ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

Three instances of rheumatic nephrosclerosis are described in patients with chronic rheumatic valvular heart disease. The underlying mechanism of this renal lesion consists of an obliterating rheumatic endarteritis, involving mainly medium-sized and small arteries of the renal cortex. The arterioles take relatively little part in these changes. The widespread occlusive vascular disease gives rise to innumerable microscopic infarctions, resulting in a coarsely granular external surface of the kidneys.A similar granular appearance of cerebral convolutions may or may not occur in these cases, depending on whether the small meningeal and cortical vessels of the brain are extensively involved.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

The hemodynamic changes following acute myocardial infarction have been studied in patients in an intensive care unit. Serial determinations of cardiac output and blood pressure have shown a wide range of hemodynamic patterns in severely ill patients varying from a low cardiac output and high peripheral resistance to a high cardiac output and low peripheral resistance. The progression of changes during the illness and their relation to the clinical findings have been discussed.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

The restriction imposed by mitral stenosis on the cardiac output response to exercise provides a unique opportunity in man to evaluate determinants of coronary flow and myocardial oxygen consumption, since one or several variables may be limited. Coronary and systemic hemodynamic patterns were therefore evaluated in 12 patients with mitral stenosis and compared with normal subjects.While cardiac output and left ventricular work were lower than normal at rest, coronary flow and myocardial oxygen consumption did not differ from normal. During exercise, despite subnormal cardiac output and left ventricular work responses, coronary blood flow and myocardial oxygen consumption increased normally in the group of patients in whom arterial pressure rose. However, coronary flow fell in four patients who experienced exertional hypotension, while myocardial oxygen consumption was reduced or unchanged. In both groups, myocardial oxygen extraction was above normal at rest and rose further during exercise. Changes in myocardial oxygen consumption followed alterations in the pressure-time index, but the excessive heart rate response to exercise resulted in a greater oxygen expenditure per unit of tension developed per beat than that found in normal subjects.It is concluded that the primary determinant of coronary blood flow in mitral stenosis is the arterial perfusion pressure while myocardial oxygen consumption is primarily dependent on the pressure-time index. In addition, heart rates inappropriately high for a given state result in energy expenditures above that required for maintenance of pressure and cardiac output.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

Sixteen patients with acute myocardial infarction were studied with continuous cardiac monitoring for 1 to 3 weeks. Patients were excluded from the study if arrhythmias were present on admission or if arrhythmias might have occurred as a result of treatment. The results indicate that cardiac arrhythmias occur with a much higher frequency (94 per cent) than previously reported. They may occur many days after the infarction. They occur in asymptomatic patients and may go undetected by conventional observation. Continuous cardiac monitoring has immediate practicality in the management of these patients, and might, if used as a guide to therapy,[see table in the PDF file]reduce the mortality from acute myocardial infarction.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

An early systolic click and a normal or accentuated aortic second sound have been found in cases of aortic valve stenosis characterized cineradiographically by a mobile, dome-shaped valve. Impaired valve mobility was usually associated with a systolic click of low intensity, and in the presence of an immobile aortic valve there was no systolic click. The aortic second sound was correspondingly diminished or absent.Early systolic clicks and loud aortic closure sounds were also present in patients in whom a diseased aortic valve had been replaced by three Teflon prosthetic leaflets. In most of these patients there was no systolic click before insertion of the prosthesis.In the patients studied, the systolic click occurred at the end of the opening movement of the aortic valve at the onset of left ventricular ejection. It followed the crossover point of the left ventricular and aortic pressure pulses by a time interval ranging from 15 to 45 msec. (average 33 msec.).The opening movement of the valve was thought to produce the systolic click by causing sudden tension of the valve membrane or sudden alteration in the velocity of blood flow. By analogy with the opening snap in mitral stenosis, the early systolic click may be regarded as the “opening snap” of the aortic valve. A systolic click is clinical evidence of a mobile aortic valve in patients with aortic valve disease.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

This study examined life expectancy and serum lipids in 120 men with atherosclerotic coronary heart disease. Five-year survival from onset of infarction was 79 per cent. No relationship could be demonstrated between survival and the level of the total serum cholesterol, Std. Sf0–12, 12–20, 20–100, and 100–400 lipoproteins. Survival for patients with an infarct less than 6 months before entry into the study was shorter, despite serum lipid levels the same as the remainder of the group.Although the age of onset of coronary disease is influenced by serum lipid levels, survival subsequent to infarction is not. This paradox suggests that serum lipids affect rate of atherogenesis in the long preclinical stage but in the short clinical stage other factors determine survival.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

Normotensive women after toxemia of pregnancy reacted to the infusion of reconstituted human plasma with a water diuresis, whereas control subjects exhibited an antidiuretic response. The latter was probably due to the presence of antidiuretic material in the infused plasma, whereas the water diuresis, which has also been found in hypertensive subjects, can be explained as the manifestation of an increased sensitivity of a volume-regulating mechanism in the hypertensive as well as in the “pre-hypertensive” state.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

A study was made of the acute effects of orally administered nethalide on the subjective and electrocardiographic responses to treadmill exercise in 11 patients with angina pectoris. Nethalide lowered the standing heart rate at rest and the maximum heart rate attained with exercise whether or not nitroglycerin was used concurrently. No consistent change in exercise capacity or time of onset of anginal pain and electrocardiographic abnormalities was noted after nethalide administration in the doses used in this study. However, the combination of nethalide and nitroglycerin in most subjects caused a strikingly greater exercise tolerance and delay in the onset of pain and electrocardiographic changes than did nitroglycerin alone.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

Recent observations have suggested that infundibularpulmonary obstruction may exist in association with a ventricular septal defect and pulmonary hypertension but not be apparent because of greater obstruction in the pulmonary arterial bed which “masks” the more proximal infundibular obstruction. Following the administration of the pulmonary vasodilator tolazoline to patients with a ventricular septal defect and pulmonary hypertension, pullback tracings have revealed infundibular obstruction where none was apparent in control studies.An analysis of the catheterization findings in those patients with a ventricular septal defect and pulmonary hypertension revealed 32 subjects who had received and responded to tolazoline. Twenty-seven of these patients had gradients after tolazoline ranging from 8 to 73 mm. Hg.The findings suggest that in the presence of pulmonary hypertension, infundibular obstruction is present from birth and continues to develop, becoming apparent or “unmasked” by virtue of a reduction (acutely with drugs or slowly by delayed maturation) in pulmonary vascular resistance.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID