Chronic Rheumatic Valvular Heart Disease Research Articles

THE ELECTROCARDIOGRAM IN CHILDREN WITH CHRONIC RHEUMATIC HEART DISEASE AND HEART FAILURE

During an investigation of the effects of digitalis on the electrocardiograms of children with rheumatic fever and chronic valvular heart disease 1 it became imperative to study the usual electrocardiograms seen in children with this condition. Digitalis affects various portions of the conduction mechanism of the heart, and the interpretation of such changes can be made only from a comparison with the usual tracing obtained. Although there have been several comprehensive studies of the electrocardiograms of normal children, 2 similar investigations have not been made in children with chronic rheumatic valvular heart disease and heart failure. Incomplete studies are mentioned by Hecht 3 and Coombs. 4 The present study was made on eighty-seven children with chronic rheumatic heart disease in various stages of heart failure. The majority were patients observed in the cardiac clinic maintained by the Montefiore Hospital; others were bed patients in the wards of the institution. The

"DIGITALIS STUDIES ON CHILDREN WITH HEART DISEASE"

To the Editor :—I was much interested in reading Dr. Sidney P. Schwartz and Dr. John B. Schwedel's article entitled Digitalis Studies on Children with Heart Disease, which appeared on pages 298 to 315 of the February number of theAmerican Journal of Diseases of Children. The conclusion that and vomiting cannot be used as criteria in estimating the optimal therapeutic dose of digitalis for children with chronic rheumatic valvular heart disease and signs of heart failure reminds me of the negro convict's lawyer who told his client that he could not be arrested for the crime with which he was charged. The negro replied, That may be so, boss, but here I is. The studies which A. W. Jacobsen and I made four years ago (Am. J. Dis. Child. 32 :373 [Sept.] 1926) demonstrated that nausea and vomiting not only could be but were used successfully as criteria