Download Selective Ventricular Chamber Enlargement

Selective
Study
Ventricular
of
the
Chamber
Electrocardiographic
Accuracy
in
and
Congenital
J.
WILLIAM
and
KUZMAN,
M.D.,
ITH
THE
DEVELOPMENT
cal techniques
ious
and
congenital
ions,
the
need
diagnosis
became
developed
to
this
been
cardiac
angiocardiography.
chamber
methods
due
examination
establishing
an
accurate
anatomic
di-
numerous
also been
arpub-
stressing
various
permit
chamber
well as
identification
of specific
cardiac
enlargements
radiographically
as
electrocardiographically.
More
rethe
have
been
to findings
limitations
and
data
in a few
obtained
and
specific
paucity
with
of
features
these
emphasized
at surgery
instances
when
at cardiac
contrast
of
studies.
the
assess
method
clearly
meth-
interest
in
the
relative
*From
San
ed by the
and
Donald
Diego
San
County
specific
chamber
carunwas
each
ventricular
Diego
County
Heart
N.
Sharp
Memorial
in
in
patients
73 cases
identifying
wherein
specific
occurred
of
to
study.
It
identify
or
when
a basis
to
credit
it did not exist
for diagnostic
two
cardiologists
findings
which
ployed
for
ricular
hypertrophy.
determining
additional
and
by
In
criteria
Winsor”
Radiologic
carried
examination
might
unduly
The
Lyons’7
right
and
the
pediatric
outlined
were
left
by
often
out
without
in each
the
chest
with
barium
ic examination
was
diologist
interpreting
SupportAssociation,
Community
tients
with
Hospital.
had
barium;
conventional
however,
299
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ventgroup
Ziegler’1
clinical
instance
several
board
certified
radiologists.
one patients
had conventional
five
these
in-
criteria
were
em-
employed.
studies,
were
without
physical
their
interpretation.
by Sokolow
and
the
study
had
read in-
electrocardiograms
of history,
other
in this
included
by
benefit
data,
was
stimulated
by
contrast as to the
Center.
pur-
Heart
Center
and anatomic
enlargement
All patients
routine
13 lead
proved
cases
of
heart
disease.
Our
Heart
be
consecutive
methods
that
failure
the
the
of
620
Diego
County
An etiologic
two
noted
be
dependently
accuracy
of
San
between
should
fluence
listed
two
methods
of study
noting frequent
sharp
dictated
to
METHODS
enlargement
or
in
or absence
error.
of the
of
AND
chamber
Because
selective
academ-
course
ventricular
diagnostic
enlargement
and acquired
board.
than
presence
was feasible
discrepancy
concerned
in establishing
chamber
congenital
charts
compared
with
catheterization
limitations
review
enlargement
diagnosis
a major
specifically
the
the
chamber
enlargement
was
considered
as
when
comor necropsy,
accuracy of the electrocardiogram
and
diac
roentgenography,
this study
was
dertaken.
The
purpose
of this review
to
more
surgical
reviewed.
comparative
reports
evaluating
that
two
or
at the
were
lished5’
ods18’4
pared
The
seen
period
have
cently
often
MATERIALS
a
agnosis.
During
this
ticles
and
textbooks
the
medical
to
sis on
cardiovascular
assumed
by
presented
sued.
as Leatham,’
has
been
with
empha-
in
the
predicted
being
cardiac-surgical
difference
of specific chamber
of
the stimulus
of physicians
such
Wood,2
and
others,34
there
gradual
return
to the bedside
a careful
enlargement
in patients
ic interest, for
been
foremost
addition,
a weekly
The
catheterization
In
two
to
Various
M.D.
California
the
les-
Disease*
S. YusKIs,
ANTON
specific
have
need,
AND
Diagnostic
Heart
SURGI-
anatomic
requisite.
Roentgenologic
of var-
cardiac
accurate
techniques
meet
have
and
an
a prime
diagnostic
which
acquired
for
specialized
OF
for correction
Diego,
A Comparative
Acquired
F.C.C.P.,
San
W
Enlargement:
swallow.
performed
the
films.
the
by
Sixtyviews
of
Fluoroscopby the
Four
five
view
fluoroscopy
rapastudy
was
300KUZMAN
done
AND
by
the
tients
were
lateral
logic
views
report
ular
chamber
without
referring
internist.
noted
to
Eight
pa-
PA
and
only
of the chest.
The official
radioindicating
the specific
ventricenlargement
was
angiocardiography
plete
history
and
50
Additional
patients.
obtained
together
physical
at surgery
and/or
In 14 patients
so typical
as
diagnosis
on
are summarized
necropsy
clinical
grounds
in Table
1.
findings
absolute
TABLE
of
2
2
stenosis
Aortic
insufficiency
Ventricular
3
Undiagnosed
Grade
II
CONFIRMATION
PATIENTS:
and
septal
aortic
OF
defect
precordial
insufficiency
1 Mitral
insufficiency
in the
systolic
and
hearts-One
form
of
mitral
insufficiency
surgery
had
for
pectus
was
established.
The
chamber
enlargement
electrocardiogram
cent).
with
The
age
proper
was
in 46
ventricular
predicted
cases,
distribution
heart
congenital
Table
in
enlargement
attributed
most
in
disease
by the
(92
per
the
frequently
encountered
noted.
The
a diagnostic
In
group
A
error
were
each
attributed
encountered
First
(B)
10
-
Second
were
(C)
2
(D)
1
(E)
2
-
-
Fifth
order
the
LESIONS:
in Table
in both
to
logic
view
error
advisable
respect
ble 3).
of
the
noted
to analyze
to specific
in
B.
6-Ventricular
stenosis
X-ray-l
C.
8-Atrial
Decade
Decade
and
over
incidence
this
further
anatomic
additional
group,
this
OF
HEART
septal
stenosis
X-ray--U
Decade
high
diagnostic
appeared
This
4-AccuRAcy
7-Ventricular
in-
is summar-
of
radio-
it was
series
diagnosis
felt
with
(Ta-
METHOD
IN
DISEASE:
defect
with
severe
(Cyanotic
tetralogy
Electrocardiogram-7
septal
(acyanotic
septal
sur-
patients.
shed
subject.
defect
X-ray--U
In
this
4.
pulmonary
of
Fallot)
Decade
Fourth
in
when
follow-up
study
significant
cardiac
enNormal
electrocardio-
recorded
in
Decade
Third
was
the
radiographic
ventricular
enlarge-
further
breakdown
of the
encountered
radiologically,
on
A.
-
single
variance
is presented
CONGENITAL
35
which
instance,
left
CONGENITAL
(A)
to wrong
Heart:
Two
patients
and
one with
pectus
the
heart
that
no
existed.
TABLE
2-50
it did
electrocardiogram
demonstrated
accuracy
of 86 per cent in this
formation
2.
TABLE
when
acquired
in
warranted
ized
or
Ventricle
Ventricle
15-Left
grams
excavatum
stenosis
Chamber
ment
to
indicated
largement
murmur
enlargement
identified
the
X-RAY
chamber
enlargement
lesion
cases)
pulmonary
Chamber
not
exist
vey.
study
(Roger)
(seven
OF
when
ventricle
(a)
13-Right
cham-
ERRORS:
latter
lesion.
Group
C-Normal
with
normal
hearts,
stenosis
manifestation
1 Aortic
2 Normal
disease
14
OF
28
heart
inclusion
properly
identified
in 19 instances,
(9
3-BREAKDOWN
Usually
in
of Fallot
heart
for
stenosis
Normal
Disease:
acquired
ventricular
was
Mitral
excavatum,
Aortic
3
Disease:
an etio-
heart
specific
existed.
tetralogy
(b)
congenital
1-CLINICAL
DIAGNOSIS
14
These
Heart
in whom
-
diagnosis
25
in 28
alone.
The
cent).
was
Group
A
Congenital
There
were 50 patients
study.
DIAGNOSTIC
RESULTS
logic
per
Heart
with
the requirements
TABLE
in
was
the cardiac
to permit
an
met
com-
confirmation
Acquired
patients
ber
enlargement
electrocardiographically
was esand/or
with
a
examination
B
in this
accepted
nature
of the cardiac
lesion
by cardiac
catheterization
Group
Twenty-one
disease
reservation.
The
tablished
cases.
were
have
Diseases
of
the Chest
YUSKIS
defect
with
pulmonary
tetralogy
of Fallot)
Electrocardiogram-5
(ostium
secundum)
Electrocardiogram-8
D.
6-Ventricular
X-ray-l
septal
defect
(small)
Electrocardiogram-5
E.
4-Ventricular
X-ray--U
septal
defect
(large)
Electrocardiogram-4
F.
8-Pulmonary
root
X-ray-I
stenosis
Downloaded From: http://publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/21367/ on 05/14/2017
with
normal
Electrocardiogram-7
aortic
41, No.
1962
Volume
March,
VENTRICULAR
CHAMBER
DIscussIoN
Our
the
results
would
impression
generally
trocardiogram
It is our
opinion
this
not
spheres.
a normal
present
was
that
ventricular,
radiographically,
study
is carried
Interestingly
enough
lesions
which
rather
One
of
the
radiographically
high
frank
listed
diac
the
various
in most
diagnosis,
cast
and
of
by
in
ious
disease
factors
concerned
agnosis
which
with
of specific
clearly
excellent
are
in
directly
precluding
chamber
carthat
disposal
A review
review
congenital
the
accurate
of our
included
both
quired
cardiac
defects
serious
demonstrat-
congenital
in all age
is
far
radiography
ventricular
most
acIn
study
bears
that the elec-
superior
in
chamber
to
conven-
identifying
specific
enlargement
u n d e r
circumstances.
los
presenta
una
autores
La
Ia
por
medio
como
el
ECG
es
las
con
para
expecifico
del
de
enfermedad
mucho
bajo
Ia
me
et
de
tous
les
groupes
de
de
que
radiografia
ventricular
circumstancias.
montrant
de
coeur.
Dans
Cette
l’un
a
et
s#{233}riecornacquises
dans
l”autre
type
#{233}tude confirme
savoir
que
a
sup#{233}rieur
identifier
et
cette
donn#{233}es d#{233}n#{224}
connues,
l’#{233}xacti-
I’#{233}iectrocardiograni-
cardiopathie,
pour
ci
de
HE
du
est
la
las
cong#{233}nitaies
d’age.
it#{233}sventriculaires
cardiaca
a
experience
radiologie
cardiogramme
ciassique
ci
estudio
cong#{233}nitas
crecimiento
relative
maladies
#{233}tiologique
les
notre
la
des
el
previas
superior
ci
mayoria
diagnostique
prend
y
observaciones
identificar
Expos#{233} de
de
para
anomalias
edades.
RESU
tude
experiencia
ECG
todas
formas
sostiene
comun
Ia
relativa
tanto
en
ambas
estudio
de
exactitud
coraz#{243}n.
incluye
adquiridad
En
di-
del
serie
revision
sobre
diagn#{243}stico,
radiol#{243}gico
Ia
Ia
plupart
l’#{233}lectro-
radiographic
l’augmentation
dans
des
des
cay-
circon-
stances.
Z
patient
the
the
and
groups.
RESUMEN
var-
enlargement.
of a
abnormality
is to avoid
experiences
series
hypertrophv.
assessment
of cardiac
if he
ing the relative
diagnostic
accuracy
of the
electrocardiographic
and roe ntgenologic
study
of the heart
has been
presented.
The
Se
Specific
cardiac
contours,
anomalous
vessels, pulmonary
vascularity,
calcification
of
valves,
location
of aortic
arch
and
other
invaluable
information
lends
itself
readily
to careful
fluoroscopic
and roentgenographic study.
In biventricular
enlargement,
previous
electrocardiographic
studies,sEsO
as
well as our experience,
clearly
reveal
distinct
limitations
to electrocardiography.
It
has ben our impression
that roentgenologic
study
is far superior
in cases
of combined
overall
form
diagnosis.
appreciate
diagnostic
the
from
This study
should
in no way detract
from
the
clinical
usefulness
of roentgenoolgic
study
in evaluating
cardiac
abnormalities.
In the
with some
accurate
in diagnosis.
tional
or indirectly
an
varwhich
SUMMARY
Wittenborg
recorded
an
the
fashion,
he must
of the
various
trocardiogram
criteria
clearly
ventricle
roentgenology
have
ventricle
without
dealing
with
of no method
their
at his
evaluate
concerned
both
forms
of heart
disease,
out our previous
observations
diagnosis.
the left ventricle.
diagnostic
heart
cardiac
radiographic
textbooks
we know
Neuhauser18
noted
the
clinical
will permit
one to differentiate
shadow
cast
by the
right
that
dilata-
difficulties
of a tentative
to make
similar
limitations
tools
to be
This
characterized
the
have
available
to him
a
physical
findings,
as well
series,
were
attribute
him
a
errors
incidence
present
to the proper
interpretation
is made
Despite
who
cardiac
in our
enlargement
when
this
benefit
one
than
major
is to
by
should
history,
proper
position
to
parameters
of study
In
the
often
felt
did exist.
the
the
ious
permit
frequently
especially
301
as the electrocardiographic
and roentgenographic
findings. Only then will he be in
enlargement,
in
heart
was more
when
enlargement
hypertrophy
elec-
specific
is
out
oriented
to represent
the
in both
disease.’3”4”
cardiac
right
thought
tion.
that
reflects
specifically
of specific
by
clearly
clinician
complete
substantiate
chamber
enlargement
and acquired
heart
especially
overdiagnosed
when
to
held
more
ventricular
congenital
is
tend
ENLARGEMENT
Es
die
wird
die
eine
relative
U SAM
MEN
tYbersicht
diagnostische
Downloaded From: http://publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/21367/ on 05/14/2017
FASSU
unserer
NG
Erfahrungen,
Genauigkeit
der
KUZMAN
302
elektrocardiografischen
Herzuntersuchung
und
demonstrieren,
Material
sowohl
umfailt
erworbene
beide
die
Fromen
aller
von
nach
das
frfiherer
Elektrocardiogramm
erlegen
fischer
in
der
den
meiten
ist hinsichtlich
Kammererweiterungen.
der
H., COTRIM,
N., DR OL1VEIRA,
R., AND
P. S.: “The Precordial Electrocardiogram,”
Am. Heart 1., 27:19,
1944.
10
Scorr,
R. C.:
Electrocardiographic
Hypertrophy
bestatigt
erheblich
11
Branch
A.:
Murmurs,”
P.:
Brit. Heart J.,
Diseases
of the
2nd
Edition,
2 Woon,
lation,
1956.
3
A.,
LEATHAM,
the
Second
Heart
4
1.,
7
Hoeber,
ricular
trophy
cordial
as
Obtained
Leads,”
Am.
cordial
9
AND
as
LYONS,
AND
by
Heart
LYONS,
in
Obtained
Leads,”
Right
by
Am.
Heart
BAUM,
of
15
and
38:273,
vitro
high
observed.
strains
was
first
media
convenient
sion
to
culture
number
of
bactericidal
dosage
Drug
and
vitamin
susceptible
tubercle
bacilli
F. D.,
AND
were
studied.
An
attempt
made
to incorporate
vitamin
C in culture
(Lowenstein-Jensen)
in this
case.
A
more
method
was
exposing
bacilli
in suspenvitamin
C for
24 and
48
hours
prior
to
on
Lowenstein-Jensen
medium.
An
equal
of controls
was
used.
The
overall
results
are
significant.
Profuse
growth
was obtained
in all
control
tubes
after
six weeks
culture;
whereas
in
experiments
2 and
3, some
growth
was obtained
only
in 31 per
cent
of
the
tube
series.
An attempt
is
being
of
made
patients
to
with
apply
these
chronic
findIngs
drug-resistant
to
diographic
Hypertrophy,”
the
treatment
AND
of
Ventricular
it
thus
W. j.: “Anatomic
#{225}orrelation
in ComHypertrophy,”
Am. Heart
OF
that
teriostatica
Confronti
if
combination
could
level
ensuring
SALISA
a
A.,
AND
in
del
J.,
Car-
Ventricular
14:451,
1952.
ZINN
VITAMIN
such
C
patients
agents
of cases.
could
become
known
with
any of
has
made
no
One
wonders
a
useful
measures.
tool
It has
were
possible
to obtain
isoniazid
and
ascorbic
possibly
facilitate
the retention
of an
of vitamin
C in the tuberculous
foci,
suggested
acid,
E. B.
Congenitai
1955.
1953.
molecular
adequate
Combined
Heart
infection.
Retreatment
of
the
available
antituberculosis
impression
on the
majority
if high
dosage
vitamin
C
in conjunction
with
other
a
Am.
J. F.: “The
GOODWIN,
Electrocardiographic
PROPERTIES
been
Test
in
2:462,
Circulation,
AND
Brit.
45:86,
Studies
Thomas,
NEUHAUSER,
Roentgenology
M. B., AND
bined
of
Circulation,
1960.
Diagnosis
LIPSETT,
Crit-
Electrocardiographic
M. H.,
19
BACTERIOSTATIC
“A
Criteria
Assoc., 1956.
“Discussion
of CPC,”
60:464,
D.: “Diagnostic
Heart Disease,”
PAGNONI,
A.,
J.,
G.:
JACKSON,
1951.
Heart
j. R.:
W1TTENBORG,
C. E.,
and Follow-up
Arch. mt. Med.,
the
Roentgen
Enlargement,”
“The
18
ROSEN-
bacteriostatic
properties
C for
M.
taberculojij
was
as
well
as
resistant
J.,
and
AND
Ill.,
WILLIAMS,
20
JONES,
Stenosis,
Electrocardiographic
Infants
and
Children,
Am.
Heart
Pre-
C.,
G.
“Mitral
W.:
Treatment
AMA
of
T.:
Book,”
17
Diagnosis
Circula-
R. F.:
Normal
WINSOR,
1949.
KOSSMAN,
M. L.,
Springfield,
16
B.
Right
Bundle
1956.
ZIEGLER,
in
in
Right
1959.
in the
EKG
Hypertrophy,”
GRIFFITH,
Group,”
ical
Evaluation
Right
Ventricular
11:391,
1955.
2nd
VentHyper-
Select
SUSSMAN,
of
“The
Unipolar
14
of
P.:
“The
VentVentricular
HyperUnipolar
and
PreJ., 37:161,
1949.
T. P.:
Ventricular
of a
97:466,
Brit.
T.
F. N., .JOHNSTON,
F. F., ERLANDER,
H.,
BACTERICIDAL
In
“Splitting
Health,”
of the Heart,
1956.
J.,
KUZMAN,
and
CircuPhiladelphia,
UNGERLEIDER,
H. E., AND CLARK,
C. P.: “A
Study
of
the
Transverse
Diameter
of
the
Heart
Silhouette
with
Prediction
Table
Based
on
the
Teleroentgenogram,”
Am.
Heart
J.,
17:92,
1939.
WILSON,
“Pitfall
W. f.,
#{149}J.
C., AND MEYER.
Clinical
Diagnosis,
13
Systolic
1955.
Clinical
Roentgenology
New
York,
1946.
in Left
Complex
trophy
8
M.,
SOKOLOW,
ricular
M.:
in
Diseases
Philadelphia,
M.,
Complex
SoKoLow,
Heart
Sound
1951.
J. B.:
SCHWEDED,
of
17:574,
TOWERS,
Saunders,
the Heart,
6
AND
C. K.:
FRIEDBERG,
Edition,
5
Classification
Lippincott,
Heart
13:575,
A. H.:
GRIEF,
of
Left Ventricular
tion, 20:30,
1959.
LEATHAM,
I. L.: “The Elec-
ROSEN,
and
Vectorcardiogram
Hypertrophy
and
Block,”
Dis. Chest, 36:,
Ventricular
spezi12
“A
AND
Between
the
Ventricular
Findings,”
of
trocardiogram
REFERENCES
I
Correlation
Patterns
the
Anatomic
1960.
and
21:256,
M.,
GARDBERG,
#{252}b-
Identifizierung
“The
Circulation,
wo-
#{252}biichen R#{246}nt-
Fallen
of
Chest
BARKER,
auch
Beobachtungen,
the
HECHT,
F#{252}r
Herzerkrankungen
Untersuchung
genaufnahme
wie
Altersgruppen.
Diseases
YUSKIS
r#{246}ntgenologischen
vorgelegt.
Das
angeborene
Herzfehler
AND
of
therapeutic
PACINI,
vitro
Baciilo
it
activity.
L:
‘L’Azione
Battericida
Alte Dosi
di Vitamins
Koch,”
Lotta
contro Tuberc.,
delle
1961.
tuberculous
Downloaded From: http://publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/21367/ on 05/14/2017
e
Bat-
C ad
31:371.