Louis Wolff

Syndrome of Short P-R Interval with Abnormal QRS Complexes and Paroxysmal Tachycardia (Wolff-Parkinson-White Syndrome)

The syndrome of short P-R interval with abnormal QRS complexes and paroxysmal tachycardia occurs in otherwise healthy individuals in all age groups. Its interest and importance are related to our knowledge and concepts of the cardiac mechanism, the prevalence and clinical manifestations of paroxysmal tachycardia, the masking of the electrocardiographic signs of heart disease, and the serious consequences involved in making an incorrect diagnosis of heart disease. A single mechanism is in all probability responsible for the abnormal electrocardiogram and the paroxysmal tachycardia. Premature activation of a small fraction of ventricular musculature shortens the P-R interval and lengthens the QRS interval, thus accounting for the electrocardiographic peculiarities of the syndrome. Whether an anomaly of impulse formation or an anomaly of conduction is responsible for pre-excitation is not known, and the propensity to paroxysmal tachycardia can be explained on either basis. There is no evidence that hitherto unknown phenomena are responsible for the syndrome. The disorder is probably congenital in nature. A noteworthy feature is the spontaneous or induced shift, back and forth, from the abnormal to the normal type of electrocardiogram. Many drugs and procedures are available for this purpose. This is of immeasurable help in establishing the diagnosis of the Wolff-Parkinson-White syndrome in doubtful cases, and in unmasking the many abnormalities which anomalous excitation conceals. Diagnostic errors are common, and the reasons for these have been discussed. Myocardial infarction, mitral stenosis, congenital heart disease, right and left ventricular hypertrophy, myocarditis, and bundle-branch block are the mistaken diagnoses most commonly made. Myocardial infarction, right and left ventricular hypertrophy, and right bundle branch block are the conditions most commonly concealed by the anomalous electrocardiogram. The most important problems still requiring elucidation are those related to etiology, and to the mechanisms responsible for the abnormal electrocardiogram and paroxysmal rapid heart action.

The normal vectorcardiogram. I

Summary The horizontal, sagittal, and frontal planar projections of the spatial vector-cardiogram are described for 100 normal subjects. The Trihedron reference system was used. Emphasis is placed upon a method of analysis that may be applied to any reference system. A detailed study is presented of the general morphology, position, and magnitude of QRS and T vectors, their direction and speed of inscription, the interrelationships of various portions of the QRS loop, and of the latter to the T loop.

Hemoptysis in rheumatic heart disease

Abstract 1. 1. Fifty cases of rheumatic heart disease in which hemoptysis occurred are analyzed. This complication is encountered in at least 10 per cent of all adults with rheumatic heart disease who are admitted to a general hospital. In our series, the average age at the onset of hemoptysis was 33.4 years. 2. 2. The symptoms most commonly associated with hemoptysis were palpitation, pain in the chest, and dyspnea. 3. 3. The associated anatomic, pathologic, and physiologic abnormalities, in the order of their frequency, were 3.1. (a) Mitral stenosis, in all but one case. 3.2. (b) Pulmonary infarction, in twenty-three cases. 3.3. (c) Multiple valve involvement, in twenty-two case 3.4. (d) Chronic auricular fibrillation, in twenty cases. Paroxysmal arrhythmia, in five cases. 3.5. (e) Marked cardiac enlargement, in nineteen eases. 3.6. (f) Active rheumatic infection, in twelve cases. 3.7. (g) Congestive failure, in eight cases. 3.8. (h) At autopsy Easily recognizable pulmonary vascular sclerosis in six cases. Right auricular thrombi in three cases. 4. 4. The prognosis and the mechanism of hemoptysis are discussed. 5. 5. It is noteworthy that only eight patients had congestive failure prior to, or at the time of, the initial hemoptysis, and that nine had hearts of normal size. Pulmonary infarction is the most likely cause when there is congestive failure and may be excluded when the heart is of normal size. The combination of pulmonary infarction, a heart of normal size, and progressive cardiac enlargement following hemoptysis may indicate a severe grade of pulmonary arteriosclerosis. 6. 6. The occurrence of hemoptysis in a case of rheumatic heart disease may help in distinguishing between an Austin-Flint murmur and the murmur of aortic regurgitation, or in the diagnosis of mitral stenosis, in certain cases. 7. 7. When hemoptysis occurs in rheumatic heart disease, only occasionally is it caused by something other than the heart disease.

Diseases of the ChestThe Normal Electrocardiogram

The present generally accepted definition of the normal electrocardiogram is inadequate. In many instances the spatial position of the initial and terminal depolarization forces can be determined from the electrocardiogram. This knowledge can be applied to a clearer differentation of normal electrocardiograms and certain abnormal states.

The Normal Electrocardiogram

The present generally accepted definition of the normal electrocardiogram is inadequate. In many instances the spatial position of the initial and terminal depolarization forces can be determined from the electrocardiogram. This knowledge can be applied to a clearer differentation of normal electrocardiograms and certain abnormal states.

The Normal Electrocardiogram* *From the Electrocardiographic Laboratory, Beth Israel Hospital, and the Harvard Medical School, Boston, Massachusetts.

The present generally accepted definition of the normal electrocardiogram is inadequate. In many instances the spatial position of the initial and terminal depolarization forces can be determined from the electrocardiogram. This knowledge can be applied to a clearer differentation of normal electrocardiograms and certain abnormal states.