E. Harvey Estes

A point-score system for the ECG diagnosis of left ventricular hypertrophy

Abstract A point-score system is presented for the diagnosis of left ventricular hypertrophy from the ECG. It is evaluated in an autopsy series of 150 hearts with hypertrophy designated on the basis of Zeeks criteria. Using this system, the ECG is positive 60 per cent of the time when LVH is present at autopsy. LVH is diagnosed in 3.2 per cent of nonhypertrophied hearts. The point-score system is significantly more sensitive in the presence of combined hypertension and coronary artery disease than in either alone.

P-Wave Analysis in Valvular Heart Disease

Electrocardiographic analysis of the P waves occurring in a series of 113 normal subjects and 100 patients with specifically defined valvular lesions are reviewed. The former methods of analysis showed a marked lack of specificity. By dividing the P wave in lead V1 into initial and terminal portions, a measure designated as the P terminal force has been derived. This measure is of value in two respects: (1) it correctly separates normal subjects from those patients with left-sided valvular lesions in 92 per cent of this series and (2) once a given valve lesion is suspected clinically, this measure enables one to make an estimation of the severity of that lesion from the degree of abnormality of the P terminal force at V1. The P terminal force does not indicate the type of valvular disease present, nor does it correlate with any one specific hemodynamic measure. The abnormality does appear to be related, within each separate type of valve disease, to the specific hemodynamic abnormality of that type of val...

The anatomy and blood supply of the papillary muscles of the left ventricle

Abstract The supply of blood to the papillary muscles is segmental in distribution, and reaches the muscle from large penetrating branches originating from epicardial vessels located radially outward from the muscle. The tip, mid-portion, and base generally receive their vascular supply from separate tributaries which have a radial arrangement. Fibrosis of the papillary muscles is most often associated with occlusive disease of the large coronary vessels. The vascular alteration accompanying this fibrosis is of two types: (1) a fine overgrowth of Class A vessels, without interruption of the Class B vessels, and (2) an interruption of all channels, with enlargement of subendocardial vessels, suggesting the utilization of these vessels in the formation of collaterals past the occluded area.

The vascular supply of the left ventricular wall: Anatomic observations, plus a hypothesis regarding acute events in coronary artery disease☆

Abstract Postmortem injection studies of the left ventricular wall in 58 human hearts have revealed a characteristic distribution of vessels: those which divide quickly (Class A), and those which penetrate to the subendocardial layers, forming multiple anastomosing arcades (Class B). This subendocardial plexus appears to play an important role as a collateral channel in coronary disease. These anatomic features suggest an explanation for certain features observed in patients with coronary artery disease. This concept assigns a permissive role to the large occlusive lesions of the coronary arteries. Such lesions make the potentially ischemic focus distal to the occlusion dependent on collateral flow through the subendocardial plexus, thus permitting dynamic factors that modify this collateral circulation to become critically significant.

Acute effect of psychologic stimuli upon plasma non-esterified fatty acid level.

Summary 1. Serum non-esterified fatty acids (NEFA) and triglyceride (TG) levels were measured in four normal individuals during difficult levels of emotional arousal. 2. Periods of arousal in which feelings of anxiety and/or hostility were evoked were accompanied by rises in serum NEFA levels, but not of TG levels.

Fat Mobilization in Man.

Excerpt The process of fat mobilization has become accessible to study in man with the recognition that the albumin-bound nonesterified or free fatty acids are the major form of transport of lipid ...

Evaluation of Patient-Care Protocol Use by Various Providers

A symptom-oriented protocol for acute pharyngitis was evaluated in a busy general medical clinic staffed by physicians and graduate and student physicians assistants. We observed significantly improved performance by all providers in collection of medical data, utilization of laboratory tests,and appropriate use of antibiotics after introduction of the protocol. Patient charges were less when the protocol was used, but these savings were offset partially by the cost of audit. Compliance with and acceptance of the protocol differed among the various health providers, with physicians demonstrating significantly lower levels than nonphysicians. Patient-care protocols provide an effective means of monitoring the process of medical care, detecting weakness in supportive clinic services, and affording educational feedback for all health providers.

The mechanism of cough syncope.

Abstract Although described in 1876 by Charcot, 1 the syndrome of cough syncope has until recently been considered a rare form of fainting. However, the excellent reports by Baker, 2 Sharpey-Schafer, 3 and Kerr and Derbes, 4 indicate that the condition may not be uncommon. Despite increasing recognition of the syndrome, the mechanism producing the syncope remains elusive. 4 Earlier investigators have suggested that this form of syncope is an epileptic equivalent 5–7 or the result of a laryngeal reflex. 6,8 These theories, however, have generally been abandoned in favor of a circulatory mechanism producing cerebral anoxia. 9 It has been suggested that the cerebral anoxia might be the result of marked reflex peripheral vasodilation 3 or a decreased cardiac output secondary to a reduced inflow or marked pulmonary vasoconstriction. 10 These theories, though attractive, fail to explain completely certain unique features of this form of syncope. For example, syncope may develop with remarkable rapidity (3 to 5 seconds) after the onset of cough. With the cessation of cough, consciousness is rapidly recovered without vasomotor or other sequelae. The syndrome is rarely observed in women and syncope may occur in the supine or standing subject. The present report, based on observations made on normal individuals and patients with cough syncope, suggests a more acceptable mechanism for this type of fainting.

Reversible Cardiopulmonary Syndrome with Extreme Obesity

A syndrome consisting of obesity, somnolence, cyanosis, periodic breathing, and polycythemia, with congestive heart failure has been observed in 6 patients. The effect of weight reduction and the mechanisms responsible for the symptoms and signs are discussed.

THE EFFECT OF 2-DEOXY-D-GLUCOSE INFUSIONS ON LIPID AND CARBOHYDRATE METABOLISM IN MAN

At the present time, the direction of change of the plasma free fatty acid (FFA) level is considered to serve as an index to the pattern of fat metabolism, representing an indicator of the balance between fat storage and fat mobilization. In the fasting, nonexercising individual, a rising plasma FFA level suggests net fat mobilization and a falling FFA level suggests net fat storage. If the status of carbohydrate metabolism does relate to fat metabolism, then plasma FFA levels may be expected to change in a number of experimental situations. Dole Was the first to (lemonstrate that glucose and insulin administration decreased fasting FFA levels (1) and Bierman, Dole and Roberts that patients with diabetes niellitus have high FFA levels (2). Experimental inteference with carbohydrate metabolism might also be expected to influence plasma FFA levels. The availability of 2-deoxy-D-glucose (2-DG) has made it possible to test this hypothesis. 2-DG is phosphorylated to 2-deoxyglucose-6-phosphate (2-DG-6-P), and it has been postulated that the 2-DG-6-P may compete for transport into the cell with glucose-6-phosphate (3). The purpose of this study was to observe the effect of 2-DG administration on FFA levels in normal human subjects and to study in addition the effect of glucose, insulin, fructose and lactate upon the pattern of response to 2-DG.