The Electrocardiogram in Biliary Tract Disease and During Experimental Biliary Distension

Abstract

S OF CARDIOLOGY The Electrocardiogram in Biliary Tract Disease and During Experimental Biliary Distension. Clinical Observations on 26 Patients. G. B. Hodge and A. L. MESSER. Surg. Gynec; Obstet., 86, 617-626, May, 1948. The effect on the electrocardiogram of experimental distension of the biliary tract was investigated in 26 patients undergoing surgery of the biliary tract. Sterile normal saline solution was introduced under pressure through a cannula into the gall-bladder or through a rubber T-tube into the common bile duct; the maximum pressure used was 100 cm. of water. Twenty-two of the patients had chronic cholecystitis, 3 had previously had cholecystectomy, and 1 had a carcinoma of the head of the pancreas with chronic cholecystitis and cholelithiasis. In 14 patients gall-bladder distension and electrocardiographic studies were carried out simultaneously during operation. Ofa second group of 13 patients the common bile duct was distended in 12 and the gall-bladder in 1 patient, without medication or anesthesia, 10 or more days after operation. No patient had angina or myocardial infarction and in none did distension of the common duct or gall-bladder cause anginal pain. All patients who experienced pain during distension of the common duct or gall-bladder complained of respiratory distress during distension and in the majority the blood pressure rose. No constant cardiographic changes were found as a result of the distension; control records obtained before operation included abnormal as well as normal tracings. It is concluded that changes in the electrocardiogram in patients with biliary tract disease are variable and may be coincidental, and that it is not justifiable to speak of improvement of the cardiac condition as a result of biliary surgery -on the basis of a single pre-operative and post-operative cardiogram, since serial tracing may show instability of the cardiographic pattern, especially of the T waves. A. Schott The Changes in the Electrocardiogram Associated with Standing. D. ScHERF and M. SCHLAcHMAN. Proc. Soc. exp. Biol., N.Y., 68, 150-153, May, 1948. Records in 80 male patients without evidence of organic heart disease were taken in the supine position, after standing for 1, 5, and 15 minutes, and again immediately, Oinnn rP,.eimvnor thiL. Qlinin nneJtiJn Toinvfl Qi5GOO+ +l1 temporary A-V rhythm was observed as a result ofchange of posture. In 11 out of 12 changes occurring immediately on standing could not be prevented by dihydroergotamine. It is concluded that the immediate and delayed changes in the cardiogram must be ascribed to different mechanisms. The former are due to the change of position of the heart and altered contact between the heart and neighbouring structures, the latter to the sympathetic nervous system acting on the heart directly or through the coronary arteries. A. Schott A Clinical and Electrocardiographic Study of Paroxysmal Ventricular Tachycardia and its Management. G. R. HLRMANN and M. R. HFJTMANCIK. Ann. intern. Med., 28, 989-997, May, 1948. In a heart that is damaged failure may be caused by sudden rapid rate. Most hearts in which ventricular tachycardia develops have been previously damaged by coronary disease or digitalis. A ventricular tachycardia is recognized by abnormally broad QRS complexes in the electrocardiogram along with an independent atrial rhythm. Twenty patients with ventricular tachycardia are reported of whom 14 had coronary disease with or without infarction. The others had rheumatic heart disease, except for 2 in whom no organic disease could be found. Nine of the 20 were receiving digitalis at the onset of the attack. In 10 the heart rhythm reverted to normal on quinidine. Quinidine by mouth in a single oral dose produces a maximum concentration in the heart in about an hour, being eliminated in 8 hours. The largest dose used was a total of 5-2 g. in 24 hours. The method of Hepburn and Rykert of intravenous dosage is useful, 3 5 g. of quinidine sulphate in 500 ml. of 5% glucose intravenously at 100 ml. per hour. Once normal rhythm has been restored, quinidine should be continued by mouth for several days or weeks, the dosage being adjusted to prevent premature ventricular contractions. Morphine intravenously has also been used successfully, 10 to 40 mg., repeated after half an hour to 2 hours. Intravenous magnesium sulphate has also been used successfully. The prognosis is that of the underlying cardiac disease. In some cases achievement of a normal rhythm may not in itself prevent a fatal outcome. J. McMichael upUll cbuliiiili ui bupiLr posuollU. 1U mvesuiga-t mne ----~~~ part played by the sympathetic nervous system 0-5 mg. ' of dihydrnergotamine (" DHE 45 ") was given intraExperience with the Schemm Regimen in the Treatment of venously to 12 patients and records were again taken Congestive Heart Failure. A. A. NEWMAN and H. J. supine and erect when the drug effect was at its height. STEWART. Ann. intern. Med., 28, 916-939, May, 1948. In 25 (31%) there were significant changes in the electroThe importance of a low salt intake in controlling cardiogram on standing, but neither the kind nor the cedema is now widely recognized. It has even been time of appearance of changes was' uniform. In 4 shown that, provided the salt intake is low, large amounts 201 group.bmj.com on October 15, 2017 Published by http://heart.bmj.com/ Downloaded from

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@inproceedings{Cooke2003TheEI, title={The Electrocardiogram in Biliary Tract Disease and During Experimental Biliary Distension}, author={William T Cooke}, year={2003} }