ISSN:0009-7322    

出版商:OVID    

年代:1974

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

A prospective study was done to determine the clinical profile of first attacks of acute rheumatic fever in children in North India. Unlike other reports, the clinical profile described here closely resembles the spectrum prevalent in the West. Arthritis, the most common manifestation, was seen in 66.6% of the 102 patients, chorea in 20.7%, and carditis in 33.7%. Carditis was considered mild in 22 patients and severe in 12; a persistent elevation of sleeping pulse rate and mitral regurgitation was noted in each case. Patients with severe carditis also had significant cardiomegaly and apical mid-diastolic murmur. Two patients with severe carditis developed congestive heart failure; one of them had pericarditis as well. Murmur of aortic origin was not noted in this series. One patient with severe carditis died from the disease. Erythema marginatum was noted in two, both of whom had severe carditis. There were two instances of subcutaneous nodules, one with and one without carditis. The close similarity of these results with those in the West is attributed to the prospective design of the study, analysis of first attacks only and survey of a general pediatric population for all manifestations suggestive of the disease.

ISSN:0009-7322    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

Twenty-four out of 25 patients with Chagas' heart disease have circulating immunoglobulins which react by indirect immunofluorescence technique with endocardium, interstitium and blood vessels of the heart. With skeletal muscle the reaction was observed in interstitium and vascular structures, but with other organs it was limited to vascular structures. This endocardial-vascular-interstitial factor (EVI) fixed complement. Some evidence indicated that this reaction could be obtained using the serum and tissues from the same patient: for instance, in one positive case a right atrium biopsy was performed. When this substrate was used for indirect immunofluorescence, employing the patient's own serum, positive results were obtained. Specificity is not related to AB blood group systems, or to Forssman or Wassermann antigens. The reacting factor was effectively absorbed from sera with organ homogenates, and with guinea pig red blood cells although it was independent of heterophil antibodies. In almost all cases studied, the EVI factor of the serum, when absorbed with epimastigotes ofT. cruzi, results in a negative reaction, suggesting that the genesis of the reacting gamma globulin is related to antigens ofT. cruzi.The EVI factor was also observed in 19 of 47 asymptomatic controls from an endemic area with positive serology forT. cruziand in 3 of 27 with negative serology. These 3 cases had anti-T. cruziantibodies in titers just below those considered of clinical value. The EVI factor was not observed in 119 normal individuals and 286 patients with selected cardiovascular diseases or another pathology from a nonendemic area. These findings and those mentioned above were statistically significant (P< 0.001). These results indicate the possibility of a more accurate diagnosis of chagasic myocardiopathy based on the study of the EVI factor, because in an individual case the diagnosis of chronic chagasic cardiopathy can be considered with a low probability in the absence of this factor.

ISSN:0009-7322    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

In 36 patients with the Wolff-Parkinson-White syndrome, ventriculo-atrial (VA) conduction was studied using the single test stimulus method. In 22 patients no significant change in VA conduction time occurred following test stimuli with increasing prematurity suggesting exclusive VA conduction by way of the accessory pathway, an accessory pathway with a shorter refractory period than the His-AV node pathway, or identical refractory periods in both pathways. In 14 patients showing this VA conduction pattern tachycardias could be initiated by a single early ventricular premature beat. This finding lends credence to the hypothesis that the accessory pathway is an essential link in the tachycardia circuit. In two of the five patients showing exclusive VA conduction over the His-AV node pathway single re-entrant beats with antegrade conduction over the accessory pathway could be elicited by appropriately timed ventricular premature beats. In one patient showing this pattern a sustained tachycardia with AV conduction over the accessory pathway could be initiated. A total of eight patients did not show VA conduction over the accessory pathway.

ISSN:0009-7322    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

The effects of pacing-induced changes in cycle length on the refractory periods of the atrium, A-V node and His-Purkinje system were studied in 24 patients using the extra stimulus technique. Refractory period determinations were made at two or more cycle lengths in all patients. Slopes relating cycle length and refractory periods were calculated using the least squares method.Both the effective and functional refractory periods (ERP and FRP) of the atrium shortened with decreasing cycle lengths, with a mean slope of +0.155 and +0.129 respectively. A-V nodal ERP lengthened (mean slope, −0.177) while A-V nodal FRP shortened slightly (mean slope, +0.126). Bundle branch refractory periods as well as relative refractory periods of the His-Purkinje system also decreased, with mean slopes of +0.270 and +0.360, respectively. The ERP of the A-V node at any cycle length was related to the A-H at that cycle length (r= +0.646,P< 0.001).The responses of the human heart to changes in cycle length are generally similar to those previously described in the animal laboratory. Such information contributes to our understanding of electrocardiographic phenomena such as aberrant conduction.

ISSN:0009-7322    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

A technique for recording His bundle activity in man without fluoroscopic guidance is described. Balloon tipped tri- or tetrapolar catheters were designed with pacing electrodes located at the catheter tip, and two fine sensing electrodes 4 and 5 cm behind it. The catheter tip was preformed into a “J’ curve. Following percutaneous transfemoral insertion, the catheter is floated to the right ventricle under electrocardiographic control. This tip configuration and the transfemoral route of insertion typically directs the catheter into an inverted “J’ position with its tip in or near the right ventricular apex. Subsequent catheter withdrawal carries the sensing electrodes through the superior portion of the tricuspid valve and permits recording from the His bundle. With this technique His bundle recordings were possible in 23 of 24 patients. Re-advancement into the right ventricular apex permits stable temporary pacing.

ISSN:0009-7322    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

Six patients underwent cardiac catheterization before and after occurrence of a myocardial infarction. Results from the two procedures allowed the quantitation of changes in coronary artery anatomy and left ventricular performance associated with myocardial infarction.Left ventricular biplane or single plane angiography and selective coronary angiography were used to evaluate coronary artery anatomy, left ventricular end diastolic pressure (LVEDP), left ventricular end diastolic volume (LVEDV), end systolic volume (LVESV), and systolic ejection fraction (SEF) under resting conditions.Four patients had developed occlusion of the artery supplying the area of infarction. In five cases new or progressive contraction abnormalities occurred. One patient had no change in contraction pattern or SEF. Systolic ejection fraction fell in three patients, with no change in LVEDV. In two patients LVEDV rose and SEF fell.These data demonstrate that a wide spectrum of functional abnormalities is associated with myocardial infarction. Infarction was always associated with significant coronary artery stenosis, but not necessarily associated with occlusion. The SEF and contractile pattern were the indicators of left ventricular dysfunction which most frequently deteriorated.

ISSN:0009-7322    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

At cardiac catheterization, the effect of isoproterenol on coronary blood flow was compared in six patients with normal coronary arteries and normal left ventricular function, and eight patients with angiographically defined coronary lesions. Coronary blood flow was measured by selective coronary artery injection of xenon-133 and external monitoring of disappearance curves with a dual probe, digital scintillation counter. Resting values did not differ in the two groups. In the normal group isoproterenol increased mean coronary blood flow 93 ml/100 g/min (152%) and cardiac output 2.3 liters/min (42%); coronary resistance/100 g decreased 60 ± 4% (SEM), while total peripheral resistance decreased 29 ± 4%. In the coronary disease group coronary blood flow increased 20 ml/100 g/min (33%) and cardiac output increased 2.8 liters/min (62%); coronary resistance decreased 26 ± 9% and total peripheral resistance decreased 37 ± 4%. In all normal patients the percent increase in coronary blood flow markedly exceeded the percent increase in cardiac output and the percent fall in coronary resistance markedly exceeded the percent fall in total peripheral resistance. In six of the eight patients with coronary lesions the percent increase in coronary blood flow was less than the percent increase in cardiac output and the fall in coronary resistance was less than the fall in total peripheral resistance. Thus measurement of coronary blood flow, cardiac output, and aortic pressure before and during isoproterenol infusion may permit differentiation of those subjects with physiologically significant coronary obstructions.

ISSN:0009-7322    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

Results of gas endarterectomy of the right coronary artery were evaluated in 29 consecutive patients. There were one surgical and two early postsurgical deaths. All three had postmortem examination, and in two there was occlusion of the gas endarterectomy. Five patients did not have repeat catheterization. Twenty-one patients were completely re-evaluated and had repeat cardiac catheterization one to sixteen months after surgery (mean eight months). Ten patients (Group A) had gas endarterectomy without a saphenous vein graft to the right coronary artery. Only one patient had significant vessel patency. Eleven patients (Group B) had the combined procedure of a saphenous vein graft anastomosed to the segment of artery that had the endarterectomy. There was excellent graft patency in seven patients (64%) and good distal flow into the segment that had endarterectomy in six of the seven patients. In conclusion, gas endarterectomy is not of value unless it can be combined with a saphenous vein graft to provide good flow to the distal vessel that had endarterectomy. Results with the combined procedure suggest that even with a severely diseased artery, gas endarterectomy can often provide continuing distal runoff for the graft.

ISSN:0009-7322    

出版商:OVID    

年代:1974

数据来源: OVID