Fredrick A. Willius

Intermittent incomplete bundle-branch block

Abstract Three cases of intermittent incomplete bundle-branch block are presented with clinical notes and a discussion of the electrocardiograms. Certain features in these three cases warrant further emphasis. In all instances there was evidence of myocardial disease without endocardial valvular involvement. Cardiac enlargement was not marked in any case and slight dependent edema occurred in only one instance. Acute cardiac decompensation was present in two cases as evidenced by pulmonary edema, while in the other case no clinical decompensation occurred. These cases demonstrate that apparent profound disturbances in ventricular conduction may be evanescent, with or without cardiac decompensation. It is important to emphasize further that the electrocardiograph may be the first and only means of detecting serious myocardial changes, as is illustrated in Case 1.

A study of the course of rheumatic heart disease

Abstract In this study of the course of 160 cases of rheumatic heart disease, it was disclosed that at the time of examination at the Mayo Clinic 81 per cent of the patients were less than fifty years of age. The disease occurred most commonly in the fifth decade, forty-seven cases (29 per cent). Only seventeen patients (19 per cent) were more than fifty. The sex incidence was equal, and no striking differences were found in a comparison of the data divided on the basis of sex. The first attack occurred before the age of thirty in 136 cases (85 per cent) and before the age of twenty in 103 cases (64 per cent). The primary infection occurred in only five cases (3 per cent) after the fortieth year. The average age at the time of death was thirty-two years. The cases were divided into three groups for comparative study according to the clinical diagnosis of valvular involvement. In Group I with mitral involvement there were 124 cases, in Group II with aortic involvement twenty-one cases, and in Group III with both mitral and aortic involvement, fifteen cases. In Group I, fifty-one patients were males and seventy-three females; the first rheumatic infection occurred before the thirtieth year in 106 cases (85 per cent), and in only three cases (3 per cent) was the first attack after the fortieth year. The average age at death was thirty years. In Group II there were nineteen males and two females; rheumatic infection occurred before the thirtieth year in seventeen cases (81 per cent); the average age at death was forty-three years. In Group III there were ten males and five females; in thirteen (86 per cent) the initial rheumatic infection occurred before the thirtieth year; the average age at death was thirty-two years. Recurrent rheumatic infections were most prevalent in the first decade of life in which they occurred in sixteen cases (55 per cent). The greatest number of attacks in any one case was eight. There was no instance of recurrent infection after the thirtieth year. There was only one instance of recurrent infection in Group II. No constant relationship is revealed in this study between the number of attacks of rheumatic fever and the age at which death occurred. There is little difference between the incidence of recurrent infection in the two sexes. In sixty-two cases (39 per cent) there was congestive failure at the time of examination. Auricular fibrillation occurred in sixty cases (38 per cent). Death from gradual heart failure occurred in 147 cases, while sudden death occurred in eight cases. Five patients died from subacute bacterial endocarditis.

Occurrence and significance of electrocardiograms displaying large Q-waves in Lead III

Abstract Three hundred cases in which there were electrocardiograms with large Q-waves in Lead III, according to the criteria of Pardee, are presented. The majority of these records (268 or 89.3 per cent) were obtained in examination of patients who had one of the following conditions: hypertensive heart disease, the anginal syndrome, hypertensive heart disease accompanied by the anginal syndrome, or arteriosclerotic heart disease not accompanied by the anginal syndrome or hypertension. The remaining thirty-two patients (10.7 per cent) had miscellaneous conditions, but the majority of them had diseases that exert their influence chiefly on the left ventricle. Only three cases (1 per cent) in which the patients apparently had normal hearts were found. In 198 cases (66 per cent of 300) the large Q-wave in Lead III was the only significant electrocardiographic feature present, permitting the conclusion that this abnormality may be considered as an additional diagnostic sign. In the composite group of 977 normal persons studied by various observers there were only two cases (0.2 per cent) in which large Q-waves occurred in Lead III.

INTERPRETATION OF THE ELECTROCARDIOGRAPHIC FINDINGS IN CALCAREOUS STENOSIS OF THE AORTIC VALVE

Excerpt In the last few years distinct progress has been made in the clinical recognition of calcareous stenosis of the aortic valve. This is clearly exemplified by the fact that, as late as 1931, ...

A study of the course of syphilitic cardiovascular disease

Abstract This study was undertaken to obtain data relative to the duration of life of patients with cardiovascular syphilis. I have been unable to find definite information regarding this point in the medical literature. Studies of this type are of considerable importance as they permit the substitution of relative quantitative values for uncertain clinical impressions. They may be said to represent the life cycle of disease. faRead by title from the Section on Cardiology, The Mayo Clinic, Rechester, Minn.

Results from trichlorethylene inhalations in the anginal syndrome of coronary sclerosis

Abstract The results of inhalations of trichlorethylene in this series of cases of the anginal syndrome of coronary sclerosis do not permit this method of treatment to be accepted with enthusiasm. In eighteen cases (45 per cent) varying degrees of improvement occurred. However, when these cases are critically analyzed it is found that onlyone patient obtained complete relief while the others had fewer attacks of less severity. In five cases (12.5 per cent), temporary improvement was noted but a return of the previous symptoms occurred while the treatment was still in progress. It is possible that these patients became imbued with a new hope in undertaking this treatment and that their primary response was influenced by this attitude. We, however, were very careful not to create any false hopes among the patients treated. They were frankly advised that the procedure was entirely experimental. In thirteen cases (32.5 per cent) no improvement whatsoever was noted. The patients in these cases received treatment from one to seven months. Four patients (10 per cent) died during the course of treatment. All deaths occurred suddenly. Two of the patient who died were temporarily improved. We have already mentioned the difficulties encountered in the evaluation of the results of therapy in the anginal syndrome of coronary sclerosis. This evaluation is based largely on the interpretation of variations in subjective phenomena. We cannot overlook the natural history of the disease or the fact that similar data have been furnished by many individual observers who have used other drugs in the treatment of this disease. While the results obtained with this method of treatment have been disappointing, it is however a procedure that warrants a trial when the usual therapeutic agents have failed to give relief. In our experience, and according to the method described, the drug is well tolerated and its administration appears to be perfectly safe.