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Unexplained fever in heart failure
279
ABSTRACTS
Ruddock, 357,
John 1934.
C.:
Dilatation
of the
Left
Auricle
to the
Right.
R.adiology
23:
The author concludes from examination of cardiac roentgenogramq together with histories and postmortem examination of the hearts, that dilatation of the right side of the heart as shown and demonstrated by roentgenographic examination in compensated cases of mitral stenosis is due to enlargement of the left auricle. He believes that as the auricle enlarges and dilates, there is an encroachment posteriorly to the right side so that the left auricle enters into the formation of the right cardiac silhouette. Enlargement of the right side of the heart in deeompensated cases as shown by roentgenographic examination is due to dilatation of the right auricle. In roentgenograms of cases of mitral stenosis, the cardiohepatic angle is either acute or obtuse and is in direct proportion to the degree of decompensation. In cases in which compensation is complete, the dilatation of the left auricle causes an acute angle which will be shown by roentgenograms as the cardiohepatic angle. In cases in which there, is a dccompensation and a resuiting dilatation of the right auricle, the angle is either right or obtuse. Description of the roentgenograms should call attention to the cardiohepatic angle, and the presence of compensation or decompensation must be known before a correct interpretation of the heart contour can be made. Hansen, tion.
Olga Am.
S., and Maly, Rev. Tubere.
Henry W.: The 30: 527, 1934.
Heart
After
Phrenic
Nerve
Interrup
In an effort to evaluate the effects of unilateral diaphragmatic paralysis bg phrenic nerve interruption and the associated intrathoracic changes upon the heart, 100 successive casts have had physical, electrocardiographic and x-ray observations before and after this operation at Glen Lake Sanatorium for tuberculosis. No other type of collapse therapy had been employed. Those with pleural effusion were discarded. Electrocardiograms showed a change in the direction and amplitude of the QRS waves in sixty-five, slight in degree in all but ten (fifty-five), but enough to indicate a shift of the electrical axis toward the left in twenty-five (all but one after a left-sided operation), and toward the right in ten (all but one after a right-sided operation). P-waves changed only six times, and no evidence of auriculoventricular conduction delay appeared. T-wave changes appeared in twenty-three eases, ten times with an increased negativity in the significant leads, and thirteen with an increase of size or a decrease of negativity. No clinical or roentgenographic evidence of myocardial changes appeared, or of defective conduction through the ventricles. The heart position was displaced from its preoperative position in sixty-nine cases. After right-sided operations there was a preponderance of shifting toward the left or healthy side (twenty-nine times out of thirty-seven). After left-sided operations the heart might be displaced to either side (fifteen toward the left and seventeen toward the right). Twice as many were displaced away from tho collapsed side as toward it (forty-six and twenty,three). Comparing the direction of the deviation of the electrical axis with that of heart displacement revealed agreement in eleven and disagreement in twenty-three. No evidence of heart damage or disturbance of function appeared. Cohn, J.
Alfred E., and Clin. Investigation
Observations brought into
Steele, J. Murray: 13: 853, 1934.
of the behavior question the wisdom
Unexplained
of certain of assuming
Fever
in
Heart
cardiac patients with fever in instances of unexplained
Failure. have fever
280
THE
AMERICAN
HEART
the presence of an infectious process. For t,his reason, the records of 368 cardiac patients have been studicc!. Of I72 who l~rcscntctl symptoms or signs of heart failure, 153 exhibited on two or more occasions, elevation of the rectal tempcrah-e to at least 100” E. Usually the ehxations were clearly associated with conditions generally recognized as accompanied by fever, but in 49 eases the occurrence of fever was wit,hout satisfactory crplanat~ion. In certain ones its developmrnt suggested an origiu, at least iu llart. dcpcndent upon heart failure itself.
It is pointcd out that fever may occur during heart failure in the absence of evidence of infection or of tho nouinfcctious conditions which have been enumerated and which are likewise associatcrl with the dcvclopmcnt of fever. Results of bacteriological studies of matrrial obtained by puncture of the lungs during life and from the lungs at aut.opsy in patients with heart failure accompanied by fcrer are presentc~l. 111 a number of cases, signs of heart failure appear or begin to increase just prior to the occurrence of fever. Fever and the signs of heart failure disappear simultaneously. These relations suggest that t.he occurrence of fever in these instances is dc pcnglerrt upon mechanisms involved in heart failure itself.
J. Murray: of the Interior
Stile,
Fever in Heart Failure. Relations Between the Temperatures and the Surface of the Body. .l. Clin. Investigation 13: S69,
1934. Daily fluctuation of surface and rectal temperatures has been studied in normal individuals, in individuals during and after recovery from heart failure, and in a few individuais suffering from infectious diseases. The patients with heart failure wcrc selcctcll for study because they exhibited fever and because evidence of infection was sought but was not found. A fairly regular normal diurnal variation in the temperature of the extremities opposite in direction to that of the rectal tcmperaturc is described. The behavior of the temperature of the surface of the body, ospccially of the extremities, in the cases of heart failure which exhibit fcvcr of unexplained source is diffcrcnt from that observed in patients with fever associated with infec,tious diseases. The temperature of the surface in cardiac patients is lower than that of normal individuals, while that of patients with infectious fever is as high as or higher than normal. The difference in behavior leads to the conclusion that elevation of rectal temperature in cases of heart failure need not he of infrctious origin but may depend upon a variety of processes iurirlcrtt to heart failure itself.
Steele, J. Murray, and Kirk, in Essential Hypertension.
Esben: J. Clin.
The Significance Investigation
of the Veesels of the Skin 13:
895,
The temperature of the skin of individuals w&ring from does not differ significantly from that of normal individuals. in surface temperature regularly occur in individuals with without significant change in arterial pressure. Elevation it in hypertensive individuals does not depend on, though by, constriction of the arterioles of the skin.
1934. arterial hypertension Diurnal variations arterial hypertension of arterial pressure may he accompanied
Page, Irvine H.: The Effect of Renal Efficiency of Lowering Arterial Blood Pressure in Cas;es of Essential Hypertension and Nephritis. J. Clin. Investigation 13: 909, 1934. The altered
efficiency of by a marked
the kidneys, as measured fall in arterial blood
by the urea clearance test, is not pressure occurring spontaneously or
ABSTRACTS
Ruddock, 357,
John 1934.
C.:
Dilatation
of the
Left
Auricle
to the
Right.
R.adiology
23:
The author concludes from examination of cardiac roentgenogramq together with histories and postmortem examination of the hearts, that dilatation of the right side of the heart as shown and demonstrated by roentgenographic examination in compensated cases of mitral stenosis is due to enlargement of the left auricle. He believes that as the auricle enlarges and dilates, there is an encroachment posteriorly to the right side so that the left auricle enters into the formation of the right cardiac silhouette. Enlargement of the right side of the heart in deeompensated cases as shown by roentgenographic examination is due to dilatation of the right auricle. In roentgenograms of cases of mitral stenosis, the cardiohepatic angle is either acute or obtuse and is in direct proportion to the degree of decompensation. In cases in which compensation is complete, the dilatation of the left auricle causes an acute angle which will be shown by roentgenograms as the cardiohepatic angle. In cases in which there, is a dccompensation and a resuiting dilatation of the right auricle, the angle is either right or obtuse. Description of the roentgenograms should call attention to the cardiohepatic angle, and the presence of compensation or decompensation must be known before a correct interpretation of the heart contour can be made. Hansen, tion.
Olga Am.
S., and Maly, Rev. Tubere.
Henry W.: The 30: 527, 1934.
Heart
After
Phrenic
Nerve
Interrup
In an effort to evaluate the effects of unilateral diaphragmatic paralysis bg phrenic nerve interruption and the associated intrathoracic changes upon the heart, 100 successive casts have had physical, electrocardiographic and x-ray observations before and after this operation at Glen Lake Sanatorium for tuberculosis. No other type of collapse therapy had been employed. Those with pleural effusion were discarded. Electrocardiograms showed a change in the direction and amplitude of the QRS waves in sixty-five, slight in degree in all but ten (fifty-five), but enough to indicate a shift of the electrical axis toward the left in twenty-five (all but one after a left-sided operation), and toward the right in ten (all but one after a right-sided operation). P-waves changed only six times, and no evidence of auriculoventricular conduction delay appeared. T-wave changes appeared in twenty-three eases, ten times with an increased negativity in the significant leads, and thirteen with an increase of size or a decrease of negativity. No clinical or roentgenographic evidence of myocardial changes appeared, or of defective conduction through the ventricles. The heart position was displaced from its preoperative position in sixty-nine cases. After right-sided operations there was a preponderance of shifting toward the left or healthy side (twenty-nine times out of thirty-seven). After left-sided operations the heart might be displaced to either side (fifteen toward the left and seventeen toward the right). Twice as many were displaced away from tho collapsed side as toward it (forty-six and twenty,three). Comparing the direction of the deviation of the electrical axis with that of heart displacement revealed agreement in eleven and disagreement in twenty-three. No evidence of heart damage or disturbance of function appeared. Cohn, J.
Alfred E., and Clin. Investigation
Observations brought into
Steele, J. Murray: 13: 853, 1934.
of the behavior question the wisdom
Unexplained
of certain of assuming
Fever
in
Heart
cardiac patients with fever in instances of unexplained
Failure. have fever
280
THE
AMERICAN
HEART
the presence of an infectious process. For t,his reason, the records of 368 cardiac patients have been studicc!. Of I72 who l~rcscntctl symptoms or signs of heart failure, 153 exhibited on two or more occasions, elevation of the rectal tempcrah-e to at least 100” E. Usually the ehxations were clearly associated with conditions generally recognized as accompanied by fever, but in 49 eases the occurrence of fever was wit,hout satisfactory crplanat~ion. In certain ones its developmrnt suggested an origiu, at least iu llart. dcpcndent upon heart failure itself.
It is pointcd out that fever may occur during heart failure in the absence of evidence of infection or of tho nouinfcctious conditions which have been enumerated and which are likewise associatcrl with the dcvclopmcnt of fever. Results of bacteriological studies of matrrial obtained by puncture of the lungs during life and from the lungs at aut.opsy in patients with heart failure accompanied by fcrer are presentc~l. 111 a number of cases, signs of heart failure appear or begin to increase just prior to the occurrence of fever. Fever and the signs of heart failure disappear simultaneously. These relations suggest that t.he occurrence of fever in these instances is dc pcnglerrt upon mechanisms involved in heart failure itself.
J. Murray: of the Interior
Stile,
Fever in Heart Failure. Relations Between the Temperatures and the Surface of the Body. .l. Clin. Investigation 13: S69,
1934. Daily fluctuation of surface and rectal temperatures has been studied in normal individuals, in individuals during and after recovery from heart failure, and in a few individuais suffering from infectious diseases. The patients with heart failure wcrc selcctcll for study because they exhibited fever and because evidence of infection was sought but was not found. A fairly regular normal diurnal variation in the temperature of the extremities opposite in direction to that of the rectal tcmperaturc is described. The behavior of the temperature of the surface of the body, ospccially of the extremities, in the cases of heart failure which exhibit fcvcr of unexplained source is diffcrcnt from that observed in patients with fever associated with infec,tious diseases. The temperature of the surface in cardiac patients is lower than that of normal individuals, while that of patients with infectious fever is as high as or higher than normal. The difference in behavior leads to the conclusion that elevation of rectal temperature in cases of heart failure need not he of infrctious origin but may depend upon a variety of processes iurirlcrtt to heart failure itself.
Steele, J. Murray, and Kirk, in Essential Hypertension.
Esben: J. Clin.
The Significance Investigation
of the Veesels of the Skin 13:
895,
The temperature of the skin of individuals w&ring from does not differ significantly from that of normal individuals. in surface temperature regularly occur in individuals with without significant change in arterial pressure. Elevation it in hypertensive individuals does not depend on, though by, constriction of the arterioles of the skin.
1934. arterial hypertension Diurnal variations arterial hypertension of arterial pressure may he accompanied
Page, Irvine H.: The Effect of Renal Efficiency of Lowering Arterial Blood Pressure in Cas;es of Essential Hypertension and Nephritis. J. Clin. Investigation 13: 909, 1934. The altered
efficiency of by a marked
the kidneys, as measured fall in arterial blood
by the urea clearance test, is not pressure occurring spontaneously or