ISSN:0009-7322    

出版商:OVID    

年代:1961

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1961

数据来源: OVID

摘要:

This study describes 18 patients from the University of Cincinnati Hospitals who died of congestive heart failure without clinical or pathologic evidence of a primary cause.Clinical features. Their ages were from 18 months to 68 years at death. Fourteen were male and four female; 11 were white and seven were Negro. Seven patients had heart failure for 5 years or more; three had heart failure for over 10 years. Seven patients were alcoholic and three had nutritional cirrhosis. Transient mitral or tricuspid systolic murmurs and apical protodiastolic gallop rhythms were common. Atrial fibrillation was present in six patients. The electrocardiograms revealed abnormal left axis deviation in three and left bundle-branch block in two.Right heart catheterization was performed in four of these patients and showed low cardiac output, increased arteriovenous oxygen difference, and elevation of pulmonary arterial, pulmonary wedge, right ventricular diastolic, and right atrial pressures.Pathologic features. Heart weights were over 500 Gm. in 13 patients; all 18 had left ventricular hypertrophy. Mural thrombi were present in 10; six had pulmonary emboli and three had systemic arterial emboli. One patient had gross myocardial scarring; only two had small accumulations of inflammatory cells in the myocardium. Ten had focal increase of elastic tissue.Primary myocardial disease may simulate coronary artery disease because of the abnormal electrocardiogram; it may simulate hypertensive heart disease because of elevation of diastolic blood pressure during heart failure in some patients; it may simulate pericardial effusion because of the poor cardiac pulsations, narrow pulse pressure, and paradoxical pulse. It may simulate rheumatic heart disease because of the apical systolic and diastolic murmurs, left atrial enlargement, and presence of Kerley lines. The cause is unknown. Only one patient in this group had a familial history of similar heart disease.

ISSN:0009-7322    

出版商:OVID    

年代:1961

数据来源: OVID

摘要:

In 36 cases of valvular heart disease with a clinical diagnosis of isolated or significant aortic stenosis we have performed percutaneous intercostal puncture of the left ventricle for pressure measurements and, in all but one case, left ventricular angiocardiography. The possible correlations between the pressure gradient and the angiocardiographic findings are discussed.With the exception of the unsatisfactory angiocardiograms due to oblique projection of the valvular planes, valuable information was obtained regarding the degree of aortic stenosis. This was especially the case if the aortic stenosis was combined with mitral valve disease, resulting in a small or no systolic pressure gradient.

ISSN:0009-7322    

出版商:OVID    

年代:1961

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1961

数据来源: OVID

摘要:

The first 100 consecutive patients with a diagnosis of tetralogy of Fallot upon whom an aortic-pulmonary anastomosis could be performed were subjected to a clinical and physiologic evaluation 11 to 13 years after operation.At this long-term follow-up 92 patients were traced. Nine patients died at the time of surgery and, in the period from 1946 to 1959, 10 patients died, most often from congestive heart failure. To our knowledge only three patients have required a second shunt operation to relieve recurrent cyanosis. The clinical results were considered good or excellent in 68 per cent of the survivors, fair in 30 per cent, and poor in 2 per cent.The long-term poor results and mortality were usually associated with too large an initial anastomosis leading to either left ventricular overwork and congestive heart failure or severe pulmonary hypertension and progressive pulmonary vascular obstruction.Right heart catheterization studies indicated that in a group of 18 patients in whom the pulmonary vascular bed could be evaluated, 15 patients had a normal pulmonary vascular resistance after 11 to 13 years of a clinically adequate aortic-pulmonary shunt.The role of the shunt procedures as a valuable salvage operation at the present time for a select segment of patients with tetralogy of Fallot and certain other complex cyanotic lesions is reemphasized.

ISSN:0009-7322    

出版商:OVID    

年代:1961

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1961

数据来源: OVID

摘要:

Three hundred and sixteen biopsies of atrial appendages obtained at mitral valvotomy were studied histologically. They were divided into those with Aschoff bodies (41 per cent), those with nonspecific granulomas (23 per cent), and those without either lesion. These findings were compared with those of previous investigators.A study of 24 hearts with mitral stenosis and survey of the literature showed that Aschoff bodies in the left atrial appendage are usually accompanied by similar lesions in the rest of the heart.The average age of patients with Aschoff bodies in their atrial biopsy was 4 years less than that of those with "nonspecific granulomas" and more than 7 years less than that of patients without inflammatory foci in the endocardium. The etiology of "nonspecific granulomas" is discussed.Aschoff bodies were rare in patients with organized atrial thrombi, most of whom were fibrillating. Statistical analysis showed that thrombosis rather than fibrillation was the principal factor associated with a lowered incidence of Aschoff bodies. It was concluded that mechanical factors may determine the localization of rheumatic lesions in the heart.Elevated sedimentation rates were recorded as often in patients with negative biopsies as in those with Aschoff bodies.The percentage of positive biopsies fell from 66 per cent in patients aged 15 to 20 years to 14 per cent in patients aged over 55 years. The age incidence of Aschoff bodies has been compared with that of acute rheumatic fever, which is rare after the age of 15 years. It is concluded that in patients with mitral stenosis, histologic activity may continue for 20 years or more in the absence of clinical signs and symptoms.The proportion of positive biopsies was lowest in June and maximal in September. This seasonal change suggests that the histologic process is only intermittently active. The seasonal variation in the percentage of Aschoff bodies is discussed in relation to the seasonal incidence of acute rheumatic fever.Our results appear to establish the concept of a "subclinical" rheumatic process which has been postulated by many previous investigators.

ISSN:0009-7322    

出版商:OVID    

年代:1961

数据来源: OVID

摘要:

A survey of 300 samples of drinking water from Southern Alberta analyzed for sodium content showed that a considerable proportion of well waters contain very high sodium levels, ranging up to 420 mg. per cent (4,200 ppm.).Two instances of recurrent episodes of heart failure at home, which ceased after substitution of a low- for unsuspected high-sodium water supplies, are described.The sodium is present in soils derived from underlying marine deposits of seas that covered the whole of the North American plains in ancient times. It is not readily recognizable by taste, especially as sulfate, and may cause darkening of soil so that its presence remains quite unsuspected.Tasteless sodium in water forms a source of perplexing decompensation in otherwise well-controlled heart disease. The features of the terrain that lead to high sodium content in water supplies are described to alert physicians to similar possibilities in their own regions.

ISSN:0009-7322    

出版商:OVID    

年代:1961

数据来源: OVID

摘要:

Twelve adult patients (10 hypertensive and two normotensive) with low serum potassium levels but without electrocardiographic signs diagnostic of hypokalemia were subjected to nonstrenuous exercise.Electrocardiographic signs of hypokalemia appeared following exercise in all but the two hypertensive patients receiving digitalis. The severity of the changes and the duration correlated with the degree of hypokalemia present prior to exercise. The results were similar in the normotensive and hypertensive patients and in those made chronically or acutely hypokalemic. Following potassium repletion, exercise did not produce electrocardiographic changes of hypokalemia.The frequency with which S-T segment and T-wave changes occurred following exercise during potassium depletion suggested that hypokalemia can introduce an error in interpreting results of exercise tolerance tests in patients receiving thiazide compounds, when serum potassium is at the low normal or borderline level.These results may reflect intracellular myocardial potassium depletion brought on by exercise.

ISSN:0009-7322    

出版商:OVID    

年代:1961

数据来源: OVID