Nicholas P. DePasquale

Coxsackie B viral myocarditis and valvulitis identified in routine autopsy specimens by immunofluorescent techniques

Abstract From a survey of 55 routinely autopsied hearts, studied by means of the immunofluorescent antibody techniques, Coxsackie B group virus antigens were found in the myocardium in 17 cases (30.90 per cent) and in both the myocardium and mitral valve in 3 cases (5.45 per cent). A chronic focal, interstitial myocarditis was noted in all 17 cases upon routine histologic study. A high percentage of positive viral antigen was found in hearts of children (75 per cent) and infants (35.71 per cent). The criteria for positive immunofluorescent identification of antigen consisted of intracytoplasmic localization of the fluorescence in the affected myofibers and in fibrocytes of the mitral valves. Chronic Coxsackie virus valvulitis is shown to be present in man in certain types of unexplained chronic valvular heart disease. It is postulated that some instances of chronic valvular disease previously thought to be post rheumatic in origin may represent chronic viral valvulitis. These studies also suggest a possible role of the Coxsackie virus as a cause of some congenital cardiac defects and stillbirths.

Bradykinin, Digital Blood Flow, and the Arteriovenous Anastomoses

Bradykinin injected ipsilaterally into the brachial artery has been shown rheoplethys mographically to produce digital vascular changes which are the same as those observed in reactive hyperemia. The changes seem to be due to a selective constriction of the A-V shunts with dilatation of the arterioles, capillaries, venules, and veins. These vessels seem to dilate largely in passive response to the constriction of the A-V shunts.

The electrocardiogram and ventricular gradient in atrial septal defect.

Abstract The electrocardiograms in 100 proved instances of atrial septal defect (90 patients with septum secundum defect and 10 with septum primum defect) were studied. The electrocardiogram was fairly characteristic in atrial septal defect, sufficiently so to be of considerable value in clinical diagnosis. The tracings had a prominent S wave in Leads I, V 5 , and V 6 , with a prominent R′ wave in Leads V 1 and V 2 . The prominence included large magnitude and/or duration, especially when considered with respect to the R wave in Leads I, V 5 , and V 6 , and the S wave in Leads V 1 and V 2 . The electrocardiograms of the septum primum defects differed significantly in a readily recognizable fashion from those of the septum secundum defects, in that the former also manifested left axis deviation of the QRS or  QRS , while in the latter the axis was shifted toward the right. This was evident from an S wave of considerable magnitude in Leads II and III. Not one of the 90 patients with septum secundum defect manifested left axis deviation of the QRS complex or  QRS . The P wave was not particularly altered in the electrocardiogram, except in Lead V 1 , in spite of right atrial enlargement in atrial septal defect. These studies show again the unreliability of the arbitrary electrocardiographic criteria of right bundle branch block. The 100 sets of tracings also indicate the value of the electrocardiogram in differentiating hypertrophy of the crista supraventricularis from that of the entire right ventricle.

The electrocardiographic diagnosis of pulmonary heart disease

Abstract The electrocardiogram in chronic pulmonary heart disease is fairly characteristic and can be explained on the basis of changes in the spatial orientation of the heart and of the insulating effects of overaerated lungs. A detailed analysis of the electrocardiogram in 20 patients with right ventricular hypertrophy secondary to chronic pulmonary emphysema established at autopsy was presented. The data from these patients were compared statistically with the data from electrocardiograms of normal medical students. Statistically significant differences were found for the height and area of the P wave in lead III, the duration of the P-R segment in lead III, the R:S ratio in lead V 6 and the magnitude of the ventricular gradient. Although the electrocardiogram in chronic cor pulmonale can be characteristic and diagnostic, it is not always reliable. Clinical states not associated with right ventricular hypertrophy but in which the electrocardiogram closely resembles that seen in cor pulmonale were described. It was noted that the electrocardiogram from 40 per cent of patients with cor pulmonale and right ventricular hypertrophy established at autopsy satisfied none of the criteria for right ventricular hypertrophy. Thus, the electrocardiogram must always be interpreted as a part of the entire clinical study. It can be extremely useful, but it is not always dependable and, therefore, must be considered only as a supplement to the clinical data.

Experimental Coxsackie virus B4 valvulitis in cynomolgus monkeys

Abstract Valvular lesions were found in 6 of 7 cynomolgus monkeys inoculated intravenously with Coxsackie virus B 4 . Typical valvular lesions of mitral stenosis were found in 2 monkeys, verrucous aortic valvulitis was found in 2 monkeys, and verrucous mitral valvulitis was found in 3 monkeys. Viral antigen was identified in the valves of the 3 monkeys in whom fluorescent antibody staining was carried out. Valvular lesions were not found in 2 monkeys inoculated with virus-free monkey kidney culture fluid. These studies demonstrate that Coxsackie virus produces valvular lesions in cynomolgus monkeys. Since Coxsackie viruses are among the most common infective agents of man, and since a substantial number of patients with chronic valvular disease give no history of rheumatic fever, it is suggested that some instances of valvulitis in man may be due to viral rather than rheumatic disease.

Endocarditis in Mice Infected with Coxsackie Virus B4

Endocarditis has not been generally considered to be a complication of viral infection. We show that mural and valvular endocarditis can be produced in mice infected with Coxsackie virus B4. Because this virus commonly infects man and is highly cardiotropic, it is important to know whether it produces valvular lesions in man similar to those we describe in mice.

The electrocardiogram, spatial vectorcardiogram, and ventriculer gradient in congenital ventricular septal defect☆

The ECG, sVCG, and Ĝ were studied in 110 patients with isolated ventricular septal defect. The electrocardiographic pattern consisted of an S1,S2,S3 pattern in the standard leads, a qR or RSR′ pattern in Lead V1, deep S waves in Leads V4, V5, and V6, and a Q wave of large magnitude in Lead V6. The sVCG characteristically displayed prolongation of the terminal vectors of ventricular activation. Isolated or combined LVH was relatively uncommon. The ventricular gradient was abnormal in about half of the patients; T-wave abnormalities, however, were seen in only 18 per cent of the electrocardiograms. It is suggested that the ventricular gradient may be useful in distinguishing hypertrophy alone from hypertrophy associated with myocardial degeneration in patients with congenital heart disease.

Electrocardiogram and spatial vectorcardiogram of localized myocardial hypertrophy.

Diagnostic electrocardiographic and vectorcardiographic manifestations of localized hypertrophy of the posterobasal portion of the left ventricle and of localized hypertrophy of the crista supraventricularis have been described. Recognition of the fact that only a portion of the myocardium may undergo hypertrophy is important in understanding certain types of electrocardiographic and spatial vectorcardiographic patterns. Several types of localized myocardial hypertrophy for which no characteristic electrocardiographic or spatial vectorcardiographic patterns have been described were also discussed. There is a need for further study of this problem, and, in particular, for detailed correlation of the necropsy data with the electrocardiogram and the vectorcardiogram.

The Electrocardiogram, Vectorcardiogram, and Ventricular Gradient in the Tetralogy of Fallot

The electrocardiogram, ventricular gradient, and spatial vectorcardiogram were studied in 140 patients with proved tetralogy of Fallot. The patients were separated into three groups according to hemodynamic data. The salient features of the electrocardiogram in patients of group I consisted of diminutive R waves in leads I and V6, a deep Q wave and high R wave in lead III, a prominent R wave in lead V1, which was not wide, and the absence of Q waves in leads I, V1, and V6. The electrocardiogram in patients of group II was similar to that of the patients of group I except for the appearance of more signs of left ventricular electric activity and less clock-wise rotation of the heart. The electrocardiogram of the patients of group III was similar to that previously described for ventricular septal defect. ÂQRS, ÂT, Ĝ, and sVCG reflected the same general trend as the electrocardiograms. The electrophysiologic data presented support clinical observations indicating that the tetralogy of Fallot includes patients with a wide range of hemodynamic differences.

The Electrocardiogram and Ventricular Gradient in Isolated Congenital Pulmonary Stenosis

The electrocardiogram and ventricular gradient were studied in 41 patients with isolated congenital pulmonary stenosis. The ventricular gradient was abnormal in 26 of the 41 patients (63 per cent). The ÂQRS migrated to the right in the frontal plane and ÂT migrated to the left. Following surgical reduction of the stenosis these vectors rotated rapidly toward the normal position. The electrocardiographic pattern in isolated congenital pulmonary stenosis tended to be of 4 types that were generally related to the right ventricular systolic pressure. The electrocardiographic changes associated with this defect, in which the work of the right ventricle was increased because of right ventricular hypertension, were different from those associated with atrial septal defect in which right ventricular work was increased because of high volume output. The duration of the QRS complex was not prolonged in the electrocardiograms of patients with pulmonary stenosis, whereas it was characteristically prolonged in those with atrial septal defect.