Encephalomyocarditis (EMC) virus infection of the mouse aorta. An ultrastructural study

Electron microscopic findings in the aortas of 10 mice infected with encephalomyocarditis (EMC) virus are described. Cellular necrosis was found mostly in the adventitia and occasionally in the smooth muscle cells closest to the adventitial tunic. Viral crystals were frequently found in association with the intracellular necrosis. Viral crystals were found in the adventitia of all 10 mice and in the smooth muscle cells of the media in some of the animals. The relationship of these findings to the production of aortitis or arteritis, which could also ultimately result in arteriosclerosis, is discussed.     

Viral infection of the aorta of man associated with early atherosclerotic changes

A 19-year-old young man who died of viral cardiomyopathy had positive staining of the myocardium, kidney, pancreas, and aorta with immunofluorescent antibodies for Coxsackie B₄ virus. The aorta was found to have an accumulation of lipid material in cells of the intima. The lipid deposits were located electron microscopically in fibroblasts, smooth muscle cells, and macrophages. It is suggested that viral infections, so common in man, may produce local sites of arterial injury which later result in the scars and lipid, calcium, and other deposits which represent the well-known lesions of atherosclerosis and arteriosclerosis. These scars and late lesions must have a beginning, and from the manifestations of immunofluorescent antibodies, histopathologic, and electron microscopic findings in the aorta of the patient described here, as well as from the clinical data, it is suggested that Coxsackie B₄ virus may initiate atherosclerosis and arteriosclerosis in man.     

Encephalomyocarditis (EMC) virus infection of the femoral vein of newborn mice

The EMC virus was found to infect and injure the femoral veins of newborn mice. EMC viral crystals were found in the adventitial fibroblasts of these veins. In view of the extensive damage observed in the extremely small amount of tissue examined electron microscopically, the extent of the viral phlebitis must have been considerable. The relationship of these findings to the pathogenesis of thrombophlebitis in man provokes interesting speculations.     

"New" treatment for chronic intractable congestive heart failure.

The use of hexamethonium injected intravenously in successive 2.5 mg. doses resulted in alpha-adrenergic sympathetic nerve blocking and associated peripheral vasodilation with dramatic improvement of the symptoms and signs in patients with marked chronic intractable CHF. The vasodilatating effect of the drug is simple to monitor at the bedside and serves as an effective, simple means to "bleed" the patient intravenously by decreasing systemic venous tone and reducing the wall stress in the vessels. This intravenous "bleeding" results in a shifting of excessive blood from the lungs and central systemic venous areas to the larger volume of the more peripheral systemic venous reservoirs. Rheoplethysmorgraphic recordings of digital blood flow in the fingertips of the patients revealed marked constriction of all vessels of the fingers during CHF. Hexamethonium dilated all these vessels and increased digital blood flow even though arterial blood pressure was reduced by the drug. Theoretic discussions of aspects of the mechanism of congestive heart failure of the two-pump system of the heart of man and the mechanical or hemodynamic advantages of the small veins over the larger centrally located veins tend to explain why the use of hexamethonium benefits the circulation by producing vendoilatation. These studies indicate the therapeutic usefulness of hexamethonium in the management of acute and chronic intractable CHF and provides physiologic and theoretic data to explain why the drug is effective.     

Interesting aspects of geriatric cardiology

Geriatric cardiology requires special knowledge and experience. It is not possible to extrapolate directly experience obtained with young patients to old people. Because of the multiple illnesses, many serious, in the elderly cardiac patients, it is imperative for the cardiologist to be, first of all, a master internist at all times. Old patients with their multiple illnesses are also sensitive to drugs, including digitalis and diuretics. There is a need to train more physicians in geriatric cardiology in order to offer the old patient the best of care since so many old people are living today. There is also a need to learn the effects of the aging process itself on the human heart. Such studies should command priorities in financial and other forms of support.     

The role of the central nervous system in chronic congestive heart failure

Even though congestive heart failure is extremely common, the mechanisms responsible for the clinical manifestations remain a puzzle. The central and autonomic (sympathetic) nervous systems are responsible for a large part of the clinical manifestations. The role of the nervous system in CHF is discussed briefly. It is evident that there are many gaps in knowledge that remain concerning the role of the central, peripheral, and autonomic nervous systems in congestive heart failure. The peripheral vascular constriction, increase in venous tone and pressure, tachycardia, sweating, dermal pallor, and tension and anxiety in patients with CHF reflect generalized sympathetic nervous system activity and the influence of the central and autonomic nervous systems on the clinical syndrome of CHF.     

Localized ventricular gradient of the papillary muscles

Ventricular gradients ? were obtained for sharply localized areas of the lateral papillary muscle and the adjacent free wall of the left ventricle of five dogs. The ventricular gradients recorded for 2 mm. segments of myocardium varied considerably in magnitude and direction. Myocardial ischemia changed the magnitude of the ? for all areas studied, but did not always change the direction. The method and concept described are applicable to the study of the influence of drugs, disease, neurogenic and physical factors, as well as other factors on local ? of the myocardium of experimental animals and man.     

Effects of cerebral angiography, pneumoencephalography, myelography and ventriculography on the electrocardiogram

The electrocardiograms of 50 patients were recorded immediately before and after they underwent cerebral angiography, ventriculography, myelography or pneumoencephalography. Definite electrocardiographic changes were produced by the diagnostic procedure in 78 percent of patients. Cerebral angiography caused the most serious electrocardiographic alterations, one patient manifesting the Wolff-Parkinson-White syndrome after the procedure. The alterations ranged from slight to marked P, QRS or T wave changes, alone or in combination. The electrocardiographic alterations produced by the four central nervous system diagnostic procedures were probably mediated through parasympathetic and sympathetic cardiac innervation.     

Echocardiographic diagnosis of vegetative aortic bacterial endocarditis

The echocardiograms of three patients with vegetative aortic valve endocarditis revealed characteristic shaggy or fuzzy echoes from the region of the aortic valve. At surgery or at necropsy vegetations were found that explained the distinct abnormal echoes recorded. Such echoes recorded from the region of the aortic valve in patients with evidence of acute aortic insufficiency should suggest endocarditis with vegetations. Differentiation of these echoes from echoes produced by normal phenomena, other disease states or artifacts is discussed.