ECHOCARDIOGRAPHIC ABNORMALITIES OF THE MITRAL VALVE ASSOCIATED WITH A LARGE PERICARDIAL EFFUSION

Features of mitral stenosis and systolic anterior motion of the mitral valve were observed on the echocardiogram of a patient with a large posterior pericardial effusion. The abnormal findings disappeared with resolution of the fluid. Because pericardial effusion may result in the echocardiographic alteration of cardiac structures, repeat study is necessary after the effusion has cleared.     

PACEMAKERS IN NITELLA : III. ELECTRICAL ALTERNANS

An electrical impulse traveling along a Nitella cell may produce a complete or a partial response. The two kinds of response may occur in regular alternation. The partial response varies greatly and may be so far reduced as to appear as a local thickening in the upstroke of the action curve, usually accompanied by a more or less pronounced hump. In consequence a considerable variety of action curves is produced. The observations show that different regions of the cell may react differently.     

DIGITALIS IN OPEN HEART OPERATIONS

In addition to the usually accepted indications for digitalis therapy, we believe there is a group of patients, not having heart failure, who would benefit from digitalis in connection with open operations on the heart. This group includes all adults, all with the tetralogy of Fallot, and all with high pressure ventricular septal defects. Digitalis preparations can be given in the usual digitalizing doses several days before operation to insure the presence of some glycosides at the end of the operation when cardiopulmonary by-pass is discontinued. An additional maintenance dose can be given by the anesthetist at the time of completion of cardiopulmonary by-pass and another dose the evening of operation. If during the immediate postoperative period supraventricular arrhythmia occurs, particularly tachycardia, the ouabain test is extremely useful and safe in determining whether or not more digitalis is needed.