Willard J. Zinn

Effect of Heparin and Treburon in Postprandial Hyperlipemia

Conclusions 1. Heparin or Treburon given intramuscularly were equally effective in producing a sharp fall in alimentary lipomicronemia within 30 to 60 minutes. 2. The alterations noted in serum fat emulsions were not related to changes in cholesterol, its fractions, or lipid phosphorus. These chemical determinations were not significantly influenced by either heparin or Treburon. 3. Treburon given intravenously produced a sharp drop in the lipid particle count within 5 to 15 minutes and this was maximal within one hour of injection. 4. Treburon given sublingually was ineffective.

SIDE REACTIONS OF HEPARIN IN CLINICAL PRACTICE.

Abstract Heparin side-reactions are of three classes. First, heparin acts on body systems other than those involved in blood coagulation. Serious reactions are minimal. Transient alopecia relieved by stopping heparin has been reported. Hepatic, renal, marrow, or neurotoxicity are absent from the literature to date. The second class, allergic reactions are more common, but still infrequent. True heparin sensitivity is rare, but occurs—even in one patient to the point of anaphylactic shock. More frequently, urticaria has been noted, induced by sensitivity to heparins animal protein. Not infrequently a histamine-like response at the injection site may appear which often gradually disappears if injections are maintained. This is a true heparin response and is not altered by changing the heparin source. The third and major group of side-reactions is related to inappropriate manifestations of heparins therapeutic properties. Most of these are avoidable by careful technic of administration (being local ecchymoses of minor or major proportions). Some are due to inappropriate dosages in susceptible patients with hemorrhage at distal, and occasionally critical sites, i.e., the wall of the intestine. When added to patients already on prolonged coumarin therapy, intractable bleeding may occur from factor IX suppression. Most frequently fatal, however, is the injudicious interruption of heparin therapy when bleeding presents. Permitting coagulation to return to normal has frequently been associated with large emboli presumably shed by laminated clot appearing on injured endocardial or endothelial surfaces. Heparin is not a simple medication. Properly used, it is a powerful therapeutic tool with relatively few intrinsic dangerous reactions.

Transposed pulmonary veins; a correlation of clinical and cardiac catheterization data.

Abstract Ten patients with transposed pulmonary veins are described. These include four patients with partial and two with complete pulmonary vein transposition, in whom cardiac catheterization and clinical findings are correlated. The other patients presented (1) pulmonary valvular stenosis accompanied by partial pulmonary vein transposition, (2) a left superior vena cava entering a sinus venosus in common with the hepatic veins, accompanied by anomalous drainage of the right pulmonary veins into the right atrium, and (3) probable tricuspid atresia with partial pulmonary vein transposition (two cases). The diagnosis of anomalous pulmonary vein drainage in these cases was made at cardiac catheterization by roentgen visualization of the catheter in the anomalous vein, by a characteristic pulmonary vein pressure curve and finally by 90 to 95 per cent oxygen saturation in the blood sample from the anomalous vein. Surgical exploration and attempts to correct this anomaly should be reserved for those patients with complete transposition in whom limitation of physical activity is progressive.

Cardiac catheterization in interatrial septal defect

Abstract 1.1. Ten proven and seven presumptive cases with atrial septal defects have been presented. 2.2. The importance of catheterization of the left auricle is emphasized, together with the differential diagnosis of atrial septal defect from transposed pulmonary veins. 3.3. A rise of oxygen content in the right atrium in comparison to the oxygen content of the superior vena cava is not necessarily present in proven atrial septal defects. 4.4. The cause for cyanosis in atrial septal defect lies primarily in the presence of a right to left shunt. 5.5. The direction of shunt is determined by the pressure gradient between the atria during the cardiac cycle. 6.6. Pulmonary vascular disease may contribute to the pulmonary resistance but is not a significant factor in the production of cyanosis.

Anatomic and electrocardiographic correlation in combined ventricular hypertrophy.

Abstract 1. 1. The precordial and augmented limb leads of seventy-three electrocardiograms from patients with necropsy evidence of combined ventricular hypertrophy have been analyzed. 2. 2. When left ventricular hypertrophy occurred as a result of hypertensive or aortic valve disease, its recognition was slightly impaired by the concomitant right ventricular hypertrophy. Left ventricular hypertrophy associated with cor pulmonale is hidden electrocardiographically. 3. 3. Right ventricular hypertrophy occurring as a result of hypertensive heart disease or mitral disease was masked by the concomitant left ventricular hypertrophy. Cor pulmonale occurring with left ventricular hypertrophy was apparent. 4. 4. The data suggest that rotational effects and the potentials of the respective ventricular walls are both important in the recognition of right ventricular hypertrophy in the presence of left ventricular hypertrophy. The electrocardiographic diagnosis of right ventricular hypertrophy in the presence of left ventricular hypertrophy may be suspected when atypical electrical positions are present, or the transition zone is shifted to the left. 5. 5. The diagnosis of combined ventricular hypertrophy is difficult and was apparent only in ten cases of seventy-three. In these cases, right ventricular hypertrophy was recognized by the rotational changes.

The Selection and Medical Management of Patients with Mitral Stenosis Treated by Mitral Commissurotomy

The selection of patients for mitral commissurotomy must be made after considering all manifestations of the rheumatic state. A conservative approach is urged and no patients should be operated upon without evidences of increasing pulmonary hypertension and right heart strain. The preparation of the patient, the management of the arrhythmias during surgery and the postoperative care are the full responsibilities of the physician. A team composed of physiologists, cardiologists and surgeons must work together.

FAMILIAL CARDIOMYOPATHY: HEART BLOCK AND STOKES-ADAMS ATTACKS TREATED BY PACEMAKER IMPLANTATION.

Abstract A case of familial cardiomyopathy is presented associated with Adams-Stokes attacks in a 33 year old patient. The family history disclosed sudden death of the patients father and uncle in the third decade of life, as well as electrocardiographic abnormalities in her two older children; her 4 year old child was free of abnormality. This is the first patient with a cardiomyopathy in whorn a pacemaker has been implanted as a lifesaving measure.

Clinical and cardiac catheterization studies in four cases of Eisenmenger's complex

Abstract 1.1. Four cases of Eisenmengers complex are reported and the results of cardiac catheterization are discussed. Right ventricular hypertrophy, pulmonary hypertension, high ventricular septal defect and overriding of the aorta were demonstrated. 2.2. The practical and theoretic difficulties of demonstrating overriding of the aorta by cardiac catheterization are discussed.

The Effect of Angiocardiography on the Heart as Measured by Electrocardiographic Alterations

Six consecutive patients studied by angiocardiography or aortography ranging in age from 1½ to 68 years were checked by a direct-writer type of electrocardiograph during the procedure. The clinical entities consisted of pulmonary stenosis, coarctation of the aorta, aneurysm of the ascending aorta, ventricular septal defect (2 cases), and atrial septal defect associated with complete transposition of the great vessels. Following angiocardiography immediate T-wave depression was noted. This was followed within three minutes by the development of short bursts of ventricular tachycardia lasting up to 27 minutes after dye injection. A different and much less spectacular picture followed aortography. None of these cases showed visible distress.

The use of oral quinidine and procaine amide as premedications for cardiac catheterization

Abstract This report is concerned with the need for prophylactic measures to reduce the incidence of potentially dangerous arrhythmias induced during cardiac catheterization. The experience of this catheterization team will be presented, and suggestions for increasing the safety of routine cardiac catheterizations will be made.