Alan F. Lyon

The phonocardiogram and apexcardiogram in patients with ventricular aneurysm

Abstract The phonocardiographic and apexcardiographic findings are presented for 60 patients with established old myocardial infarction, 30 of whom had fluoroscopic evidence of ventricular aneurysm. The data indicate that presystolic gallop (83.4 per cent) and quadruple rhythm (40.0 per cent) are very common in patients with ventricular aneurysm and represent the most reliable and characteristic clinical and phonocardiographic findings in such patients. These gallops were far more frequent in patients with ventricular aneurysm than in patients with uncomplicated myocardial infarction. Isolated protodiastolic gallop was rare in both groups. No diastolic or pansystolic murmur was recorded in the study, and a nondescript early systolic ejection murmur was recorded with equal frequency in both groups of patients. An ejection click was recorded in 1 patient with ventricular aneurysm. No difference in the quality or intensity of the heart sounds was evident in either group. A prominent a wave was the most common abnormality palpated and recorded on the apexcardiogram of patients with ventricular aneurysm; only 1 patient in this group had a paradoxic apical pulsation. On the basis of these data it is recommended that patients with old myocardial infarction with stable, compensated conditions who have a presystolic gallop, quadruple rhythm, or a palpable apical a wave be given appropriate fluoroscopic and x-ray studies to rule out the presence of a ventricular aneurysm.

Nonobstructive Primary Myocardial Disease Hemodynamic Studies in Fourteen Cases

Abstract 1. 1. Fourteen patients with primary myocardial disease of the alcoholic type underwent hemodynamic studies at rest, during exercise and during isoproterenol infusion. 2. 2. No ventricular outflow gradient during isoproterenol infusion developed in any patient. In all patients studied, isoproterenol markedly improved cardiac function. 3. 3. In this group of patients with established nonobstructive cardiomyopathy who had previously demonstrated congestive heart failure, the cardiac index could be normal or depressed and the ventricular volumes and pressures normal or increased; however, in all patients a presystolic gallop, a reduced systolic ejection fraction and markedly altered exercise response were present.

Severe mitral regurgitation with normal pulmonary artery wedge pressures.

Excerpt The preoperative diagnosis of mitral regurgitation and the estimation of its degree rest, ultimately, on the angiographic demonstration of radiopaque dye in the left atrium after injection ...

Use of oral potassium salts in the assessment of T-wave abnormalities in the electrocardiogram: A clinical test

Abstract The oral administration of 10 grams of potassium chloride in a single dose has been found to restore repolarization toward normal in a series of patients without organic heart disease, but has little or no effect on T abnormality in patients with organic heart disease. The test has been shown to be safe in the patients for whom it would be useful, but potentially dangerous in patients with documented heart disease. In addition, the dose and mode of administration are critical to the result.

Reappraisal of digitalis. Part II. Hemodynamic effects of the cardiac glycosides

Abstract The administration of the cardiac glycosides will result in a reduction in filling pressures, increase in cardiac output, diuresis, and symptomatic improvement in most patients in congestive heart failure, irrespective of cardiac rhythm. Although they exert direct effects on the peripheral arterial and venous beds and on kidney function, the improvement in heart failure that the cardiac glycosides produce is due primarily to an increase in contractility of ventricular muscle. The degree of increase in contractility is related to dosage in the therapeutic range.

Reappraisal of digitalis. Part VIII. Digitalis dosage

Abstract In long-term digitalis therapy, it is important to assess the dose regularly and to adjust it on the basis of clinical observation. Increasing symptoms and signs of heart failure are always indications for a trial of an increased dose of the cardiac glycoside rather than for the immediate institution of diuretic therapy.

Prolapse of the pulmonic valve through a ventricular septal defect

Abstract A case is reported of a high interventricular septal defect close to the pulmonic valve, in which the adjacent leaflet of the pulmonic valve prolapsed through the septal defect and produced marked pulmonic insufficiency.

Indications for anticoagulant therapy.

Abstract The value of anticoagulant therapy is solidly established in the presence of deepvein thrombosis and pulmonary embolism, in the presence of recurrent cerebral ischemic episodes when reparative vascular surgery is not possible, and in postoperative and bedridden patients, at least those with a high risk of pulmonary embolism. There is strongly suggestive evidence for the use of anticoagulants in the presence of recurrent systemic emboli due to mitral valve disease, in patients with valvular prostheses, and in patients immediately following reparative vascular surgery. There is suggestive evidence favoring the use of anticoagulants in progressive strokes in men under 55 for two years after myocardial infarction, and in central retinal vein thrombosis. In all other areas in which they are used, the evidence for the use of anticoagulant drugs remains quite uncertain.

Retrograde transpulmonary propagation of giant A waves in aortic stenosis and primary myocardial disease

Abstract Giant a waves were demonstrated in the pulmonary artery and left ventricle in 4 patients with primary myocardial disease and 1 patient with aortic stenosis and insufficiency. The peak pressure of this left atrial a wave was greater than the diastolic pressure in either the pulmonary artery or the left ventricle. The hemodynamic data strongly suggest that retrograde transmission of the left atrial a wave may occur across the pulmonary arteriolar bed. Temporary retrograde flow should be expected in this situation.

Paradoxical acceleration of atrial flutter after “cardioversion”

mhe application of a direct-current. IL -capacitor-stored, synchronized, electric countershock (hereafter referred to as “cardioversion”) has proved to be a valuable contribution to the management of certain cardiac arrhythmias. The use of direct rather than alternating current, and the synchronization of the shock to avoid the phase of ventricular vulnerability have undoubtedly contributed to the safety and efficacy of the procedure.‘,” In the clinical application of cardioversion, the synchronization of the shock is such that, although the period of ventricular vulnerability is avoided, the discharge often occurs during the period of atria1 vulnerability. Therefore, such a shock could conceivably initiate an atria1 arrhythmia potentially more serious than the one for which cardioversion was employed. Moreover, arrhythmias, such as atrial, nodal, and ventricular premature contractions, whose production is not readily explicable on the basis of a discharge occurring during the phase of atria1 vulnerability have occurred immediately after cardioversion. To our knowledge, the case reported below is the first occurrence of the unexpected acceleration of the atria1 rate after “cardioversion.” Ca5e report