Showing papers in "Circulation in 1957"
TL;DR: The results of these studies support the concept that contraction of the heart muscle, by compression of the myocardial vascular bed, behaves as a throttling mechanism and impedes coronary flow.
Abstract: In the experimental animal the basic and controversial problem was studied of the influence of cardiac contraction on coronary blood flow. Normally beating hearts were perfused at a constant pressure, and coronary inflow and outflow were determined. In order to assess the role of systole, prolonged periods of ventricular asystole and fibrillation were induced and observations were made of the changes in coronary flow. With the cessation of cardiac contraction blood flow in the coronary arteries and coronary sinus rose appreciably. The results of these studies support the concept that contraction of the heart muscle, by compression of the myocardial vascular bed, behaves as a throttling mechanism and impedes coronary flow. The method employed permits a separation and quantitation of the effects on coronary flow resulting from cardiac contraction and the vasomotor state of the coronary vessels.
213 citations
TL;DR: Bacterial endocarditis may result from dental and other surgical procedures in patients with rheumatic or congenital heart disease, and patients should be protected by administration of antibiotics in therapeutic doses.
Abstract: This article is the second revision of the American Heart Association statement on the prevention of rheumatic fever issued January 1953. This statement was prepared by the Committee on Prevention of Rheumatic Fever and Bacterial Endocarditis appointed by the Council on Rheumatic Fever and Congenital Heart Disease of the American Heart Association. The committee is cognizant of the fact that no recommendations of any group can be final at this time. The present approach may not be the eventual solution of the problem of preventing rheumatic fever. Revisions and changes will be made as new knowledge may indicate.
157 citations
TL;DR: Depending on the type and degree of response in the pulmonary vascular bed, there may be a varying functional picture among patients having the same anatomic or functionally comparable malformation.
Abstract: While there are many anatomic varieties of congenital malformations of the heart and great vessels, most may be divided, from a functional point of view, into 3 types: (1) communication between the ventricles or between the aorta and pulmonary arteries, (2) anomalous drainage of pulmonary venous blood into the right atrium, and (3) obstruction to pulmonary venous flow. In each of these categories the responses of the pulmonary vascular tree have to be considered in understanding the altered dynamics. Depending on the type and degree of response in the pulmonary vascular bed, there may be a varying functional picture among patients having the same anatomic or functionally comparable malformation.
149 citations
TL;DR: It may be concluded that the pathways of cardiac pain have been thoroughly established, with the exception of the conduction of anginal attacks occasionally referred to the neck and jaws.
Abstract: It may be concluded that the pathways of cardiac pain have been thoroughly established, with the exception of the conduction of anginal attacks occasionally referred to the neck and jaws. Afferent impulses traverse axons that travel in the cervical and thoracic sympathetic cardiac nerves. In the case of the cervical pathway, all impulses on entering the paravertebral ganglionated chain in the neck must descend to the upper thoracic level before they can gain access to the spinal cord. Other impulses reach the 3 superior thoracic ganglia via the more direct thoracic cardiac nerves. Both the cervical and thoracic fibers join the spinal nerves over the communicant sympathetic rami. After passing through the intervertebral foramina, they enter the posterior roots and terminate in the lateral horn of the spinal cord. Here they establish synapses with secondary afferent neurons of the spinothalamic tract, decussate to the opposite anterior column, and are carried rostrally to the nucleus ventralis posterolateralis of the thalamus. This is the principal locus in the brain for the perception of visceral pain. In contrast to well-defined cutaneous sensibility, there is no cortical area for exact visceral localization in the postcentral region of the cerebral cortex. Another factor in the poor localization of cardiac pain is the paucity of sensory endings in the heart. A third appears to be the limited number of secondary sensory fibers in the spinothalamic tracts. These central axons must be shared with other impulses from the surface of the body. As a result, pain from the heart is in large part referred to the cutaneous distribution of the upper 4 thoracic spinal segments. Accounting for the superficial reference of visceral pain by Mackenzie9s theory of a viscerocutaneous reflex is no longer justifiable. Even after cutaneous afferent fibers are interrupted by procaine or amputation of the arm, pain from the heart can still be felt over its previous distribution. Neither stimulation of the vagi nor interruption of transmission in these nerves has been found to have any beneficial effect in patients suffering from angina pectoris. Sensory denervation of the heart must therefore be carried out by destruction of the upper ganglia in the thoracic sympathetic trunks or by severing the corresponding posterior spinal roots.
147 citations
TL;DR: The coronary arteries of young individuals ranging from fetuses to young adults were studied and there was an apparent decrease in the rate of intimal fibrosis in older individuals.
Abstract: The coronary arteries of young individuals ranging from fetuses to young adults were studied. Sclerotic lesions were not demonstrated in the coronary arteries of fetuses. In infants the early stages of arteriosclerosis were frequently present and consisted of rupture, degeneration and regeneration of the internal elastic membrane, deposition of mucopolysaccharide, and proliferation of endothelial cells and fibroblasts. These alterations were most prominent in infants of 3 to 4 months. In older individuals there was an apparent decrease in the rate of intimal fibrosis. The lesions of the coronary arteries of young individuals were identical with the early phases of arteriosclerosis in adults.
145 citations
TL;DR: Results favor the causative role of limited venous inflow in the cardiac output response and suggest the presence of neurogenic myocardial inhibition or markedly limited volume of blood available to the heart.
Abstract: Vasodepressor syncope is characterized hemodynamically by a sudden fall in total peripheral resistance with little associated change in cardiac output. The failure of the cardiac output to compensate for the fall in peripheral resistance is a striking feature of the fainting reaction. Possible explanations for this phenomenon are the presence of neurogenic myocardial inhibition or markedly limited volume of blood available to the heart. The effects of atropine injections, inflation of antigravity suit, negative pressure breathing, and albumin infusions on the syncopal reaction were studied. Results favor the causative role of limited venous inflow in the cardiac output response.
131 citations
TL;DR: A report to the American Heart Association and to theAmerican Society for the Study of Arteriosclerosis the Nutrition Committee of the Council on Community Service and Education of the American heart Association and others.
Abstract: A report to the American Heart Association and to the American Society for the Study of Arteriosclerosis the Nutrition Committee of the Council on Community Service and Education of the American Heart Association and others.
116 citations
TL;DR: The electrocardiographic and clinical aspects of nonparoxysmal nodal tachycarida were studied in 30 cases and the relative importance of the disturbance was evaluated in 3 conditions in which it is found most frequently, namely, digitalis effect, acute rheumatic fever, and recent posterior wall infarction.
Abstract: Acceleration of impulse formation in the ordinarily subsidiary A-V nodal pacemaker is manifested in clinical electrocardiograms in a paroxysmal and a nonparoxysmal variety. The former occurs as a rule in normal hearts, the latter in pathologic conditions, frequently, but not invariably also causing A-V block. The electrocardiographic and clinical aspects of nonparoxysmal nodal tachycarida were studied in 30 cases and the relative importance of the disturbance was evaluated in 3 conditions in which it is found most frequently, namely, digitalis effect, acute rheumatic fever, and recent posterior wall infarction.
113 citations
TL;DR: New criteria for the electrocardiographic diagnosis of right ventricular hypertrophy are proposed, which decrease the incidence of "false negative" and "false positive" interpretations, and make possible the recognition ofright ventricularhypertrophy in the presence of the R′ - V1 pattern, provided the QRS duration is less than 0.12 second.
Abstract: Electrocardiographic and vectorcardiographic studies on normal subjects and patients with heart disease suggest that criteria for the diagnosis of right ventricular hypertrophy can be improved and simplified. This report proposes new criteria for the electrocardiographic diagnosis of right ventricular hypertrophy. These criteria decrease the incidence of "false negative" and "false positive" interpretations, and also make possible the recognition of right ventricular hypertrophy in the presence of the R' - V1 pattern, provided the QRS duration is less than 0.12 second. The findings and limitations of vectorcardiography in right ventricular hypertrophy and "right bundle-branch block" are discussed.
110 citations
TL;DR: Sf 20-100 was found to be the most sensitive of the 3 lipid measures to sex and race differences and was the only one that exhibited a definite race and sex differential and had the highest correlation with weight and with blood pressure.
Abstract: Measurements of Sf 12-20, Sf 20-100, and total serum cholesterol made on 10,690 men and 3,404 women are reported and the relation of lipid level to race, source, age, sex, blood pressure, and weight is described. Distributions for men 40 to 59 are reported in detail. The groups studied, while not selected as representative of the population at large, were remarkably similar in their lipid levels. The lipid levels of only 2 of the 33 groups—Los Angeles and the prisoners—differed significantly from the average. No convincing explanation for either of these exceptions was discovered. The data in this study were mainly from a white population. Data for nonwhites came primarily from 2 aberrant groups and were too meager to allow a clear characterization of lipid levels. The levels for nonwhites from these 2 sources were closer to those of the white members of these groups than to the levels of the general population. Cholesterol levels for men and women were found to be about the same at age 20. For both sexes...
110 citations
TL;DR: In 4 patients with aortic stenosis and regurgitation, progressive dilatation of the ascending aorta and dissecting aneurysm developed and Cystic medial necrosis was discovered histologically.
Abstract: In 4 patients with aortic stenosis and regurgitation, progressive dilatation of the ascending aorta and dissecting aneurysm developed. Cystic medial necrosis was discovered histologically. It is suggested that the change in the aorta is secondary to hemodynamic stresses imposed by the disease at the aortic valve.
TL;DR: Some features of the clinical symptomatology and the pharmacologic and operative treatment of patients with chromaffin-cell tumors are given.
Abstract: For detection and diagnosis of pheochromocytoma the method of urine analysis is considered the most convenient, safe, and accurate. Analysis of blood samples obtained by catheterization at different levels in the vena cava aids in localization. Some features of the clinical symptomatology and the pharmacologic and operative treatment of patients with chromaffin-cell tumors are given.
TL;DR: The diagnosis of Raynaud's disease was suspected in 756 female patients at the Mayo Clinic from 1920 through 1945 and substantiated from the records of the initial examination or from the follow-up data or examination in 474.
Abstract: The diagnosis of Raynaud's disease was suspected in 756 female patients at the Mayo Clinic from 1920 through 1945. The diagnosis was substantiated from the records of the initial examination or from the follow-up data or examination in 474. The clinical characteristics, including diagnostic criteria, clinical course, complications, and sequelae are discussed.
TL;DR: The frequency of recurrence of the syndrome with subsequent pregnancies and the predominance in the puerperium of this type of congestive failure over those of the usual etiologies suggests that the relationship to pregnancy is not fortuitous.
Abstract: Instances of congestive heart failure due to unexplained myocardial disease are not infrequently discussed in the literature. The present study, an extension of a similar study reported by Hull in 1937, relates this type of case to the terminal aspects of pregnancy and the puerperium with an incidence of 1 in 1300 deliveries. Four case reports with necropsy findings, together with the clinical observations made on a total of 15 cases are presented. The frequency of recurrence of the syndrome with subsequent pregnancies and the predominance in the puerperium of this type of congestive failure over those of the usual etiologies suggests that the relationship to pregnancy is not fortuitous.
TL;DR: A syndrome consisting of obesity, somnolence, cyanosis, periodic breathing, and polycythemia, with congestive heart failure has been observed in 6 patients.
Abstract: A syndrome consisting of obesity, somnolence, cyanosis, periodic breathing, and polycythemia, with congestive heart failure has been observed in 6 patients. The effect of weight reduction and the mechanisms responsible for the symptoms and signs are discussed.
TL;DR: Left atrial pressures were determined by transbronchial puncture in 53 patients with mitral valve disease of proved type, and were analyzed by several methods, finding the rate of the y descent divided by the mean left atrial pressure afforded the best separation of the patients with Mitral insufficiency from those withMitral stenosis requiring a commissurotomy.
Abstract: Left atrial pressures were determined by transbronchial puncture in 53 patients with mitral valve disease of proved type, and were analyzed by several methods. Two new methods of analysis, the rate of the y descent divided by the mean left atrial pressure, and the y descent for each 0.1-second interval divided by the mean left atrial pressure afforded the best separation of the patients with mitral insufficiency from those with mitral stenosis requiring a commissurotomy. In the presence of predominant mitral stenosis, however, the severity of accompanying mitral regurgitation could not be assessed.
TL;DR: Thirty cases of myocardial infarctions with left bundle-branch block in which the location of the infarction could be determined with certainty, by autopsy, or by a previous electrocardiogram with normal intraventricular conduction are studied.
Abstract: It is generally accepted that most myocardial infarctions are obscured on the electrocardiogram by left bundle-branch block. The number of published cases in which this could be evaluated, however, is small, and the case reports are scattered. We have studied 30 cases of myocardial infarction with left bundle-branch block in which the location of the infarction could be determined with certainty, by autopsy, or by a previous electrocardiogram with normal intraventricular conduction. Twenty such published cases have also been collected. Electrocardiographic abnormalities have been correlated with infarctions in different locations. The possible specificity of these abnormalities is discussed.
TL;DR: In this paper, the authors defined electrocardiographic patterns typical of hypopotassemia and compatible with hypo-phosphatasemia based on the number of signs of hypoaphyric acidosis present in two leads (generally leads II and V3).
Abstract: Electrocardiographic patterns typical of hypopotassemia and compatible with hypopotassemia were defined on the basis of the number of electrocardiographic signs of hypopotassemia present in 2 leads (generally leads II and V3). In 50 hypopotassemic patients a good correlation was found between the electrocardiographic pattern and plasma potassium concentration. Appearance of the electrocardiographic signs of hypopotassemia was not prevented by disturbance of other plasma electrolytes or by blood pH.
TL;DR: Left heart catheterization is proving of increasing importance in the study of a variety of congenital and acquired cardiovascular defects and its usefulness in clinical investigation and in the assessment of valvular heart disease is described.
Abstract: Left heart catheterization is proving of increasing importance in the study of a variety of congenital and acquired cardiovascular defects. More than 500 left heart catheterizations have been performed by the transbronchial method without death or serious sequelae. This technic and its usefulness in clinical investigation and in the assessment of valvular heart disease are described.
TL;DR: On the basis of an examination of 2,263 patients operated upon for acquired and congenital heart disease during a 5-year period terminating in November 1955, bacterial endocarditis appears to be an infrequent complication of surgery, is caused by organisms not so commonly encountered in unoperated patients, and is characterized by a clinical pattern quite different from that ordinarily associated with bacterialendocarditis.
Abstract: Intracardiac surgery for rheumatic and congenital heart disease entails direct trauma to both normal and abnormal endocardium. This communication inquires into the incidence and nature of the endocardial infections that develop subsequent to this injury. On the basis of an examination of 2,263 patients operated upon for acquired and congenital heart disease during a 5-year period terminating in November 1955, bacterial endocarditis appears to be an infrequent complication of surgery, is caused by organisms not so commonly encountered in unoperated patients, and is characterized by a clinical pattern quite different from that ordinarily associated with bacterial endocarditis. The rate of attrition in this group of patients is high, and unquestionably is related to the antibiotic resistance of the unusual organisms and the severity of the basic heart disease.
TL;DR: The benzyl analog of serotonin (BAS) (1-benzyl-2-methyl-3methoxy-tryptamine), both intravenously and orally, reduces or prevents the symptoms caused by serotonin this article.
Abstract: Serotonin, (5 hydroxy-tryptamine), a naturally occurring compound, is pharmacologically active on intravenous injection in man. It consistently increases the pulse rate but has a variable pressor depressor, or biphasic effect on the arterial pressure. The mode of action of serotonin on these functions is not clear. Serotonin consistently and characteristically increases ventilation. However, it does not cause striking circulatory changes in the kidney although it usually produces moderate antidiuresis. The benzyl analog of serotonin (BAS) (1-benzyl-2-methyl-3-methoxy-tryptamine), both intravenously and orally, reduces or prevents the symptoms caused by serotonin. Intravenously, BAS in addition has demonstrable \"antiserotonin\" effects on the characteristic blood pressure and respiratory responses to serotonin.
TL;DR: A patient is described in whom an aneurysm of the right coronary sinus of Valsalva ruptured into the right atrium and a new method of surgical closure is presented along with pertinent physiologic data obtained before and after operation.
Abstract: A patient is described in whom an aneurysm of the right coronary sinus of Valsalva ruptured into the right atrium. A new method of surgical closure is presented along with pertinent physiologic data obtained before and after operation.
TL;DR: The major manifestations of rheumatic fever experienced by patients from the onset of the disease is related to the degree of residual cardiac damage.
Abstract: The object of this study is to provide information on the natural course of rheumatic heart disease in the third, fourth, and fifth decades of life It is concerned with 757 out of 1,042 children under observation during the years 1916 to 1956 who reached the age of 20 or more years The major manifestations of rheumatic fever experienced by these patients from the onset of the disease is related to the degree of residual cardiac damage Survival to successive ages was analyzed with respect to sex, type of valvular lesion, and degree of cardiac enlargement
TL;DR: It was hoped that potent serotonin antagonists might relieve symptoms of the carcinoid syndrome in the inoperable patient and the influence thereon of 3 serotonin antagonists, a benzyl analog of serotonin, bromo-lysergic acid diethylamide, and chlorpromazine.
Abstract: The pathogenesis of flushing attacks in patients with malignant carcinoid tumors is attributed to the direct pharmacologic effect of excessive amounts of circulating serotonin. It was hoped that potent serotonin antagonists might relieve symptoms of the carcinoid syndrome in the inoperable patient. The nature of flushing attacks was studied in carcinoid patients and the influence thereon of 3 serotonin antagonists, a benzyl analog of serotonin, bromo-lysergic acid diethylamide, and chlorpromazine. The systemic, subjective, and vascular effects of these antagonists in normal subjects were also investigated.
TL;DR: A microscopic study was made of the lungs of 18 patients with congenital malformations of the heart in which there was obstruction of pulmonary venous drainage and anatomic alterations found in these children were compared to those of adults with acquired mitral stenosis.
Abstract: A microscopic study was made of the lungs of 18 patients with congenital malformations of the heart in which there was obstruction of pulmonary venous drainage. Alterations in various components of the pulmonary vascular bed and of the lung parenchyma were described and correlated with the clinical course and the type of malformation present. A quantitative evaluation of the pulmonary arterial thickening was made by determining the lumen:wall ratio of small vessels. The anatomic alterations found in these children were compared to those of adults with acquired mitral stenosis.
TL;DR: Unusually comprehensive studies of pulmonary function in hypertensive patients during left ventricular failure and cardiac asthma are presented, compared to those in mitral stenosis with congestive failure and in pulmonary emphysema with right heart failure.
Abstract: Unusually comprehensive studies of pulmonary function in hypertensive patients during left ventricular failure and cardiac asthma are presented. These findings are compared to those in mitral stenosis with congestive failure and in pulmonary emphysema with right heart failure. All patients were severely dyspneic and bedridden.
TL;DR: The technic and equipment of underwater listening developed and used by the Navy in antisubmarine warfare is described, which has proved helpful in the evaluation of patients with valvular and congenital heart disease.
Abstract: This paper describes a new method for the detection of sound from within the heart in man. It employs the technic and equipment of underwater listening developed and used by the Navy in antisubmarine warfare. Records are shown to illustrate the localization of heart sound production to an extent not possible by phonocardiograms from the chest wall. The technic has proved helpful in the evaluation of patients with valvular and congenital heart disease.
TL;DR: An unusual combination of arrhythmias attributed to disease of the sinus node and the effects of various pharmacologic agents, especially atropine, are described and discussed.
Abstract: Disease of the sinoatrial node due to coronary arteriosclerosis is rare. An unusual combination of arrhythmias attributed to disease of the sinus node and the effects of various pharmacologic agents, especially atropine, are described and discussed.
TL;DR: Catheterization of the coronary sinus revealed that cigarette smoking in patients without heart disease results in a significant rise in coronary blood flow and heart rate and a significant decline in coronary vascular resistance and myocardial extraction of oxygen and glucose.
Abstract: The effect of smoking on the heart has been a controversial subject. The present studies were undertaken to investigate the effect of cigarette smoking on the coronary flow, myocardial usage of oxy...