Allan L. Friedlich

Ruptured Papillary Muscle: Report of a Case with Successful Mitral Valve Replacement

A case of severe mitral regurgitation secondary to myocardial infarction and rupture of the anterior papillary muscle is presented. Mitral valve replacement resulted in striking improvement.

Respiratory and Circulatory Studies of Patients with Mitral Stenosis

Sixteen patients with severe mitral stenosis have been studied by means of cardiac catheterization, ventilatory and respiratory tests. A decrease in the oxygen diffusing capacity and an increase in venous admixture were observed in a majority of the cases. The degree of pulmonary arterial and arteriolar abnormality observed in lung biopsies failed to correlate with the pulmonary arteriolar resistances calculated from the hemodynamic data. It is suggested that reversible vasoconstriction plays an important role in the pathogenesis of the pulmonary hypertension associated with mitral stenosis.

A severe reaction to tetraethylammonium chloride.

TETRAETHYLAMMONIUM salts have been found to block efferent autonomic impulses at both the sympathetic and parasympathetic ganglions.1 , 2 Because of this action, the drug is being employed in a var...

Survival Following Free Rupture of Left Ventricular Aneurysm: Report of a Case

A 50-year-old man sustained free rupture of the left ventricle four weeks following a massive anterior myocardial infarction. The rupture occurred at the junction between a bulging left ventricular aneurysm that was not yet fibrotic and normal myocardium without evidence of fresh myocardial infarction. Accurate preoperative diagnosis aided by echocardiography and right heart catheterization made possible a planned surgical approach. Postoperative support with intraaortic balloon pumping appeared to be beneficial in maintaining statisfactory cardiac function until an adequate stroke volume could be reestablished, presumably by an increase in left ventricular volume.

Case 20-1968

Presentation of Case A fifty-seven-year-old woman was admitted to the hospital because of pain in the chest. Two months before admission there was the onset of episodes of dyspnea and left precordi...

Usefulness and limitations of left heart catheterization in mitral disease

Abstract Hemodynamic data obtained at left heart catheterization in 110 instances of mitral valve disease have been presented, with particular emphasis on the value of this procedure in differentiating mitral stenosis from regurgitation. Configuration of the left atrial pressure curve, diastolic gradient across the mitral valve, and left ventricular end diastolic pressure are all helpful in determining the relative degree of mitral stenosis or regurgitation. However, there is still a significantly high number of cases in which the predominant lesion cannot be determined by this means, and it is felt that left ventriculography will be helpful in these cases to assess the degree of mitral regurgitation.

James B. Herrick Award Acceptance

Dr. Allan L. Friedlich worked closely with Dr. White for many years at the Massachusetts General Hospital, in American Heart Association affairs and in international cardiological meetings. He was chosen by Dr. White as his personal deputy at several meetings of the International Society and International Federation of Cardiology, and accepted the James B. Herrick Award presented by the Council on Clinical Cardiology of the American Heart Association to Dr. White on November 8, 1973.

The calibration of heart sound intensity.

There is no standardized method for the calibration of total energy conducted to the surface of the chest caused by the cardiac sounds. Loudness is a subjective term which is dependent upon total energy, frequency of the main components and the specific sensitivity of the human hearing mechanism. A method is described in which the amplitude of the chief component of the heart sounds is compared to that produced by a standard sound signal at 80 decibels at 500 cycles per second and an intensity ratio calculated. The method has been applied to normal individuals of different ages and to those with mitral valve disease and those with pulmonary hypertension. The findings confirm the clinical observation that mitral stenosis with persisting mobility of the valve leaflets is associated with a loud first heart sound. However, the measurement of intensity of the second heart sound did not show so reliable a correlation between the loudness of the sound and the pulmonary blood pressure. The relationship is somewhat obscured by the wide range of normal values in the intensity of the second heart sound.

Case 77-1963

Presentation of Case A twenty-nine-year-old university instructor entered the hospital because of chest pain. Twenty months previously the patient consulted a physician because a heart murmur had b...

Case 17-1973

Presentation of Case A 33-year-old man was admitted to the hospital because of a murmur. The patient was known to have a heart murmur since birth. He recalled frequent epistaxes and headaches durin...