Ejection phase indexes by invasive and noninvasive methods: an apexcardiographic, echocardiographic and ventriculographic correlative study.

A new noninvasive method of measuring ejection fraction and the mean velocity of circumferential fiber shortening from the apexcardiogram and carotid pulse tracing is described and compared with the echocardiographic and angiographic measurement of these values in 35 patients with coronary artery disease. The correlations of the apexcardiographic derived values with the angiographic measurements were excellent (r = 0.89 and 0.96, respectively, P less than 0.001) even though asynergy was present in 14 of the 35 patients. Only 6 percent of the derived ejection fractions and none of the mean velocity measurements were discordant with the angiographic data. In contrast, correlations of the echocardiographic measurements of the ejection phase indexes with the same angiographic data were poorer (r = 0.75 and 0.66, respectively, for ejection fraction and mean velocity, P less than 0.01). Twenty-eight percent of echocardiographic ejection fraction measurements and 20 percent of the echocardiographic mean velocity measurements were discordant with the angiographic data. It is concluded that the apexcardiogram is a dependable bedside test for estimating left ventricular function and is superior to the echocardiogram for measuring ejection phase indexes.

Effect of heparin in anticoagulant doses on the electrocardiogram and cardiac enzymes in patients with acute myocardial infarction. A clinical pilot study.

The effect of heparin in clinical anticoagulant doses on S-T segment and cardiac enzymes was studied in 18 patients with acute myocardial infarction by electrocardiogram and enzyme evaluation 1 hour and 24 hours after initial heparin infusion. Intestinal mucosa heparin was given by infusion, 10,000 units after the admission electrocardiogram, and 5,000 units every 6 hours. Data in the nine control and nine treated patients were statistically similar on admission. The electrocardiograph findings were improved, but not significantly, 1 hour after administration of heparin. At 24 hours of heparin therapy, the S-T deviations were reduced 64% (from 139 +/- 2.1 [standard error of the mean] to 50.5 +/- 1.2 mm); in control patients S-T deviations were reduced 21% (from 109 +/- 1.8 to 86 +/- 0.9 mm (t=2.9, P less than 0.019). At 24% hours electrocardiographic leads with 2 mm or more deviation were reduced 86% in heparin-treated patients and 28% in control subjects. Cardiac enzymes were comparably elevated at 24 and 48 hours in both groups, with no clear trend. It is concluded that heparin in anticoagulant doses reduces the 12 lead electrocardiographic pattern of injury without discernibly modifying cardiac enzymes. The question of heparin efficacy in acute myocardial ischemic injury, reopened by findings with large dose heparin in therapy in dogs and anticoagulant dose in this study, awaits further expanded investigation.

Atrial septal defect--ostium secundum variety. A review of 117 cases.

Atrial septal defect is one of the most common congenital cardiac lesions seen at most centers. Typically one notes on physical examination a pulmonic lift with associated right ventricular lift. Wide splitting of the second sound is assocated with a Grade II to III systolic pulmonary ejection murmur. Characteristically, the electrocardiograph discloses an incomplete or complete right bundle branch block. This lesion is often well tolerated into the third and fourth decades of life. Subsequently one notes progressive cardiac symptomatology and eventual inoperability due to fixed pulmonary vascular changes. Our experience would indicate this entity to be readily correctable with an extremely low morbidity and mortality. Good result can be anticipated in all age groups.

Intracardiac Shunt-Use of the Hydrogen-Sensitive Catheter to Clarify False Positive Diagnosis of Left-to-Right Shunt.

The charts of 142 patients who had diagnostic right heart catheterization with conventional oximetry, oxygen content determinations and hydrogen electrode curve recording for left-to-right shunt were reviewed. A false positive diagnosis of surgical significance would have been made in nine patients if the hydrogen electrode had not been used. In addition, a diagnosis of left-to-right shunt could have been made at the wrong chamber level in three additional cases.

Pulmonary artery stenosis, a frequent part of the congenital rubella syndrome.

The case records, cardiac catheterization and angiographic findings in 32 patients were reviewed to illustrate the high incidence of pulmonary artery stenosis in congenital rubella syndrome. These interesting lesions often are of equivocal or unknown clinical significance compared with the other malformations that beset these patients, but to know of them explains certain physical findings and to study their incidence is an unusual opportunity to pinpoint a definite cause for a congenital cardiac lesion.

Electrical cardioversion-effectiveness of quinidine prophylaxis following countershock.

Direct current countershock was given to 46 patients with chronic atrial fibrillation of diverse causes, with successful conversion in 87 per cent of them. Patients were observed while receiving quinidine prophylaxis, with serial determination of serum quinidine levels, for up to 22 months. Two quinidine preparations were employed, one a long-acting form, in various dosage regimens and both preparations were found to be effective prophylactic agents for maintaining reliable serum quinidine levels. Fifty per cent of patients remained in normal sinus rhythm at three months, 28 per cent at six months and 13 per cent at twelve months.