Studying electrocardiogram (ECG) in 84 patients with chronic pulmonary disease, especially chronic pulmonary emphysema, the relation of ECG findings to the clinical course and prognosis of the disease was observed. ECG criteria of right ventricular hypertrophy (RVH) by Roman et al. and right axis deviation of P wave of +80° or more in the frontal plane were found at a high incidence in the cases of poor prognosis. Slurred S in the. right precordial lead was found to be an useful index for early diagnosis of RVH.
The direct myocardial depressant effects of lidocaine, ajmalin, propranolol and quinidine were determined in vitro in isolated right ventricular papillary muscles and spontaneously beating right atria of the cat. In concentrations similar to therapeutically effective serum levels, the average depression in contractile force produced by each drug was: lidocaine 1%, ajmalin 1.9%, Propranolol 3.5%, and quinidine 8.3%. Similarly, the reduction in spontaneous atrial rate was: ajmalin 4.5%, Propranolol 5%, and quinidine 11%. The minimal depressive effects of lidocaine and ajmalin confirm their relative safety in patients as compared to quinidine. The combination of the direct myocardial depressant effects and beta blocking effects of propranolol suggest that this drug, as well as quinidine, must be used with caution in patients with heart failure.
Effects of renal venous pressure (RVP) elevation on the renal hemodynamics, urine formation and renin secretion rate (RSR) were studied in the pentobar-bital anesthetized dogs. Gradual increment of RVP produced no changes in RBF and GFR till 30 mmHg but a significant decrease in them at RVP above 35 mmHg. The urine flow response to RVP elevation was divided into two groups: an increased urine flow with an increase of sodium excretion and a decreased urine flow with a decrease of sodium excretion. In the former group, gradual RVP elevation produced a significant increase in UNaV, Na/K ratio and TCH20 without changes in UKV and Cosm, while the latter group showed a decrease in UNaV, UKV and TCH20. Renin secretion rate (RSR), the product of RPF and renal venous-arterial difference of plasma renin activity, increased significantly as function of RVP elevation. This RSR increment seemed to be independent of changes in RBF, GFR, urine flow, or UNaV and the increased mechanism of RSR was discussed. It is concluded that tubular handling of sodium is not essential but intrarenal baroreceptor mechanism seems to be responsible for renin release in case of RVP elevation.
Acyanotic congenital heart diseases with prolonged bleeding time, normal platelet count and normal clotting time were encountered in 18 of 128 cases of acyanotic congenital heart diseases. And the hemostatic tests were per-formed in 14 cases. Major abnormalities in the hemostatic tests were impaired prothrombin consumption, platelet adhesiveness and activity of platelet factor 3. So these bleeding tendencies were thought to be chiefly caused by thrombocyte dysfunction. By the postoperative hemostatic tests, shortening of bleeding time, and improvement of prothrombin consumption, platelet adhesiveness and platelet factor 3 activity were recognized in several cases, though activities of factor VIII and IX showed no changes. These bleeding tendencies occurred frequently in a group of heart diseases such as ventricular septal defect, patent ductus arteriosus and pulmonary stenosis, in which turbulences of blood flow with high gradient of pressure were apt to occur. Considering the postoperative improvement and the frequency of occurrence, one of the important factors of these bleeding tendencies would be the secondary platelet dysfunction due to hemodynamic disorders of heart diseases. Generally, these bleeding tendencies have no close relation to the post-operative bleeding, when fresh blood transfusion is used and cautious hemostasis is carried out during operation.
Genealogical study and experimental fat-cholesterol and salt loadings showed that the present strain (F26-27) of spontaneously hypertensive rats consisted of several substrains with no difference in the level of blood pressure but with a marked difference in the incidence of cardiovascular lesions. Biochemical specificities of these substrains were demonstrated by ALPase and esterase isozymes in the liver and serum. Different responses in serum cholesterol level to the hypercholesterolemic diet served as a further differentiation of some lines among these substrains and were seemingly related to their vulnerability to cardiovascular lesions under these experimental conditions.
The use of cineangiocardiography has brought a remarkable progress in the study of myocardial function as well as diagnosis of heart disease. This study is to measure left ventricular volume by one-plane cineangiocardiography, and to apply this method to (1) measurement of regurgitation and left-to-right shunt, (2) measurement of left ventricular work by making a pressure-volume curve, and (3) investigation of left ventricular function in health and disease by comparing left ventricular volume with the hemodynamics of the left ventricle. Material and Method: Twenty patients, 9 to 48 years in age and male in 10 and female in 10, underwent the examina-tion, who consisted of 7 cases with innocent cardiac murmur, 5 with mitral incompetence, 4 with primary myocardial disease, and 4 with miscellaneous heart diseases. The examination was made with only local anesthesia in supine position in the fasting state. After the right heart catheterization through the saphenous vein, the transseptal left atrial puncture was made by a Brockenbrough catheter, and then the tip of the catheter was advanced into the left ventricle to measure left ventricular pressure during cinematographing. A Ducor catheter was put in the left ventricle through a femoral artery for the left ventricular cineangiocardiography. The angiography was made in the right anterior oblique position and the anteroposterior position. During the cinematization left ventricular pressure, electrocardiogram, the injection sound of contrast media and neon-maker were recorded in a polygram. The neon-marker flashed at 2 cycles per sec and was pictured simultaneously in both the cinefilm and the polygram. Cardiac output was measured by the dye method using a cuvette. The volume (V) of the left ventricle was calculated by V = πLM2/6f3 using one-plane cineangiogram on the assumption that the left ventricle is a revolving ellipsoid, where L is the longest axis of the ventricle, M is short axis intersecting at right angles at a midpoint of L and f is a co-efficient for the correction of magnification rate by X-ray beam and its distortion. The rate of regurgitation or shunt was calculated as follows, the rate = (left ventricular output by cineangio-cardiography - forward cardiac output by dye method) × 100/(forward cardiac output by dye method). Systolic, diastolic and net cardiac words were calculated from a pressure-volume diagram in one cardiac cycle.
Parasystole is an arrhythmia resulting from co-existence of two independent impulse-forming foci. Ventricular parasystole which arises from an ectopic focus situated in ventricle, is relatively common. On the contrary, well-documented cases of atrial parasystole are extremely rare, and since the first case of atrial parasystole was reported by Kaufmann and Rothberger, only 24 cases have hitherto been reported. In the present paper is described and discussed a case of atrial parasystole with exit block, fusion phenomenon and interpolation. Case Report: A 60-year-old man was admitted to the hospi-tal for upper jaw carcinoma. He had not complained of his heart condition, and therefore, had never received digitalis nor any antiarrhythmic drug. The blood pressure was 134/72 mmHg, and the only cardiac findings were a functional murmur of grade 2 at the apex and a rhythm disturbance which was diagnosed clinically as premature systole. The chest roentgenogram showed evidence of slightly emphysematous findings, but no infection. Urinalysis, blood count and blood chemistry were all normal. The 12-lead ECG showed no abnormalities but an atrial arrhythmia. Analysis of Electrocardiograms: The electrocardiograms shown in Fig.1-3 are a continuous strip of standard lead II. Shown in Fig.1 are two different types of P waves, viz., one is the type of normal sinus P wave which is rather small and low in amplitude (under 0.l mV), and the other (marked P'), is the type of ectopic P wave. The ectopic P waves are positive, wide, sharp and tall. The premature P' waves (P'2, and P'3 in A, B and E. P'2, and P'4 in C. P'1 and P'3 in D) are not accurately coupled with their preceding normal sinus P waves. The coupling (P-P' interval) shown in Fig.1 widely varies in a range of 0.41 sec to 1.18 sec. The intervals between the ectopic P (P') waves (the inter-ectopic intervals) are all in simple multiples of 49 to 54 in 1/100 sec, thereby indicating that these beats are related to each other. This combination of conspicuously varied coupling and simply related interectopic intervals is evidence of atrial parasystole. Almost all intervals between the ectopic P (P') waves and the following sinus P waves-the returning cycle-are longer (about 1, 20 sec) than the normal sinus cycle, but as far as P'3 in B-strip is concerned, the returning cycle is considerably shorter (0.62 sec) than the measureable sinus cycle (P-P) in the same record, and the interval of P-P'3-P (1, 12 sec) remains the same as the sinus cycle. This phenomenon is the interpolated atrial premature systole.