Milton Kissin

Induced general anoxemia causing S-T deviation in the electrocardiogram

Abstract Electrocardiograms of 38 individuals were taken during the induction of progressive anoxemia. Eleven subjects developed deviation of the S-T segment. Eight of the 11 suffered from angina pectoris, three did not. The deviation of the S-T segment was usually downward but in one case was upward. The degree of deviation was related to the degree of anoxemia. No qualitative electrocardiographic finding appeared during anoxemia that will serve to distinguish between individuals with unimpaired coronary circulation and those with impaired coronary circulation.

A nomogram for rate correction of the Q-T interval in the electrocardiogram

Abstract 1. 1. A nomogram for correcting the Q-T interval for heart rate, according to Bazetts formula, is presented. 2. 2. The Q-T corrected for rate represents the Q-T corresponding to a heart rate of 60 (cycle length 1.0 second). It is suggested that it be known as the Q-Tc. 3. 3. The lead in which the Q-T interval is largest is the correct lead in which to measure it.

The effect of intravenous aminophylline on the capacity for effort without pain in patients with angina of effort.

Abstract 1. 1. An intravenous injection of 0.24 Gm. aminophylline increases the capacity for effort without pain in patients with angina of effort. There are fairly marked individual variations in this response. 2. 2. The increased capacity for effort without pain lasts longer than one hour.

Anginal Syndrome Induced by Gradual General Anoxemia

With individuals subject to attacks of chest pain, in whom there is no evidence by physical or electrocardiographic examination of myocardial (coronary) disease, it is often difficult to be certain of the origin of the pain. We wished to distinguish between those with pain due to impaired coronary circulation, and those in whom the pain arose otherwise. It occurred to us that if one were to produce a general anoxemia, and, therefore a local cardiac anoxemia, there might appear differentiating responses in these 2 groups. By means of rebreathing, we were able to produce a state of general anoxemia in human subjects. The carbon dioxide was absorbed. It usually took about 10 minutes for the oxygen to become so low that the patient became uncomfortable. Twenty-seven patients were subjected to the test. Fourteen patients were used as controls. The controls consisted of 4 patients with normal hearts. The remaining cases were patients with chronic valvular disease, paroxysmal auricular fibrillation, rheumatic fever, spondylitis, gall bladder disease, and cardiospasm. None of these patients developed pain. Thirteen were patients with clear-cut histories of attacks of precordial pain brought on by exertion, excitement, eating, or exposure to cold. Ten developed pain during the rebreathing test. Eight of these had no physical or electrocardiographic signs of myocardial disease. The pain appeared when the oxygen fell to about 9 to 10%. This ordinarily took about 8 to 10 minutes. Subjects were advised to raise their hands when they felt uncomfortable, and the experiment was stopped. It is furthermore interesting to observe that 2 other patients with clinical angina and intra-ventricular block developed pain and additional electrocardiographic changes during the anoxemia.

Influence of Hyperpyrexia on Velocity of Blood Flow.

Conclusions During hyperpyrexia, induced by radiothermy, there is an acceleration of the velocity of blood flow.

A two-step test of exercise tolerance in intermittent claudication.

Several tests of exercise tolerance have been used in studies of intermittent claudication. Barker, Brown and Roth (1, 2) studied claudication time. The time was measured by having the patient walk at 120 steps per minute on level ground until pain developed. An attendant carried a stop watch to regulate the speed. The time between the beginning of the exercise and the occurrence of pain was known as the claudication time. Simmons (3) employed an ergometer consisting of an inclined plane splint with a hinged foot piece. He used a five pound weight and governed the rate of exercise with a metronome set at sixty beats per minute. Landis devised an ergometer, the muscle contractions being rhythmically induced by a faradic current applied to the leg to insure constant effort. Hitzrot, Naide and Landis (4) used this apparatus, producing involuntary contractions of the calf muscles by faradic stimulation at set intervals. They recorded graphically the development of fatigue under standard conditions of stimulus and load.

Reticulum cell sarcoma of the heart simulating viral pericarditis

Abstract A case of reticulum cell sarcoma involving the heart is reported. The presenting picture originally was that of a pericarditis with effusion, and apparently a cure was effected after a few weeks. One year later the pericardial effusion returned, in association with substernal pain. Rapid death followed.

The effect of condensers in the electrocardiograph

Abstract 1. 1. Condensers placed in the string galvanometer or amplifier type of electrocardiography make compensation for “skin current” automatic. String galvanometers are not ordinarily equipped with condensers; whereas most amplifier electrocardiographs are so equipped. 2. 2. The presence of condensers introduces distortion. 3. 3. The chief distortions that may be introduced by condensers in the electrocardiograph in clinical practice are RS-T deviation and diminution in the height of the R-wave. Since attention is paid to the RS-T segment in the diagnosis of coronary artery disease, rheumatic fever, etc., its deviation is significant. The time relationships are unaltered. 4. 4. The magnitude of the distortion is proportional to the duration and amplitude of the wave being recorded and is also, in a simple circuit (string galvanometer), inversely proportional to the product of the esistance and capacity. 5. 5. This product is known as the time constant. An amplifier circuit (which is a series of simple circuits) has an equivalent time constant to which the distortion is likewise inversely proportional. A simple method is given for determining this constant. 6. 6. Formulas are given for determining the magnitude of the distortion. 7. 7. If the time constant of the circuit is 2.0 seconds or more, the distortion is not usually significant in clinical practice.

Oscillation-Free Ballistocardiography A Simple Technic and a Demonstration of Its Validity

Body motion resulting from cardiac forces may be recorded as displacement, velocity or acceleration by a variety of methods. None of these is identical with the cardiac force curve because of distortion due to body oscillations. Schwarzschild devised an electronic mixer that combines displacement, velocity, and acceleration in any proportion desired. This device permits recording ballistocardiograms that are free of oscillations due to body resonance. Validity of the technic was established by the identity of strain gage records of forces applied to a log phantom with simultaneous records obtained with the method presented.

The Effect of Drugs Used in the Treatment of Inter Mittent Claudication On the Exercise Tolerance of Individuals With Obliterating Arteriosclerosis

From the Joseph and Helen Yeamans Levy Foundation in Memory of Miriam Levy Finn, Beth Israel Hospital, New York, N. Y. In earlier studies on intermittent claudication (1), we found that the exercise tolerance, as measured by the two-step test, remained constant when repeated at intervals on a single day. We then proceeded to a study of the effect of drugs used in the treatment of intermittent claudication. This paper, which reports the study, is concerned only with acute experiments done on a single day. The subjects varied in age from 49 to 77 years. Their intermittent claudication was caused by arteriosclerosis. Each drug was tested on ten patients, except aminophyllin, which was tested on twenty. A &dquo;blind&dquo; technique was used. In this technique, neither the patient nor the observer knows whether the drug or control substance is being tested. Written and sealed codes were drawn up in advance to record the order of administration of drugs tested. These codes were not examined until the experiments were completed. Half the experiments were done with the drug studied being given first and half with the control substance first.