Biomedical subjects
Publications and source records attributed to J W Hurst.
This article emphasizes that the abnormalities noted on chest x-ray films of the chest can be diagnostic of giant left atrium. It also points out that a giant left atrium that occasionally occurs in patients with rheumatic mitral valve regurgitation does not occur in patients with mitral regurgitation due to other causes.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
This article extols the value of using Grant's approach to the interpretation of electrocardiograms (ECGs). The essay includes a discussion on how people learn and emphasizes the difference in memorizing information, thinking, and learning. Simply stated, the brains of most people are not designed to memorize countless numbers of ECG patterns. Accordingly, the essay supports the view that a method of interpretation must be used, and the reader is encouraged to use basic principles of electrocardiography, including vector concepts, to interpret each ECG.
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This article emphasizes that medical schools only introduce students to the skills, including cognitive skills, that are needed to solve and manage medical problems. These skills, including cognitive skills, should be perfected during house staff training. The teaching-attending physician is in the key position to be a true teacher. Without the help of excellent teaching-attendings, trainees may not develop proficiency in the skills, including cognitive skills, needed for the practice of medicine.
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This paper extols the value of combining two systems in order to improve learning, teaching, communication, patient care, and clinical research in patients with heart disease. This is accomplished by using Weed's recommendation regarding the creation of a complete Problem List and, within this context, characterizing the cardiac or vascular problem according to the recommendations of the New York Heart Association.
BACKGROUND: Right ventricular dysfunction occurs in many patients with significant pulmonary valve regurgitation late after initial total repair of tetralogy of Fallot. Methods to predict which of these patients are at increased risk of late morbidity and mortality are not yet known. HYPOTHESIS: This study evaluated electrocardiographic (ECG) predictors of severe right ventricular dilatation determined by magnetic resonance imaging (MRI) volumes in patients with tetralogy of Fallot late after initial corrective repair. METHODS: We retrospectively reviewed the ECGs and MRI right ventricular volume measurements of 20 patients (age 4.4 to 19.3 years, mean 10.0 years) with significant pulmonary valve regurgitation late after repair of tetralogy of Fallot. All patients had enlarged, hypokinetic right ventricles by echocardiography. The patients were grouped based on an indexed right ventricular end-diastolic volume (RVEDV/BSA) of < 102 ml/m2 (Group 1) or > or = 102 ml/m2 (Group 2). We determined the sensitivity, specificity, positive and negative predictive values of QRS duration, and mean frontal plane QRS axis for predicting right ventricular volumes. RESULTS: A maximal QRS duration of > or = 150 ms or a northwest quadrant frontal plane QRS axis had 85% sensitivity, 86% specificity, 92% positive predictive value, and 75% negative predictive value for predicting an RVEDV/BSA of > or = 102 ml/m2. The mean QRS duration was significantly longer in Group 2 than in Group 1 patients (156 ms vs. 125 ms, p = 0.005). CONCLUSIONS: In patients late after repair of tetralogy of Fallot with significant pulmonary valve regurgitation a maximal manually measured QRS duration of > or = 150 ms and/or a frontal plane QRS northwest quadrant axis can predict patients with marked right ventricular enlargement. The presence of either of these findings on the ECG signifies patients who require further evaluation and consideration for pulmonary valve replacement.
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Irritating errors are called crotchets. This paper discusses the following electrocardiographic crotchets: memorizing patterns rather than using basic principles, failure to use the electrocardiogram as a diagnostic tool, failure to correlate all available data, failure to appreciate the limitation of the computer interpretation, failure to appreciate the diagnostic value of P-wave abnormalities, the identification and misuse of abnormal Q waves, the misuse of left or right axis deviation of the QRS complexes, the misuse of the amplitude of the QRS complexes as a sign of left ventricular hypertrophy, identification of left ventricular hypertrophy, failure to identify uncomplicated and complicated bundle-branch block, failure to identify secondary and primary T-wave abnormalities, failure to identify secondary and primary S-T abnormalities, and lack of knowledge of the U waves.