Isoenzymes of creatine phosphokinase in acute myocardial infarction.

Serial determinations of creatine phosphokinase (CPK) isoenzymes were performed in 400 patients with definite acute myocardial infarction (AMI). The findings were correlated with the clinical course and the findings in another 300 cases of increased CPK levels. MB-CPK, the cardiac fraction, was present in all 400 cases of AMI and in only 5 cases of the 300 patients with high CPK due to causes other than AMI.

Cerebral arteriovenous fistula causing congestive heart failure in infancy.

The case of a newborn female in congestive heart failure due to a cerebral A-V fistula is presented. The cardiac manifestations in the presence of this condition are described, and the diagnostic importance of auscultation of the skull is stressed. Because of the precarious condition of most of these neonates, diagnostic procedures should be minimized if the clinical picture is compatible with this diagnosis, and cerebral angiography should be performed before any heart studies are undertaken.

"Coronary" T waves in the presence of complete left bundle-branch block: a normal variant?

The case report of a patient with an ECG pattern of intermittent left bundle-branch block, presenting inverted and symmetric ("coronary") T waves in leads V1 to V3 during periods of normal intraventricular conduction, is presented. The patient was followed up for eight years during which time no relevant symptoms appeared while extensive noninvasive investigations repeatedly failed to reveal any organic basis for the ECG changes. It is stressed that inverted, symmetric T waves in right-sided chest leads may be encountered in young, otherwise healthy subjects with intermittent left bundle-branch block during periods of normal intraventricular conduction.

Specific metabolic effects imposed by Streptococcus pneumoniae upon the response to femoral fracture in the rat.

The possible potentiation of an infection upon the metabolic consequences of trauma was tested in rats using a 2 X 2 block design which included control, femoral fracture, pneumococcal infection, and fracture plus infection groups. Infection introduced unique metabolic effects different from those of starvation, femoral fracture, or both together. Infection-induced effects included an accelerated conversion of 14C-alanine to glucose, higher serum haptoglobin, alpha2-macrofetoprotein, copper, and ceruloplasmin values, and lower serum iron, zinc, and transferrin concentrations.

Arteriosclerotic aneurysm of the coronary artery.

The findings in a patient with an angiographically proven aneurysm of the coronary artery are described. The case is reviewed in the light of 115 similar cases reported in the literature. The patient had had numerous episodes of variant angina, a feature not previously described in coronary arterial aneurysms, which may be related to embolic showers originating from the aneurysm.

Effect of inflammatory and noninflammatory stress on ketone bodies and free fatty acids in rats.

Both bacterial and viral infections prevented or reversed the expected ketogenic response induced in rats by starvation. In contrast, ketogenesis was not inhibited by stresses such as aseptic femoral fracture or immobilization by screen restraint. Infection had no effect on mitochondrial enzymes of terminal respiration and fatty acid oxidation.

Surveillance of pacemaker patients by an automatic pacemaker function analyzer.

An external, simply operated, fail-safe, automatic pacemaker function analyzer (PFA) has been designed for routine examination of ambulatory patients in local medical clinics and for continual surveillance of hospitalized patients in cardiology units. The instrument provides a comprehensive test of the pacing system, including the battery, pulse generator, and electrodes (leads), during varying heart activity. In the recorded ECG from 92 pacemaker patients, the PFA recognized all but 0.

Current problems in cardiology.

Many achievements in medicine in general, and in cardiology in particular, are the result of joint endeavors by cardiologists, surgeons, research workers and engineers. This paper deals briefly with some of the devices which have been developed as a result of this interdisciplinary cooperation. They included cardiac pace-makers, the use of computers in the analysis of electrocardiograms and echocardiograms in intensive coronary care units (ICCU) and in catheterization laboratories.

Isorhythmic Dissociation--a "physiological" arrhythmia.

The behavior of the sino-atrial mechanism in isorhythmic dissociation (IRD) was studied in 21 patients, nine with spontaneous IRD and 12 with artificially pacemaker-induced IRD following electrode placement for heart block. Successive P-P, R-R and P-R intervals and blood pressure (BP) fluctuations were determined and graphically interrelated at control and during IRD. Several features were observed: a.

The human coronary microcirculation: an electron microscopic study.

The ultrastructure of the terminal vascular bed of human coronary arteries was studied in the myocardial tissue obtained at surgery from different locations in the heart in five patients. The following vessels were identified: (1) Arterioles; slender and prolonged endothelial cells, flat nuclei and two to three layers of smooth muscle cells. (2) Precapillary sphincters: short endothelial cells, large nuclei bulging into the lumen, close myoendothelial junctions and a single layer of circular smooth muscle.

Chordal rupture: a common complication of myxomatous degeneration of the mitral valve.

In two patients with a clinical picture of acute mitral insufficiency, the presence of chordal rupture secondary to myxomatous degeneration of the mitral valve was disclosed during surgery. There was no evidence of previous rheumatic valvulitis, subacute bacterial endocarditis or other etiologies. It appears from the literature and from the cases described that ruptured chorda tendinea is a not uncommon complication of myxomatous transformation of the mitral valve.

Pulmonary hydatid embolization. Report on 2 operated cases and review of published reports.

Two patients with pulmonary hydatid embolization are described and commented upon in the light of 43 similar published cases. The diagnosis was strongly suspected from the medical history and the chest x-ray films and supported by angiocardiography. The angiocardiographic features of this condition have not been described previously in detail.

The operative problem of small left atrium in total anomalous pulmonary venous connection: report of 5 patients.

A moderately small left atrium is a common finding in total anomalous pulmonary venous connection (TAPVC). In most patients in whom the common pulmonary vein is anastomosed to the left atrium, the small size of this chamber does not interfere with good operative results. Recently a patient was encountered in whom the left atrium measured less than 2 cm in its greatest dimension.

The effect of bacterial infections on ketone concentrations in rat liver and blood and on free fatty acid concentrations in rat blood.

The concentrations of cytoplasmic lactate and pyruvate and the NAD+/NADH ratio and the concentrations of mitochondrial acetoacetate, beta-hydroxybutyrate, and the NAD+/NADH ratio were determined in normal, fed, and fasted rats, and in rats infected with Streptococcus pneumoniae, Francisella tularensis, and Salmonella typhimurium. The various infections were found to have little or no effect on the cytoplasmic parameters. In normal rats, fasting caused a marked increase in blood and hepatic ketone concentration and in serum free fatty acid content.

Left ventricular aneurysm of unusual aetiology: report of two cases.

Two young patients aged 14 and 25 with left ventricular aneurysms are described. In both, a clinical picture initiated by attacks of supraventricular tachycardia led to the discovery of the condition. In the first patient the clinical picture clearly suggested a traumatic aetiology.

False aneurysm of the left atrium after closed mitral commissurotomy: diagnosis by cineangiocardiogrpahy. Report of one case treated surgically.

A case of false aneurysm of the left atrium after closed mitral commissurotomy which was demonstrated by cineangiography is here reported. It is believed that the false aneurysm resulted from a tear of the left appendage which accidentally occurred during the surgical procedure. The diagnosis was suspected in plain chest X-ray and fluoroscopy.