No abstract

A left ventricular type of apical impulse, left ventricular preponderance in the electrocardiogram, and left ventricular enlargement in the chest X-ray are the three cardinal signs on which the diagnosis of left ventricular hypertrophy complicating hypertension is made clinically. In this paper we have analysed with the aid of optical records the detailed characteristics of the apical impulse in a series of patients with hypertension and related the nature and amount of left ventricular heave to the presence and degree of hypertrophy indicated in the electrocardiogram and X-ray of the chest. A new method of recording the apical impulse was used, in which a photoelectric cell recorded the displacement of the chest wall. THE INVESTIGATION DESCRIBEDThe Impulse Recorder. Instruments used previously to record prmcordial pulsation have been broadly divisible into two types: those measuring relative movement of a small area in an intercostal space in relation to the surrounding area of the chest wall (

No abstract

Five patients with constrictive pericarditis are described, in whom the main constriction was found at operation to be concentrated in an annular band forming a hoop around the pericardial sac, at the level of the atrio-ventricular grooves. In four of them, although the constriction was predominantly at this annulus, the effect on the heart was similar to that resulting from more generalized constriction. In the fifth, signs of functional pulmonary, mitral, and aortic stenosis developed seven years after the original operation for constrictive pericarditis, due to a double annular constriction, encircling the heart at the atrio-ventricular groove and also the root of the aorta and pulmonary artery.The five patients were under the care of Dr. William Evans and of Mr. Vernon Thompson, who operated upon them. Pre-operative investigation included postero-anterior and lateral radiograms, an electrocardiogram, and a phonocardiogram. In addition, cardiac catheterization was carried out before operation in two and in one it was repeated after operation. CLINICAL FEATURESThe patients were all male and their ages, at the time of operation, were 13, 46, 47, 54, and 66 years respectively. The boy, aged 13 years, who developed functional pulmonary, mitral, and aortic stenosis, will be discussed separately.In two of these four, aged 46 and 54, the diagnosis was made on finding a calcified pericardium in the radiogram, the symptoms being effort dyspncea only, without cedema. In addition, the older patient had a definite history of pericarditis at the age of 14 years; the younger had had a long and serious illness at the age of 17, which may have been complicated by pericarditis. In neither was there a family history of tuberculosis.In spite of the absence of cedema, both patients had a raised venous pressure. This measured 10 cm. above the sternal angle in the older and 5 cm. in the younger, when lying at 450 to the horizontal. The liver was enlarged one to two finger-breadths in both. In the jugular venous pulse, there was a clear early diastolic dip, and, on examination of the prxcordium, a diastolic rapid inflow beat was noted, accompanied by an early diastolic sound (Fig. 1) (Potain, 1856; Mounsey, 1955 and1957). The radiogram showed annular calcification of the pericardium around the middle of the pericardial sac, the plane of the ring lying sagitally, the posterior portion being slightly to the left and the anterior slightly to the right of the mid-line (Fig. 2). In both patients pulsation of the apex of the heart appeared relatively free on screening. The general heart size was normal in the younger patient and the electrocardiogram showed low voltage T waves in y 325 on 26 April 2019 by guest. Protected by copyright.

No abstract