Definite Heart Disease Research Articles

Noninvasive Tests in the Initial Evaluation of Heart Murmurs in Children

We prospectively examined the usefulness of electrocardiography, chest radiography, and M-mode echocardiography in discriminating between the presence and absence of heart disease in 280 children older than one month and newly referred for evaluation of a heart murmur. After taking a history and performing a physical examination but before reviewing diagnostic tests, we categorized the children as having "no heart disease" (142), "possible heart disease" (34), or "definite heart disease" (104). Among the children initially thought to have no heart disease, the diagnosis was changed after a review of diagnostic tests in eight--three with mitral-valve prolapse, two with possible cardiomyopathy, and three with no heart disease on follow-up. Among those initially thought to have possible heart disease, the tests changed the diagnosis to definite heart disease in four, of whom only one had heart disease (mitral-valve prolapse) on follow-up. In no case did a review of tests change the diagnosis of definite heart disease. We conclude that the results of diagnostic tests are unlikely to change the clinical diagnosis of no heart disease or definite heart disease, when made by a qualified pediatric cardiologist in children newly referred for evaluation of a heart murmur.

Congenital heart disease in a cohort of 19,502 births with long-term follow-up

The Child Health and Development Studies are longitudinal studies of pregnancy and the normal and abnormal development of the offspring. Women who were members of the Kaiser Foundation Health Plan entered the study in early pregnancy, and their children were examined frequently until the youngest child in the study was 5 years old. This is a more intensive follow-up than hitherto reported. Of the 19,044 live-born children, 163 had definite and another 31 had possible congenital heart disease; the crude incidence rates per 1,000 live births were 8.8 for definite congenital heart disease and 10.4 for definite plus possible congenital heart disease. The incidence rate of congenital heart disease was 7.9 percent among all stillborn fetuses subjected to autopsy and 10.2 percent among those in this group with autopsies evaluated as being detailed enough to detect heart disease. Among the live-born children with congenital heart disease, 21 died in the neonatal period and 22 died in later infancy and childhood; about half the deaths were judged to have been due to heart disease. About 30 percent of the children with congenital heart disease had associated severe anomalies of other systems. In the whole cohort, 50 children had diagnosed chromosomal abnormalities ( 2.63 1,000 live births ) and about 30 percent of them had congenital heart disease. Among the group of 163 children with definite congenital heart disease, the diagnosis was made in 46 percent by age 1 week, in 88.3 percent by age 1 year and in 98.8 percent by age 4 years.

Acute cerebral infarction. Evaluation and treatment.

Patients with recent strokes, suspected strokes, or transient ischemic attacks should be hospitalized to permit comprehensive evaluation and initiation of proper therapy. Immediate short-term measures to prevent further brain infarction may be advisable. In many cases definite heart or lung disease is present and requires primary treatment.

Effect of Propranolol on “Nonspecific” S-T Segment and T-Wave Changes: Differentiation of Coronary from Noncoronary ECG Changes

This study evaluates the effect of propranolol 10 to 20 mg per os, on so-called nonspecific S-T segment and T-wave changes in patients suspected of having coronary insufficiency. One hundred forty three subjects were tested. Of these, 41 patients with definite heart disease (31 coronary patients and ten with left heart hypertrophy and strain) served as a control. One hundred two patients with nonspecific S-T-T changes to be evaluated were divided into two subgroups according to their clinical history: 53 of these patients had no clinical history of heart disease and had precordial pain clinically not suggestive of coronary insufficiency; 49 patients, in whom, on clinical grounds, the diagnosis of coronary insufficiency remained doubtful and angina pectoris could not be definitely excluded. No patients in the control group reverted to normal ECG patterns after propanolol. In most subjects in whom, on clinical grounds, angina pectoris could be excluded, the ECG pattern reverted to normal. In the doubtful cases, both clinically and electrocardiographically, a good separation of coronary from noncoronary could be established. The mode of action and the rationale of this test, as well as its clinical significance, are discussed.

Tissue copper and lead content in ischemic heart disease.

An association between softness of municipal drinking water and an increase in cardiovascular disease has been repeatedly reported from several different countries. Lead and copper have both been reported to be increased in soft water and have been suggested as possible etiologic agents. Therefore, autopsy tissue was obtained and analyzed for these two metals. Fifty-five persons without and 46 persons with definite ischemic heart disease were studied. Renal lead was not significantly different. Hepatic copper was increased (P=.05) in subjects with ischemic heart disease in the absence of diabetes or hypertension.

Congenital heart disease in 56,109 births. Incidence and natural history.

Within a prospective study of 56,109 total births, 457 youngsters have been found to have congenital heart disease. The overall incidence is 8.14/1000 total births, 8.0/1000 for the Negro and 8.3/1000 for the white. A specific lesion has been identified for each patient and lesion frequencies given for each class of patient, stillbirth, neonatal death, infant death, childhood death, and survivors. The percentage of autopsies was 93% in the stillbirths, 89% in the neonatal deaths, and 76% for those dying after 28 days of age. Of those classified as having definite congenital heart disease, 93% have been examined by a pediatric cardiologist. The average follow-up time for the 272 survivors is 3 years. Thirty-five per cent of patients with ventricular septal defect surviving more than 6 months had their lesion close spontaneously; one-half of the survivors with tetralogy of Fallot were "atypical," and essentially equal numbers of blacks and whites had all types of coarctation of the aorta in line with the study population, which is 47% black and 53% white.

Screening Children for Heart Disease with a Portable Tape Recorder

CREENING of children for heart disease is at this time best done by an auscultatory technique. Previous articles have described the process of recording heart sounds on high fidelity equipment and listening to them on playback equipment (1-3). The main advantage of this process over direct auscultation is that the physician may listen to the tapes in a quiet place at a time of his, choice. A preliminary study to investigate the feasibility of this method for screening children's heart sounds for heart disease was begun in Chicago in 1954 (1). Satisfactory results led to a mass field trial on more than 33,000 school children in that city during 1959-60 (2,3). About 1,000 children were screened per week, using fixed equipment set up in a mobile trailer. Sixty-four cases of definite organic heart disease, a rate of 2 cases per 1,000 children screened, were found in the study. Half of these cases were previously unknown. In late 1961, the Advisory Committee of the Heart Disease Control Program, Chronic Diseases Division, Public Health Service, recommended that comparative and evaluative studies of this method be initiated using portable equipment assembled by the program from adaptable components available on the commercial market (4). Since the Pennsylvania Department of Health was interested in the method for possible use in school health programs, a preliminary field test using the ne-w equipment was conducted in that State during the 1962-63 school year. Lancaster County was selected as a trial area for several reasons. The Heart Association of Lancaster County, a new organization, was eager to initiate a community service project and the Pennsylvania Department of Health had a well-functioning cardiac clinic which could provide followup for the children found positive in screening. The county, a medium-sized community with 275,000 people, was ideal for a field trial. It had urban, suburban, and rural communities and schools. The study's main objectives were to: (a) test the practicability of using portable equipment by determining its portability and sturdiness and the frequency and cost of repairs and maintenance under field conditions; (b) determine how many children could be screened in an hour and in a school day; (c) ascertain the, number of tapes to which a physician could Dr. Myron M. Rubin, senior physician and associate cardiologist, Lancaster General Hospital, Lancaster, Pa., served for the Lancaster County Heart Association as medical administrator of the screening project described in this paper; Mrs. Bushnell served as project coordinator for the heart association. Dr. Hayman, associate director for preventive services, District of Columbia Department of Health, was at the time of the study medical director of region VI, Pennsylvania Department of Health. Dr. Levy is chief of the Congenital Heart Disease Section, Heart Disease Control Program, Division of Chronic Diseases, Public Health Service. The late Dr. William Kraus, director, division of chronic diseases, and Dr. Clarence A. Tinsman, chief, heart and metabolic diseases section, Pennsylvania Department of Health, were instrumental in obtaining support for this study, which was conducted under a contract from the Pennsylvania Department of Health.

The detection of heart disease in children. Results of a mass field trial with use of tape-recorded heart sounds.

A mass field trial was accomplished utilizing a heart sounds tape-recording procedure to detect organic heart disease in school children. The survey involved 35,934 children, with selection of an 8.2 per cent stratified random sample of Chicago elementary public-school children, drawn from eight representative geographic-socioeconomic-racial areas of the city. Of the total base population, 33,026 (91.9 per cent) were recorded. A total of 506 children was recalled for direct auscultation, based on suspicious findings on the tape recordings. Effective detection required that the tapes be interpreted by two specially trained cardiologists. Of the 506 children scheduled for recall, 492 were actually examined; 85 were evaluated as having probable organic heart disease, and were referred for complete work-up. Definite organic heart disease was ultimately diagnosed in 64 children, of whom 48 had congenital heart disease and 16 rheumatic heart disease. The prevalence rate of organic heart disease in the stratified random sample was 2 per 1,000, 1.5 for congenital heart disease and 0.5 for rheumatic heart disease. Of the total cases, 1 per 1,000 were previously unknown; all such cases have been brought under appropriate medical management as a result of their detection. A special study of the nonrespondents (those not tape recorded) revealed a six-fold higher prevalence rate of organic heart disease in these children, compared with those surveyed. A census was also made of cardiac children in special schools for the handicapped, in hospitals, or under home care. Based on the data from the sample, the nonrespondent study, and the foregoing census, the over-all prevalence rate of organic heart disease in Chicago elementary public-school children was estimated to be 3.4 per 1,000, 2.1 for congenital heart disease and 1.3 for rheumatic heart disease. A validity study was accomplished by randomly inserting 34 cases of known organic heart disease among 2,525 children in one school. Thirty-one of these 34 cases (91.2 per cent) were detected; two of the three cases missed had aortic insufficiency with highpitched grade II murmurs. It is concluded that this tape-recording procedure is a valid, feasible, and efficient method for the detection of organic heart disease in school children.

Bundle branch block without significant heart disease

The occurrence of bundle branch block in the absence of definite organic heart disease has been regarded as a rarity. On the other hand, it has been well recognized that some cases of bundle branch block, especially if the right branch is involved, carry an excellent prognosis. The present study includes several patients known to have had a bundle branch disturbance for a number of years without suffering any cardiac disability. They have developed no other objective signs of cardiac disease, and they should not be considered to have clinically significant cardiac disease. Only continued observation will determine whether or not the remaining individuals who now have bundle branch block without any other subjective or objective evidence of cardiac disease may be placed permanently in the same category.

SHORT P-R INTERVAL ASSOCIATED WITH PROLONGATION OF QRS COMPLEX; A CLINICAL STUDY DEMONSTRATING INTERESTING VARIATIONS

Article1 July 1944SHORT P-R INTERVAL ASSOCIATED WITH PROLONGATION OF QRS COMPLEX; A CLINICAL STUDY DEMONSTRATING INTERESTING VARIATIONSOSCAR A. PALATUCCI, JAMES E. KNIGHTONOSCAR A. PALATUCCISearch for more papers by this author, JAMES E. KNIGHTONSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-21-1-58 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptBecause of the recent interest in the syndrome of the short P-R interval associated with a prolonged QRS complex, without organic heart disease (Wolff-Parkinson-White syndrome), as evinced by the publication of several articles on this subject in the past two years, it is desired to add four other cases to the rapidly growing list of reports. In accordance with the sex predominance previously reported1all of these have occurred in healthy, young male subjects. Other characteristics include absence of definite organic heart disease, slurring of the initial ventricular deflection, a peculiar susceptibility to attacks of paroxysmal tachycardia, either supraventricular or...Bibliography1. BUTTERWORTHPOINDEXTER JSCA: Short P-R interval associated with a prolonged QRS complex, Arch. Int. Med., 1942, lxix, 437. CrossrefGoogle Scholar2. BISHOP LF: Bundle branch block with short P-R interval in individuals without organic heart disease: case report with review of literature, Am. Jr. Med. Sci., 1937, cxciv, 794. CrossrefGoogle Scholar3. HUNTERPAPPPARKINSON ACJ: The syndrome of short P-R interval, apparent bundle branch block, and associated paroxysmal tachycardia, Brit. Heart Jr., 1940, ii, 107. CrossrefGoogle Scholar4. WOLFERTHWOOD CCFC: The mechanism of production of short P-R intervals and prolonged QRS complexes in patients with presumably undamaged hearts: hypothesis of an accessory pathway of auriculo-ventricular conduction (Bundle of Kent), Am. Heart Jr., 1933, viii, 297. CrossrefGoogle Scholar5. WOLFERTHWOOD CCFC: Further observations on the mechanism of the production of a short P-R interval in association with prolongation of the QRS complex, Am. Heart Jr., 1941, xxii, 450. CrossrefGoogle Scholar6. HARTWELLBURRETTGRAYBIELWHITE ASJBAPD: The effect of exercise and of four commonly used drugs on normal human electrocardiogram, with particular reference to T wave changes, Jr. Clin. Invest., 1942, xxi, 409. CrossrefGoogle Scholar7. SPRAGUE HB: Modern concepts of cardiovascular disease, 1941, x, 10. Google Scholar8. FOXTRAVELLMOLOFSKY TTJL: Action of digitalis on conduction in the syndrome of short P-R interval and prolonged QRS complex, Arch. Int. Med., 1943, lxxi, 206. CrossrefGoogle Scholar9. LEVINEBEESON SAPB: The Wolff-Parkinson-White syndrome, with paroxysms of ventricular tachycardia, Am. Heart Jr., 1941, xxii, 401. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: *Received for publication March 27, 1943. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byMimics of ventricular tachycardia associated with the W-P-W syndromeWolff-Parkinson-White syndromeDie Rhythmusstörungen des Herzens (einschließlich der intramuralen Leitungsstörungen und des Alternans)The Wolff-Parkinson-White syndrome associated with paroxysmal ventricular tachycardiaA case of Wolff-Parkinson-White syndrome with paroxysmal ventricular tachycardiaThe effect of atropine on the cardiac mechanism in anomalous atrioventricular conductionVentricular Tachycardia during Cardiac Catheterization of Patient with Wolff-Parkinson-White SyndromeModification of the electrocardiogram of myocardial infarction by anomalous atrioventricular excitation (Wolff-Parkinson-White syndrome)The electrocardiographic diagnosis of acute myocardial infarction in the presence of the Wolff-Parkinson-White syndromeWolff-Parkinson-White syndrome 1 July 1944Volume 21, Issue 1Page: 58-69KeywordsCardiovascular therapyTachycardia ePublished: 1 December 2008 Issue Published: 1 July 1944 PDF downloadLoading ...

Statistical studies bearing on problems in the classification of heart disease: III. Heart disease in children

1. 1. Of 500 children ranging in age from two to twenty-two years, observed in a heart clinic, four-fifths presented a rheumatic history. 2. 2. Congenital heart defects occurred in 50, or 11.2 per cent. In 18 of these there was subsequent rheumatic infection. 3. 3. Children with “possible heart disease” (systolic murmur heard between the second and fourth left interspaces) retained the same physical signs without progress over a period of years. 4. 4. The average age at onset of rheumatic infection was 7.3 years. In one-half the children the onset occurred between the ages of six and nine years. 5. 5. Rheumatic infection concerns itself primarily with children of the grade-school age; about the age of twelve the tendency to infection begins to diminish. 6. 6. Three-fourths of 413 children with a rheumatic history developed definite heart disease and one-fourth were “potential heart disease” cases. 7. 7. The heart is probably always involved to some extent at the time of the first infection (some evidence of involvement was noted in 91 per cent at the time of last observation), although marked involvement was noted in only 63 per cent within one year of onset. 8. 8. The associated manifestations of rheumatic infection were not indicative of the degree of heart involvement. Growing and joint pains bear the same relation to heart involvement as polyarthritis or chorea. 9. 9. The degree of heart involvement seemed closely related to the number of attacks of carditis. 10. 10. Twelve per cent of the children died. Eighty-eight per cent of the deaths were due to rheumatic heart disease. The most common age at death was between eleven and fourteen years. 11. 11. The earlier the age of onset of infection the greater is the number of recurrences. The later the age at onset the greater is the number of recurrences within one year.