Johnson McGuire

Anomalous Right Subclavian Artery

Anomalous right subclavian artery, originating as the last vessel from the aortic arch, is one of the commonest anomalies of the great vessels. Anatomists have been familiar with this condition for more than two centuries, yet few clinicians are aware of its existence. Despite its frequency and the ease with which it can be detected roentgenologically, the correct diagnosis is seldom made during life. This is due, in part, to the fact that the anomaly is usually asymptomatic. Occasionally, however, severe symptoms may develop and progress to a fatal outcome. This anomaly has assumed greater significance with the advent of the surgical approach to the treatment of congenital malformations of the heart and great vessels. Gross (12), in 1946, successfully ligated an anomalous right subclavian artery. Since that time he has surgically cured 4 additional patients with symptoms related to this cause (13). Blalock (5) encountered the anomaly five times during operations on patients with the tetralogy of Fallot, ...

Left Ventricular Hypertrophy: A Study of the Accuracy of Current Electrocardiographic Criteria When Compared with Autopsy Findings in One Hundred Cases

The current electrocardiographic criteria for the diagnosis of left ventricular hypertrophy have been analyzed in 100 cases of pure left ventricular hypertrophy proved at autopsy. Only those cases were used in which the greatest thickness of the left ventricle was 13 mm. or more, the right ventricle did not exceed 4 mm. in thickness, and the heart weight exceeded the upper limit of the expected normal. Also, only those cases were studied on whom multiple lead electrocardiograms were available. Conclusions are presented as to which sets of electrocardiographic criteria give the greatest accuracy in the diagnosis of left ventricular hypertrophy.

The Effect of Meals on the Electrocardiogram and the Ballistocardiogram in Patients with Angina Pectoris

The effect of meals on the electrocardiogram and the ballistocardiogram was studied in 59 patients with angina of effort. Approximately one-fourth of the group showed a 0.5 to 1.0 mm. depression of the S-T segment, while the normal controls did not show this change. Premature ventricular contractions and inversion of the T wave were found more frequently in patients with angina following meals than in normal individuals. The patients with angina were unable to increase the cardiac output significantly following meals as compared to normal individuals. It is suggestetd that these findings may prove to be of value in evaluating cardiac function in patients with angina.

Ectopic tachycardia, auricular in origin, of unusual duration

Abstract Two instances of ectopic auricular tachycardia of many years duration have been described. As far as can be ascertained, these cases are unique. In neither patient was there evidence of myocardial insufficiency as a result of the tachycardia. One of the patients developed a coronary occlusion associated with temporary slowing of the heart rate but survived the attack despite the reappearance of tachycardia.

Organic and relative insufficiency of the pulmonary valve

Abstract The pathological and clinical features of 9 cases of pulmonary insufficiency have been presented. The lesion is ordinarily considered very unusual, yet 4 cases have been observed in the Cincinnati General Hospital within the past year. The etiological factors found in this series of cases were: Rheumatic fever, bacterial endocarditis, pulmonary arteriolosclerosis; systemic and probably pulmonary hypertension; syphilitic pulmonary arteritis, and mitral stenosis. In all the cases caused by rheumatic fever there were clinical signs of involvement of more than one valve. Lesions of all four valves were found at autopsy in each case. The presence of multiple valvular lesions makes the diagnosis of pulmonary insufficiency very difficult. There were no symptoms in our cases characteristic of pulmonary insufficiency per se. The symptoms depended upon the existing disease process and the degree of myocardial insufficiency. The clinical features characterizing pulmonary insufficiency were a diastolic murmur in the second left interspace transmitted towards the axilla, accentuation of the pulmonary second sound, prominence of the pulmonary conus, marked pulsation of the hilum vessels, and right axis deviation of the electrocardiogram.

Studies on the Effect of Oral and Parenteral Administration of Visammin (Khellin) in Patients with Angina Pectoris

Of 20 carefully studied patients with angina pectoris given oral visammin, 4 had a significant reduction in number of pains. Eleven stated that their pains were less severe and less easily precipitated while taking visammin. There was questionable improvement in the exercise tolerance test in 2 of 9 patients after oral visammin therapy. The daily oral dose ranged from 40 mg. to 240 mg. Undesirable side effects were encountered in 17 of the 20 patients. Parenteral administration of visammin was evaluated by means of the ballistocardiograph, the exercise tolerance test, and by tilting.

The influence of thyroid extract and hyperthyroidism on the electrocardiogram, with special reference to the T-waves

Abstract It is apparent, therefore, that there has been no uniformity in the electrocardiographic findings in patients with thyrotoxicosis. The “thyroid” T-waves seem to bear no relation to the pulse rate nor to the basal metabolic rate. Furthermore, there is no constancy in their occurrence. Patients with marked degrees of tachycardia may fail to show T-waves of high amplitude and, conversely, with a slow pulse rate they may be encountered. This would seem to eliminate the heart rate as a factor in determining the height of the T-waves. And similarly it appears that the basal metabolic rate can be shown to have no relation to the amplitude of the T-waves. Characteristic, so-called “thyroid” T-waves have been found in our records of patients with thyrotoxicosis with metabolic rates as low as —32. Some other factor must be sought to explain their occurrence. This factor, we believe, is probably unrelated to the thyroid gland per se, since we have found similar T-waves in cases of neurocirculatory asthenia. Since a high pulse pressure is common in thyrotoxicosis and is not infrequent in neurocirculatory asthenia, we are investigating its relation to the amplitude of the T-waves, but can express no opinion at the present time.

Fatal digitalis poisoning occurring in a normal individual

Abstract Death from respiratory failure occurred in a normal individual twelve hours after the ingestion of approximately 300 grains of digitalis. Auricular tachycardia, A-V block, and marked depression of S-T segments were shown electrocardiographically.

Circulatory studies on a case of arteriovenous aneurysm

Abstract The deleterious influence of arteriovenous fistulas upon the heart was first demonstrated by Reid 1 in a series of interesting survival experiments on animals. Following the production of large arteriovenous communications in dogs, cardiac hypertrophy and dilatation and the evidence of myocardial insufficiency developed. This investigation was prompted by Reids clinical experience with patients with arteriovenous aneurysms. In two such cases cardiac hypertrophy and dilatation had been noted by Osler and Halsted, but no causal relationship was considered. The present knowledge of the pathological physiology associated with such fistulas is in large measure due to Reid 2 , Holman 3 , Lewis and Drury, 4 but certain of the phenomena associated with this interesting condition are still incompletely understood. The results of the study of this case added a new observation to the published data regarding arteriovenous aneurysms. In general, our findings are in accord with the excellent clinical and experimental work of Holman, but differ in several respects from the investigations of Lewis and Drury.

Studies on the Use of Dioxyline Phosphate in the Treatment of Angina Pectoris

Dioxyline phosphate, on the basis of pharmacologic studies, appeared to be worthy of trial in the treatment of the anginal syndrome. The patients were studied during a control period and during alternate periods of placebo and dioxyline phosphate administration. Exercise tolerance tests were performed during each of the three periods of observation. The dosage of dioxyline phosphate was 800 mg. per day orally. Five of the 12 patients with angina experienced fewer pains while taking dioxyline phosphate than they did during either the control period or the period of placebo administration. The low incidence of serious side reactions was a conspicuous feature of the study.