Jacob Zatuchni

Reactivation of Rheumatic Fever Following Mitral Commissurotomy

A febrile syndrome following mitral commissurotomy is described. This syndrome consists of the episodic recurrence of a combination of events first occurring after a variable latent phase following mitral commissurotomy and is uniformly characterized by precordial pain and fever, is commonly featured by the precipitation or intensification of pre-existing heart failure, is variably accompanied by migratory joint pains, arrhythmias, hemoptysis or psychosis and sometimes terminates in death. The syndrome was found to occur in 43 (24.0 per cent) of 179 consecutive individuals subjected to mitral commissurotomy. Because we have never encountered such a syndrome following any other type of nonrheumatic cardiac or pulmonary surgery and for other reasons we are compelled to regard it as a reactivation of rheumatic fever.

Serum myoglobin in acute myocardial infarction: A clinical study and review of the literature

The diagnosis of acute myocardial infarction (AMI) is made conventionally on the basis of the clinical history, serial electrocardiograms, and serum enzyme changes. This approach suffices in the majority of instances. However, recent enthusiasm for early intervention to reduce infarct size and the attempt to’optimize coronary care utilization.on a cost-effective basis has raised the need for early, sensitive, and specific indicators of myocardial necrosis. Recent reports have suggested that elevations of serum myoglobin (SMb) might provide such a parameter and permit estimation of prognosis and infarct size.lw3 However, a recent editorial has questioned the value of SMb in assessing suspected myocardial injury.4 We report here a study of serum myoglobin in a consecutive series of patients with suspected acute myocardial infarction (AMI), and in several other noncardiac conditions. The sensitivity, specificity, and practical value of SMb are discussed in relation to a review of the literature.

The Heart in Progressive Muscular Dystrophy

A case of progressive muscular dystrophy with cardiac involvement in a young Negro man is reported. The presenting problem was cardiomegaly and congestive heart failure. It was not until compensation was achieved that the underlying myopathy became apparent. Death was unexpected and presumably sudden. An unusual finding at the postmortem examination was the marked thickening of the endocardium. The literature in regard to the clinical and pathologic manifestations of cardiac involvement in this myopathy is reviewed.

Retrieval of Entrapped and Knotted Balloon-Tipped Catheters from the Right Heart

Excerpt Entrapment and knotting of ballon-tipped catheters within the right heart are rare complications of hemodynamic monitoring. Depending on the nature of the problem, and the ingenuity of the ...

The diabetogenic effect of thiazide diuretics

Abstract 1. 1. Two hour post prandial blood specimens were obtained for glucose determination before and after administration of either chlorothiazide or trichloromethiazide in twenty-five hospitalized ambulant patients after a weeks stabilization of illness and unrestricted high carbohydrate diet. All but one had no knowledge of diabetes mellitus. 2. 2. Fourteen of the twenty-five patients showed a value greater than 120 mg. per cent after thiazide administration. Of these fourteen, the control value was less than 120 mg. per cent in four and greater in ten. In these ten, all with a control value greater than 120 mg. per cent, the glucose level after thiazide administration was higher in six, unchanged in one and less in three. 3. 3. A total of ten of the twenty-five patients had an increase in blood glucose values to abnormal levels after thiazide administration, ranging from 6 to 70 mg. per cent over control values. 4. 4. Thiazide compounds may precipitate or intensify hyperglycemia.

The Angiocardiographic Diagnosis of Left Atrial Thrombosis

With the advent of modern cardiac surgery the clinical diagnosis of intramural thrombi, ball valve thrombi and myxomatous and other tumors in the left atrium has assumed great importance. It is shown here that a diagnosis of thrombosis within the left atrium is possible by angiocardiography. The angiocardiographic features of mural and ball valve thrombi of the left atrium and of left auricular thrombosis are described.

Relationship of Left Atrial Volume to Pulmonary Artery and Wedge Pressures in Mitral Stenosis

The significance of left atrial volume has been studied in 20 consecutive patients with mitral stenosis. Cardiac catheterization was performed and resting pressures in the right atrium, right ventricle, and pulmonary artery, as well as wedge pressure, were determined. Angiocardiography was performed immediately after cardiac catheterization. On the basis of these data the relationship between the estimated left atrial volume and these pressures is stated.

The "blue toe" syndrome with renal atheroembolism and failure.

The occurrence of atheromatous embolization following cardiac catheteriza tion and coronary artery bypass surgery is described. It was manifested initially by bluish discolored toes inciting suspicion of vasospasm and then by progres sive renal failure. The diagnosis was confirmed by renal biopsy. The syndrome of multiple atheromatous or cholesterol emboli is probably more common than previously reported because of its masquerade of other illnesses and failure of consideration of diagnosis.

The electrocardiogram in pregnancy and the puerperium

Abstract Observations of the electrocardiographic changes in normal pregnancy have been based on bipolar leads in which the distant electrode has significant voltage and varies not only from individual to individual, but also in the same individual from time to time. Wilson and associates 21 suggested a method for the electrocardiographic study of the human heart employing indirect leads which record the potential difference between an exploring electrode and one remaining at or near zero voltage. Such leads closely resemble direct leads from the ventricular surface 5 . This electrocardiographic study, employing unipolar leads, is concerned particularly with late pregnancy and the early puerperium, for a change occurring in either period would be more apparent in relation to values obtained in the other. Its purposes are: first, to define the positional changes in terms of the mean electrical axis of QRS and the electrocardiographic position, and, second, to determine whether there is any evidence of ventricular hypertrophy.

Cardiac Chamber Volumes and their Significance in Rheumatic Heart Disease with Isolated Mitral Stenosis

The total capacity of the heart and the volume of each of its chambers were determined by the technic of simultaneous biplane stereoscopic venous angiocardiography in 18 persons with surgically confirmed, isolated severe mitral stenosis. Although cardiac capacity and chamber volumes varied greatly, the left atrium was almost always the largest chamber. The left ventricle was not always the smallest chamber. In fact, it was larger than the right ventricle in 7 of the 18 and was the only chamber to be significantly correlated with total cardiac capacity greater than 1,000 ml. The right ventricular volume was found to be significantly correlated with its systolic pressure, or with the pulmonary artery systolic or mean pressures. Disproportionate enlargement of the right atrium can occur in the absence of tricuspid stenosis. Finally, atrial fibrillation was commonly present in patients with a large total cardiac capacity.