Harold Miller

The Action of Norepinephrine, Epinephrine and Isopropyl Norepinephrine on the Rhythmic Function of the Heart

The actions of norepinephrine and isopropyl norepinephrine on the rhythmic property of the heart were studied and compared with that of epinephrine. Norepinephrine does not abolish cardiac standstill by carotid sinus stimulation, has no effect on the ventricular rate of heart block and induces a sinus bradycardia. Isopropyl norepinephrine acts similarly to epinephrine in that it abolishes the induced cardiac standstill, increases the ventricular rate of heart block and produces a sinus tachycardia. In the treatment of cardiac arrest, the isopropyl compound appears to possess optimum features as it is very potent in the prevention of cardiac standstill and does not predispose to ventricular fibrillation.

The Selection and Medical Management of Patients with Mitral Stenosis Treated by Mitral Commissurotomy

The selection of patients for mitral commissurotomy must be made after considering all manifestations of the rheumatic state. A conservative approach is urged and no patients should be operated upon without evidences of increasing pulmonary hypertension and right heart strain. The preparation of the patient, the management of the arrhythmias during surgery and the postoperative care are the full responsibilities of the physician. A team composed of physiologists, cardiologists and surgeons must work together.

POLYMYALGIA RHEUMATICA, GIANT-CELL ARTERITIS AND BLINDNESS: A REVIEW AND CASE REPORT

Polymyalgia rheumatica is a chronic disease of two to four years’ duration which occurs in older people, especially women, and is characterized by muscular pain predominantly of the girdle area, malaise, slight fever, sweating, and elevation of the erythrocyte sedimentation rate. The syndrome, frequently reported in European literature, has been described under the names of anarthritic rheumatoid disease, periarthrosis humeroscapularis, periextra-articular rheumatism, myalgic syndrome of the aged with systemic reaction, pseudopolyarthrite rhizom6lique1 and giant-cell arteritis of the aged (1, 2). History: In 1957, Barber (3) first suggested the term polymyalgia rheumatica in his report of 12 patients with this syndrome. Earlier Holst and Johansen (4) described the disease in 5 persons, using the term periextra-articular rheumatism. Meulengracht and Schwartz ( 5 ) reported 78 patients with periarthrosis humeroscapularis ; their group must have included local shoulder disturbances as well as “periarthrosis humeroscapularis with prolonged fever, loss of weight, and a greatly elevated sedimentation reaction” (apparent polymyalgia rheumatica) . Bagratuni (6-8) used the term anarthritic rheumatoid disease in his description of similar cases. Incidence: Alestig and Barr (9) of Sweden reported 10 hospitalized patients seen during an 18-month period from a population area of 250,000 people. They believed the disease was common. A review of some of the reported cases shows the age range to be 46-88 years with a slight predominance of women (Table 1 ) . Etiology: The cause of the syndrome is unknown (9, 12, 13) although it has been considered a collagen disease (11) possibly related to auto-immunity or to a foreign-body reaction from nonspecific irritation (9). Clinical picture: There is often an acute onset of muscular aching in the neck and shoulders with increasing pain which may involve the back and thighs (1, 3, 6, 10-12). A preceding period of malaise, lassitude and depression has been reported. Anorexia and weight loss often occur. There may be fever with sweating, especially a t night. Headache (1) ) pruritis and disorders

The use of oral quinidine and procaine amide as premedications for cardiac catheterization

Abstract This report is concerned with the need for prophylactic measures to reduce the incidence of potentially dangerous arrhythmias induced during cardiac catheterization. The experience of this catheterization team will be presented, and suggestions for increasing the safety of routine cardiac catheterizations will be made.

Use of oral quindine and procaine amide as premedications for cardiac catheterization

With the rapid and widespread development of the cardiac catheterization technique as an aid to diagnosis and a tool for physiologic research, increasing numbers of these procedures will be done under less than ideal conditions. With the rapid advances in cardiac surgery careful exploration of the cardiac chambers for transposed pulmonary veins and septal defects will increase the amount of direct probing of the endocardium with the catheter tip. If any measures may be taken to reduce the irritability of the myocardium to direct catheter stimuli, they will be of great importance not only in reducing the hazards of the procedure, but in permitting adequately detailed study to reveal surgically correctable anomalies. The report of Goldman and associates, in February, 19.50,’ emphasized the need for measures to interrupt major rhythmic disturbances once they had occurred. The present study is an evaluation of prophylactic medication used during the past three years in preparing patients for cardiac catheterization.