R. Hegglin

Heart sounds in atrial tumors.

Abstract The phonocardiograms in three cases of atrial tumors are analyzed. The cases included one left-sided, one right-sided and one bilateral atrial tumor. There was marked homolateral shortening of systolic duration in two cases. Shortening of systole is compared with findings in stenosis of the mitral and tricuspid valves. One case with predominantly right-sided atrial tumor showed abnormally large respiratory variations in the splitting of the heart sounds and in the length of right and left ventricular systole. The pulse pressure of the pulmonary artery paralleled the systolic duration of the right ventricle. The exaggerated respiratory variations disappeared after surgical removal of the tumor. The following phonocardiographic signs should suggest the presence of an obstructive atrial tumor or thrombus: marked unilateral shortening of mechanical systole; exaggerated variation of systolic length with breathing, with postural changes, or within a short period of time. The phonocardiogram is an important diagnostic aid, particularly in the diagnosis of right atrial tumors, as there are few signs and clinical diagnosis seemed impossible as recently as fifteen years ago.

Über einige Korrelationen zwischen Systolenlänge und hämodynamischen Parametern beim Hund

ZusammenfassungAn Hand von 77 Kontrollwerten bei 42 Hunden wurde versucht, die elektromechanische Systole in Beziehung zu andern Herzparametern zu setzen. Dabei erwies sich die Frequenznormierung durch Bildung des Quotienten

Zur Differentialdiagnose der Mitralvitien mit Hilfe der Indikatorverdünnung

\frac{{Q - II}}{{Frequenz}}

What is the Significance of a Shortened Systole

, die auf dem direkten linearen Verhältnis zwischenQ-II und Frequenz basiert, als sehr nützlich. Dieser Quotient ist direkt korreliert zum Schlagvolumenindex, zur Schlagarbeit und zum reziproken Wert des Austreibungswiderstandes. Er ersetzt bei den Kontrollfällen und wie bisherige Untersuchungen ergeben haben auch in einem große Teil von verschiedenen Belastungen das enddiastolische Volumen in der zur Umschreibung und Abgrenzung einer Herzinsuffizienz entscheidenden Korrelation enddiastolisches Volumen zu Austreibungswiderstand.

Zur oxymetrischen Differenzierung zwischen links-rechts-Shunt und Klappeninsuffizienz des linken Herzens

Abstract The hemodynamic response to angiotensin infusion in intact dogs was investigated with the thermodilution method developed in this clinic. End-diastolic volume (EDV), stroke volume (SV) and cardiac output (CO) were determined with this method, and calculations were made of the end-systolic volume (ESV), SV/EDV ratio, stroke work and power, mean ejection rate, circumference shortening, the total wall tension and the time derivative of intraventricular pressure generation (dP/dt) of the left ventricle. The moderate elevation of the mean systolic pressure (MSP) of the left ventricle (38.5 mm. Hg) was observed with the infusion rate of 0.49 μg./kg. min.; no significant change in CO, SV index (per kilogram body weight) and heart rate was seen in this range, but EDV index, ESV index, stroke work and power increased significantly. Post-infusion hypotension and tachycardia were also recorded. At the rate of 0.87 μg./kg./min., MSP was raised by 80 mm. Hg, SV index, stroke work and power all increased significantly, brady-cardia occurred, but CO, EDV index and ESV index did not change markedly. An average of 6.4 mg./kg. of Nethalide, a beta-adrenergic blocker, produced significant increases in EDV index and length of systole and significant decreases in heart rate, dP/dt and mean power. In response to angiotensin infusion under the blockade, increases in MSP, dP/dt, stroke work and power were shown to be somewhat less, but EDV index and ESV index increased proportionately with the rate of infusion. The correlation between EDV index and ESV index and the correlation between the total tension of the left ventricle at the end of systole and either EDV index or ESV index was good in all experiments studied. Stroke power and work increased roughly parallel to EDV index, and with the beta blockade a depressed function curve was observed. Complexity of the cardiovascular control mechanism and importance of the sympathetic innervation were briefly discussed.