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Showing papers in "Heart in 1979"


Journal ArticleDOI
01 Sep 1979-Heart
TL;DR: Sir, The authors read with great interest the recent report from the Committee of Principal Investigators on the cooperative trial in the primary prevention ofischaemic heart disease using clofibrate (British Heart Journal, 1978, 40, 1069-1118).
Abstract: Sir, We read with great interest the recent report from the Committee of Principal Investigators on the cooperative trial in the primary prevention ofischaemic heart disease using clofibrate (British Heart Journal, 1978, 40, 1069-1118). We note with satisfaction that our dietary prevention trial in two mental hospitals near Helsinki (Miettinen et al., 1972) was considered by the Principal Investigators in their Discussion. However, the results of our study were partly misrepresented. On page 1101 it is stated, correctly, that 'there was a significant reduction in IHD mortality' during the experimental diet periods. However, on page 1096 the authors say that 'mortality from IHD, . . . , was not reduced in ... primary prevention trials using a diet rich in polyunsaturated fats (. . .; Miettinen et al., 1972)'. This statement is in obvious contradiction to the previous one and is false. On page 1098 it is stated that in our study (Miettinen et al., 1972) there was 'a non-significant excess in total mortality among the experimental group taking a polyunsaturated fat diet'. This is not true. On the contrary, in our trial total mortality among the experimental groups was not higher but lower than among the control groups. The relevant mortality figures per 1000 man-years were as follows (cf. Table 6, loc. cit.):

453 citations


Journal ArticleDOI
01 May 1979-Heart
TL;DR: A totally descriptive nomenclature is proposed that describes in turn the connections of the cardiac segments, their morphology, their relations, and additional anomalies in any segment.
Abstract: At present there is no universally accepted nomenclature for congenital cardiac malformations. Much of the controversy results from failure to distinguish the structural connections of the heart from the morphology and spatial relations of its components. The confusion is compounded by an abundance of individual definitions, many of them speculative. The present article proposes a totally descriptive nomenclature. It describes in turn the connections of the cardiac segments, their morphology, their relations, and additional anomalies in any segment. Each step in the segmental approach is discrete. The overall effect is to force a succinct and comprehensive description of any cardiac malformation, no matter how complex.

244 citations


Journal ArticleDOI
01 Jun 1979-Heart
TL;DR: The theory that Coxsackie B viruses may cause congestive cardiomyopathy is supported and further research into the mechanisms of myocardial cell damage by these visuses is encouraged.
Abstract: Fifty patients with congestive cardiomyopathy have been studied for evidence of previous Coxsackie B virus infection and compared with age- and sex-matched controls who had been admitted to hospital for investigation of other cardiac diseases. High neutralisation titres (greater than or equal to 1024) to Coxsackie B viruses were more common among the controls. On subdividing the patients according to their length of symptomatic history before study, high titres were more common only in those with a short history (less than or equal to 1 year). High titres were more common when there had been a febrile illness at the onset of symptoms. Endomyocardial biopsies of 18 patients disclosed no evidence of myocarditis, or, in 12 cases, of viral involvement. Although the evidence remains circumstantial, these results support the theory that Coxsackie B viruses may cause congestive cardiomyopathy and encourage further research into the mechanisms of myocardial cell damage by these visuses.

223 citations


Journal ArticleDOI
01 Mar 1979-Heart
TL;DR: The histological study showed that the ductus was easily distinguished from the walls of the aorta or pulmonary artery, and the anatomical study of the hearts with obstructive aortic lesions emphasised the necessity of distinguishing 'coarctation' from 'tubular hypoplasia'.
Abstract: A histological study has been made in an attempt to study further the relation between the ductus arteriosus, coarctation, and tubular hypoplasia of the aortic arch. Thirty-five aortic arch systems were studied using serial sectioning techniques. Twelve were from patients with coarctation and/or tubular hypoplasia. The other 23 hearts were from patients without aortic obstructive lesions, 7 from anatomically normal hearts, and the others from malformed hearts with anomalies elsewhere from the aortic arch. The anatomical study of the hearts with obstructive aortic lesions emphasised the necessity of distinguishing 'coarctation' from 'tubular hypoplasia', since the curtain lesion of coarctation was found to coexist with tubular hypoplasia in some cases. The histological study showed that the ductus was easily distinguished from the walls of the aorta or pulmonary artery. In all these cases with coarctation or tubular hypoplasia a sling of ductal tissue was located around the aortic isthmal orifice. In 6 hearts a diaphragm of ductal tissue was seen to form the coarctation lesion.

205 citations


Journal ArticleDOI
01 Feb 1979-Heart
TL;DR: This drug appears to be effective in the management of patients with frequent attacks of angina at rest, according to results of a therapeutic trial performed in 12 patients admitted to coronary care unit because of frequent daily attacks of Angina at Rest attributed to coronary vasospasm.
Abstract: A therapeutic trial with verapamil, a calcium-antagonist drug, was performed in 12 patients admitted to our coronary care unit because of frequent daily attacks of angina at rest attributed to coronary vasospasm. After a 48-hour run-in period, oral verapamil 480 mg/day and placebo were administered alternately during 4 randomised 48-hour periods. Transient ischaemic attacks with ST segment elevation or depression, with or without pain, were documented by continuous electrocardiographic monitoring. The number of attacks during the run-in and 2 placebo periods were 128, 123, and 130, respectively, and 31 and 23 during the 2 treatment periods (P less than 0.006 and P less than 0.003). This drug therefore appears to be effective in the management of patients with frequent attacks of angina at rest.

198 citations


Journal ArticleDOI
01 Aug 1979-Heart
TL;DR: The risk of haemorrhage was unrelated to age and was greatest in those patients in whom the prothrombin ratio had proved difficult to control from the outset and in men with an aortic valve prosthesis.
Abstract: Anticoagulant treatment reduces the risk of embolic and thrombotic complications in certain patients but haemorrhagic problems of the treatment have been less critically assessed. In this study 501 fully documented outpatients treated between 1970 and 1977, comprising 1199 patient-years of treatment, have been analysed in an attempt to clarify the iatrogenic risks of haemorrhage associated with oral anticoagulants. Forty-one patients experienced 51 haemorrhages of sufficient severity to seek medical advice. The incidence was 8'2 per cent among patients and 4*3 per cent per treatment year. There were 24 occasions when the haemorrhage was potentially lethal and 2 patients died. In 23 of these 24 events, the prothrombin ratio at the time of haemorrhage was prolonged beyond the therapeutic range. In contrast, the prothrombin ratio was only known to be prolonged beyond the therapeutic range on 1 of the 27 occasions with less serious haemorrhages. The risk of haemorrhage was unrelated to age and was greatest in those patients in whom the prothrombin ratio had proved difficult to control from the outset and in men with an aortic valve prosthesis. There was no cumulative risk in the first 3 years of treatment but a trend for increased risk between 4 and 7 years. It is in these groups with a high risk of bleeding that prothrombin control and patient education call for the closest attention.

186 citations


Journal ArticleDOI
01 Jul 1979-Heart
TL;DR: From all available clinical data it is concluded that verapamil treatment is superior to beta-blocker therapy.
Abstract: Twenty-two patients with hypertrophic obstructive cardiomyopathy were treated with the calcium inhibitor, verapamil, which was administered in a mean oral dose of 480 mg per day. After an average of 15 months of treatment (4 to 24 months), the QRS amplitude in the electrocardiogram was significantly reduced from 4.2 to 3.8 mV. Heart volume calculated from chest x-ray films in the supine position decreased significantly from 858 to 766 ml per 1.73 m2. In 10 patients, follow-up heart catheterisation showed a decrease in left ventricular muscle mass in 7 patients and a slight increase in 3 patients. Coronary artery diameter decreased in 7 patients, increased in 1, and was unchanged in 2. The reduction in coronary artery diameter is considered to be a consequence of a reduced heart muscle mass. From all available clinical data it is concluded that verapamil treatment is superior to beta-blocker therapy.

182 citations


Journal ArticleDOI
01 Jan 1979-Heart
TL;DR: Connections between the sinus node and atrial myocardium were diffuse and abundant but in no instances were tracts of specialised cells observed leaving the node and traversing any distance through the atrial wall.
Abstract: The exact location of the sinus node was determined in 25 infant hearts using reconstructive techniques. The sinus node was found to lie on the lateral aspect of the superior cavo-atrial junction in the great majority (22 hearts). In only 3 hearts was it found to straddle the summit of the crest of the right atrial appendage where it is popularly believed to be located. In the majority of instances a single artery supplied the node (in 11 hearts the artery approached posteriorly, and in 10 the artery approached anteriorly), though there was considerable variation in the exact anatomy of the arterial supply. Connections between the sinus node and atrial myocardium were diffuse and abundant but in no instances were tracts of specialised cells observed leaving the node and traversing any distance through the atrial wall. These findings are relevant to the sinus node dysfunction that may follow cardiac surgical procedures.

158 citations


Journal ArticleDOI
01 Mar 1979-Heart
TL;DR: The morphological features of a series of 37 specimens of pulmonary atresia with intact ventricular septum were reviewed and if these anatomical findings are representative for the condition as a whole, they provide a good explanation for its disastrous prognosis.
Abstract: The morphological features of a series of 37 specimens of pulmonary atresia with intact ventricular septum were reviewed with particular emphasis on features which might influence the results of pulmonary valvotomy. The degree of right heart hypoplasia was quantified by measuring right and left heart dimensions and comparing them with 20 normal infant hearts. Right ventricular cavity size was usually smaller than normal but constituted a spectrum ranging from tiny to a dilated ventricle larger than normal. There was a positive correlation between triscuspid annular size and right ventricular size but no correlation between the size of the pulmonary artery and the right ventricle. Successful pulmonary valvotomy with subsequent adequate right ventricular function would have been precluded by a tiny right ventricular cavity or infundibular atresia in 14 specimens and by severe tricuspid stenosis or regurgitation in an additional 4. Severe right or left ventricular endocardial fibroelastosis may have adversely affected ventricular function in several others. Ten specimens displayed convex bulging of the left ventricular septal surface. If these these anatomical findings are representative for the condition as a whole, they provide a good explanation for its disastrous prognosis.

131 citations


Journal ArticleDOI
01 Jan 1979-Heart
TL;DR: In patients with secondary left ventricular hypertrophy, cavity size and peak circumferential fibre shortening rate were normal, and values of peak rate of dimension increase and septal to posterior wall thickness ratio were indistinguishable from those in the patients with hypertrophic cardiomyopathy.
Abstract: Echocardiograms showing left ventricular cavity and mitral valve were recorded and digitised in 100 patients with secondary left ventricular hypertrophy caused by severe hypertension (23), aortic valve stenosis (21), fixed subaortic stenosis (13), and postoperative aortic stenosis (13), or regurgitation (30). Left ventricular dimension and its rate of change were determined and related to mitral valve opening. These values were compared with those from 30 patients with hypertrophic cardiomyopathy. In the patients with secondary left ventricular hypertrophy, cavity size and peak circumferential fibre shortening rate were normal. In diastole, the peak rate of increase of dimension was reduced in 56, and mitral valve opening, normally synchronous with minimum dimension, was delayed in 78, both the result of abnormal left ventricular relaxation. The septal to posterior wall thickness ratio was greater than 1-3 in 40. Values for delay in mitral valve opening were distributed bimodally in the population of patients with secondary left ventricular hypertrophy, with one subgroup in which it was normal and the other in which it was significantly delayed. The distribution of the latter, along with those of values of peak rate of dimension increase and septal to posterior wall thickness ratio were indistinguishable from those in the patients with hypertrophic cardiomyopathy. Abnormalities similar to those of hypertrophic cardiomyopathy therefore occur in patients with secondary left ventricular hypertrophy, and these echocardiographic criteria cannot separate the two conditions.

123 citations


Journal ArticleDOI
01 Aug 1979-Heart
TL;DR: Nifedipine thus appears safe in patients with angina pectoris who have disorders of atrioventricular nodal conduction, and in those receiving beta-adrenergic blocking drugs.
Abstract: Intravenous nifedipine, a powerful calcium antagonist, had no obvious effect on atrioventricular conduction when administered to 11 patients during routine intracardiac electrophysiological studies. Verapamil on the other hand showed potent antiarrhythmic properties, depressing atrioventricular nodal conduction. Nifedipine thus appears safe in patients with angina pectoris who have disorders of atrioventricular nodal conduction, and in those receiving beta-adrenergic blocking drugs. There appear to be differential effects on the slow inward channels of cardiac cells with different 'calcium antagonists'.

Journal ArticleDOI
01 Jan 1979-Heart
TL;DR: It is concluded that thallium-201 scintigraphy, when performed within a time interval of 10 hours after the last episode of chest pain, may be ofvalue as a means of selecting those patients requiring further stay in hospital and observation in the coronary care unit.
Abstract: The potential value of thallium-201 scintigraphy as a means of selecting patients for appropriate coronary care unit admission was evaluated. Studies were made prospectively on 203 patients with possible acute myocardial infarction but atypical history and non-diagnostic electrocardiogram at a time when the clinical diagnosis was still in doubt. Under conventional circumstances, this particular group of patients will be admitted to the coronary care unit for observation in order to rule out myocardial infarction by further clinical evaluation. Scintigraphy was performed upon arrival in the coronary care unit and within 10 hours after the last episode of chest pain. Of 203 patients, 49 had positive, 47 had questionable, and 107 had normal thallium-201 scintiscans. Serial serum enzyme determinations and further clinical follow-up disclosed acute myocardial infarction in 34 patients: all had abnormal scans. Of47 patients subsequently determined to present with unstable angina, 27 had abnormal scans, ofwhom 7 subsequently developed acute myocardial infarction. Of 24 patients with previous myocardial infarction, 18 patients had abnormal scans. None of either the 25 patients with stable angina or the 73 patients with atypical complaints showed frank perfusion defects, though questionable abnormal scintiscans were obtained in 5 and 12 patients in these groups, respectively. It is concluded that thallium-201 scintigraphy, when performed within a time interval of 10 hours after the last episode ofchest pain, may be ofvalue as a means of selecting those patients requiring further stay in hospital and observation in the coronary care unit.

Journal ArticleDOI
01 Dec 1979-Heart
TL;DR: Hearts with these anatomical features can be divided into partial and complete forms depending on the morphology of the atrioventricular annuli, which is dependent upon the presence or absence of an ostium primum atrial septal defect.
Abstract: Anatomical studies were made on 114 necropsy specimens of atrioventricular defects with atrioventricular concordance. The malformation is characterised by disproportion between the ventricular inlet and outlet dimensions and a malorientation of the aortic valve relative to the atrioventricular valve or valves. Associated with this there is a characteristic 'scopped-out' appearance of the muscular ventricular septum, gross abnormalities of the membranous components of the septum as compared with the normal heart, and narrowing of the aortic outflow tract. Hearts with these anatomical features can be divided into partial and complete forms depending on the morphology of the atrioventricular annuli. In the partial form the septal leaflets are conjoined to give separate mitral and tricuspid orifices, the conjoined leaflets being displaced into the ventricles and usually attached to the crest of the septum. In the complete form, anterior and posterior components of the 'septal' leaflets are separate, so that a single valve orifice connects the atrial to the ventricular chambers. Further subdivision of the complete form, apart from the morphology of the anterior leaflet, is dependent upon the presence or absence of an ostium primum atrial septal defect.

Journal ArticleDOI
01 Sep 1979-Heart
TL;DR: This study shows that all the waves in the electrocardiogram are useful in assessing infarct size and the fact that maximum sigma ST predicts final sigma Q may be used to assess the efficacy of interventions designed to salvage ischaemic myocardium.
Abstract: The value of the electrocardiogram in assessing infarct size was studied using serial estimates of the MB isomer of creatine kinase (CK MB) in plasma, serial 35 lead praecordial maps in 28 patients with anterior myocardial infarction, and serial 12 lead electrocardiograms in 17 patients with inferior myocardial infarction. In patients with anterior infarcts, sigma ST, sigma R, sigma Q, sigma R/(Q+S), and the number of sites with ST elevation more than 2 mm or with QS waves, were obtained from each map. Correlation between both maximum sigma Q and maximum sigma ST with cumulative CK MB was highly significant. There was also a significant correlation between sigma R and sigma R/(Q+S) with cumulative CK MB. There was no significant correlation between maximum number of sites with ST elevation or with Q or QS waves and cumulative CK MB. Maximum sigma ST and number of sites with ST elevation predicted maximum sigma Q and number of sites with QS or Q waves at a time when infarction was not complete. In patients with inferior infarcts, there was a significant correlation between maximum sigma Q and maximum sigma ST in leads II, III, and a VF, and cumulative CK MB. This study shows that all the waves in the electrocardiogram are useful in assessing infarct size. The fact that maximum sigma ST predicts final sigma Q may be used to assess the efficacy of interventions designed to salvage ischaemic myocardium.

Journal ArticleDOI
01 Sep 1979-Heart
TL;DR: Sixteen patients had two-dimensional echocardiographic diagnosis of the presence or absence of left ventricular thrombi and anatomical, radiological, or clinical confirmation of the diagnosis and 11 patients had positive diagnoses, which were confirmed in 10 and possibly incorrect in one.
Abstract: Sixteen patients had two-dimensional echocardiographic diagnosis of the presence or absence of left ventricular thrombi and anatomical, radiological, or clinical confirmation of the diagnosis. Eleven patients had positive diagnoses, which were confirmed in 10 and possibly incorrect in one. Five other records were reviewed because the patients had undergone aneurysmectomy after two-dimensional echocardiograms: three were true negative and two were false negative studies.

Journal ArticleDOI
01 Jul 1979-Heart
TL;DR: Data strongly support the concept of re-entry in the pathogenesis of early ventricular fibrillation and questions the validity of experimental studies of myocardial ischaemia based on comparisons of sequential coronary occlusions using the first as the control.
Abstract: Electrophysiological changes occurring soon after experimental coronary occlusion have been examined in 13 dogs by combined recording of epicardial action potential, endocardial-epicardial conduction time, and epicardial ST segment elevation during successive 5-minute occlusions of the left anterior descending coronary artery. Mter initial coronary occlusion, action potential duration shortened from 182 ± 9 ms to 113 ± 9 ms at 2 minutes and conduction time was prolonged from 24 i 1 ms to 71 ± 17 ms associated with progressive ST segment elevation. These changes were followed by the appearance of potentials of 'slow response' type morphology, alternans of action potential duration and amplitude, alternans of epicardial and endocardial ST segment elevation, and intermittent conduction block. Ventricular fibrillation was preceded by action potential alternans in 95 per cent and by conduction block in 65 per cent of instances and occurred at a time of maximum conduction delay. These data strongly support the concept of re-entry in the pathogenesis of early ventricular fibrillation. Changes in action potential duration and conduction time were significantly greater during the first occlusion compared with subsequent occlusion periods. There was no significant difference however between data taken from occlusions 2, 3, 4, or 5. This questions the validity of experimental studies of myocardial ischaemia based on comparisons of sequential coronary occlusions using the first as the control.

Journal ArticleDOI
01 Jan 1979-Heart
TL;DR: An investigation of defects of the haemostatic mechanism in 41 children with cyanotic congenital heart disease concluded that such abnormalities were common and normally involved factors synthesised in the liver, that is the vitamin K dependent factors and factor V.
Abstract: An investigation of defects of the haemostatic mechanism in 41 children with cyanotic congenital heart disease concluded that such abnormalities were common and normally involved factors synthesised in the liver, that is the vitamin K dependent factors (rothrombin, factors VII and IX) and factor V. No evidence was found of activation of the coagulation or fibrinolytic systems. The defects can be explained by deficient synthesis resulting from systemic hypoxia as well as from sluggishness of the local microcirculation caused by high blood viscosity. Vitamin K parenterally had no demonstrable effect. Replacement of these factors, possibly combined with measures to improve the microcirculation, therefore, appears to be the appropriate treatment.

Journal ArticleDOI
01 Sep 1979-Heart
TL;DR: Clinical manifestations of coronary heart disease showed similarities within sibships, whereas angina was commonest in sibs of the fatal myocardial infarction probands, whereas cardiac deaths were commonmost in siberians of the angina pectoris probands.
Abstract: Occurrence of coronary heart disease was assessed in families of 211 men under the age of 56 from East Finland. Fifty men were survivors of recent myocardial infarctions, 55 had died of myocardial infarction, 53 suffered from uncomplicated angina pectoris, and 53 were healthy reference men. Overall prevalence of coronary heart disease was similar in familes of all case probands. By age 70, case fathers had a 6 times greater cumulative risk (a 36% chance) of dying from coronary heart disease than reference fathers, whereas there was only a small difference between case and reference mothers. Cumulative risk of developing fatal or non-fatal coronary heart disease by age 65 was 4.5-fold for case brothers (70%) and 2.6-fold for case sisters (40%), when compared with reference sibs. The risk was greatest for case sibs with a parental, especially a maternal, history of premature coronary heart disease. Clinical manifestations of coronary heart disease showed similarities within sibships. Cardiac deaths were commonest in sibs of the fatal myocardial infarction probands, whereas angina was commonest in sibs of the angina pectoris probands.

Journal ArticleDOI
01 May 1979-Heart
TL;DR: The accuracy of a non-invasive ultrasound Doppler technique for the determination of the pressure gradient in mitral stenosis was evaluated and indicates that the ultrasound technique is sufficiently accurate for diagnostic purposes.
Abstract: The accuracy of a non-invasive ultrasound Doppler technique for the determination of the pressure gradient in mitral stenosis was evaluated in a study of 8 adult patients. Transseptal left atrial catheterisation and retrograde left ventricular catheterisation were performed. The same diastoles were used to compare the gradient constructed from the ultrasound data (delta PU) with that constructed from the manometric data (delta PM). In the 8 patients the difference betweent he mean diastolic values of delta PU and delta PM was - 0.54 +/- 1.0 (SD) mmHg. The corresponding figure for mid-diastole was 0.01 +/- 0.9 (SD) mmHg. The results indicate that the ultrasound technique is sufficiently accurate for diagnostic purposes.

Journal ArticleDOI
01 Mar 1979-Heart
TL;DR: Uptake was lower in failing heart muscle and was inhibited not only by increasing the noradrenaline concentration in the incubating medium but also by adding the drugs desmethylimipramine, amitryptyline, and ouabain.
Abstract: Noradrenaline uptake was studied using heart muscle from 102 patients undergoing cardiac surgery. Slices of right atrium were incubated in Krebs-Henseleit solution containing 1.3 x 10(-7) M 3H-noradrenaline. Uptake was lower in failing heart muscle and was inhibited not only by increasing the noradrenaline concentration in the incubating medium but also by adding the drugs desmethylimipramine, amitryptyline, and ouabain.

Journal ArticleDOI
01 Apr 1979-Heart
TL;DR: Under appropriate physiological conditions and competitive pacing, patients would be more vulnerable to arrhythmias with bipolar stimulation than with unipolar cathodal, so the anodal surface area should be 5 to 7 times the cathode, or the anode should be removed from the ventricle, to decrease that risk.
Abstract: premature contractions is greater during bipolar or anodal stimulation than with unipolar cathodal (with electrodes of equal cathodal and anodal surface area) because the anodal and bipolar absolute refractory periods are shorter, enabling easier excitation in the vulnerable period. To compare the relative safety of stimulation with various commercial electrodes, strength-interval curves were determined in patients during the initial period after electrode implantation (acute studies) and after a few years of pacing (chronic studies). In 9 of 10 acute studies in patients with permanent bipolar electrodes (anode surface area 4-4 times cathode) and in 9 of 10 chronic studies in patients with bipolar electrodes, the unipolar cathodal and bipolar refractory periods were equal. However, in 7 of 12 patients with temporary bipolar electrodes (equal anodal and cathodal surface areas) and in 2 out of 20 acute and chronic studies in patients with permanent bipolar electrodes, the bipolar refractory periods were significantly shorter than cathodal because of anodal stimulation at the proximal electrode. Under appropriate physiological conditions and competitive pacing, these patients would be more vulnerable to arrhythmias with bipolar stimulation than with unipolar cathodal. To decrease that risk, the anodal surface area should be 5 to 7 times the cathodal, or the anode should be removed from the ventricle, especially for temporary pacing in circumstances of high vulnerability to arrhythmias.

Journal ArticleDOI
01 Mar 1979-Heart
TL;DR: It is shown that a spectrum of response exists which may have a -bearing on the nature of cardiomyopathy itself and that too much emphasis has been given to alterations in cardiac rhythm, a phenomenon symptomatic of associated muscle excitability.
Abstract: The concept of thyrocardiac disease was introduced by Samuel Levine (Levine and Sturgis, 1924) who described atrial arrhythmias, congestive cardiac failure, and cardiac enlargement in hyperthyroidism occurring even in the absence of overt evidence of thyroid disorder. His clinical descriptions are as pertinent today as when they were written but it has always been a matter for conjecture whether thyroid disease in any of its forms can produce either specific pathological changes in the heart or an identifiable cardiac syndrome. The consensus from published work indicates that thyrocardiac disease as such is a clinical entity (Sandler and Wilson, 1959a; Staffurth and Morrison, 1968). Probably too much emphasis has been given to alterations in cardiac rhythm, a phenomenon symptomatic of associated muscle excitability. This survey discusses some of the experimental and clinical aspects of thyrocardiac disease and shows that a spectrum of response exists which may have a -bearing on the nature of cardiomyopathy itself.

Journal ArticleDOI
01 Dec 1979-Heart
TL;DR: The findings showed that there is a 'spectrum of normality' with respect to the anatomy of the mitral valve chordal apparatus, which provides an anatomical basis for echocardiographic recordings of disharmonious mitral valves movements, frequently recorded among otherwise healthy individuals.
Abstract: The intricate anatomy of the mitral valve apparatus suggests that variations in its architecture may have functional significance. In this study, therefore, deviations from a basic scheme of normality of chordal support have been documented, with particular reference to the occurrence of deficient chordae. Chordae were considered as deficient when they had an irregular branching pattern, not compensated by neighbouring chordae, leaving parts of the valve leaflets less well supported than others. One hundred 'normal' heart specimens were studied, in which the mitral valve in the unopened state showed a regular appearance, and compared with 40 hearts in which the valve showed a deformity, classified as ballooning in 38 cases and as prolapse in two. Deficient chordae were identified in eight of the 100 'normal' hearts and in 36 of the 40 hearts with a valve deformity. In the latter group the chordal deficiency was directly related to the leaflet deformity present. Deficiencies in chordal branching and distribution affected commissural chordae and rough zone chordae, showing a particular preference for the posteromedial commissural area and the middle scallop of the posterior leaflet. The latter abnormalities showed a tendency to be associated with finger-like posteromedial papillary muscle groups and a haphazard arrangement of chordal take-off. Both specimens with necropsy evidence of prolapse had such an arrangement. The findings showed that there is a 'spectrum of normality' with respect to the anatomy of the mitral valve chordal apparatus. It provides an anatomical basis for echocardiographic recordings of disharmonious mitral valve movements, frequently recorded among otherwise healthy individuals. Moreover, it is assumed that such minor variations may play a role in the pathogenesis of the syndrome of mitral valve prolapse, by rendering unsupported parts of leaflets particularly vulnerable to high

Journal ArticleDOI
01 Apr 1979-Heart
TL;DR: Two cases of angiosarcomas of the heart are described, in which the tumour, which arose from the right atrium, was demonstrated during life by angiography and at necropsy.
Abstract: Two cases of angiosarcomas of the heart are described. In one the tumour, which arose from the right atrium, was demonstrated during life by angiography. In the other, diagnosed only at necropsy, the tumour arose from the right ventricle. Both cases illustrate many of the typical features of this rare tumour and the difficulties of antemortem diagnosis.

Journal ArticleDOI
01 Oct 1979-Heart
TL;DR: Most of the familial aggregation of coronary heart disease is mediated by familial aggregations of hyperlipidaemia and hypertension, with the most impressive aggregation of both traits in case families with a maternal history of early coronary death.
Abstract: The occurrence of main coronary risk factors was assessed in the families of 211 men under age 56 from East Finland. Fifty men were survivors of a recent myocardial infarction, 55 had died of myocardial infarction, 53 suffered from uncomplicated angina, and 53 were healthy reference men. Familial hyperlipidaemia was twice and familial hypertension three times as common in case as in reference families; other risk factors were equally common in both. Familial hypercholesterolaemia was commonest in the families of men with fatal myocardial infarction, and multiple type familial hyperlipidaemia in those of men with angina. Any increase in familial aggregation of coronary heart disease was invariably paralleled by increased aggregation of hyperlipidaemia and hypertension, with the most impressive aggregation of both traits in case families with a maternal history of early coronary death. It is concluded that most of the familial aggregation of coronary heart disease is mediated by familial aggregations of hyperlipidaemia and hypertension.

Journal ArticleDOI
01 Jan 1979-Heart
TL;DR: In babies born alive with cardiac malformations, some adaptive changes in the cardiovascular system already may have been superimposed upon the basic structural abnormalities by the time of birth.
Abstract: The relation between form and function is the relation between anatomy and physiology; change in one leads to change in the other. By the time of birth, in babies born alive with cardiac malformations, some adaptive changes in the cardiovascular system already may have been superimposed upon the basic structural abnormalities. These alterations in pathological anatomy continue throughout postnatal life but time is needed for the changes to evolve and show their physiological effects. Such alterations may

Journal ArticleDOI
01 Jul 1979-Heart
TL;DR: In patients with hypertension, the timing of aortic valve closure was normal, but isovolumic relaxation was prolonged, so that mitral valve opening was significantly delayed, occurring at a mean of 80 + 25 ms after the minimum left ventricular dimension.
Abstract: apex cardiograms were performed, and the resulting traces digitised. In normal subjects, aortic valve closure (A2) occurred at a mean of 40 + 10 ms before the minimum left ventricular dimension, and the duration of isovolumic relaxation, taken as the period from A2 to the onset ofmitral valve cusp separation was a mean of 65 + 15 ms. In patients with hypertension, the timing of aortic valve closure was normal, but isovolumic relaxation was prolonged to a mean of 105 + 25 ms, so that mitral valve opening was significantly delayed, occurring at a mean of 80 + 25 ms after the minimum left ventricular dimension. In patients with coronary artery disease, aortic valve closure was significantly delayed by a mean of 5 + 40 ms with respect to the minimum left ventricular dimension. The mean duration of isovolumic relaxation did not differ significantly from normal, though the scatter was wide, but mitral valve opening

Journal ArticleDOI
01 Jun 1979-Heart
TL;DR: Another well-documented case of Uhl's anomaly of the heart is presented with a review of the published reports outlining the main clinical features and the bad overall prognosis.
Abstract: Uhl's anomaly of the heart is a rare condition. Another well-documented case is presented with a review of the published reports outlining the main clinical features and the bad overall prognosis. Right atriotomy should be avoided if closure of the atrial septal defect is attempted.

Journal ArticleDOI
01 Dec 1979-Heart
TL;DR: Anatomical studies were made on 70 necropsied hearts with atrioventricular defects from patients with situs solitus and atriventricular concordance, all having a common atriOVentricular orifice, and it proved possible to subdivide the hearts, depending on the morphology of the valve leaflets.
Abstract: Anatomical studies were made on 70 necropsied hearts with atrioventricular defects from patients with situs solitus and atrioventricular concordance, all having a common atrioventricular orifice. The arterial connections were concordant in 68 and were double outlet right ventricle in two; cases with arterial discordance (transposition) or single outlet of the heart were excluded. It proved possible to subdivide the hearts, depending on the morphology of the valve leaflets. Five leaflets were distinguished by the commissural pattern and their insertion to major papillary muscles. They were a posterior bridging leaflet, right and left lateral leaflets, and right and left anterior leaflets. Subdivision was made on the basis of the disposition of the anterior leaflets. In six hearts the left anterior leaflet was committed to the left ventricle and the right anterior leaflet to the right ventricle, the commissure between them being on the crest of the ventricular septum. In 39 hearts there was minimal bridging of the left anterior leaflet so that it extended between the anterior papillary muscle of the left ventricle and the medial papillary complex of the right ventricle. In eight hearts the right margin of the left anterior leaflet was attached to an apical papillary muscle, while in 17 hearts it was attached to the anterolateral papillary muscle of the right ventricle. As the bridging of the left anterior leaflet increased, so the size of the right anterior leaflet decreased, but in all hearts both leaflets were identified. These findings were compared with previous classifications of complete atrioventricular defects.

Journal ArticleDOI
01 Mar 1979-Heart
TL;DR: It is considered that the findings indicate that the transformation of the membranous septum into atrioventricular and interventricular components occurs in the late fetal and early postnatal period rather than during closure of the embryonicinterventricular foramen.
Abstract: The anatomy of the membranous part of the ventricular septum is described in 25 hearts from patients ranging in age from 15 weeks of gestation to the ninth decade of adult life. Both atrioventricular and interventricular components were recognised in all the adult subjects, and the atrioventricular component was evident in all 25. The interventricular membranous septum was present in only 1 of the fetal hearts and 4 of the infant subjects. We consider that these findings indicate that the transformation of the membranous septum into atrioventricular and interventricular components occurs in the late fetal and early postnatal period rather than during closure of the embryonic interventricular foramen. It is associated with the liberation of the medial leaflet of the tricuspid valve from the muscular ventricular septum.