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At least 559 records · Page 31Linked to original sources
PubMed1975

Arrhythmias following cardiac surgery: relation to serum digoxin levels.

Arrhythmias were analyzed in 50 patients undergoing cardiac surgery: 27 with valve surgery, 15 with coronary artery bypass (CAB), 5 with CAB and valve surgery, and 3 with miscellaneous procedures. The role of electrolyte abnormalities, pericarditis, serum osmolarity, digoxin level, and the type of surgery performed was evaluated. Thirty-seven out of 50 patients (74 per cent) had a postoperative arrhythmia, and a total of 78 different arrhythmias were noted. Twenty-six out of 27 patients with valve surgery had an arrhythmia vs. six out of 15 patients with CAB (p less than 0.001). Atrial fibrillation was the most common arrhythmia in all groups. Although postoperative hypocalcemia, hypomagnesemia, pericarditis, and wide shifts in osmolarity were common, they did not correlate with arrhythmias. Seventeen patients developed postoperative arrhythmias compatible with digitalis toxicity, including junctional rhythm, atrioventricular dissociation, or atrial tachycardia with block. However, the range of serum digoxin levels in these patients was zero to 2.80 ng. per milliliter. This suggests increased sensitivity to digitalis glycosides or the effects of surgical trauma as the etiology of arrhythmia in many patients. The distinction between digitalis-induced arrhythmia and spontaneously occurring arrhythmia cannot be made with certainty in most postoperative patients. Therapy should reflect an awareness of the potential for postoperative digitoxicity.

Aortic Valve↗
PubMed1975

A His bundle electrocardiographic analysis of cardiac conduction in the pediatric and adolescent patient.

Bipolar electrode catheter recordings of His bundle electrograms with three simultaneously recorded surface electrocardiographic leads were obtained from 30 pediatric and adolescent patients (aged 3 to 18 years). In 14 patients, cardiac murmurs were proved to be innocent by cardiac catheterization. The control conduction intervals were compared to those of 13 patients with congenital heart disease, and three with acquired heart disease (myocardiopathy, rheumatic valvular disease, and Friedreich's ataxia). P-R, intra-atrial (P-A), A-V nodal (A-H), and intraventricular (H-V) conduction intervals were measured to the nearest 5 msec. Conduction delays were analyzed in each of the three components of the P-R interval. These delays occurred both in single components of the system as well as in combined conduction delays and were not always demonstrable by surface electrocardiograms. The Wenckebach phenomenon induced by atrial pacing was localized to the A-V node as well as the His-Purkinje system. This technique of intracardiac electrogram recordings is safe, does not significantly prolong cardiac atheterization time, and often yields unique and useful data concerning A-V conduction.

Adolescent↗
PubMed1975

Sound envelope averaging and the differential diagnosis of systolic murmurs.

Phonocardiography previously has been limited in scope because the attained suboptimal signal-to-noise ratio has interfered with the sensitivity and clarity of recordings. A new system is described that reduces this problem by utilizing demodulation and synchronous averaging of the "envelop" of cardiac sounds. A limited survey of the differential diagnostic capabilities of this technique is presented for 80 patients having one of six common forms of pathological systolic murmurs and an 89 per cent diagnostic accuracy is demonstrated. This system promises to be a valuable noninvasive adjunct in cardiologic diagnosis research and education.

Diagnosis, Differential↗
PubMed1975

The problem of nonejection systolic clicks and associated mitral systolic murmurs: emphasis on the billowing mitral leaflet syndrome.

Nonejection clicks and associated mitral systolic murmurs are common in routine cardiologic practice and can result from multiple etiologic factors affecting the complex mitral valve mechanism. Such factors include a specific syndrome the essential feature of which is that the mitral leaflets or part thereof, primarily the posterior one, are voluminous. The syndrome has stimulated widespread interest and study during the last decade and various descriptive terms, including the "billowing mitral leaflet syndrome" (BMLS), have been applied to it. A familial occurrence of the BMLS may be detected and symptoms include chest pain, palpitations, syncope, and anxiety. Arrhythmias, conduction defects, and ECG abnormalities which mimic occlusive coronary artery disease are important features which remain ill understood. It is suggested that there is a possible relationship between the so-called "athlete's heart" and the BMLS. We also postulate that the entity of acute myocardial infarction without demonstrable occlusive coronary artery disease is, in at least some instances, a complication of the BMLS-possibly on the basis of coronary spasm. More severe mitral regurgitation, infective endocarditis, or, rarely, sudden death may supervene in the BMLS but we conclude, from published data and our own experience, that the prognosis is generally good.

Adolescent↗
PubMed1978

Origin of the basal systolic murmurs in mitral stenosis. A study with intracardiac phonocardiography.

In order to study the origin of the basal systolic murmurs in mitral stenosis, left and right heart catheterization was performed in 18 patients with mitral stenosis using intracardiac phonocardiography. Our data revealed that the basal systolic murmurs originated in the aorta, the pulmonary artery, and the outflow tract of the right ventricle. In 14 cases, we noted the maximal ejection systolic murmur in the aorta near the aortic valve. However, in two cases, there was a loud systolic murmur in the pulmonary artery. These murmurs occurred in early to mild-systole and were crescendo-decrescendo in configuration. The pitch of the murmur ranged from low to medium frequency in the majority of cases. They are produced by the turbulence of blood flow in the aorta and the pulmonary artery. A late systolic murmur was also recorded in the outflow tract of the right ventricle in two patients. This is thought to occur due to functional or relative infundibular stenosis of the right ventricle. It differs in location and timing from those in the aorta and the pulmonary artery. The outflow tract of the right ventricle is regarded as the third origin of the basal systolic murmur in mitral stenosis.

Adult↗
PubMed1978

The effects of exercise on the amplitude of the first heart sound in normal subjects.

The cardiovascular responses to isometric and dynamic exercise have been studied in six normal subjects, before and after intravenous propranolol, using the amplitude of the first heart sound (S1), measured from an ultra-low frequency phonocardiogram, as an index of left ventricular mechanical performance. Dynamic exercise caused significant increases in heart rate and S1 amplitude which were largely inhibited by beta-adrenergic blockade. Isometric exercise also produced increases in heart rate and blood pressure, but a decrease in S1 amplitude. Propranolol had no significant effect on the cardiovascular response to isometric exercise. These results confirm previous suggestions that, in contrast to dynamic exercise, the normal cardiovascular responses to isometric exercise are relatively independent of the beta-adrenergic nervous system. Possible reasons why the improvement in left ventricular performance, which has previously been shown to occur during isometric handgrip, was not reflected in the phonocardiogram, are also discussed.

Adult↗
PubMed1979

Maladie du Roger 1879: a new translation for the centenary.

A new translation of Roger's description of the clinical and anatomical findings in uncomplicated small VSD is presented. Reappraisal of Roger's observations in the light of our present understanding confirms that only our attitudes change; diseases remain the same.

Child↗