Showing papers in "Circulation in 1950"
TL;DR: Following aseptic occlusion of the anterior descending artery of the dog's heart ectopic ventricular tachycardia develops after a latency of four and one-half to eight hours, and persists for two to four days.
Abstract: Following aseptic occlusion of the anterior descending artery of the dog's heart ectopic ventricular tachycardia develops after a latency of four and one-half to eight hours, and persists for two to four days. Large gross infarcts are found in all hearts. The duration of latency of onset of major ectopic activity approximates the minimal period of ischemia required to produce histologic signs of necrosis. It is suspected that products or processes of necrosis have excitatory effects on tissues bounding the ischemic zone. Evidences concerning various possible excitatory factors are briefly reviewed.
684 citations
TL;DR: The quantity of blood measured by electrical impedance plethysmography is defined by its resistive effect in parallel to the resistance of other tissue of the segment, which is derived by substitution of this parallel resistive value together with data relative to the resistivity of blood and the length of the segments in the formula for the volume of an electrical conductor.
Abstract: The quantity of blood measured by electrical impedance plethysmography is defined by its resistive effect in parallel to the resistance of other tissue of the segment. By substitution of this parallel resistive value, together with data relative to the resistivity of blood and the length of the segment in the formula for the volume of an electrical conductor, we are able to derive the volume of the pulse in cubic centimeters. It follows that the volume displaced from the venous reservoir and the rate of refilling of the venous reservoir of an extremity may also be determined quantitatively.
484 citations
TL;DR: With this technic it is possible to demonstrate the presence of certain lipid and lipoprotein components which are related to coronary atherosclerosis, to hypertension and to other diseases associated with atheros sclerosis, such as diabetes mellitus, the nephrotic syndrome and hypothyroidism.
Abstract: The transport of cholesterol and other lipids of serum is almost wholly in the form of very large molecular complexes of these lipids with variable amounts of protein. The exact components present in the blood of a particular individual may be quantitatively described both as to character and concentration by ultracentrifugal flotation of these components in the analytic ultracentrifuge. With this technic it is possible to demonstrate the presence of certain lipid and lipoprotein components which are related to coronary atherosclerosis, to hypertension and to other diseases associated with atherosclerosis, such as diabetes mellitus, the nephrotic syndrome and hypothyroidism. The blood level of these components may be influenced by dietary means. The blood level of these components is poorly correlated with the analytic serum cholestrol determined by the Schoenheimer-Sperry method.
390 citations
TL;DR: The data were studied primarily in regard to prognosis of this condition but in addition, all clinical manifestations of abdominal aortic aneurysm were reviewed.
Abstract: Data were compiled from the records of 101 cases of abdominal aortic aneurysm, almost all of which were due to arteriosclerosis. These records were selected only when there was unequivocal evidence of aneurysm, and cases of true dissecting aneurysm were not included. The data were studied primarily in regard to prognosis of this condition but in addition, all clinical manifestations of abdominal aortic aneurysm were reviewed.
260 citations
TL;DR: The results reveal that the degree of coronary atherosclerosis is not primarily related to age as is commonly assumed.
Abstract: The amount of coronary atherosclerosis in each decade from 30 to 89 years of age, in the male, is evaluated. A large number of hearts were examined in great detail to increase accuracy. The results reveal that the degree of coronary atherosclerosis is not primarily related to age as is commonly assumed. The effect of cardiac hypertrophy on coronary atherosclerosis is also discussed.
234 citations
TL;DR: The state of the lesser circulation in normal man at rest and under conditions of exercise and acute anoxia is defined in detail in order to provide the physiologic background against which to present the accumulated data in patients with certain types of chronic cardiopulmonary diseases.
Abstract: A review of present day knowledge of the pulmonary circulation in man is presented. In particular the state of the lesser circulation in normal man at rest and under conditions of exercise and acute anoxia is defined in detail in order to provide the physiologic background against which to present the accumulated data in patients with certain types of chronic cardiopulmonary diseases.
204 citations
TL;DR: The equation defining the field of an eccentric dipole in a spherical medium might be useful for projected experimental studies and for better understanding of the way in which a given electrical position determines the electrode potentials.
Abstract: The electrical position of the heart with reference to the electrodes used in studying its field is unknown. For reasons presented, it is more likely eccentric; hence, the equation defining the field of an eccentric dipole in a spherical medium might be useful for projected experimental studies and for better understanding of the way in which a given electrical position determines the electrode potentials. A method introduced by Helmholtz was used for deriving the desired equation. It is discussed since its concepts are of considerable importance to other electrocardiographic problems, too. The more simple mathematical example dealing with the centric dipole in the sphere is discussed. The equation for the field of the eccentric dipole is given and data based upon it are presented in numerical and map form. The Helmholtz equation for the field in the spherical conductor produced by two small spherical electrodes arbitrarily located is also presented and briefly discussed.
198 citations
TL;DR: A new method for the interpretation of conventional electrocardiographic leads is presented, based upon evidence that all body surface leads tend to record from the same resultant electrical forces.
Abstract: A new method for the interpretation of conventional electrocardiographic leads is presented. It is based upon evidence that all body surface leads tend to record from the same resultant electrical forces. The various leads write different QRS and T contours in a given case, then, simply because the axis for each of the leads has a different direction in the electrical field and therefore registers different components of these electrical forces. The method has many advantages over "pattern" methods of interpretation. To illustrate its use, a study of QRS vectors is presented with special reference to the SlS2S3 pattern.
184 citations
TL;DR: In the majority it was associated with acute coronary thrombosis or coronary sclerosis, in some with rheumatic valvular disease, and in others with no organic heart disease.
Abstract: A review is presented of 107 cases of paroxysmal ventricular tachycardia. In the majority it was associated with acute coronary thrombosis or coronary sclerosis, in some with rheumatic valvular disease, and in others with no organic heart disease. It is generally critical and demands careful attention. Occasional cases are overlooked because only one heart sound is present for each cardiac cycle and the heart rate is misjudged to be one-half the actual rate. The outlook often is serious if the condition is not effectively treated. Therapy generally is successful in controlling the arrhythmia. The most valuable drug is quinidine. Other medications are magnesium sulfate, atropine, potassium salts, and possibly morphine.
182 citations
TL;DR: A laboratory study designed to investigate the independent pump-like function of the right ventricle of the dog heart is presented and the results are discussed and explained in terms of a postulated mechanism based upon the architecture of the individual ventricular muscle bands.
Abstract: A laboratory study designed to investigate the independent pump-like function of the right ventricle of the dog heart is presented. Systolic and diastolic pulmonary arterial pressure fluctuations were used as the definitive criterion for pumping efficiency. Control pressure levels are compared with those recorded after complete damage, by electrosurgical coagulation, of the free right ventricular myocardium. The degree of damage so produced was ascertained from an analysis of electrocardiographic, physiologic and histologic observations. The results are discussed and explained in terms of a postulated mechanism based upon the architecture of the individual ventricular muscle bands.
179 citations
TL;DR: The paper includes a discussion of all published cases of single coronary artery and a consideration of the embryologic development and physiologic significance of this anomaly.
Abstract: The paper includes a discussion of all published cases of single coronary artery and a consideration of the embryologic development and physiologic significance of this anomaly. The incidence and types of associated cardiac diseases are reviewed. Two additional case reports of this anomaly are included.
TL;DR: In this article, the effects of acute digitalization upon the dynamics of the circulation were observed in patients with chronic cor pulmonale, using the technic of cardiac catheterization, and further investigated in the same patients following recovery from failure.
Abstract: The effects of acute digitalization upon the dynamics of the circulation were observed in patients with chronic cor pulmonale, using the technic of cardiac catheterization. The state of the circulation was further investigated in the same patients following recovery from failure. The mode of action of intravenous digoxin is discussed, and a tentative concept of the pathogenesis of chronic cor pulmonale is presented.
TL;DR: Animal experiments were done to learn the level of coronary narrowing required to produce the larger intercoronary collateral channels, their speed of development, and the degree of protection afforded the myocardium.
Abstract: Animal experiments were done to learn the degree of coronary narrowing required to produce the larger intercoronary collateral channels, their speed of development, and the degree of protection afforded the myocardium. Twelve or more days of 75 per cent narrowing were required to produce sufficiently rich anastomotic communications to protect the myocardium from damage, and to permit survival after superimposed acute complete occlusion. The physiologic and pathologic significance of the intercoronary collateral communications and the clinical implications in coronary artery disease are discussed.
TL;DR: It is demonstrated that the interrelationships of the lipids in coronary heart disease are more important than any one of the constituents taken by itself.
Abstract: Serum cholesterol (free, esters and total) and serum phospholipids were determined in 97 men who had experienced coronary heart disease prior to the age of 40, 146 healthy nonhospitalized men of comparable age and a group of 97 men who were "matched" to the coronary disease group. The mean values for serum cholesterol (total) were 286 mg. per 100 cc., 224 mg. per 100 cc., and 247 mg. per 100 cc. for the coronary disease group, control group and matched control group, respectively. The serum phospholipids were highest in the coronary disease group. It is demonstrated that the interrelationships of the lipids in coronary heart disease are more important than any one of the constituents taken by itself. The theoretic implications of the total cholesterol: phospholipids ratio are considered.
TL;DR: The findings on history, physical examination, x-ray and fluoroscopy, and electrocardiogram have been analyzed and the variations in circulatory dynamics encountered in these individuals are described in detail.
Abstract: Congenital pulmonic stenosis is indicated by cardiac catheterization by the finding of a higher systolic pressure in the right ventricle than in the pulmonary artery. Eight cases of uncomplicated pulmonic stenosis are studied. The findings on history, physical examination, x-ray and fluoroscopy, and electrocardiogram have been analyzed and the variations in circulatory dynamics encountered in these individuals are described in detail.
TL;DR: Hearts from the undernourished exhibited less atherosclerosis than did hearts from average weight or overweight individuals, and cardiac hypertrophy and diabetes were associated with increased degrees of Atherosclerosis.
Abstract: The degree of coronary artery atherosclerosis present in 600 hearts obtained from women, 100 in each of the decades from 30 through 89 years, was determined by one observer. Coronary atherosclerosis increased with age until the eighth decade when the atherosclerosis tended to level off. Cardiac hypertrophy and diabetes were associated with increased degrees of atherosclerosis. Hearts from the undernourished exhibited less atherosclerosis than did hearts from average weight or overweight individuals. A comparison with data compiled on 600 hearts from men by White and associates has been included.
TL;DR: With the tip of the catheter at the root of the aorta, the authors have succeeded in entering the left ventricle only in patients with free aortic insufficiency due to syphilis.
Abstract: The technic employed in catheterization of the left heart in man is described. A catheter is introduced into the left ulnar artery and passed through the brachial, axillary and subclavian arteries into the arch of the aorta. With the tip of the catheter at the root of the aorta, we have succeeded in entering the left ventricle only in patients with free aortic insufficiency due to syphilis. Failure to pass the aortic valves in normal subjects is discussed.
TL;DR: The tricuspid valve is displaced downward so that the upper portion of the right ventricle is incorporated in the right auricle, which is called Ebstein's anomaly as discussed by the authors.
Abstract: In Ebstein's anomaly the tricuspid valve is displaced downward so that the upper portion of the right ventricle is incorporated in the right auricle. This imipairs the efficiency of the right side of the heart and produces a distinctive syndrome, which is described here for the first time. Diagnosis is important because this malformation, which is not amenable to surgery, may be confused with the tetralogy of Fallot.
TL;DR: Results indicate that this drug is responsible for causing more effective conversion of oxidative energy into work and agrees with the concept that the oxidative metabolism of the failing heart in vivo is not abnormal.
Abstract: The action of strophanthus preparations on the coronary blood flow and the oxidative metabolism of the normal and failing human heart has been studied by coronary sinus catheterization. It has been found that strophanthus preparations have no effect on the coronary flow or oxidative metabolism of either the normal or failing heart. This agrees with the concept that the oxidative metabolism (energy production) of the failing heart in vivo is not abnormal. The results indicate that this drug is responsible for causing more effective conversion of oxidative energy into work.
TL;DR: Blood quinidine determinations by the photofluorometric method were made in 30 patients with auricular fibrillation or flutter in whom conversion to sinus rhythm was attempted, and vomiting and ventricular tachycardia were the most important toxic manifestations.
Abstract: Blood quinidine determinations by the photofluorometric method were made in 30 patients with auricular fibrillation or flutter in whom conversion to sinus rhythm was attempted. Successful conversion occurred in 82 per cent of the patients, with a mean blood level of 5.9 mg./liter. Vomiting and, in one case, ventricular tachycardia were the most important toxic manifestations. Doses of 0.4 to 0.6 Gm. every two hours for five doses daily were usually adequate to obtain the average conversion blood level. The importance of the quantitative aspects of quinidine therapy and the relation of time, dose and concentration of quinidine in the blood are discussed.
TL;DR: The literature has been reviewed, and 58 autopsied cases of dissecting aneurysm of the aorta observed at the Los Angeles County Hospital over a ten year period have been carefully studied to help solidify the clinical syndrome or syndromes of the condition and thus facilitate diagnosis in dubious instances.
Abstract: The literature has been reviewed, and 58 autopsied cases of dissecting aneurysm of the aorta observed at the Los Angeles County Hospital over a ten year period have been carefully studied. Clinical-pathologic correlation has been attempted whenever possible, with emphasis on diagnostic features. The increasing incidence of accurate diagnosis of dissecting aneurysm has been noted, and it is hoped that this review will help solidify the clinical syndrome or syndromes of the condition and thus facilitate diagnosis in dubious instances.
TL;DR: Previously unreported large positive QRS deflections were found in records from the lower part of the right atrium, from the pulmonary artery, and in two instances from within the right ventricle itself close to the base.
Abstract: Electrical records were made from the interior of the right heart and attached vessels in 14 normal subjects. Technics differed somewhat from those previously reported in that simultaneously recording string galvanometers were used exclusively, and tracings were made whenever the catheter-electrode was moved within the heart. Previously unreported large positive QRS deflections were found in records from the lower part of the right atrium, from the pulmonary artery, and in two instances from within the right ventricle itself close to the base. The possible anatomical origin of these is discussed.
TL;DR: An attempt is made to correlate the pulmonary hypertension and the electrocardiographic evidence of right ventricular hypertrophy in a group of 40 patients with pulmonary artery hypertension either at rest or during exercise.
Abstract: Detection of right ventricular hypertrophy during life has often been exceedingly difficult. In a group of 40 patients with pulmonary artery hypertension either at rest or during exercise, in whom right ventricular hypertrophy of varying degree could therefore be anticipated, an attempt is made to correlate the pulmonary hypertension and the electrocardiographic evidence of right ventricular hypertrophy.
TL;DR: The amplitude of the ballistocardiogram measures the maximum force exerted by the heart in moving the blood and preliminary normal standards for this estimate of cardiac strength have been set up.
Abstract: The interpretation of ballistocardiograms has been attacked by a method entirely new; a physiologic experiment performed at necropsy. While the subject lies on the ballistocardiograph a normal diastolic pressure is created and the heart's function is simulated by injecting fluid into the aorta and pulmonary artery, the amount injected at each instant being recorded. The resulting ballistocardiograms can be directly compared with many aspects of cardiac function. The amplitude of the ballistocardiogram measures the maximum force exerted by the heart in moving the blood and preliminary normal standards for this estimate of cardiac strength have been set up.
TL;DR: A special group of cases of fatal myocardial infarction is presented in which only T wave and RS-T segment changes developed even when patients were observed over a considerable period, and the curves as such could not be considered diagnostic of myocardia infarct.
Abstract: In the ordinary evolution of an acute myocardial infarct the electrocardiogram shows T wave (ischemia), RS-T segment ("current of injury") and QRS (death of muscle) changes. This paper presents a special group of cases of infarction in which only T wave and RS-T segment changes developed even when patients were observed over a considerable period. Therefore, the curves as such could not be considered diagnostic of myocardial infarction. The authors here describe a unique and intriguing group of cases of fatal myocardial infarction with electrocardiograms resembling those seen in stress tests for coronary insufficiency and showing rimlike subendocardial infarcts at postmortem.
TL;DR: Criteria and examples of peri-infarction block are presented and an incidence and explanation are offered.
Abstract: Curves which represent bundle branch block can usually be identified. More important are those which represent peri-infarction block. Multiple unipolar leads enable identification of the latter from the former, which they may closely resemble in the limb leads, and from intraventricular block of other types. Criteria and examples of peri-infarction block are presented and an incidence and explanation are offered.
TL;DR: Induced alterations in shape and form of the action current of a single heart muscle fiber should provide further insight into the nature of the normal and abnormal electrocardiogram.
Abstract: An initial report is made on the electrocardiogram of a single heart muscle cell in vivo The potential variations obtained by electrodes placed on opposite sides of the membrane of a heart muscle fibre are 50 to 100 times as large as those recorded by standard limb leads The observations support the assumption that during activation the cell interior becomes positive with respect to its surrounding (depolarization, followed by polarization reversal) Induced alterations in shape and form of the action current of a single heart muscle fiber should provide further insight into the nature of the normal and abnormal electrocardiogram
TL;DR: Gangrene of the extremities of venous origin is reviewed; complete blockage of the venous system appears to be the initiating and main cause, angiospasm playing a secondary role.
Abstract: Gangrene of the extremities of venous origin is reviewed; it is a rare but distinct clinicopathologic entity hitherto not widely known. A classification of the cases of thrombophlebitis complicated with gangrene is presented, based on the presence of the peripheral pulses: (1) cases with palpable arteries; (2) cases with nonpalpable but patent arteries. Patency of the entire arterial system of the involved extremity, as verified by anatomic findings, is necessary for correct diagnosis. Complete blockage of the venous system appears to be the initiating and main cause, angiospasm playing a secondary role. The gangrene usually remains superficial and limited. Hence, a conservative surgical attitude is emphasized.
TL;DR: A series of cases shows that there is an excellent chance of relieving hypertension by such surgery and certain complicated types of cases carry too high a risk and should not be accepted for surgery.
Abstract: Coarctation of the aorta can be recognized in most instances by simple findings of physical examination. The anomaly is one which carries a variable prognosis. The condition may be tolerated through a long life with little incapacitation or may be accompanied by early and serious complications in the form of cardiac failure, aortic rupture, or intracranial hemorrhage. In a high percentage of patients it is possible to remove the aortic block and establish a pathway of satisfactory size. A series of cases shows that there is an excellent chance of relieving hypertension by such surgery. Mortality rates for these operations have not been unduly high. Certain complicated types of cases carry too high a risk and should not be accepted for surgery.
TL;DR: The case to be reported is characterized by stenosis of the ostium infundibuli of the right ventricle and biventricular origin of the aorta, similar to the Eisenmenger complex.
Abstract: The case to be reported is characterized by stenosis of the ostium infundibuli of the right ventricle and biventricular origin of the aorta. Certain of the anatomic features of the heart in this case are similar to those of the Eisenmenger complex. One difference between the two conditions is that in the case herewith reported subpulmonary (infundibular) stenosis existed, while in the Eisenmenger complex there is no anatomic barrier to pulmonary blood flow, either in the heart or great vessels. On these gross anatomic differences seem to depend the differences in structure of the intrapulmonary arteries in the two conditions.