Abner J. Delman

Serial P wave changes in acute myocardial infarction

Abstract Tall, peaked P waves of normal duration were recorded in Lead 2 of the ECG in 24 patients during the course of acute myocardial infarction and were observed to be transient in 21 of these. No patient had evidence of valvular heart disease, pulmonary emboli, or other pulmonary pathology. Fourteen patients had manifestations of left-sided congestive heart failure during the time of greatest P-wave abnormality. Twelve patients had concomitant abnormal posterior rotation of the P-wave vector, indicative of left atrial overloading. The possible factors in the genesis of these P-wave alterations are discussed. The pattern of P pulmonale may occur during the course of an acute myocardial infarction in the absence of demonstrable pulmonary emboli or other pulmonary pathology.

VALSALVA'S MANEUVER AND THE SYSTOLIC MURMUR OF HYPERTROPHIC SUBAORTIC STENOSIS; A BEDSIDE DIAGNOSTIC TEST.

Abstract An increase in the intensity of the systolic ejection murmur, during the positive pressure phase of the Valsalva maneuver, is described as a bedside differential diagnostic test for hypertrophic subaortic stenosis.

The Second Sound-Mitral Opening Snap (A2-OS) Interval during Exercise in the Evaluation of Mitral Stenosis

Cardiac catheterization and phonocardiography data were obtained from patients with mitral stenosis at rest and during exercise. There was a linear relationship between the percentage decrease of the interval from closure of the aortic valve to the mitral valve opening snap (A2-OS) and the percentage increase[see figure in the PDF file]of the left atrial mean pressure from rest to exercise. The duration of the A2-OS interval was an effective indicator of the level of the left atrial mean pressure during exercise. The duration of the A2-OS interval during exercise allowed separation of patients with mild stenosis from those with moderate or severe stenosis but could not be used to distinguish moderate stenosis from severe stenosis.

Normal splitting of the second heart sound in significant valvular pulmonic stenosis

Abstract Normal splitting of the second heart sound in two patients with significant valvular pulmonic stenosis is described. In 30 other patients with moderate to severe valvular pulmonic stenosis, second sound splitting was abnormally wide. A normal expiratory duration of the A 2 -P 2 interval has been considered a reliable indicator of the absence of significant pulmonic stenosis. This report demonstrates that exceptions to this rule may occur. The possible causes of normal splitting of the second sound with significant valvular pulmonic stenosis are discussed.

Hypogonadotrophic Hypogonadism Simulating Turner's Syndrome

Excerpt The clinical manifestations of panhypopituitarism secondary to destruction of the adenohypophysis are well known. After its original description by Simmonds (1) in 1914, panhypopituitarism ...

The direct brachial arterial pulse-pressure curve in the evaluation of patients with aortic valvular stenosis

Abstract An evaluation of the direct brachial arterial pressure-pulse curve revealed that, by analysis of the rate-correlated systolic ejection time, the upstroke time, and the upstroke velocity, the presence of aortic valvular stenosis, regardless of severity, could be recognized with a high degree of accuracy. In addition, those patients with significant obstruction could be distinguished from those without significant disease.

The artificially paced human heart

Abstract In 10 patients with complete heart block and an artificial ventricular pacemaker, there was a significant improvement in the form and amplitude of the ballistocardiographic complex when the P-R interval was 0.10 to 0.20 sec. Maximal ballistocardiographic improvement was associated with maximal increase in the brachial arterial systolic and pulse pressures. These findings suggest an improved efficiency of ventricular contraction in complete heart block when there is a normal sequence of atrioventricular activity. The hemodynamic consequences of the changing atrial systole-ventricular systole interval in complete heart block and their effect upon the ballistocardiogram are discussed.