Biomedical subjects
G E Burch
Publications and source records attributed to G E Burch.
Now the treadmill!
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Of smoking and the respiratory tract.
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Clinical evaluation of aortic and mitral valve prostheses.
The clinical follow-up for a large number of patients with aortic and mitral valve prostheses is now the responsibility of the general internist and cardiologist, particularly those physicians who recommended operation. Proper follow-up of patients with prosthetic heart valves can be performed only if the physician is aware of the "natural history" of the patient following valve replacement as well as of the common complications associated with cardiac valve prostheses. This article discusses the hemodynamic changes which follow cardiac valve replacement, complications associated with valve replacement (congestive heart failure, suture disruption, "ball variance," thromboembolism, hemolysis, cardiomyopathy, etc.) and simple clinical means of detecting these complications. Some special techniques which may be useful in diagnosing complications of prosthetic cardiac valve malfunction are described. It is emphasized that the physician should not consider the patient "cured" once he has undergone cardiac valve replacement, but rather should consider him to be the subject of meticulous long-term medical care.
Letter: Of the heart-to-chest ratio.
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Of URI and cardiomyopathy.
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Viral coronary arteritis and myocardial infarction.
Two young male patients are described in whom a viral type of upper respiratory tract infection was followed by myocardial infarction. Based upon previously reported experimental studies in mice and monkeys in which Coxsackie B4 virus produced extensive coronary arterial and capillary injury, and upon the clinical data in these two patients, it is suggested that the myocardial infarcts in our two patients were the result of viral coronary arteritis.
Of teaspoons, tablespoons and droppers.
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Of the p-r segment depression and atrial infarction.
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"New" treatment for chronic intractable congestive heart failure.
The use of hexamethonium injected intravenously in successive 2.5 mg. doses resulted in alpha-adrenergic sympathetic nerve blocking and associated peripheral vasodilation with dramatic improvement of the symptoms and signs in patients with marked chronic intractable CHF. The vasodilatating effect of the drug is simple to monitor at the bedside and serves as an effective, simple means to "bleed" the patient intravenously by decreasing systemic venous tone and reducing the wall stress in the vessels. This intravenous "bleeding" results in a shifting of excessive blood from the lungs and central systemic venous areas to the larger volume of the more peripheral systemic venous reservoirs. Rheoplethysmorgraphic recordings of digital blood flow in the fingertips of the patients revealed marked constriction of all vessels of the fingers during CHF. Hexamethonium dilated all these vessels and increased digital blood flow even though arterial blood pressure was reduced by the drug. Theoretic discussions of aspects of the mechanism of congestive heart failure of the two-pump system of the heart of man and the mechanical or hemodynamic advantages of the small veins over the larger centrally located veins tend to explain why the use of hexamethonium benefits the circulation by producing vendoilatation. These studies indicate the therapeutic usefulness of hexamethonium in the management of acute and chronic intractable CHF and provides physiologic and theoretic data to explain why the drug is effective.
Acute viral pericarditis.
Viral infections of the pericardium occur frequently. Unfortunately, the viruses responsible for the infection are rarely isolated or even identified. The clinical manifestations are those of fluid in the pericardium and usually an associated friction rub. There is no specific treatment for a viral agent, but supportive care is important and valuable. The diagnostic and therapeutic principles in the clinical care of patients with viral pericarditis are discussed. Viral pericarditis never occurs without associated subepicardial myocarditis and often occurs in association with diffuse myocarditis. For this reason the disease may be better termed viral myopericarditis.
Myocardial infarction: is a CCU really so important?
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Effect of glucagon on digital circulation.
The effect of glucagon on the digital circulation was studied in 7 subjects using the digital rheoplethysmograph (RPG). Rheoplethysmograms were continuously recorded while glucagon (0.1 to 2.0 mg) was injected into the brachial artery of the same extremity being studied with the RPG. The injection of glucagon was associated with a "tingling" or "burning" sensation in 3 subjects. The initial response, which was maximal 8 to 27 sec after the injection of glucagon, was constriction of the arteries, veins, and A-V shunts. The late response consisted of reopening of the arteries and veins. However, in some patients, there was RPG evidence of persistent constriction of the A-V shunts. It is suggested that the late response is similar to that observed in reactive hyperemia and following injection of bradykinin and, therefore, may be related to local release of vasoactive substances by glucagon.
Interesting aspects of geriatric cardiology.
Geriatric cardiology requires special knowledge and experience. It is not possible to extrapolate directly experience obtained with young patients to old people. Because of the multiple illnesses, many serious, in the elderly cardiac patients, it is imperative for the cardiologist to be, first of all, a master internist at all times. Old patients with their multiple illnesses are also sensitive to drugs, including digitalis and diuretics. There is a need to train more physicians in geriatric cardiology in order to offer the old patient the best of care since so many old people are living today. There is also a need to learn the effects of the aging process itself on the human heart. Such studies should command priorities in financial and other forms of support.
A need for more care at home.
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