Mary Mayo

Pulmonary function in left ventricular failure, including cardiac asthma.

Unusually comprehensive studies of pulmonary function in hypertensive patients during left ventricular failure and cardiac asthma are presented. These findings are compared to those in mitral stenosis with congestive failure and in pulmonary emphysema with right heart failure. All patients were severely dyspneic and bedridden.

Variant angina: case reports and critique.

Abstract Variant angina, as herein described in three patients, is a rare clinical entity characterized by episodes of spontaneous pain and is rarely related to exertion. Marked elevation of the J point is common, although not invariable, and dysrhythmias, although characteristic and dramatic, are rare. It is distinguishable from preinfarction angina, with which it is often confused, by its chronicity. Coronary arteriography should be utilized early in an effort to identify obstruction in a single large coronary vessel because of the important possibility of serious dysrhythmias and sudden death.

Sequential changes in the development of the electrocardiographic pattern of left ventricular hypertrophy in hypertensive heart disease

A lthough recent reviews1-5 have summarized the available data concerning the diagnostic value of the electrocardiogram in left ventricular hypertrophy, little attention has been directed toward the sequential changes in the development of this pattern. Much of the controversy concerning the significance of the electrocardiographic pattern of left ventricular hypertrophy has centered upon the interpretation of ST-T changes. The problem of long standing6-* is whether the ST-T abnormalities are purely secondary to the increasing magnitude of the QRS vector or whether they represent an additional complication. Adequate analysis of these relationships would be enhanced by clinical electrocardiographic correlations over the entire lifespan of developing hypertrophy. Long-range electrocardiographic studies have been hampered since routine precordial leads have only been available since 1945. The present material consists of such studies of developing hy-pertrophy in 22 patients.

Complete heart block: Prognostic value of electrocardiographic features and clinical complications☆

Abstract Eighty of 98 patients with acquired complete heart block are presented and discussed with respect to the effect on prognosis of age, etiology, presence of cardiac and extracardiac complications and electrocardiographic data. In this series of 48 control and 32 paced patients, mortality was adversely affected by myocardial infarction, uremia, shock, diabetes, a ventricular rate below 30/min., and Stokes-Adams attacks. Mortality was not affected by changing block, duration of the QRS interval, or the presence of cardiac failure. The prognosis in complete heart block was improved by pacing except in the presence of severe renal or metabolic complications.

Respiratory effects of Tris (THAM) in acidosis and alkalosis

Tris is an effective, safe, rapidly acting amine buffer for the treatment of metabolic and mixed acidosis. It is useful in diminishing cardiac irritability associated with acidosis and in treating acidosis of cardiopulmonary bypass. This study reports the quantitative effects of Tris in 14 normal patients and 13 others with varying degrees of acidosis and alkalosis, primarily metabolic. In patients with a normal resting pH and in those with acidosis, the expected changes of hypoxia, hypoventilation, and hypocapnia appeared. In patients with initial alkalosis, hyperventilation and a tendency to increased pO2 were comman. In the maiority of patients, particularly those with stable initial ventilation, controlled, mild alkalosis could be produced and maintained within narrow limits. Control of shifts in pH may be of value in the therapy of cardiac irritability associated with acidosis.

The vector-electrocardiogram in acute coronary insufficiency and in acute myocardial infarction

Abstract 1. 1. In twenty-seven patients with acute coronary insufficiency and in twenty-four patients with acute myocardial infarction, electrocardiograms and mean spatial vectors of QRS and T have been described and compared. 2. 2. Acute coronary insufficiency is a common clinical entity, at least half as common as acute transmural myocardial infarction. 3. 3. The diagnosis of acute coronary insufficiency may be made with reasonable accuracy and implies an area of subendocardial necrosis which is anterior in location three times as frequently as posterior. 4. 4. The mean spatial vector of QRS, being a composite figure, shows little change in myocardial infarction, and, of course, in coronary insufficiency. 5. 5. The mean spatial T-vector shift is greater in acute myocardial infarction than in acute coronary insufficiency. The maximum shift occurs earlier, on the third day in acute coronary insufficiency, and considerably later in myocardial infarction. 6. 6. In acute myocardial infarction, anterior in location, there is a close correlation between the degree of shift of the mean spatial T vector and the severity of the illness. Thus in this situation the degree of shift of the T vector appears to be a measure of the extent of myocardial injury. 7. 7. Complete electrocardiographic recovery occurs more frequently in acute coronary insufficiency; also the attainment of a stable electrocardiogram occurs earlier than in acute myocardial infarction. 8. 8. Vector-electrocardiography is of real value in acute coronary insufficiency and in acute myocardial infarction; it is a semiquantitative yardstick for the more detailed appraisal of the degree of myocardial injury and the amount of recovery.

Left ventricular dyskinesia in infarction and angina

In 29 patients, the site and extent of coronary artery obstruction were related to the position and area of abnormally contracting segments of the left ventricle, both in patients with a history of angina without myocardial infarction (group I) and in patients with prior documented myocardial infarction (group II). The degree of coronary artery obstructive disease was estimated in the standard manner and also by a coronary artery index which considered not only the degree of obstruction but also the total length of the obstructed segment. A kinetic or dyskinetic segments were present in 22 of the 29 patients. An abnormally contracting segment was present in 12 or 18 patients without prior myocardial infarction in comparison with 10 of the 11 patients with prior infarction. Complete obstruction of a coronary vessel and resultant dyskinesia were more frequent in the right coronary artery than in either the left anterior descending or the circumflex artery. There was a significant correlation between total per cent of vessel obstruction and degree of ventricular asynergy in both groups; consideration of length of obstructed segment did not improve this correlation.

Long-Term Use of Anticoagulants Following Acute Myocardial Infarction

ence or absence of subsequent episodes of acute coronary insufficiency or acute transmural infarction was noted, as was the presence or absence of diabetes, hypertension or bleeding episodes. All patients placed on an oral anticoagulant for at least six months were classified in the anticoagulant group. If such patients were seen without anticoagulants for at least 6 months prior to, or after anticoagulation, they were considered