Progress in Cardiology 7

Tartalom

CONTENTS
1. ANOTHER LOOK AT CARDIAC EMBRYOLOGY 1
{Robert H. Anderson)
Early Development of the Heart 1
Further Development of the Atria 5
Maldevelopment of the Atrial Chambers 10
Atrial Situs 10
Anomalous Venous Drainage 13
Atrial Septal Defects 15
Cor Triatriatum 16
Normal Development of the Ventricles 16
Normal Ventricular Anatomy 22
Anatomy with Abnormal Ventricles and Chambers 24
Abnormal Development of the Ventricles 25
Atrioventricular Connections 25
Ventricular Septal Defect 38
Two-chambered Right Ventricle 38
Malformations of the Ventricular Outflow Tracts 38
Normal Development of the Truncus and Aortic Arches 46
Abnormal Development of the Truncus and Great Arteries 48
Abnormal Septation 48
Abnormalities of the Arterial Valves 49
Abnormalities of the Aortic Arches 49
Abnormalities of the Pulmonary Arteries 49
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2. ROLE OF THE AUTONOMIC NERVOUS SYSTEM IN REFLEX
CARDIOVASCULAR CONTROL 55
{P. I. Korner)
The Cardiovascular Control System 5f;
CNS Pathways 57
Receptor Properties 58
Arterial Baroreceptors 5g
Cardiac Baroreceptors 59
Arterial Chemoreceptors 60
Lung Inflation Receptors 61
Other Spinal Afferents 61
Open-loop Reflex Effects 61
Arterial Baroreceptor Reflex 61
Cardiopulmonary Baroreceptor Reflexes 64
Arterial Chemoreflex 67
Lung Inflation Reflex 69
Muscle Chemoreceptor Reflex 69
CNS Arterial Baroreflex "Resetting" 69
Circulatory Defenses of the Body's Oxygen Supply 73
Different Models of Tissue Hypoxia 73
Direct Circulatory Effects 73
Autonomic Patterns 76
Afferent Mechanisms 80
Role of Some Afferent Interactions 81
Grading ot Autonomic Responses 83
Comment 85
Some Pathophysiological Changes in Reflex Properties 85
Hypertension 86
Myocardial Infarction and Heart Failure 91
Concluding Remarks 92
3. EMOTIONS, CATECHOLAMINES AND THE ELECTROCARDIOGRAM 103
(Peter Taggart, Malcolm Car ruthers, and Walter Somerville)
Emotion and Catecholamines
Influence of Catecholamines on the Electrocardiogram
Aggression
Racing Drivers
City Car Drivers
Public Speakers
Anxiety "3
Parachutists 114
Climbers 1'5
Dental Treatment 116
Aversion " ^
Pseudoischemic ECO ' 1 ^
Practical Application 122
104
105
105
106 107 111
Contents xi
4. DIET, DRUGS, AND PULMONARY HYPERTENSION 125
{Donald Heath and J. M. Kay)
Pyrrolizidine Alkaloids and the Pulmonary Circulation 125
Toxicity of Pyrrolizidine Alkaloids in Animals 126
Toxicity of Pyrrolizidine Alkaloids in Man 129
Mechanism of Pulmonary Toxicity of Pyrrolizidine Alkaloids . . 130
Anorexigens and the Lung 131
Aminorex 131
Chlorphentermine 135
Phentermine Resinate 137
Oral Contraceptives and Pulmonary Vascular Disease 137
Conclusion 138
5. VIRUSES AND THE HEART: VIRAL MYOCARDITIS AND
CARDIOMYOPATHY 141
(Chuichi Kawai, Akira Matsumorl, Yasushi Kitaura, and Tadasu Takalsu)
Viral Myocarditis, Past and Present 141
Coxsackie Virus Infection 141
ECHO Virus 143
Other Cardiotropic Viruses 143
Clinical Manifestation of Viral Myocarditis 145
Diagnosis of Viral Myocarditis 145
Therapy 146
Idiopathic Myocarditis—Myocarditis of Unknown Etiology 147
Malignant Type (Fiedler's Myocarditis) 147
Benign Type 149
Silent Viral Infection and Subclinical Myocarditis 152
Incidence of Viral Myocarditis 152
Viral Myocarditis as a Possible Etiological Factor in Idiopathic
Cardiomyopathy 153
Experimental Coxsackie B Virus Myocarditis and Immunological .
Mechanisms in the Pathogenesis of Cardiomyopathy . . . . 156
6. HYPERTENSION AND ANGINA PECTORIS 163
{Francis G. Dunn and Edward D. Fröhlich)
Background and Introductory Discussion 163
Magnitude of Problem 164
Links between Hypertension and Coronary Arteiy Disease . . . 164
Pathophysiology 166
Determinants of Pressure 166
Myocardial Oxygen Consumption 167
Determinants of Myocardial Oxygen Consumption 169
Vessel Wall Changes 169
Myocardial Adaptation 170
Hemodynamic Effects 171
Hypertension (General) 171
Coronary Arterial Disease 174
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Integrative Concepts 175
Clinical Correlations with Physiology 176
Symptoms 176
Physical Examination 177
Laboratory Studies 179
Therapy 183
Hypertension 183
Coronary Arterial Disease 185
Hypertension and Coronary Artery Disease 186
Hypertension and Myocardial Infarction 188
Hypertension, Coronary Artery Disease, and Dissecting Aortic .
Aneurysm 188
Hypertension, Coronary Artery Disease, and Congestive Heart Failure 189
Prognosis 189
Summary 191
7. NEW OPERATIONS FOR CONGENITAL CARDIAC ANOMALIES . . 197
(Dwight C. McGoon)
Septation of the Univentricular Heart 198
Operative Technique 199
Results of Operation 201
Comment 202
Complete Atrioventricular Canal 205
Operative Technique 205
Results of Operation 205
Comment 206
Extracardiac Conduit 206
Truncus Arteriosus 207
Pulmonary Atresia with Ventricular Septal Defect 209
Pulmonary Atresia with Diminutive Pulmonary Arteries . . . .211
The Rastelli Operation for Transposition of the Great Arteries . . 212
Miscellaneous Procedures 214
8. RECENT ADVANCES IN PERIPHERAL VASCULAR DISEASE: THE
OUTLOOK FOR THE ISCHEMIC LOWER LIMB 219
(C. W. Jamieson and Charles A. C. Clyne)
Chronic Ischemia 220
Intermittent Claudication 220
Rest Pain and Gangrene 222
Acute Ischemia 224
Acute-on-Chronic Ischemia 225 - 240

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