Thomas W. Parkin

Constrictive Pericarditis: Assessment of Current Diagnostic Procedures

Constrictive pericarditis frequently poses a diagnostic challenge because of its varied manifestations. Accurate diagnosis is essential, however, because surgical decortication may yield excellent clinical results. Although new diagnostic procedures have helped the clinician to diagnose constrictive pericarditis, the initial clinical suspicion of this diagnosis must be high for appropriate interpretation of these tests. Echocardiography is useful, primarily for distinguishing various other cardiac abnormalities that may simulate constrictive pericarditis. Computed tomography is a valuable procedure for assessment of pericardial thickening. In addition, evaluation of early diastolic filling by computerized digitization in conjunction with echocardiography, angiography, and invasive hemodynamics shows promise as a diagnostic tool. Even with these new diagnostic aids, distinguishing constrictive pericarditis from restrictive cardiomyopathy may be difficult and, in some cases, may necessitate an exploratory operative procedure.

THE ELECTROCARDIOGRAPHIC AND HEMODYNAMIC FINDINGS IN PULMONARY STENOSIS WITH INTACT VENTRICULAR SEPTUM.

In certain forms of heart disease when the diagnosis is readily apparent from clinical examination, it would be desirable to assess the degree of hemodynamic abnormality by the simplest method. If electrocardiographic data could provide a sufficiently accurate indication of altered function, the need for cardiac catheterization might be obviated. However, detailed electrocardiographic criteria1, 2 do not appear to correlate with the weight of the ventricle or the thickness of the ventricular wall.3 A more definitive result might be obtained from correlations of the electrocardiographic details with function, as attempted by Cosby and co-workers,4 rather than with anatomic structure. For this functional approach, Cabrera and Monroy5 disseminated the concepts of the systolic and the diastolic overloading of the ventricle. Statistical support for these ideas is not yet available even though modified views have been presented.6 Studies of correlation between the severity of pulmonary stenosis and electrocardiographic evidence of right ventricular hypertrophy7–11 disclose a wide variability. From a functional view, the simplicity of the abnormality makes pulmonary stenosis an ideal disease to study; there is solely a systolic or pressure overload of the right ventricle. In order to overcome obstruction to outflow through the pulmonary valve, the right ventricular systolic contraction takes a longer time and becomes more powerful. Recent investigators12, 13 have compared the peak right ventricular systolic pressure with various aspects of the electrocardiogram. But as Haywood, Selvester, and Griggs14 realized, pressure data alone are insufficient to assess hemodynamic function; flow must also be considered. For example, to double the flow rate through an orifice, the pressure gradient must be quadrupled if there is no change in resistance to flow due to altered turbulence. The purpose of this study is to determine the relationships between the electrocardiographic data and hydraulic data that consider the effect of blood flow.

Peri-infarction block: Postmyocardial-infarction intraventricular conduction disturbance

Abstract The cardiac pathology is reported in 21 adult patients in whom the angle between the mean initial and mean terminal 0.04-second QRS vectors was greater than 110 degrees, but in whom there were no Q waves of 0.04-second duration in the standard limb leads. In only one case was myocardial infarction present. It is suggested, therefore, that the term “periinfarction block” be restricted to the combination of abnormalities of the terminal QRS forces with the initial QRS deformity characteristic of infarction.

Problems in the electrocardiographic diagnosis of ventricular enlargement.

T WO PRINCIPAL TYPES of diffieulty are encountered in the electrocardiographic diagnosis of venltricular enlargement. One is the type of problem that confronits the physician who is trying to learn or to enlarge on his knowledge of electrocardiocraphy. le has to recognize and apply ilnformationi on (1) the large number of electrocardiographic criteria, (2) the differenit inethods of correlating electrocardioarams, with anatomic findings, (3) the uncertainty concerning the nature of certain eleetrophysiolocic phelnomena, (4) the velntricular gradient, (5) the terminology, and (6) the velntricular overload syndromes. The other type of difficulty concerns the number of situations in the adult patient that tend to obscure the electrocardiographic diagmnosis of ventricular enlargement. A few of these are (1) digitalis, (2) intraventricular conduction defects, and (3) coronary sclerosis and myocardial infaretion. These nine problems are considered in this presentation.

Clinical findings in acquired aortic valve stenosis: Effect of disease of other valves

Abstract The symptoms, physical findings, electrocardiographic features, and transaortic pressure gradients in a group of 172 patients with isolated aortic valve stenosis were compared with similar data from a group of 35 patients with predominant aortic valve stenosis and coexistent abnormalities of either the mitral or tricuspid valve, or of both. The incidences of angina pectoris, exertional syncope, palpable aortic systolic thrills, left ventricular hypertrophy, left ventricular strain pattern, and marked increase in the transaortic pressure gradient were lower in the group with multiple valve involvement, whereas congestive failure and arrhythmias were more common.

Atherosclerotic Popliteal Aneurysm in a Man Thirty-five Years Old Report of a Case

This case of atherosclerotic aneurysm of the popliteal artery is of interest because the patient was a man 35 years old and because the condition was discovered only because palpation of the peripheral arteries was included as a part of routine examination. Only after the aneurysm had been found was a history of intermittent claudication elicited. The indications for the surgical treatment of popliteal aneurysms are discussed.