《Diseases Of The Heart And Arteries Fourth Edition》

INTRODUCTION—SCOPE—PLAN17

CHAPTER ⅠDEVELOPMENTAL AND STRUCTURAL ANATOMY OF THE HEART AND PHYSIOLOGY OF THE CIRCULATION19

Developmental Anatomy19

The Anatomy of the Heart25

General Physiology of the Circulation29

CHAPTER ⅡDEFINITIONS—IMPLICATIONS—BASES—SYMPTOMS AND SIGNS FOE THE DIAGNOSIS OF HEART DISEASE31

Definition31

Implications or Significance of the Diagnosis31

The Basis of the Diagnosis32

The Diagnosis of Heart Disease33

The Clues to the Diagnosis of Heart Disease34

General Symptoms of Heart Disease34

The Cardinal Symptoms of Heart Disease35

Secondary Symptoms39

Contributory Data in Cardiovascular Disease39

General Signs in Patients With Heart Disease40

The Reliable Criteria or Cardinal Signs of Heart Disease41

CHAPTER ⅢSTUDY OF A PATIENT SUSPECTED OF HAVING HEART DISEASE．THE CLINICAL CASE RECORD42

The History42

Chief Complaint42

Present Illness43

The Social History43

Review of Systems44

Marital History45

Past History45

Family History46

The Physical Examination46

General Inspection47

Detailed Regional Studies48

Head48

Neck48

The Thorax in General48

The Heart49

Lungs53

The Abdomen54

Extremities56

The Relevant Laboratory Studies57

CHAPTER ⅣCOMMON INSTRUMENTS AND METHODS USED IN CLINICAL HEART STUDIES59

The Stethoscope59

The Sphygmomanometer and Sphygmomanometry62

The Procedure for Taking Peripheral Arterial Pressure62

Recording Sphygmomanometer65

Electromanometer65

The Normal Blood Pressure65

Formulas，Ratios，and Age Levels65

The Venous Pressure67

Circulation Time69

Fluorescein Method for the Study of Circulation Time to Various Parts of the Body70

The Thoracic Diameters70

Vital Capacity71

Breath-Holding Tests73

The Cold Pressor Test74

The Oscillometer75

Phonocardiography or Stethocardiography76

Analysis of the Stethocardiogram or Phonocardiogram78

Normal Heart Sounds80

The Value and Limits of Stethocardiography81

CHAPTER ⅤTHE RADIOLOGICAL STUDY OF HEART DISEASE84

Cardiological Radiology85

Technique and Clinical Value87

Teleradiology87

Cardiac Outline90

In Pathological States92

Radiokymography96

Special Radiological Methods99

CHAPTER ⅥELECTROCARDIOGRAPHY102

Theoretical Principles102

Special Anatomy of the Heart102

Special Physiology of the Heart104

Biophysical Phenomena of Heart Action106

The Dipole Theory of the Electrocardiogram106

The Principles of the Electrocardiograph110

Practical Applications113

The Taking of an Electrocardiogram113

Electrocardiographic Tracings113

Some Diagnostic Data Obtainable From Electrocardiograms121

Analysis and Interpretation of Electrocardiograms123

Procedure in Electrocardiogram Analysis123

Interpretation of Waves and Intervals，Normal and Abnormal，in Standard Leads124

Analysis and Interpretation of the Precordial Electrocardiogram127

The Electrical Position of the Heart132

The Electrical Axis of the Heart135

The Ventricular Gradient142

Pathysiology of Disorders of the Cardiac Mechanism145

Significance of the Electrocardiogram in Cardiac Diagnosis147

In General147

In Disturbances of the Cardiac Mechanism148

In Coronary Artery Disease148

In Ventricular Hypertrophy153

Diagnostic Significance of Hypertrophy157

In Atrial Hypertrophy157

In Bundle Branch and Intraventricular Block157

In Acute Infectious Diseases162

In Following Therapy168

In Cardiac Valvular Disease168

In Electrolyte Disturbances170

In the Progress of Life172

Differential Diagnostic Electrocardiographic Patterns174

Conditions That May Be Responsible for Abnormalities of S-T and T Segments(Modified From Sprague)176

CHAPTER ⅦTHE DISORDERS OP THE HEART＇S ACTION178

Classification of the Mechanism Disturbances of the Heartbeat178

General Disturbances of Cardiac Mechanism180

Clinical Study of the Heart＇s Action180

More Detailed Discussion of Common Cardiac Mechanism Disorders182

Sinus or Sinoatrial Tachycardia182

Sinus or Sinoatrial Bradycardia184

Sinus Arrhythmia185

Atrioventricular or Nodal Rhythm187

Premature Contractions，Ectopic Beats or Extrasystoles188

Paroxysmal Tachycardia192

Atrial Flutter198

Atrial Fibrillation200

Ventricular Fibrillation203

Heart Block203

Alternation213

General Therapy of Bundle Branch Block and Alternation214

The Pharmacological Effects of Digitalis and Quinidine on Atrial Muscle and Vagus Endings215

Digitalis Administration217

CHAPTER ⅧA CLASSIFICATION OF CARDIOVASCULAR DISEASES220

A Classification of Diseases of the Cardiovascular System221

Classification of Patients Attending a Cardiac Clinic225

The Bases for Etiological Diagnoses226

CHAPTER ⅨNERVOUS DISORDERS WITH HEART MANIFESTATIONS233

Psychoneurocardiovascular Disturbances233

Neurocirculatory Asthenia235

Vasovagal Syndrome236

Treatment of Psychoneurocardiovascular Disturbances236

Cardiac Neurosis in Patients With Heart Disease237

Organic Nervous Diseases With Cardiac Manifestations238

CHAPTER ⅩCONGENITAL HEART LESIONS240

Congenital Heart Lesions in General241

General Symptoms241

General Physical Signs241

The Mechanism of the Development of Cyanosis in Congenital Heart Disease242

The Clinicopathological Classification243

Congenital Cardiovascular Anomalies245

Details of Specific Congenital Cardiovascular Anomalies246

Dextrocardia246

Eight Aortic Arch248

Double Aortic Arch250

Coarctation of the Aorta251

Hypoplasia of the Aorta and/or Coronary Arteries With or Without Diffuse Endocardial Fibrosis or Congenital Fibroelastosis253

Congenital Arteriovenous Communications254

Congenital Intrapulmonary Cirsoid Hemangioma255

Aberrant Coronary Artery Origin From the Pulmonary Artery255

Persistent Common Truncus Arteriosus256

Aortic Septal Defect257

Patent Ductus Arteriosus258

Atrial Septal Defect264

Atrial Septal Defect and Mitral Stenosis267

Atrial Septal Defect With Tricuspid Defect268

Pure Ventricular Septal Defect270

Tetralogy of Stensen-Fallot273

Dalrymple-Eisenmenger Complex277

Congenital Subaortic Stenosis，Aortic Atresia，and Hypoplasia280

Pure Pulmonary and Infundibular Stenosis282

Tricuspid Stenosis and Atresia285

Transposition of the Great Trunks287

CHAPTER ⅪCARDIOVASCULAR SYPHILIS290

The Clinical Picture290

Myocardial Syphilis291

Aortitis291

Aortic Incompetency294

Aneurysm296

General Treatment of Syphilis300

The Old Standard Heavy Metal Regime301

Atheromatous Valvulitis，Aortitis，and Aneurysm302

Dissecting Aneurysm of the Aorta303

Arteriovenous Fistula or Aneurysm304

CHAPTER ⅫRHEUMATIC HEART DISEASE308

Pathogenesis and Morbid Anatomy309

The Clinical Picture311

Treatment of Rheumatic Fever and Carditis316

CHAPTER ⅩⅢBACTERIAL ENDOCARDITIS OR VALVULITIS318

Acute Bacterial Endocarditis320

Subacute Bacterial Endocarditis325

The Clinical Picture326

Differential Diagnosis329

Prognosis330

Treatment330

CHAPTER ⅩⅣPERICARDITIS332

Classification of Pericarditis332

Acute Pericarditis333

Acute Fibrinous Pericarditis334

Acute Pericarditis With Effusion336

Cardiac Tamponade339

Differential Diagnosis of Acute Pericarditis340

Acute or Subacute Serous and Serofibrinous Pericarditis341

Nonspecific Pericarditis341

Other Acute Affections of the Pericardium343

Chronic Affections of the Pericardium343

Chronic Constrictive Pericarditis345

CHAPTER ⅩⅤBLOOD PRESSURE ABNORMALITIES349

The Autonomic Blood Pressure Regulatory Apparatus349

Abnormal Blood Pressure Levels352

Essential Hypotension352

Secondary Hypotension354

Hypoadrenalism354

Postural or Orthostatic Hypotension356

CHAPTER ⅩⅥHYPERTENSION359

Types of Hypertension359

Classification of Hypertension360

Essential Hypertension361

The Nervous Mechanism361

The Clinical Picture in Essential Hypertension362

Hypertensive Arteriolar Disease367

The Cardiovascular Complications367

Malignant Hypertension368

Hypertensive Heart Disease369

General Therapy of Hypertension373

The Surgical Treatment for High Blood Pressure374

Thoracolumbar Sympathectomy for Essential Hypertension374

Routine Studies for Hypertensive Patients as Candidates for Sympathectomy375

Classification of Hypertensives for Prognostic Evaluation and Surgical Treatment376

Special Drug Therapy in Essential Hypertension376

CHAPTER ⅩⅦGENERAL SYSTEMIC TYPES OF HEART DISEASE379

Thyroid Disease and Heart Disease379

Cardiac Manifestations in Hyperthyroidism379

Cardiac Manifestations in Myxedema382

The Heart and Circulation in Anemia385

The Heart in Sickle-Cell Anemia386

Myelophthisic Anemia of Leukemia387

Hypoxyhemoglobinemia387

The Heart in Erythremia388

Pulmonary Blood＂Pressure Elevation389

Cor Pulmonale—Heart Diseases of Pulmonary Origin390

Electrocardiographic Manifestations in Acute Cor Pulmonale392

CHAPTER ⅩⅧDISEASES OP THE GREAT ARTERIES—ANGIOPATHY，ANGIOSIS，ANGIITIS394

Degenerative Arteriopathies396

Coronary Artery Disease397

Clinical Coronary Syndromes398

Arteriosclerotic Heart Disease and General Coronary Artery Heart Disease399

Management and Treatment400

CHAPTER ⅩⅨANGINA PECTORIS401

The Mechanism of Production and Propagation of Cardiac Pain401

Theoretical Genesis of Cardiac Pain401

The Propagation of Cardiac Pain and Interruption of the Pathways402

Angina Pectoris403

Coronary Failure408

Differential Diagnosis of Thoracic Pain，Angina Pectoris，and Coronary Insufficiency409

Mechanical Abdominal Cardiac Distress409

Somatic Pain410

Referred Nerve Pressure Pain410

Scalenus Anticus Spasm Pain410

Nerve Root Pain410

Vasomotor Crises With Pain411

Tobacco，Coffee or Food Allergy412

Cardiovascular Neuroses With Pain412

Psychoneuroses412

Da Costa＇s Syndrome With Pain413

Fatigue Ache413

Cor Pulmonale Pain414

Pain in Aortic Disease415

Dissecting Aneurysm of the Aorta415

Cardiac Pain of Aortic Regurgitation415

Angina Pectoris416

Pain of Coronary Insufficiency and Coronary Occlusion416

CHAPTER ⅩⅩCORONARY OCCLUSION OR THROMBOSIS WITHOUT OR WITH MYOCARDIAL INFARCTION417

The Pathological Anatomy of Coronary Thrombosis417

The Clinical Picture419

The Symptoms of Coronary Occlusion419

The Signs of Myocardial Infarction420

Differential Diagnosis422

The Localization of Myocardial Infarctions423

The Prognosis in Coronary Thrombosis425

Complications of Myocardial Infarction432

Treatment439

Treatment of Myocardial Shock of Coronary Thrombosis439

The Treatment of Coronary Thrombosis439

CHAPTER ⅩⅪ CHRONIC CARDIAC VALVULAR DISEASE443

General Symptoms of Chronic Cardiac Valvular Disease448

General Physical Signs of Chronic Cardiac Valvular Disease448

Diastolic Murmurs449

Systolic Murmurs450

CHAPTER ⅩⅫMITRAL DISEASE—MITRAL STENOSIS AND INSUFFICIENCY453

Mitral Stenosis453

Pathogenesis and Pathysiology453

The Clinical Picture456

The Cardinal Diagnostic Signs457

The Stages of Mitral Stenosis461

Treatment of Mitral Stenosis463

Mitral Insufficiency465

Pathysiology465

CHAPTER ⅩⅩⅢAORTIC DISEASE—REGURGITATION AND STENOSIS468

Aortic Regurgitation468

Pathogenesis or Pathysiology468

Aortic Stenosis476

CHAPTER ⅩⅩⅣTRICUSPID AND PULMONARY VALVE DISEASE480

Tricuspid Insufficiency or Incompetency480

Tricuspid Stenosis482

Pulmonary Regurgitation486

Pulmonary Stenosis487

CHAPTER ⅩⅩⅤDISTURBANCES OF MYOCARDIAL FUNCTION490

Myocardial Insufficiency or Heart Failure491

Symptoms of Heart Failure in Detail491

Signs in Detail495

Myocardial Fatigue，Weakness，and Insufficiency497

Acute Myocardial Changes in Acute Infections497

Acute Heart Shock498

Chronic Myocardial Insufficiency(So-called＂Chronic Myocarditis＂)499

The Anatomical Basis for Heart Failure501

Cardiac Enlargement501

Morbid Anatomy502

Symptoms505

Signs505

CHAPTER ⅩⅩⅥCIRCULATORY FAILURE507

Mechanisms of Congestive Heart Failure507

Edema Formation in Terms of Hydrostatic and Osmotic Pressures510

Some Modern Concepts of Congestive Heart Failure512

Clinical Reconsiderations515

Paroxysmal Dyspnea，Orthopnea，and Cardiac Asthma With Pulmonary Edema in Reference to Origins and Relations517

The Advance of Congestive Heart Failure518

Treatment of Acute Heart Failure519

Acute Pulmonary Embolism—Cor Pulmonale520

Pathysiology523

Treatment523

CHAPTER ⅩⅩⅦMORE DETAILED TREATMENT OF CONGESTIVE FAILURE WITH EDEMA524

General Measures524

Details of the Drug Treatment of Edema524

Details of Management of Chronic Heart Failure524

The Xanthine Diuretics526

The Heavy Metals as Diuretics530

Rehabilitation537

Further Management of the Cardiac Cripple as Compensation Is Re-established537

The Diet in Heart Disease538

Modifications of the Karell Diet538

The Lonalac 50mg．Sodium Diet539

General Suggestions for Cardiac Diets539

High Energy Yielding Foods539

CHAPTER ⅩⅩⅧEMERGENCY SITUATIONS OF CARDIOVASCULAR ORIGIN544

Resuscitation of the Heart548

Evaluation of the Added Risks of Surgical Treatment in Patients With Cardiovascular Disease550

Some Problems of Pregnancy in Patients With Heart Disease552

CHAPTER ⅩⅩⅨPERIPHERAL VASCULAR DISEASES555

Diagnostic Procedure557

The Differentiation of Functional and Organic Disease—The Vasomotor Test562

Localization563

Functional Peripheral Vascular Disorders or Neuroses565

General Vasoconstriction Neurovascular Disorders565

Lewis Syndrome or the Vascular Crises of Pal566

Local Vasoconstriction Neurovascular Disorders566

Digital Syncope566

Raynaud＇s Disease567

Acrocyanosis568

General Vasodilatation Neurovascular Disease568

Idiopathic Hypotension and Postural Hypotension568

Local Vasodilatation Neurovascular Disease569

Erythralgia569

Erythrocephalgia569

Acrodynia570

The Immersion Foot Syndrome570

Organic Peripheral Vascular Diseases572

Thromboangiitis Obliterans572

Special Therapeutic Measures for Thromboangiitis Obliterans575

Solutions for Intravenous Use to Increase Blood Volume and to Decrease Blood Viscosity575

Polyarteritis or Periarteritis Nodosa576

Isolated Idiopathic Peripheral Arteritis578

Atherosclerosis Endarteritis Obliterans579

Embolism in the Major Arterial Pathways582

Thrombotic Emergencies584

General Treatment of Peripheral Arterial Diseases584

Treatment of Functional Arterial and Arteriolar Obstruction584

Treatment of Organic Arterial or Arteriolar Obstruction586

CHAPTER ⅩⅩⅩMILITARY CARDIOVASCULAR EXAMINATIONS AND INTERPRETATIONS590

The Effort Syndrome590

Exercise Tolerance Tests—The Schneider Index592

Importance of Rigid Examinations for Aviation Recruits594

Exercise Tolerance Test for Circulatory Insufficiency595

The Detection of Organic Heart Disease in the Recruit595

Cardiovascular Conditions That Disqualify the Recruit for Active Service600

APPENDIXTHE DIAGNOSIS OF HEART DISEASE603

The Pathognomonic Evidence of Heart Disease605

Details of the Diagnostic Criteria of Heart Disease606

The Inevitable Outcome of Heart Disease613

The Cardiac Output615

Compensatory Mechanisms615

The Symptoms and Signs and Their Origin616

The Interruption of These Vicarious Mechanisms617

COMMON ERRORS IN THE DIAGNOSIS OF HEART DISEASE619

CORRECTION OF CARDIOVASCULAR DEFORMITIES BY SURGICAL PROCEDURES622

Technique of and Data From Right Heart Catheterization624

Criteria in Congenital Heart Disease Found on Catheterization626