Lawrence Gould

The phonocardiogram and apexcardiogram in patients with ventricular aneurysm

Abstract The phonocardiographic and apexcardiographic findings are presented for 60 patients with established old myocardial infarction, 30 of whom had fluoroscopic evidence of ventricular aneurysm. The data indicate that presystolic gallop (83.4 per cent) and quadruple rhythm (40.0 per cent) are very common in patients with ventricular aneurysm and represent the most reliable and characteristic clinical and phonocardiographic findings in such patients. These gallops were far more frequent in patients with ventricular aneurysm than in patients with uncomplicated myocardial infarction. Isolated protodiastolic gallop was rare in both groups. No diastolic or pansystolic murmur was recorded in the study, and a nondescript early systolic ejection murmur was recorded with equal frequency in both groups of patients. An ejection click was recorded in 1 patient with ventricular aneurysm. No difference in the quality or intensity of the heart sounds was evident in either group. A prominent a wave was the most common abnormality palpated and recorded on the apexcardiogram of patients with ventricular aneurysm; only 1 patient in this group had a paradoxic apical pulsation. On the basis of these data it is recommended that patients with old myocardial infarction with stable, compensated conditions who have a presystolic gallop, quadruple rhythm, or a palpable apical a wave be given appropriate fluoroscopic and x-ray studies to rule out the presence of a ventricular aneurysm.

Phentolamine: Use in digitalis-induced arrhythmias: Canine experiments

Abstract The antiarrhythmic effect of phentolamine was investigated in 10 normal dogs acutely digitalized with ouabain. Phentolamine was infused intravenously for an average of 10 minutes at 0.3 mg. per minute. Ventricular arrhythmias were abolished in 7 of 8 cases (there was complete heart block in 1 case), and the rate was increased in one case with sinus bradycardia. Administration of the drug produced no untoward side effects and did not produce hypotension. These studies indicate that phentolamine may be of clinical value as an antiarrhythmic agent and warrants further study.

Severe mitral regurgitation with normal pulmonary artery wedge pressures.

Excerpt The preoperative diagnosis of mitral regurgitation and the estimation of its degree rest, ultimately, on the angiographic demonstration of radiopaque dye in the left atrium after injection ...

Cold pressor test in aortic stenosis and idiopathic hypertrophic subaortic stenosis: Preliminary report∗

Abstract The cold pressor test produced pulsus alternans in 5 patients with aortic stenosis but no alternation in 4 patients with idiopathic no alternation in 4 patients with idiopathic hypertrophic subaortic stenosis. The diagnostic implications and the probable hemodynamic mechanism of this response are presented.

Prolapse of the pulmonic valve through a ventricular septal defect

Abstract A case is reported of a high interventricular septal defect close to the pulmonic valve, in which the adjacent leaflet of the pulmonic valve prolapsed through the septal defect and produced marked pulmonic insufficiency.

Retrograde transpulmonary propagation of giant A waves in aortic stenosis and primary myocardial disease

Abstract Giant a waves were demonstrated in the pulmonary artery and left ventricle in 4 patients with primary myocardial disease and 1 patient with aortic stenosis and insufficiency. The peak pressure of this left atrial a wave was greater than the diastolic pressure in either the pulmonary artery or the left ventricle. The hemodynamic data strongly suggest that retrograde transmission of the left atrial a wave may occur across the pulmonary arteriolar bed. Temporary retrograde flow should be expected in this situation.

Aortic saddle embolus in acute myocardial infarction: Successful removal by a Fogarty catheter technic∗

Abstract A patient is described who sustained an aortic saddle embolus after a myocardial infarction. The Fogarty embolectomy catheter successfully extracted the embolus, and arterial flow was completely restored.

Vectorcardiographic Features of Wolff-Parkinson- White Syndrome With and Without Associated Myocardial Infarction

* From the Medical Service of the Veterans Administration Hospital, 130 West Kingsbridge Road, Bronx, New York 10468. Since its first description in 1930, anomalous atrioventricular (AV) conduction seen in the preexcitation of Wolff-Parkinson-White syndrome (WPW) has caused a great deal of controversy as to its possible explanation. Several theories have been proposed as to the etiology of the formation of the delta wave and short P-R interval. These were in part based on the electrocardiographic manifestation of the early deformed QRS complex. Recently, Lev’and James2 demonstrated numerous variations in internodal conduction, atrial conduction and AV conduction which affords an anatomical explanation of the various forms of anomalous AV conduction. With recent advances of vector-

The effect of stepwise doses of digitalis on hemodynamic function in man.

From the Medical Service of the Bronx Veterans Administration Hospital, 130 West Kingsbridge Road, Bronx, New York 10468, and The Animal Medical Center, New York City, New York. Lawrence Gould, M.D., Chief, Cardiology Section, Veterans Administration Hospital, Bronx, New York. Alan F. Lyon, M.D., Chief, Cardiology Section, Brookdale Hospital Center, Linden Boulevard at Brookdale Plaza, Brooklyn, New York. Stephen Ettinger, D.V.M., Post Doctoral Fellow of the National Heart Institute of the National Institutes of Health. Grant No. 5-F1-H3-31, 587-05, Animal Medical Center, New York City, New York. Francis X. McGinn, M.D., Former Chief Resident, Cardiology Section, Veterans Administration Hospital, Bronx, New York. Mary Di Lieto. B.S., Technician, Cardiac Catheterization Laboratory, Veterans Administration Hospital, Bronx. New York. At the present time the physician does not have an easily derived objective index to measure the contractile effects of digitalis in man. Ideally, one would desire to achieve that level of digitalization that would produce the maximal increase in the force of contraction without inducing arrhythmias

Comparison of the left ventricular, aortic and brachial arterial first derivative.

eter should be used to determine the left ventricular dpldt, because of its high frequency response, and in order to avoid the frequent artifacts related to motion of the catheter within the heart. We have found that this instrument will produce excellent recordings, but the extremely high replacement cost of the catheter limits its use. The catheter manometer system usually used in cardiac catheterization can also be used to obtain excellent recordings, if care is taken in placing the catheter in the left ventricular chamber, so that it is reasonably free of motion. A study of the first derivative of the left ventricle, aorta and brachial artery, in patients undergoing diagnostic cardiac catheterization, was undertaken in order to compare these different parameters and to determine their usefulness.