Howard A. Joos

Studies of pulmonary hypertension. VI

Abstract During the past 3 years physiologic studies of patients with mitral stenosis have been reported from various laboratories. 1–17 Most of these patients tend to have decreased cardiac output, elevated pulmonary “capillary” and pulmonary artery pressures, and increased pulmonary resistance. Many show increased work of the right ventricle against pressure and physiologic evidence of right ventricular failure. Pulmonary hypertension correlates well with the degree of disability. It is the purpose of this paper (a) to present physiologic data of forty-three patients with predominant mitral stenosis, (b) to correlate various determinants related to pressure and flow in the pulmonary circuit, and (c) to emphasize the importance of pulmonary “capillary” pressure and its relation to other factors.

Pulmonary hypertension: III. Physiologic studies in three cases of carbon dioxide narcosis treated by artificial respiration

Abstract 1.1. Three patients with severe pulmonary insufficiency who developed coma following the administration of oxygen have been presented. Coma was associated with severe hypercapnia and respiratory acidosis. 2.2. Mechanical ventilation in the Drinker respirator resulted in recovery in two instances. 3.3. The course of each patient was followed by serial arterial blood gas analyses and pH determination. 4.4. Cardiac catheterization in one case prior to therapy revealed severe pulmonary hypertension associated with marked hypoxemia, hypercapnia and respiratory acidosis. Cardiac catheterization following treatment in each case demonstrated moderate pulmonary hypertension and increased total pulmonary resistance associated with a normal cardiac index.

Unipolar electrocardiogram in normal infants and children

Abstract Unipolar limb and precordial electrocardiograms were made on 100 infants and children without evidence of cardiovascular disease. The rate, electrical position of the heart, and the contour, voltage, and duration of various components of the electrical cycle in each of the nine leads were analyzed and the data summarized in tabular form. The following points are of special interest: 1.1. Q waves were frequently seen in Leads aV R , aV F , V 4 , V 5 , and V 6 . 2.2. The T waves were usually inverted in V 1 and V 2 , often in V 3 , and sometimes in V 4 , especially in infants and younger children. The incidence of positivity of the T waves in the precordial leads increased with increasing age. 3.3. The maximum, minimum, and mean values of corrected Q-T interval, which do not vary with age or sex, are presented. The importance of the establishment of normal value of corrected Q-T interval is discussed.

AN UNUSUAL CASE OF MASSIVE PERICARDIAL EFFUSION WITH HEMODYNAMIC STUDIES

Excerpt Despite clinical and pathologic investigations of many patients with pericardial effusion,1-5few such patients have been studied by cardiac catheterization.6, 7It is the purpose of this man...

Studies of pulmonary hypertension. VII. Hemodynamic effects of acute hypoxia in patients with mitral stenosis.

Abstract The hemodynamic effects of hypoxia have been studied in normal subjects and in patients with various cardiopulmonary diseases by many investigators. 1–6 In most normal subjects during hypoxia the pulmonary artery pressure rises significantly, the cardiac output increases or does not change, the heart rate is more rapid, and the pulmonary “capillary” pressure is unaltered. Total pulmonary and pulmonary vascular resistances increase and the systemic artery pressure and peripheral vascular resistance decline. The number of patients with mitral stenosis studied under similar conditions is still small. 3–5 It is the purpose of this report to describe the hemodynamic effects of breathing low oxygen concentrations in twenty-four such patients and to analyze the pulmonary pressure and the flow relationships during acute hypoxia and recovery.

Studies of pulmonary hypertension. VI: Pulmonary “capillary” pressure in various cardiopulmonary diseases at rest and under stress☆

Abstract Studies of pulmonary “capillary” pressure or pulmonary artery wedge pressure and pulmonary artery—pulmonary “capillary” pressure gradient are reported in 150 patients with cardiopulmonary disease, including the effects of acute stress in certain patients. Sixteen of twenty-eight patients with chronic pulmonary disease, five patients with congenital heart disease, and three cases of primary pulmonary hypertension had precapillary pulmonary hypertension and an elevated PAm—PCm gradient. Postcapillary pulmonary hypertension occurred in forty-one of forty-five cases of predominant mitral stenosis with elevation of the PAm—PCm gradient in two-thirds and with correlation, in general, between the magnitude of the PCm and the PAm—PCm gradient. Postcapillary pulmonary hypertension was observed in seven of eight patients after mitral valvuloplasty and in various other examples of impaired left heart flow. Most cases of congenital heart disease, tricuspid and aortic valve disease, hypertension without failure, and twelve of twenty-eight patients with chronic pulmonary disease had a normal PAm and PCm. Maximal cough caused a sharp rise in PAm and PCm, the latter more marked with chronic pulmonary disease and mitral stenosis. The Valsalva maneuver usually caused a rise in PAm greater than that of PCm. Exercise caused a rise in PAm and little change in PCm in patients with precapillary pulmonary hypertension. In the postcapillary type both PAm and PCm rose significantly with exercise. Acute hypoxia elevated the PAm in unoperated patients with mitral stenosis and elevated the PCm in two of three patients. With chronic pulmonary disease hypoxia elevated the PAm without effect on the PCm. The differentiation of pre- and postcapillary pulmonary hypertension is discussed, and the significance of the pulmonary “capillary” pressure pattern is reviewed. The effects of various acute stresses and their interpretation are discussed.

Problems of Blood Pressure in Childhood.

Many clinical disciplines must concern themselves with the measurement of arterial blood pressure and the interpretation of such measurements under the peculiarly difficult conditions of early life. They will all find this monograph entirely worthy of their attention. The authors have reviewed their own extensive experience concisely and with a clarity of style which makes the volume enjoyable as well as profitable reading. A readily understood clinical perspective is preserved throughout. Depth is added by including a brief historical review, sections on instrumentation and techniques, and some rather speculative physiologic interpretations. The simplicity preserved in many of the explanatory and descriptive sections contributes much to their excellence. The necessary statistical analyses will tax the clinically trained reader at times, and the reviewer is included. An exhaustive review has not been intended, but the authors have turned to the literature freely, acknowledging differences between their own results and those in other