Venous Pulse Tracings Research Articles

Magnetocardiography in the diagnosis of fetal arrhythmias

In 1899, Wenckebach described the phenomenon that bears his name. His initial observation was in a 40-year-old patient “with nervous temperament” who had an irregular pulse, in whom he worked out the mathematical relationship between atrial and ventricular activity. Often forgotten is the fact that Wenckebach accomplished this feat before the advent of clinical electrocardiography. While electrocardiographic tracings were recorded with Gabriel Lippmann’s capillary electrometer, for example, by Waller, it was Einthoven’s sentinel publication of the development of the galvanometer for the recording of the electrocardiogram in humans in 1902 that led to the adoption of electrocardiography in clinical studies. Wenckebach used carotid and jugular venous pulse tracings in his patient and went on to further study the phenomenon in frog suspended heart preparations. His methods, therefore, relied entirely on mechanical cardiac events, from which he hypothesized electrical events, interestingly, before the anatomic description of the atrioventricular (AV) node. Today’s fetal cardiologists are, for the most part in the same boat with Einthoven, forced to deduce electrical events in the fetal heart from recordings of mechanical events (via M-mode and Doppler tracings). Attempts at recording a standard electrocardiogram by the use of electrodes placed on the mother’s abdomen have not been reliably successful, likely owing to a low signal-to-noise ratio, exacerbated in late gestation by fetal vernix caseosa, which acts as an insulator. Thus, most fetal cardiologists are unable to observe characteristics that electrocardiographers rely on routinely, such as QRS duration, preexcitation, QRS axis, and P-wave morphology, as well as critical findings such as QT interval prolongation and T-wave alternans. Enter the magnetocardiogram (MCG). It is beyond the scope of this commentary to fully describe this technology. However, the technique records the changes in the electrical fields that are generated by cardiac electrical activity, producing a higher signal-to-noise ratio, through the use of a sensitive recording device. It is feasible for use in recording fetal cardiac electrical activity. This methodology is currently limited to a few centers worldwide.

Sir James Mackenzie: from auricular paralysis and nodal rhythm to auricular fibrillation

The aim of this paper is to underline the role of Sir James Mackenzie in stating that atrial fibrillation is a distinct and clinically important arrhythmia and that it is a common condition in patients with cardiac disease. Around 1900, a few clinical researchers were dealing with cardiac arrhythmias with the use of arterial and venous pulse tracings. Sir James Mackenzie, who has been one of the fathers of modern cardiology, introduced registration of the venous pulse at the bedside using the clinical polygraph he had invented. He applied the results of his experimental and clinical discoveries to the explanation of many kinds of arrhythmias before ECG introduction. In our paper, we have especially considered the three steps of his approach to atrial fibrillation, the first two developed in the pre-ECG era. The invention of an instrument of precision, the electrocardiograph, revolutionized the diagnosis of heart disease and catalyzed the formation of cardiology as a specialty.

Is it possible to estimate the pressure's change of the right atrium in arrhythmias from jugular venous pulse tracing (JVPT)?

Is it possible to estimate the pressure's change of the right atrium in arrhythmias from jugular venous pulse tracing (JVPT)?

The Noninvasive Diagnosis of Constrictive Pericarditis

Until the mid-20th century, the noninvasive diagnosis of constrictive pericarditis (CP) was based on a typical constellation of physical signs and detection of pericardial calcification on the chest X-ray. The introduction of phonocardiography, apexcardiography and jugular venous pulse tracings made it possible to record in graphic form certain important physical signs such as the pericardial ‘knock’ and prominent jugular venous Y descent. During the 1970s, the availability of M-mode echocardiograms recorded on strip charts was an important advance, because it permitted imaging of the presence and extent of pericardial thickening or calcification. It also enabled the cardiologist to visualize and time certain abnormalities of motion of the ventricular septum, ventricular wall or pulmonic valve, each of which was hailed, when first introduced, as a ‘new echo sign of CP’. However, most such signs are nonspecific, not consistently present, or subtle to perceive. On the two-dimensional echogram, typical appearances include normal to small ventricles within a rigid thick pericardial shell, with abrupt halting of ventricular expansion early in diastole, and biatrial dilatation. The Doppler pattern of transmitral flow shows diagnostic promise, in particular an abnormally short deceleration phase of rapid early left ventricular filling indicates ‘restrictive’ or ‘constrictive’ ventricular pathophysiology. Recent imaging techniques such as computed tomography and magnetic resonance imaging also have a diagnostic role in CP inasmuch as they may provide better visualization of the extent and degree of thickening of the whole pericardial perimeter than can be achieved by cardiac ultrasound. In conclusion, the diagnosis of CP depends on assessment of physical signs and noninvasive investigations taken together. CP may be suspected if several échocardiographie ‘signs’ are evident in the same patient, especially if pericardial thickening and normal left ventricle size, contraction and wall thickness are noted in a patient with frank apparent right-sided congestive failure but no significant valve disease.

Assessment of tricuspid regurgitation by directional analysis of right atrial systolic linear reflux echoes with contrast M-mode echocardiography

Twenty-seven individuals were studied for diagnostic assessment of tricuspid regurgitation (TR) using directional analysis of echo contrast lines on M-mode echocardiograms (MME). Group I consisted of 12 patients with physical findings, as well as phonocardiogram and jugular venous pulse tracings, compatible with TR. Group II consisted of five normal volunteers and 10 control patients without any evidence of congestive heart failure or TR. Following peripheral venous injection of contrast material, all 12 patients in group I demonstrated linear reflux contrast echoes in the right atrium (RA) on MME consisting of multiple posteriorly directed echo lines throughout systole behind the tricuspid valve. In addition, linear reflux contrast echoes in the hepatic vein directed away from its entry into the inferior vena cava were noted in 8 of the 12 patients by a cursor-placed MME. The remaining 15 patients in group II showed none of the above findings on contrast echocardiography. These observations indicate that linear systolic reflux contrast echoes in the RA behind the tricuspid valve on MME may be a specific and sensitive sign of TR.

Right sinus of Valsalva-right atrial fistula secondary to nonpenetrating chest trauma: a case report with description of noninvasive diagnostic features.

A sinus of Valsalva-right atrial fistula secondary to nonpenetrating chest trauma is described. Echocardiogrpahy demonstrated diastolic fluttering of the anterior tricuspid valve, suggesting a left-to-right shunt at the level of the right atrium. External jugular venous pulse tracings revealed large alpha waves and attenuation of the y descent. Cardiac catheterization disclosed a fistulous communication between the right sinus of Valsalva and right atrium. After surgical repair of the fistula, the ultrasonic recording and external pulse tracing reverted to normal. We believe this is the first description of such a shunt after blunt thoracic trauma.

Value of reference tracings in diagnosis and assessment of constrictive epi- and pericarditis.

Reference tracings are of great value in the diagnosis and assessment of constrictive pericarditis. The Q-h interval in the jugular venous pulse tracing is strongly correlated with the mean right atrial pressure (r=0.91). The left ventricular ejection time, the Q-A2 interval, and the Q-h interval are independent during atrial fibrillation from the preceding diastolic filling interval. This differentiates constrictive pericarditis from valvular heart disease. Cases with haemodynamically significant constrictive epicarditis are characterized by a rapid evolution, absence of pericardial calcification and absence of an early diastolic filling sound, a dominant a wave in the jugular venous pulse tracing, and a high early diastolic ventricular pressure. The haemodynamic behaviour is similar to that found in cases with myocardial fibrosis.

Apex cardiography in the elucidation of a double or multiple impulse apex beat

An atrial thrust, a bifid systolic impulse and a palpable diastolic bulge account for a double or multiple pulsation at the cardiac apex. Various causes and the mechanisms of production of these abnormalities of the apex beat were discussed. The role of the simultaneously recorded electrocardiogram, arterial and venous pulse tracing, apex cardiogram and phonocardiogram in the elucidation of this cardiac sign was demonstrated. It is to be hoped that an intelligent palpation of the precordial movements, often neglected, will become an integral part of the physical examination in the differential diagnosis of heart disease.

STUDIES ON THE VENOUS PULSE. I

A wave is described occurring in the venous pulse of man late in the diastolic period. This wave is a diastolic wave, since in an increase in length of the cardiac cycle it follows the h wave at its regular interval and becomes separated from the a wave of the next cardiac cycle. There is no wave on the venous pulse in man which can be referred to a contraction of the region of the great veins or sinus region of the heart. The h wave is a normal occurrence in the venous pulse curve from man and the dog. It occurs, according to the experience in this work, in all normal individuals in which the heart rate is sufficiently slow to prevent its obliteration by the a wave. The x wave, while not infrequent, is not always present in man even when the cardiac cycle is of sufficient length to prevent its obliteration by the a wave. This wave has not been observed in the dog. There is no wave on the venous pulse curve of the dog that can be referred to a contraction of the sinus region of the heart. Extra-systoles from stimulation of the venous region of the dog's heart produce no contraction of this region sufficiently pronounced to be recorded on a venous pulse tracing. After an interval of from 0.07 to 0.I second, representing the interval of veno-auricular conduction plus the latent period of the auricle, the auricle contracts. Extrasystoles from stimulation of the right auricle show, after an interval following the stimulus much shorter than that noted above and representing the latent period of the auricle, an a wave followed by ventricular systole after the usual a-c interval. It would seem probable that the sinus region of the heart, while capable of irritability, conductivity and rhythmicity (Erlanger and Blackman (I6)), does not normally manifest contractility.