Ellet H. Drake

Survival Rates after Acute Myocardial Infarction with Long-Term Anticoagulant Therapy

Evidence is set forth to show the value of continuous long-term anticoagulant therapy by comparison with a control group of patients who have also had multiple coronary occlusions or single infarcts, followed by severe angina pectoris or episodes of coronary failure. Statistical life-estimate determinations are included. Bleeding complications are encountered less frequently with improved methods of management and are considered a justifiable risk, in view of the serious consequences of the natural progress of the disease. After a program of long-term anticoagulant treatment has been instituted, cessation of therapy may be hazardous.

Ruptured papillary muscle following myocardial infarction with long survival. Report of two cases.

Two cases of rupture of a papillary muscle of the left ventricle are presented. We believe that these are the two longest recorded survivals of this complication of acute myocardial infarction. A presumptive clinical diagnosis is possible from the characteristic history of sudden deterioration together with the development of a loud apical systolic murmur. The differential diagnosis and the possibility of corrective surgery in a patient who survives the acute event are discussed.

Cardiac manifestations of hyperparathyroidism, with presentation of a previously unreported arrhythmia

Abstract A patient with primary hyperparathyroidism exhibiting A-V block, sinus arrest with ventricular rates as low as 15 per minute, and bouts of paroxysmal atrial fibrillation is described. Removal of a parathyroid adenoma completely abolished the arrhythmias. We believe that this is the only documented instance of this degree of conduction disturbance in clinical hyperparathyroidism.

Radiographic Demonstration of Myocardial Penetration by Permanent Endocardial Pacemakers

Abstract The epicardial fat defines the limit of the myocardium. It can be regularly visualized using image intensification and recorded on spot-films obtained by a special technique. The relationship between the electrode of the transvenous pacemaker and the epicardial fat indicates the relationship between the electrode and the myocardium. If the separation is less than 3 mm, penetration has occurred. Of 33 patients examined, 11 demonstrated some degree of penetration.

Pulmonary Angiography and Pulmonary Embolism

In the past twenty-four months we have engaged in a program to encourage the performance of pulmonary angiography in suspected cases of life-threatening pulmonary embolism. Pulmonary embolectomy is performed with or without the aid of the heart lung bypass (1), following clipping (2) or ligation of the inferior vena cava in patients with occlusion of more than 60 per cent of the pulmonary arterial bed. Anticoagulant therapy, with or without inferior vena cava interruption, is administered to patients with lesser obstruction. If pulmonary embolism is excluded, appropriate studies are performed to establish the proper diagnosis, and indicated therapy is instituted. Treatment which may have been directed toward embolism is discontinued. The following cases illustrate the advantages of pulmonary angiography. Case I: A 50-year-old woman in critical condition with the diagnosis of pulmonary embolism was transferred from an outside hospital. Four weeks previously resection of a small bowel hemangioma had been pe...

Atrial Myxoma: A Review of 9 Cases

The clinical symptoms, laboratory findings, apexcardiograms, phonocardiograms and echocardiographic features are related to hemdoynamic and angiocardiographic measurements in 9 patients with atrial myxoma (6 left atrial and 3 right atrial tumors). Emphasis is placed on the clinical clues to the diagnosis. Echocardiography has become the most useful non-invasive method of investigation. However, angiocardiography remains the definitive diagnostic procedure.

Ruptured Congenital Aneurysms of the Sinuses of Valsalva A Report of Two Cases Treated Surgically

Two cases operated upon for ruptured sinus of Valsalva aneurysm are presented and discussed. Operations done previously for this condition are noted. Aspects of the deformity that are pertinent to its recognition and treatment are briefly reviewed.

Angiographie Study of the Left Atrium in Mitral Stenosis1

Systemic embolization of left atrial thrombi is a dread complication of mitral stenosis which is particularly likely to occur during and immediately following surgery on the mitral valve. The threat of embolization is confined to patients with atrial fibrillation. Taber and Lam (4) reported from this institution (The Henry Ford Hospital, Detroit) operative or postoperative embolization in only 2 patients of a group of 226 with normal sinus rhythm, compared to 29 operative or postoperative embolizations in 200 patients with atrial fibrillation. In 41 of the 200 patients preoperative embolization was present, and in 11 of these, emboli were noted in the operative or immediate postoperative period. The presence of an atrial thrombus is a contraindication for closed mitral commissurotomy, and unless all patients with fibrillation are to be operated upon by open heart technics the preoperative determination of the presence or absence of thrombi assumes importance. The angiographic demonstration of left atrial ...

Conversion of atrial flutter to atrial fibrillation with carotid sinus pressure

Summary A case of atrial flutter converted to atrial fibrillation with carotid sinus pressure in the postoperative period of a patient with an aortic valve prosthesis is reported. A review of the literature revealed 23 other cases of the apparent excitatory effects of carotid sinus pressure manifested by either an increase of the atrial flutter rate or by conversion of the atrial flutter to atrial fibrillation. The possible mechanism of action is discussed.

Pseudotruncus arteriosus: Report of the oldest surviving patient

Abstract A 43-year-old housewife with “pseudotruncus arteriosus” was presented and is believed to be the oldest individual with this anomaly described in the literature. An early ejection click, a continuous heart murmur heard over the precordium and left scapular area, mild cyanosis, and clubbing of the fingers and toes were the main clinical features. The difficulty in the clinical differential diagnosis from a truncus arteriosus with absent pulmonary arteries was emphasized.