Showing papers in "Circulation in 1967"
790 citations
TL;DR: It is not clear yet that circulating anti-arterial antibodies are the direct cause of Takayasu's arteritis, but the erythrocyte sedimentation rate and C-reactive protein were high values during the active stage of this disease.
Abstract: The manifestations of Takayasu's arteritis of the aorta were studied in 84 patients. The extent of the involvement of the aorta was classified on aortographic examination in 54 patients and from the clinical manifestations in 30. Involvement of the aorta was classified as: (1) arch type in 47 cases; (2) extensive type (whole aorta and its branches involved) in 27 cases; and (3) descending thoracic and abdominal type (only descending thoracic and abdominal aortas involved) in 10 cases. The three types resembled one another in clinical manifestations and laboratory findings except for ischemic signs which varied with the type of lesion and a slight difference in the ratio of male to female patients. Generalized, cardiac and pulmonary symptoms were noted by about two thirds of the patients in the early stage. About one third complained of local pain. The erythrocyte sedimentation rate and C-reactive protein were high values during the active stage of this disease. The hemagglutination test using tannic acid-...
590 citations
TL;DR: It was concluded that the precipitation of angina is normally the result of a rise in the work of the myocardium to a critical level which is essentially fixed in each patient.
Abstract: Arterial pressure was recorded directly and continuously in 15 patients with angina pectoris while pain was repeatedly induced by exercise of various types and severity. In every case, the precipitation of angina could be consistently related to the level reached by the product of heart rate and systolic blood pressure (corrected when necessary for changes in ejection time). This relationship persisted even when there were large variations in the type, intensity, and duration of the exercise and was also maintained in a patient in whom spontaneous and emotional episodes of pain were observed. A substantial improvement in exercise tolerance occurred in one patient and this was completely accounted for by a reduction in the circulatory response to exercise. It was concluded that the precipitation of angina is normally the result of a rise in the work of the myocardium to a critical level which is essentially fixed in each patient. The varying ease with which pain is provoked on different occasions can usual...
572 citations
TL;DR: One-plane cineangiographic measurement of left ventricular volume uses angiocardiograms taken in the right anterior oblique view, which means that effects of drugs and other interventions can be studied by the informative techniques of semi-continuous volume measurement and pressure-volume analysis.
Abstract: One-plane cineangiographic measurement of left ventricular volume uses angiocardiograms taken in the right anterior oblique view. Its basic assumption is that the third (unvisualized) dimension, depth from septum to free wall, is of the same magnitude and behaves in the same way as the visualized short axis. Examination of this assumption with biplane x-ray equipment revealed that the unmeasured length averages 7% less and varies directly with the length of the measured short axis. Volumes measured correlate well with consecutive studies using serial biplane x-rays and are systematically somewhat larger than volumes obtained in autopsy specimens injected with barium sulfate paste. The method is tolerant of variations in positioning of the patient, is convenient, yields repeatable analyses from one experienced observer to another, allows 60 volume measurements per second so that rapid cardiac events can be studied, and the small doses of x-rays and contrast medium permit several observations at one cathete...
480 citations
TL;DR: In four patients with WPW syndrome atrial and ventricular premature beats were induced and the changes in form of the ventricular and atrial complexes were studied, results suggest that a circus movement involving the atria, the normal atrioventricular conduction system and the Kent bundle is present.
Abstract: In four patients with WPW syndrome atrial and ventricular premature beats were induced and the changes in form of the ventricular and atrial complexes were studied. Results indicate that, depending upon the timing of the premature atrial beat and the state of refractoriness of the His and Kent bundles, excitation of the ventricles occurs predominantly through the atrioventricular nodal system, predominantly through the Kent bundle or exclusively through one or both conduction systems. With short delays conduction through the Kent bundle may be blocked and only normal excitation of the ventricles occurs. In one patient with a history of attacks of tachycardia these normal QRS complexes were followed by retrograde activation of the atria by the Kent bundle, and attacks of supraventricular tachycardia of shorter or larger duration occurred. They stopped spontaneously, sometimes by delay or block, either of retrograde Kent conduction or of antegrade A-V nodal conduction, making it possible for the sinus node to capture the ventricles. They also could be terminated by induced atrial premature beats.
456 citations
TL;DR: In patients with advanced mitral valve disease, associated tricuspid regurgitation is of a functional nature and secondary to right ventricular hypertension and dilatation of the tricsuspid annulus, the present results indicate that in such patients tric Suspid Regurgitation will improve or disappear after mitral replacement and that tricwing valve replacement is seldom necessary.
Abstract: Among 100 consecutive patients undergoing mitral valve replacement, 28 had clinically and hemodynamically significant tricuspid regurgitation without tricuspid stenosis. In 21 patients the mitral valve was regurgitant, and in eight it was stenotic. The characteristic murmur of tricuspid regurgitation was present in 27 patients; 25 had abnormal venous distention, 14 peripheral edema, and seven ascites; and in 27 the liver was enlarged more than 4 cm below the costal margin. The mean right atrial pressure was abnormally high in every patient (average 11 mm Hg), and 25 had severe pulmonary hypertension (average systolic pressure 75 mm Hg). At the time of mitral replacement, 25 patients had no operative procedure on the tricuspid valve, and three had a tricuspid annuloplasty. Four patients died, a mortality rate (14%) not different from that in the patients without tricuspid regurgitation. Twenty-four patients were reassessed at postoperative intervals of one to four years (average 30 months). All evidenced s...
397 citations
TL;DR: A theoretical analysis presented indicated that when approximately 20 to 25% of left ventricular area is inactivated by any pathological process, the degree of shortening distance required of the myofiber to maintain stroke volume exceeds physiological limits, and cardiac enlargement must ensue to maintain adequate ejection of blood.
Abstract: Thirteen patients with left ventricular aneurysm due to coronary heart disease were studied by left heart and coronary sinus catheterization, including cineventriculography and measurement of ventricular mechanics and energetics at rest, and in some subjects, during either isoproterenol infusion or supine leg exercise. Eight patients had an aneurysm estimated to comprise greater than 20% of the left ventricular surface area, associated with increased left ventricular end-diastolic volume and pressure and mean systolic force. Average isometric rate of pressure rise and mean fiber shortening velocity and distance were uniformly decreased. Five patients had an aneurysm, estimated to comprise less than 15% of the left ventricular surface, associated with normal or nearly-normal left ventricular end-diastolic volume and pressure and mean systolic force. Average isometric rate of pressure rise was normal, but fiber shortening velocity and distance were moderately depressed. Stroke output and cardiac output were...
300 citations
TL;DR: By COMMITTEE MEMBERS: CHARLES E. KOSSMANN, M.D., CHAIRMAN, DANIEL A. BRODY, MD., GEORGE E. BURCH,M.D, and HUBERT V. PIPBERGER, M,D, of the SUBCOMMITTEE on Instrumentation.
Abstract: By COMMITTEE MEMBERS: CHARLES E. KOSSMANN, M.D., CHAIRMAN, DANIEL A. BRODY, M.D., GEORGE E. BURCH, M.D., HANs H. HECHT, M.D., FRANKLIN D. JOHNSTON, M.D., CALVIN KAY, M.D., EUGENE LEPESCHKIN, M.D., HUBERT V. PIPBERGER, M.D., AND by MEMBERS OF THE SUBCOMMITTEE ON INSTRUMENTATION: * HUBERT V. PIPBERGER, M.D., CHAIRMAN, GERHARD BAULE, PH.D., ALAN S. BERSON, M.S., STANLEY A. BRILLER, M.D., DAVID B. GESELOWITZ, Ph.D., LEO G. HORAN, M.D., AND OTTO H. SCHMITT, Ph.D.
295 citations
TL;DR: The maximum tolerated exercise, as indicated by the highest achieved level of oxygen consumption (Vo2), diminished with age; the arteriovenous oxygen difference did not increase abnormally on high loads, and the cardiac response to exercise in older subjects appeared to be adequate.
Abstract: Respiratory and hemodynamic measurements were made on 54 sedentary subjects during progressive exercise on a bicycle ergometer up to the point of maximal voluntary effort. The age range of the group was from 18 to 68 years. The maximum tolerated exercise, as indicated by the highest achieved level of oxygen consumption (Voo2), diminished with age. Older subjects had a lower resting cardiac output (Q) than normal subjects, but an identical increase in Q with Voo2. There was no evidence of flattening of this curve as the older subjects approached highest exercise loads. Consequently, the arteriovenous oxygen difference did not increase abnormally on high loads, and the cardiac response to exercise in older subjects appeared to be adequate. The relationship between inspired air volume and heart rate with Voo2 at submaximal loads was not influenced by age. Systolic pressure increased progressively with exercise and showed a greater change in older subjects. Total peripheral resistance at rest increased with a...
285 citations
TL;DR: The data suggest that overweight may be instrumental in bringing out symptoms of angina pectoris or in precipitating sudden death by imposing an increased workload on a heart with an already compromised coronary circulation.
Abstract: Interrelationships between weight change, serum cholesterol, blood pressure levels, and the risk of developing coronary heart disease have been explored in 5,127 men and women who have been followed over 12 years for signs of initial development of coronary heart disease. Antecedent relative weight and weight gain after age 25 years proved to be strongly related to risk of angina pectoris and sudden death but were unassociated with development of myocardial infarction. An excess risk of angina pectoris and sudden death appeared to exist in obese men both with and without elevations of blood pressure and serum cholesterol, indicating an independent contribution of obesity to the rate of development of these manifestations of coronary heart disease. Unless accompanied by an increase in blood pressure and serum cholesterol level, obesity appeared to play a negligible role in women. Subjects with both these predisposing factors and obesity had a pronounced increase in risk, greater than that associated with e...
275 citations
TL;DR: Evidence has been presented that 1.0 mm of ischemic S-T segment shift was the best criterion for a positive test in the subjects studied and was positive in 84% of 67 patients with angina pectoris and 3.7% of 107 normal subjects (excluding vasoregulatory hyperreactors).
Abstract: A system of multiple-lead exercise electrocardiography has been applied to the study of 107 normal subjects and 67 patients with angina pectoris. The results of this test are compared to those of coronary cinearteriography in 84 patients. In-exercise ECGs gave useful additional information in 59% of the angina patients but were essential for interpretation in 9%. It added considerably to the safety of the test. The value of each individual lead and of the multiple lead system was assessed. Lead V6 was the most often positive, but each made a contribution in some cases. Test-retest reproducibility survey indicated that five of 65 tests on 25 subjects failed to conform. Evidence has been presented that 1.0 mm of ischemic S-T segment shift was the best criterion for a positive test in the subjects studied. The test was positive in 84% of 67 patients with angina pectoris and 3.7% of 107 normal subjects (excluding vasoregulatory hyperreactors). The double two-step test given to the first 41 of the same angina patients for comparison was found to give 61% positive reactions despite the use of multiple leads and in-exercise recording. The test was administered to 84 subjects who were studied concurrently by selective coronary cinearteriograms and these two parameters were compared with the clinical diagnosis of angina in each patient. Since each of these parameters represents a different facet of coronary arterial disease, the agreement among them is very instructive.
TL;DR: This study suggests that the developmental complex of multiple spleens is closely related to the asplenic syndrome, with the important difference being left- sided symmetry rather than right-sided symmetry.
Abstract: The well-recognized association of congenital cardiac disease with asplenia has been termed "bilateral right-sidedness" or dextro-isomerism, since the spleen is absent, the liver is symmetrical, and each lung has three lobes and an epiarterial bronchus. In a study of pathological material from 12 patients with congenital cardiac disease associated with multiple spleens (as contrasted to accessory spleen), we found a definite tendency for the symmetrical development of organs but with a tendency for bilateral left-sidedness or levo-isomerism. The abnormalities assumed one of three forms as follows: (1) absence of a normal right-sided structure, (2) bilateral organs, each with the structure of a left-sided organ, or (3) excessive tissue of a left-sided organ. Thus, in polysplenia we observed a tendency for (1) absence of the hepatic segment of the inferior vena cava and absence of the gallbladder, (2) two lobes in each lung with hyparterial bronchi, and (3) multiple spleens. Other noncardiac abnormalities w...
TL;DR: Epicardial excitation was explored by means of an exploring electrode during operation on a patient with a large atrial septal defect of the secundum type, whose ECG indicated a Wolff-Parkinson-White syndrome of type B.
Abstract: Epicardial excitation was explored by means of an exploring electrode during operation on a patient with a large atrial septal defect of the secundum type, whose ECG indicated a Wolff-Parkinson-White syndrome of type B. Very early excitation occurred, 10 msec after the end of the P wave, at the right lateral border, near the atrioventricular sulcus, an area which is located a relatively large distance from the atrioventricular node. Because the epicardial region closest to this node did not show early excitation, it was concluded that in this heart the node was not involved, but that a muscular bypass between the right atrial muscle and the closely adjacent right ventricular surface was responsible. The location corresponds with that described in several extensive anatomic studies of hearts with a WPW syndrome. The right ventricle was activated predominantly or completely by an excitation wave originating in this area; the excitation pattern of the left ventricle did not differ significantly from the normal.
TL;DR: It is suggested that neurogenic activity is highest in mild hypertension and in the more severe forms of the disease, it is least, and the three hypertensive groups were compared with respect to clinical features, orthostatic hypertensives had the least severe vascular disease.
Abstract: Hemodynamic changes associated with diastolic hypertension were investigated using 50° head-up for 52 untreated hypertensive patients not in cardiac failure, and for 17 normotensive subjects. Normals responded to tilt with±10 mm Hg change in mean arterial pressure. Twenty-four hypertensives responded similarly; the remainder had either orthostatic hypertension (18) or orthostatic hypotension (10). During tilt, cardiac output reduction of each hypertensive group was greater than normal, but only orthostatic hypertensives responded with exaggerated increase in peripheral resistance. When supine, orthostatic hypotensives had lower cardiac indices and higher peripheral resistances than orthostatic hypertensives. When the three hypertensive groups were compared with respect to clinical features, orthostatic hypertensives had the least severe vascular disease; orthostatic hypotensives were the opposite extreme, and normal responders were intermediate. These findings suggest that neurogenic activity is highest i...
TL;DR: Both large and small vessels are occluded to about the same extent in diabetics and nondiabetics when amputation is required, and either diabetes or sudden occlusion in conjunction with chronic vascular disease can result in insufficient collateral flow and subsequent death of tissues.
Abstract: Casts were made of the vascular lumen of 20 successive extremities amputated for gangrene. Half of the patients were diabetic. All nondiabetics had arteriosclerotic vascular disease plus acute occl...
TL;DR: The records of 62 patients on whom the diagnosis of aortic dissection was proved are reviewed with particular attention to the clinical features and prognosis in each case, finding no definite conclusions about the efficacy of any form of therapy of this disorder.
Abstract: The records of 62 patients on whom the diagnosis of aortic dissection was proved are reviewed with particular attention to the clinical features and prognosis in each case. This was the consecutive experience of a large general hospital over approximately 17 years. The initial and long-term survival was far better in patients in whom the ascending aorta was spared by the disease process. No patients in whom such involvement was present were known to survive more than 3 weeks. Eight of 19 patients whose disease began distal to the arch of the aorta are known to have survived 6 to 69 months even though six of these eight were not operated on. Striking differences in the clinical findings of the two groups were also found. Aortic regurgitation, impairment of a radial or carotid pulse, neurological signs, and hypotension were rare in the group whose dissection began beyond the left subclavian artery. Marked systemic hypertension was frequently observed in this group, over a third having a diastolic pressure o...
TL;DR: The mechanism by which propranolol is efficacious in this disease is probably related to the diminution of myocardial O2 requirements resulting from the reduction of wall tension, velocity of contraction, and heart rate induced by beta-adrenergic receptor blockade.
Abstract: Beta-adrenergic receptor blockade has been demonstrated to reduce obstruction of the left ventricular outflow tract in patients with idiopathic hypertrophic subaortic stenosis (IHSS) and has also proved helpful in reducing angina pectoris due to ischemic heart disease Accordingly, the effects of oral propranolol on the level and duration of exercise required to produce angina in seven patients with IHSS were compared with a placebo Improvement in exercise performance was observed in six patients taking propranolol orally in doses ranging from 80 mg to 480 mg daily Clinical improvement was sustained in the four patients given propranolol since discharge from the hospital for periods up to 15 months, and in three it has been possible to obviate corrective operations The mechanism by which propranolol is efficacious in this disease is probably related to the diminution of myocardial O2 requirements resulting from the reduction of wall tension, velocity of contraction, and heart rate induced by beta-adren
TL;DR: The usual hemodynamic indices employed to evaluate cardiac performance during exertion were unreliable in separating patients from normal persons and the cardiac index achieved at a pulmonary arterial O2 saturation of 30% was found to be highly reliable and sensitive for distinguishing the normal from the abnormal response to exercise.
Abstract: The circulatory responses to mild and maximal upright exercise were studied in six normal subjects and 21 patients with various types of cardiac disease. It was found that the usual hemodynamic indices employed to evaluate cardiac performance during exertion were unreliable in separating patients from normal persons. In contrast, the cardiac index achieved at a pulmonary arterial (PA) O2 saturation of 30% was found to be highly reliable and sensitive for distinguishing the normal from the abnormal response to exercise. At a level of exercise that lowers PA O2 saturation to 30%, all normal subjects achieved a cardiac index greater than 7.0 L/minm2 while no patient exceeded 4.8 L/min/m.2 In addition, the maximal capacity to extract O2 was greater in patients than in normal subjects; thus, during maximal exercise it was not unusual for patients to achieve PA O2 saturations of 15% or less, while the lowest value achieved in normal subjects was 23%.
TL;DR: Factors significantly increasing the risk of arterial Entry include the existence of aortic valvular incompetence in the patient, systemic anticoagulation at the time of the arterial entry, and the presence of arteriosclerosis or hypertension in the patients.
Abstract: A study of 3,193 arterial entries of various types disclosed 66 major complications and 321 minor complications for a total complication rate of 13%. The Seldinger technique of percutaneous arterial catheterization was followed by the highest incidence of complications, the percutaneous needle puncture method was associated with an intermediate complication rate, and the cutdown arteriotomy with suture repair resulted in the lowest complication rate. Utilizing the brachial artery as the entry site resulted in a significantly higher complication rate than utilizing other sites for entering the arterial tree did. Factors significantly increasing the risk of arterial entry include the existence of aortic valvular incompetence in the patient, systemic anticoagulation at the time of the arterial entry, and the presence of arteriosclerosis or hypertension in the patient.
TL;DR: A patient with an atrial septal defect, paroxysmal tachycardia, and the Wolff-Parkinson-White syndrome had epicardial exploration to determine the nature of the excitation anomaly, and this sequence supported the concept of a circus movement.
Abstract: A patient with an atrial septal defect, paroxysmal tachycardia, and the Wolff-Parkinson-White syndrome (type B) had epicardial exploration to determine the nature of the excitation anomaly. Right bundle-branch block in association with the WPW syndrome (type B) was evidenced by the late activation (0.12 sec) of the epicardium over the outflow tract of the right ventricle. Early activation of the base of the right ventricle (near the atrioventricular groove at the right border of the heart) was interpreted as indicating an actively conducting atrioventricular muscle bridge (bundle of Kent) in this region. During paroxysms of tachycardia, the ventricular area excited much later than when sinus mechanism was present, and the adjacent right atrium was excited in sequence. This sequence supported the concept of a circus movement, that is, movement from atrium to ventricle via atrioventricular bundle (His) and ventricle to atrium via a muscle bridge (Kent). Injection of procaine into the base of the right ventr...
TL;DR: An integrated approach, utilizing cine coronary angiography, the standard 12-lead and post-exercise electrocardiograms, and regional myocardial lactate metabolism, is presented for detection of regionalMyocardial ischemia in patients with coronary heart disease.
Abstract: An integrated approach, utilizing cine coronary angiography, the standard 12-lead and post-exercise electrocardiograms, and regional myocardial lactate metabolism, is presented for detection of regional myocardial ischemia in patients with coronary heart disease. The normal electrocardiogram was of no predictive value and was present with extensive coronary disease and myocardial production of lactate. The abnormal electrocardiogram gave an accurate indication of a portion, but not all zones of ischemia. Multiple electrocardiographic abnormalities were invariably associated with severe coronary artery disease, although in most patients many more coronary lesions were present than electrocardiographic abnormalities. The regional lactate pattern was very helpful in localizing myocardial ischemia and significant coronary artery lesions. Regional lactate abnormalities may have a great practical value in the selection of patients for myocardial revascularization surgery and in their postoperative evaluation.
TL;DR: In the two cases of multiple system disease due to atheromatous embolization presented, increasingly severe hypertension developed owing to renal involvement and it is suggested that the "purple toe syndrome" may be a manifestation of cholesterol embolized secondary to anticoagulant therapy.
Abstract: In the two cases of multiple system disease due to atheromatous embolization presented, increasingly severe hypertension developed owing to renal involvement. One patient had acute pancreatitis from embolization to the pancreas. The second patient had mottling of the skin of the legs. Purple toes were present and gangrene developed in 3 toes. The possible influence of anticoagulant therapy in promoting peripheral cholesterol embolism is discussed. It is suggested that the "purple toe syndrome" may be a manifestation of cholesterol embolization secondary to anticoagulant therapy.
TL;DR: An editorial emphasis will be placed on two basic assumptions regarding the artery wall and atherogenesis, which represent a single cell type in the arterial media, smooth muscle cells and fibroblasts.
Abstract: Summary Accumulating evidence indicates that there is really only one cell type in the artery media and that it is a multifunctional cell in the sense that it fabricates or directs the fabrication of elastic fibers, collagen fibers, mucopolysaccharides and myosin. In the arteries of man and experimental animals with atherosclerosis this cell, in situ , frequently is found to contain lipid which on fluorescent microscopy has the antigenic specificity of low-density lipoproteins. During the development of fatty plaques this cell type probably both proliferates and migrates to contribute to the thickened intima. It seems possible that much of the fibroplasia in the thickened intima may be the result of relatively increased collagen formation by these cells at the expense of elastic fiber formation or myosin formation. Similar diversion of synthetic processes may account for the increased acid mucopolysaccharides seen in some atheromatous lesions. It is possible that this cell sometimes circulates and colonizes in order to produce the atheroma which have been observed occasionally on prosthetic implants in arterial lumina.
TL;DR: It was proposed that this mechanism plays an important part in producing the intraventricular pressure gradient in many patients with idiopathic hypertrophic subaortic stenosis.
Abstract: The angiographic features of the left ventricle were examined in patients with idiopathic hypertrophic subaortic stenosis who had clinical and hemodynamic evidence of obstruction. Of 36 combined hemodynamic and angiographic studies considered to be technically satisfactory, 33 showed a characteristic combination of abnormalities. In the frontal projection in systole, a linear radiolucent area extended across the left ventricular outflow tract 2 to 2.5 cm below the aortic annulus, at a level corresponding to the site of intraventricular pressure change. In the left oblique and lateral projections, the mitral leaflets did not swing posteriorly in a normal fashion, but projected into the outflow tract during mid and late systole. The radiolucent line, seen in the frontal views, was considered to represent contact of the leading edge of the leaflet with the hypertrophied muscular interventricular septum. The jet of mitral regurgitation, when present, was seen immediately below the anterior mitral leaflet. Sev...
TL;DR: The findings strongly suggest reevaluation of diagnostic criteria according to race both for recognition of ventricular hypertrophies and myocardial infarcts and for epidemiological investigations, particularly studies on aging.
Abstract: Correlations were computed between 333 different electrocardiographic measurements and constitutional variables of 518 normal men. The variables consisted of age, body weight, height, chest configuration, race, and deviations from ideal weight according to height. The most significant correlations were encountered with age. With every decade of life, QRS amplitude measurements decreased at an average rate of 6.5%. Although less in absolute voltage terms, amplitude decreases with age were even more significant for the ST-T complex where the average decline was 9.75% for each decade. Comparison of records from white and Negro subjects revealed marked differences. Most amplitude measurements were higher in the latter group. Furthermore, configurations of leads X and Y differed significantly, with smaller Q/R ratios in Negroes. These findings strongly suggest reevaluation of diagnostic criteria according to race both for recognition of ventricular hypertrophies and myocardial infarcts. Correlations with chest...
TL;DR: Data signify that there was a significant increase in collateral circulation at rest, during or after exercise, or both, improving the blood supply to the obstructed leg.
Abstract: Five men with arteriosclerosis obliterans (ASO) underwent a 3 to 8-month physical training program. The systolic pressure at the ankle (AP) before and after exercise, maximal walking time (MWT), and time of onset of claudication pain (CPT) were recorded on 4 different days. After training, these measurements were repeated on 3 different days. In addition, each subject was retested at his initial MWT. There were significant increases in resting AP levels of three subjects, in CPT and MWT of all five subjects and in the postexercise AP levels of all five subjects. Pain diminished or disappeared for varying periods of time while four of the subjects were walking. These data signify that there was a significant increase in collateral circulation at rest, during or after exercise, or both, improving the blood supply to the obstructed leg.
TL;DR: Severe involvement of single arteries was most frequent in patients who had myocardial infarction without angina pectoris or in those who had rest pain only, and no pattern of arterial involvement was pathognomonic of a clinical syndrome.
Abstract: The distribution of obstructions exceeding 30% of the normal diameter of the lumen of one or more major coronary arteries was studied in 627 of 1,000 patients who had selective cinecoronary arteriograms. An additional 99 patients had lesser degrees of narrowing, and in the arteriograms of 274 patients, normal arteries were demonstrated. An average of 2.0 lesions resulting in at least 50% luminal narrowing of major arteries was found per patient. The anterior descending coronary artery was involved slightly more frequently than were other vessels. More than 75% of the symptomatic patients had 90% or more obstruction of at least one vessel, and more than 50% had total occlusions of one or more vessels. A single major artery was the site of obstruction exceeding 30% of the luminal diameter in 131 patients (20.9% of the 627 patients), and in 43 of these (6.9%) the other arteries appeared to be entirely normal. Severe involvement of single arteries was most frequent in patients who had myocardial infarction wi...
TL;DR: There was nothing to indicate that increase in triglycerides rather than increase in cholesterol is related to coronary disease in these families, but no environmental factor was found to account for the higher death rate among the members with hypercholesterolemia.
Abstract: A report of 20 years' experience with coronary disease in 11 Danish families with hypercholesterolemia and normal serum triglycerides is given. A significantly higher death rate was found in family members who inherited the trait of hypercholesterolemia than in those who did not. The death rate of hypercholesterolemic family members was significantly higher than that found in all other persons of their age and sex living from 1943 to 1964 in Denmark; the death rate for the normocholesterolemic families was not. Most hypercholesterolemic family members died from coronary disease and at an earlier age than is usual for persons with coronary disease in Denmark. There was nothing to indicate that increase in triglycerides rather than increase in cholesterol is related to coronary disease in these families. No environmental factor was found to account for the higher death rate among the members with hypercholesterolemia.
TL;DR: The hypothesis that left ventricular stroke volume was proportional to the amplitude of an echo originating from a portion of the left ventricle near the mitral ring times the distance between the echoes from the anterior and posterior ventricular walls (LVD) has been validated.
Abstract: Several empirical observations made during ultrasound examinations for pericardial effusion have led to the possibility that this diagnostic technique might be used to measure left ventricular stroke volume in man. The hypothesis that left ventricular stroke volume was proportional to the amplitude of an echo originating from a portion of the left ventricle near the mitral ring (MREa) times the distance between the echoes from the anterior and posterior ventricular walls (LVD) has been validated. Ultrasound examinations were performed simultaneously with cardiac output determinations using the direct Fick method on 16 patients proven to have competent mitral and aortic valves. Correlation between the two methods of measuring left ventricular stroke volume was excellent (r = 0.973; P < 0.001). When ultrasound measurements were used in the regression equation to predict stroke volume, the calculated values were within 11 ml or 15% of those determined by the Fick method. The fact that an ultrasound examinati...
TL;DR: A beneficial effect of anticoagulation was demonstrated for patients having replacement of the aortic valve with a ball-valve prosthesis, particularly when this treatment was carefully controlled.
Abstract: The incidence of thromboembolism after insertion of prosthetic cardiac valves is related to the type of prosthesis and in the cases reviewed here was highest for the ball-valve prosthesis. The risk of thromboembolism was studied by constructing actuarial curves showing the proportion of patients with embolism at increasing time intervals postoperatively. Such curves for the patients studied suggest that the risk of thromboembolism diminishes with time, particularly by the third postoperative year. The risk was remarkably similar for patients having aortic, mitral, and multiplevalve replacements, being 15% for the first 6 postoperative months, another 8% for the next 6 months, and another 20% for the next 2 years. Emboli lodged in cerebral, coronary, renal, and other sites in these patients in diminishing frequency. The risk of fatality averaged 15%. None of the nonfatal embolisms resulted in significant continuing disability, save for 7% of the cerebral embolisms. A beneficial effect of anticoagulation wa...