.04 seconds after the first heart sound. The regularity with which it was loudest in the second left intercostal space is stressed, the authors believing that continuous murmurs with their greatest intensities in the third and fourth intercostal spaces or the aortic area indicate other types of anomaly. Three pre- and postoperative phonocardiograms of patients with patency of the ductus arteriosus are reproduced, as well as tracings of a patient thought at operation to have a persistent truncus communis. The continuous murmur in this latter instance was loudest in the third left intercostal space. The thyroid murmur was studied in thirteen women with Graves’ disease and found to haye a frequency extending up to 400 to 500 cycles per second. ‘There was frequently a difference itr intensity between the two lobes. Three cases of arteriovenous aneurysm were studied, two intracranial and one at the ankle. The frequencies ranged between 500 and 1000 cycles per second. One tracing of a fontanel murmur was reproduced. It was recorded both at the anterior iontanel and the external auditory meatus, and was of moderate amplitude in all frequencies between 50 and 500 cycles per second. It was believed to have heen produced in the intracranial veins. The venous hum in the neck was studied in forty children selected from 250 children examined. ‘l‘he incidence of the hui was 42.8 per cent from birth to 3 years, 65.5 per cent between 3 and 6 years, 52.9 per cent between 6 and 9 years, 47.8 per cent between 9 and 12 years, and 30.X per cent between 12 and 15 years. The intensity was equal on both sides in one-half the cases studied, the remaining half being divided about equally between right and left sides as to maximal intensit).. Turning the head to the opposite side increased the intensity of the murmur, as did deep inspiration, while digital compression of the jugular vein made it disappear. These characteristics were illustrated by tracings. The frequency range was SO to 500 cycles per second bllt usualI> nai not greater than 100 cycles per second.
.\kesson. s.: Arterial Orthostatic (SuppI.) 196:192, 1947.
4nemia
With
Cardiac
Pains.
Acta
med.
Scandlnav.
The author reports a 21-year-old man who developed vague and variable precordial pain and palpitation which became gradually worse for eighteen months and were related to exertion, anxiety, and eating. The blood pressure in recumbency was found to IX! I.45 90 and the pulse, 80 per minute. After the patient had stood i’or eight minutes, these 1igurt.a wcrts, rcspcc‘tively, I 15/85 ant1 104 per minute. The heart was normal by Auoroscopy. ‘The l,lertl-t~;Irtliograru when the patient was recumbent showed slightly low ‘1‘ waves in thr limb leads ;~nd a slightly diphasic T wave over the left prerordium with a rate of 75 per minute. Wheu the patient stood, marked T-wave inversion appeared in all leads, with 1.0 mm. of RS-‘T segment depression at a rate of 120 per minute. Breathing a mixture of 6.7 per cent oxygen and 4.5 per cent
AMERICAN
HEART
JOURNAL
The authors conclude that anticoagulant therapy is of great value in the prevention of thromboses of veins and arteries subsequent to trauma. However, with the possible exception of the superiority of heparin in the prevention of thrombosis of injured small arteries, the difference between the anticoagulants, heparin and Dicumarol, was not significant. LoRIX Elkin,
D. C., Cooper, F. W., Jr., Rohrer, R. H., Miller, W. B., Jr., Dennis E. W. : The Study of Peripheral Vascular Disease With Part I. Surg., Gynec. & Obst. 87:i (July), 1948.
Shea, I’. Radioactive
C.,
Jr., and Isotopes.
The authors utilized radioactive sodium 24 in the investigation of the circulation to the extremities. Two methods were studied. In one, 5 C.C. of the prepared solution was rapidly injected into an antecubital vein and the circulation time to the lower extremity was determined by noting the sudden rapid increase in the rate of count of the Geiger-Mueller detector placed posterior to each gastrocnemius muscle and at the ball of each foot. The figure obtained depended not only upon the flow of blood to the part but also upon the diffusion of sodium chIoride from the vessel into the extravascular spaces. The second method consisted of injecting the sodium directly into the gastrocnemius muscle and determining the rate of disappearance of the material as recorded on a detector placed behind the gastrocnemius muscle. The rate of removal depended upon the circulation through the nutrient capillaries. It is the authors’ opinion that with this procedure a means is at hand for determining the relative blood flow to the muscles, since the rapidity of removal of the sodium from this tissue is related to the volume of blood flow locally. ABRAMSON. Puddu, V., and Mussafia, Tests. Acta Cardiol.
A. : Considerations 2:140, 1947.
on the Electrocardiogram
During
Exercise
Depression of the RS-T segment during exercise in patients with coronary artery disease may be explained by a delay of endocardial repolarization. Occasional elevation of the RS-T segment must be assumed to be the result of a diffusion of the ischemic region toward the epicardial layers. Uprighting of a previously inverted T wave during the test is explained as the result of a balance between two regions, one of which is characterized by delay of repolarization at rest, the other by a normal resting condition which upon exercise becomes equally delayed. A temporary “normalization” of the record must result. HECHT. Segers,
M.
:
Interaction
Between
Auricles
and
Ventricles.
Acta
Cardiol.
2:335,
1947.
Three clinical examples are presented in which an interaction between auricles and ventricles could be demonstrated in the presence of complete A-V block. The presence of such interaction in the apparent absence of anatomical pathways may be seen (1) in synchronization of auricular and ventricular beats in instances of complete A-V block; (2) in shortening of P-P intervals in complete A-V bIock during the ventricular excitation; (3) in alteration of the contour of the P wave in complete block in auricular beats that follow the ventricular complex; (4) in auricular extrasystoles appearing in close relationship to the ventricular beats in A-V block; and (5) in an abnormal duration of the ventricular compensatory pause after ventricular extrasystoles. No physiological explanation has been attempted. HECHT. Wallgren,
A. :
Tuberculous
Deart
Disease.
Three cases of tuberculous pericarditis exudative and adhesive pericarditis following enlarged retrocardiac nodes. A left upper pericardial surface. In contrast to this, two friction rubs, enlarged cardiac shadows, and
.\rta
med.
Scandinnv.
(Suppl.)
196:132,
1947.
are reported. ‘I’hc lirst, an S-year-old bo),, died of fever, crythema nodosum, and a left hilar lesion with lobe caseous pneumonia was found adherent to the boys, 9 and 6 years of age, respectively, developed altered T waves one month after the onset of febrile
SELECTED
AHSTKACTS
4hi
primary tuberculosis of the lung. The cardiac signs persisted about three weeks and were accompanied by increased fever and further elevation of the sedimentation rate. There were no demonstrable cardiac sequellae except a change in the contour of the right auricular border in one ho);. This was attributed to a pericardial adhesion. No rheumatic manifestations were recorded in the past histories, nor did any appear for the duration of a three-year follow-up period after the pcricarditis. The author compares the situation in his latter two patients with acute “tuber-l.ulous-allergic” serofibrinous pleurisy on the basis of the brief course and good prognosis.
Graf,
W.. Moller, T., Srandinav. (Suppl.)
and Mannheimer, 196:167, 1947.
E.:
The
Continuous
.\cta
Murmur.
n~:d.
Phonocardiographic records in five frequency ranges were recorded simultaneously with Lead II of the electrocardiograph to demonstrate the characteristics and points of maximal intensity oi the main types of continuous murmurs: in patent ductus arteriosus, the thyroid murmur of G raves’ disease, arteriovenous aneurysm, the fontancl murmur of infants, and the venous huts 01 children. The murmur of patent ductus arteriosus began atjout 0.04 seconds after the first heart sound. The regularity with which it was loudest in the second left intercostal space is stressed, the authors believing that continuous murmurs with their greatest intensities in the third and fourth intercostal spaces or the aortic area indicate other types of anomaly. Three pre- and postoperative phonocardiograms of patients with patency of the ductus arteriosus are reproduced, as well as tracings of a patient thought at operation to have a persistent truncus communis. The continuous murmur in this latter instance was loudest in the third left intercostal space. The thyroid murmur was studied in thirteen women with Graves’ disease and found to haye a frequency extending up to 400 to 500 cycles per second. ‘There was frequently a difference itr intensity between the two lobes. Three cases of arteriovenous aneurysm were studied, two intracranial and one at the ankle. The frequencies ranged between 500 and 1000 cycles per second. One tracing of a fontanel murmur was reproduced. It was recorded both at the anterior iontanel and the external auditory meatus, and was of moderate amplitude in all frequencies between 50 and 500 cycles per second. It was believed to have heen produced in the intracranial veins. The venous hum in the neck was studied in forty children selected from 250 children examined. ‘l‘he incidence of the hui was 42.8 per cent from birth to 3 years, 65.5 per cent between 3 and 6 years, 52.9 per cent between 6 and 9 years, 47.8 per cent between 9 and 12 years, and 30.X per cent between 12 and 15 years. The intensity was equal on both sides in one-half the cases studied, the remaining half being divided about equally between right and left sides as to maximal intensit).. Turning the head to the opposite side increased the intensity of the murmur, as did deep inspiration, while digital compression of the jugular vein made it disappear. These characteristics were illustrated by tracings. The frequency range was SO to 500 cycles per second bllt usualI> nai not greater than 100 cycles per second.
.\kesson. s.: Arterial Orthostatic (SuppI.) 196:192, 1947.
4nemia
With
Cardiac
Pains.
Acta
med.
Scandlnav.
The author reports a 21-year-old man who developed vague and variable precordial pain and palpitation which became gradually worse for eighteen months and were related to exertion, anxiety, and eating. The blood pressure in recumbency was found to IX! I.45 90 and the pulse, 80 per minute. After the patient had stood i’or eight minutes, these 1igurt.a wcrts, rcspcc‘tively, I 15/85 ant1 104 per minute. The heart was normal by Auoroscopy. ‘The l,lertl-t~;Irtliograru when the patient was recumbent showed slightly low ‘1‘ waves in thr limb leads ;~nd a slightly diphasic T wave over the left prerordium with a rate of 75 per minute. Wheu the patient stood, marked T-wave inversion appeared in all leads, with 1.0 mm. of RS-‘T segment depression at a rate of 120 per minute. Breathing a mixture of 6.7 per cent oxygen and 4.5 per cent