ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

Measurements have been made of total exchangeable sodium, total body potassium, and total body water in a group of 13 previously edematous patients with heart disease, and in 20 “control” patients. The data show that while both groups have the same quantity of water as the per cent of bodyweight and the same body potassium concentration, the cardiac group has an excess of exchangeable sodium when compared with the “controls.” Since the excess sodium in the cardiac group cannot be attributed to the loss of potassium or the accumulation of water, the results of these studies are taken as evidence that osmotic inactivation of a considerable amount of some cation, probably sodium, has taken place. It is suggested that a likely site for cation binding is in the polyanionic constituents of the connective tissues.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

Analysis of the cardiovascular manifestations caused by loss of thoracic kyphosis has been incomplete. Accordingly, this study was designed to investigate the physical signs and the electrocardiographic, radiologic, hemodynamic, and pulmonary ventilatory features of this skeletal defect. Twenty-three patients with straight thoracic spines in lateral chest x-rays were selected. Ratios of anteroposterior to transthoracic dimensions were uniformly below a mean derived from 100 normal subjects. Cardiac features included pulmonic ejection murmurs, palpable left parasternal systolic impulses, loud delayed sounds of tricuspid valve closure, exaggerated respiratory splitting of the second heart sound, vertical electrical axes, rSr′ patterns in leads V1or aVR, radiologic prominence of the pulmonary arteries, levodisplacement of the heart, a “pancake” cardiac configuration simulating cardiomegaly, occasional alterations in height or contour of the right ventricular diastolic pressure pulse, and an occasional mild pulmonary ventilatory restrictive defect. Differential diagnoses principally included atrial septal defect, mild pulmonic stenosis, and idiopathic dilatation of the pulmonary artery.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

Symptoms of myocardial ischemia occur in aortic stenosis in the absence of coronary artery disease. Increased left ventricular wall tension, a principal determinant of myocardial oxygen requirements, may contribute to these symptoms. This investigation was undertaken during the course of transseptal left heart catheterization in order to study the effect of nitroglycerin on left ventricular wall tension in eight patients with fixed orifice aortic stenosis. In seven of the subjects, nitroglycerin significantly reduced tension-time index per beat and per minute. In addition, left ventricular size may have diminished as a consequence of lower diastolic filling pressure. In view of the relationship between wall tension and myocardial oxygen consumption, these effects should favorably influence the balance between oxygen availability and oxygen requirements in patients with fixed obstruction to left ventricular outflow. The eighth patient experienced an appreciable increase in tension-time index, suggesting secondary hypertrophic subaortic stenosis.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

Right and left heart hemodynamics were studied in 12 patients with mitral valvular disease and atrial fibrillation before and immediately after external direct-current countershock resulting in restoration of normal sinus rhythm. The change of rhythm was accompanied by the following hemodynamic variations in the majority of cases: Systolic and mean pressures in the right and left ventricles and in the pulmonary and brachial arteries were not systematically altered, with a tendency, however, to a decrease in ejection pressures in the right heart and increase in the left heart. Mean right atrial and right ventricular end-diastolic pressures as well as left ventricular end-diastolic pressure decreased significantly. The behavior of the mean left atrial pressure appeared to be influenced by the degree of mitral valvular disease. Cardiac output and index and stroke volume and index increased; pulmonary vascular and systemic resistances decreased.The stroke work of the ventricles also increased in the majority of patients.An analysis of the changes in left ventricular end-diastolic pressure in relation to the left ventricular stroke work indicated that sinus rhythm resulted usually in a shift of the ventricularfunction curve to an area of improved performance.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

An oral sodium tolerance test was devised to detect and quantify impaired Na excretion in patients with heart failure. Following a 4-day period during which daily Na intake was limited to 10 mEq., 80 mEq. of Na were administered daily for 4 days and 150 mEq. for another 4 days. The total urinary Na excretion during the 8-day test period was determined. Thirteen normal subjects excreted between 550 and 734 mEq. of Na. Of 41 patientswith heart disease, 31 excreted subnormal amounts of Na, between 10 and 550 mEq. and only 10 excreted normal quantities. An alternate plan, in which 320 mEq. of Na was administered in 8 days, was also utilized in patients in whom the standard 920-mEq. Na load was considered inadvisable. There was no correlation between the impairment of Na excretion, as estimated by the Na tolerance test, and the etiology of the heart disease, the glomerular filtration rate, or any hemodynamic variable. Patients with marked functional disability excreted less Na than those with few symptoms, and the patients with the most severe impairment of Na excretion all had a history of edema. Striking improvement in Na tolerance followed corrective cardiac operations. The Na tolerance test was found of particular usefulness in the evaluation of patients in whom clinical examination and hemodynamic studies gave no conclusive evidence as to the presence or absence of congestive heart failure.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

Twenty-three children with pulmonary stenosis were studied by means of displacement tracings taken over the right ventricle. The transducer was selected to pick up vibrations in the ultra-low frequency or palpable range. The patients were studied by cardiac catheterization and angiocardiography.Criteria previously established for normal children were applied to the patients with pulmonary stenosis. These provide a measure of the duration and relative height of the out-ward movement associated with ventricular systole.Recordings of precordial movement over the right ventricle in all of five children with severe pulmonary stenosis were abnormal by these criteria. Patients with mild pulmonary stenosis were normal in six of seven cases. An intermediate group (right ventricular peak pressures 60 to 100 mm. Hg) had abnormal records in seven of 11 instances. The “a” waveresulting from atrial contraction was exaggerated in severe pulmonary stenosis and was larger than normal in many of the mild and moderate cases.Recordings of precordial movement in pulmonary stenosis, though nonspecific in morphology, are nevertheless useful as an index of severity of the lesion, in timing phases of the cardiac cycle, in following the progress of cases before and after surgical interference, and as a method of improving appreciation of palpable phenomena at the bedside.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID