ISSN:0009-7322    

出版商:OVID    

年代:1972

数据来源: OVID

摘要:

The long-term effects of surgery (ventriculomyotomy) and oral propranolol therapy were assessed by echocardiographic recordings in 51 studies conducted on 37 patients with hypertrophic subaortic stenosis. The incidence and severity of echocardiographic findings in 19 patients treated with propranolol and in 18 not so treated showed no significant differences. Likewise these findings were unaltered by administration of propranolol in 12 patients who were studied both while they were on the drug and while they were not. In contrast, of 14 patients studied after surgery, only one had persistently abnormal mitral valve motion, two had inconstant abnormality, and 11 had no abnormality at rest. The echocardiographic findings correlated well with independent postoperative hemodynamic assessment. The echocardiographic studies provide a noninvasive objective method for longitudinal evaluation of patients with hypertrophic subaortic stenosis (HSS).

ISSN:0009-7322    

出版商:OVID    

年代:1972

数据来源: OVID

摘要:

A patient with W-P-W syndrome (type A) and disabling supraventricular tachycardia was studied with epicardial mapping prior to surgical interruption of the circus pathway. Analysis of the delta vector and results of the epicardial mapping strongly suggested aberrant pathway located very posteriorly and crossing the atrioventricular sulcus in or adjacent to the interventricular septum. A circus movement responsible for the supraventricular tachycardia was felt to be a mechanism of antegrade A-V conduction and retrograde accessory bundle conduction. Attempts to interrupt the aberrant pathway primarily were unsuccessful, and surgical A-V block was performed. An epicardial demand pacemaker was inserted as a safety feature. Since the operation the patient has been free of supraventricular tachycardia. The postoperative electrocardiograms demonstrated antegrade accessory pathway conduction, but neither antegrade nor retrograde A-V conduction. Failure to interrupt the accessory pathway after incision of the entire right posterior A-V sulcus supported a location with, or to the left of, the atrioventricular septum for the pathway. This case, with the recent results of others, adds to the further understanding of accessory pathway location in W-P-W syndrome (type A).

ISSN:0009-7322    

出版商:OVID    

年代:1972

数据来源: OVID

摘要:

This paper reports a patient with Wolff-Parkinson-White syndrome who presented with a tachycardia showing an unusual QRS morphology closely resembling that of a ventricular tachycardia. On reversal to a normal rhythm the electrocardiogram showed changes of a type A preexcitation, with subsequent conversion to a type B pattern. This phenomenon was observed on two separate occasions. Such conversion would suggest the presence of two distinct sites for bypass location resulting in preexcitation, thus lending support to the theory of aberrant atrioventricular conduction via a bundle of Kent or neuromuscular tissue connecting atrium to ventricle. The configuration of the QRS complexes during the tachycardia would appear to be due to a circus movement with antegrade anomalous atrioventricular conduction and retrograde atrial stimulation via the bundle of His, although in this case, due to the presence of two distinct anomalous atrioventricular conduction pathways, both antegrade and retrograde conduction via these two pathways alone cannot be excluded.

ISSN:0009-7322    

出版商:OVID    

年代:1972

数据来源: OVID

摘要:

Intravenous glucagon, in doses of 2.5-15 mg/hour, was administered to 50 patients for periods of 1-7 days. Forty patients had either intractable heart failure or cardiogenic shock or both; the remaining 10 had less severe heart disease. In all patients glucagon was added to conventional therapy. Twenty-two of the 40 with very severe heart failure showed a clinical improvement, and 18 were discharged from the hospital; 16 of the 18 patients who did not respond died in the hospital. Only two of the 10 with less severe heart disease improved with glucagon but all could be discharged from the hospital. Glucagon did not initiate or aggravate a tendency to arrhythmias in any of the 17 patients with acute myocardial infarction. In two patients with bradycardia and cardiac failure due to beta-adrenergic blocking drugs, glucagon increased heart rate and there was clinical improvement in heart failure. However, there was no effect in two patients with digitalis-induced nodal bradycardia and heart failure. Nausea was the most troublesome side effect and this could usually be controlled by intramuscular prochlorperazine (Stemetil) which was given routinely before the infusion in all except postoperative patients and repeated as required during the infusion. The results show that glucagon has a definite place in the management of patients with severe heart failure when used as an adjunct to conventional therapy.

ISSN:0009-7322    

出版商:OVID    

年代:1972

数据来源: OVID

摘要:

The prognosis for 115 rheumatic fever patients subsequently receiving regular intramuscular penicillin prophylaxis for at least 5 years was studied. Average follow-up was 9.3 years, and 57 patients were followed for 10 years or longer. Of the 79 patients with acute mitral regurgitation, 70% lost their murmur from 4 days to 8.5 years after it was first heard. This is in contrast to those with acute aortic regurgitation which persisted in 73%. No patient developed mitral or aortic stenosis: this suggests that regular prophylaxis may prevent the development of stenosis. Congestive failure, cardiomegaly, and arrhythmia correlated closely with persistence of murmurs, but increased P-R interval, acute QRS or T-voltage variation or both, and ST-T abnormalities did not.

ISSN:0009-7322    

出版商:OVID    

年代:1972

数据来源: OVID

摘要:

Complications encountered during a typical 12-month period of routine work with the Judkins percutaneous transfemoral method of selective coronary arteriography are reviewed. In 445 examinations, 20 complications (16 local and four cardiac) occurred. Local complications included nine delayed hemorrhages, five thromboses of femoral arteries, and two peripheral emboli. Cardiac complications included one ventricular fibrillation, one significant bradyarrhythmia, and two myocardial infarctions. Causes of individual complications are analyzed and means for their prevention discussed. Guidelines of the procedure are proposed to minimize the complications of selective coronary arteriography. Emphasis is placed on patient evaluation, preparation for the procedure, and meticulous examination technique.

ISSN:0009-7322    

出版商:OVID    

年代:1972

数据来源: OVID

摘要:

We studied mitral valve motion in 15 patients with aortic regurgitation and an Austin Flint murmur by recording simultaneously the phonocardiogram, apexcardiogram, and mitral valve echocardiogram. In 14 patients the murmur was presystolic, and in 13 of these a middiastolic component was present as well. The middiastolic component occurred after the period of rapid ventricular filling as the mitral valve was closing. The presystolic component occurred either as the mitral valve was rapidly closing following normal atrial opening movement or during the entire period of atrial systole. In this latter situation the valve did not open completely with atrial systole. All of these patients demonstrated a prominent A wave on the apexcardiogram. In patients with a two-component Flint murmur, isometric handgrip exercise greatly accentuated the murmur, altered the pattern of valve motion so that atrial systole was no longer effective in opening the valve, and reduced the size of the apex A wave.One patient had only a middiastolic Flint murmur. The mitral valve was open for only a brief period in middiastole and did not reopen with atrial systole. Cardiac catheterization documented elevation of ventricular diastolic pressures above left atrial pressures during most of diastole. Amyl nitrite reduced diastolic ventricular pressure and permitted the mitral valve to open with atrial systole. The apex A wave, which was small at rest, increased in size after amyl nitrite.Our findings suggest that the Flint murmur is due to antegrade flow across the mitral valve. The rumble occurs during rapid closure of the valve as flow velocity is increasing although actual volume of flow may be decreasing.

ISSN:0009-7322    

出版商:OVID    

年代:1972

数据来源: OVID

摘要:

The hypotensive efficacies of two vasodilators, hydralazine and minoxidil, were assessed as these drugs were used individually in combination with beta-adrenergic blockade and diuretics in 11 hypertensive patients in whom elevated blood pressure had not been adequately controlled previously by other antihypertensive therapy.Control supine blood pressure fell from 191/128 mm Hg on propranolol and hydrochlorothiazide to 169/108 mm Hg on hydralazine, with a significantly greater reduction to 142/92 mm Hg on minoxidil. Although sodium retention and tachycardia were controlled by the use of concomitant diuretics and beta-blockade, an increment in each of these drugs was occasionally required to prevent these complications. Renal function was changed little with the decrease in blood pressure. Plasma renin increased from a standing control of 14.5 mμg/ml/hr to 35.9 and 31.1 mμg/ml/hr, respectively, on hydralazine and minoxidil. These data suggest the role of vasodilators used in combination with beta-blockers and diuretics and indicate the greater therapeutic efficacy of minoxidil.

ISSN:0009-7322    

出版商:OVID    

年代:1972

数据来源: OVID

摘要:

Arterial and mixed venous oxygen tensions were measured in 24 patients following acute myocardial infarction while they were breathing air and 100% oxygen. Total venous admixture and the right-to-left shunt during 100% oxygen breathing were calculated. These data were related to the pulmonary arterial diastolic pressure, the cardiac index, and the central blood volume.Patients with myocardial infarction that was not complicated by congestive failure had blood gases, pulmonary shunts, and pulmonary arterial diastolic pressures comparable to control patients who were at rest in bed.When congestive failure complicated myocardial infarction, arterial blood oxygen tension was lower, pulmonary shunting was increased, and the pulmonary arterial diastolic pressure was elevated. Cardiac index and central blood volume were usually normal.The present data quantitate the contribution of anatomic shunting to the hypoxemia observed in myocardial infarction. Hypoxemia and increased anatomic shunting are closely correlated to the degree of elevation of pulmonary arterial diastolic pressure. The interrelationships of arterial hypoxemia, venous admixture, arterial-alveolar oxygen gradient, and pulmonary arterial diastolic pressure suggest that pulmonary venous congestion is an important determinant of the hypoxemia and shunting observed in patients with acute myocardial infarction.

ISSN:0009-7322    

出版商:OVID    

年代:1972

数据来源: OVID