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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 Downloaded From: http://publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/21367/ on 05/14/2017 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.