Correlation of X-ray Plates, Clinical Findings and Blood Pressure Readings in a Series of 300 Cases

Abstract

SINCE July, 1925, over 2,700 health examinations have been made for the Employees' Mutual Benefit Association of Wisconsin. Among the X-ray plates taken, there are 300 of the chest, which have been studied with special reference to blood pressure. It is very difficult to know the normal blood pressure or to determine the normal heart size for any given individual, but by comparing the variations of blood pressure at intervals and the cardiac shadow as it appears on several successive X-ray films, it may be possible to reach a definite conclusion. In each of the 2,700 examinations, blood pressure readings were made from both arms, and any abnormal variation was followed in a few days by a supplementary test. A group of cases was found having an increase in the cardiac shadow in both the aortic and left ventricular areas. These cases had pulse pressures of 80 or over and had, on physical examination, evidence of both aortic and mitral lesions. A group of cases of mitral insufficiency showed an increase of cardiac shadow in the left ventricular area and a pulse pressure of 50 or over, with a slight increase in heart rate and slight dyspnea after exercise. A group of cases of mitral regurgitation with pulse pressure of an average of 40 and blood pressure, systolic, 120 to 135, had no dyspnea on exertion or increase in pulse rate after exercise. Normal blood pressure and pulse pressure with marked enlargement of the cardiac shadow would seem to indicate an adjustment of circulation. Five trained athletes with systolic blood pressure of 100 were examined. It is difficult to say whether in all cases this was a normal low blood pressure or merely a temporary one. High systolic blood pressure, 150 and over, may show evidence of increase in X-ray shadow in both aortic and left ventricular areas. A lowering of systolic blood pressure or a short pulse pressure may be more important than high blood pressure. A study of X-ray slides of the following groups was made: (1) Those having a pulse rate approaching 90; (2) those with evidence of dyspnea on exertion; (3) those with high systolic or diastolic blood pressure; (4) those with short or long pulse pressure. Examination of the lungs should precede physical examination of the heart. Careful inspection, palpation, and percussion should always precede auscultation. Special attention should be called to the shape of the chest, any bony malformation, the movement of the costo-sternal angles on inspiration and expiration, deviation of the trachea to the right or left—in fact, any pathological condition of the lungs that would either embarrass the heart's action or change its anatomical position. Percussion and inspection should be given first place in physical examination, and auscultation used to clarify these findings. The internist should realize the limitations of physical examination. He should know the superficial areas that are most accessible.