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[Diagnosis of pulmonary hypertension with the aid of electrokymography].

Electrokymography was carried out in 198 patients with cor pulmonale and mitral defect with clinical signs of elevated blood pressure in the pulmonary circulation. The electrokymographic signs of pulmonary hypertension were developed, as well as those for the evaluation of the functional state of the myocardium of both ventricles. In making the diagnosis of elevated--pressure in the pulmonary artery system of special importance is the analysis of the electrokymogrammes of the pulmonary artery, right atrium and right ventricle, and the determination of the pulse wave speed along the pulmonary vessels. The study of the electrokymogrammes and their comparison with the clinical pattern permitted to classify all the electrokymographic criteria of pulmonary hypertension into true and relative ones, requiring verification. A differentiated analysis of the systolic and diastolic phases of the left and right ventricles was conducted. All the phases of the cardiac cycle were calculated with due regard of the contractions rate. The phase analysis permitted to assess separately the functional state of the myocardium of both halves of the heart. Electrokymography helped to reveal pulmonary hypertension that could be often diagnosed with its aid at an early stage. It permitted to diagnos an initial reduction of the contractile finction of the right ventricle.

Electrokymography

[Study of mechanical work of the heart in patients with toxic goiter by means of electrokymography].

A study was made of the electrokymogram (EKG) of the left and the right ventricle of the heart in 54 patients suffering from toxic goiter chiefly with a marked clinical picture of the disease. Electrokymography permitted to detect enlargement of the ventricles. Excited pulsation of the ventricles with a rapid rise in systole and a sharp fall in diastole pointed to myocardial hyperfunction. Rapid and energetic contractions of the heart led to intensification of the oscillatory movements of the heart in the chest cavity, and to its rotation. A low-wave pulsation with small frequent waves of low amplitude pointed to a reduction of the contractile function of the myocardium; this was also indicated by the increase of the latent EKG time and the paradoxical movements at the beginning of systole. After the effective treatment the EKG of the ventricles showed almost no difference from the curves of healthy individuals. Changes in the character of the ventricular pulsation in toxic goiter were observed already at the early phase of the disease when some of the patients still displayed no changes in the ECG, and no X-ray data pointing to the affection of the heart were as yet evident. In the presence of phenomena of cardiac insufficiency the EKG objectively proved the presence of changes in the myocardium. The EKG data corresponded to the severity of the clinical picture of the disease. Electrokymography serves as a valuable method for analysis of the function of myocardium of the ventricles in toxic goiter.

Adolescent

[Surface and electrokymography of the ventricular wall of the heart in a comparison of myocardial function in patients with myocardial infarct].

We examined 21 patients with infarction of the anterior or lateral wall and 29 patients with infarction of the posterior wall at an average age of 48.3 years in rehabilitation stage II by means of kymographic methods. By reason of our results the surface kymogramme is a valuable screening method for the recognition of a pathological movement of the ventricular wall in myocardial infarction. The simultaneously performed electrokymographic examinations on patients with myocardial infarction referred to a relatively high proportion of clinically insignificant surface-kymographic findings. Except from this is the surface-kymographic motion paradoxis, which in every case also electrokymographically showed a considerable disturbance of the movement of the ventricular wall in the sense of a dynamic aneurysm of the heart wall after Heckmann with a decreased heart function. A pathological electrokymogramme of the heart wall was to be found only from stage II of the heart function after Roskamm, i.e. with reduction of the contractility of the heart in rest. From this results the clinical significance of the pathological electrokymogramme as reference to a considerable functional disturbance of the myocardium, partly without any subjective complaints present at the time of examination or clinical symptoms of heart insufficiency. The importance of these findings for rehabilitation will be possible only after longitudinal investigations of many years. As preliminary examination for electrokymography in chronic ischaemic heart disease a surface kymogramme is to be demanded, since in an unconspicuous surface kymogramme no indication to electrokymography is given.

Coronary Disease