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CALCIFICATION OF THE AORTIC VALVE AND OF THE CORONARY ARTERIES

1951; BMJ; Volume: 13; Issue: 3 Linguagem: Inglês

10.1136/hrt.13.3.355

1468-201X

David A. Pyke, C. Symons,

Hydrogen embrittlement and corrosion behaviors in metals

This paper reports a clinical and radiological survey to find the frequency of calcareous aortic stenosis and of calcification elsewhere in the heart. 400men over the age of 60 were chosen at random-200 inor out-patients of a general hospital (series A) and 200 in-patients of a mental hospital (series B).In the clinical examination Levine's (1945) method of grading the loudness of murmurs was used.The technique of X-ray screening was that described by Sosman (1943).To compare the clinical and post-mortem incidence of cardiac calcification, 72 hearts from cgnsecutive routine necropsies were radiographed. RESULTSAmong the 400 men, 27 cases (6.75%) of cardiac calcification were detected on screening: aortic valve (Fig. 1), 11 cases (2 75%); coronary arteries (Fig. 2, 3 and 4), 14 cases (3.5%); mitral valve (Fig. 5), 1 case; pericardium, 1 case.Calcified aortic valve.The clinical findings in these 11 cases are set out in Table I, and their average age, compared with other patients', in Table II.There was no past history of rheumatic fever.Six of the seven men in series A had been passed fit for military service in 1914-18 and three had served throughout that war.Three of the four men in series B, being examined annually, were noted, after being found free of murmurs for 12, 31 and 37 years, to have developed systolic murmurs at the ages of 65, 54 and 66 respectively.In only three patients was dyspnoea a feature; one patient had a history of six months' angina of effort.The physical signs were those generally found in aortic stenosis.The second heart sound at the base was diminished or absent in all cases except one.A systolic murmur was present in all and a diastolic in one; there was a systolic thrill in five patients.However, none had a plateau pulse and, in all except one, the pulse pressure was normal.Electrocardiograms -were taken in six cases.Three showed left ventricular preponderance, one auricular fibrillation with incomplete right bundle branch block, one left axis deviation, and one was normal.On screening, the left ventricle was enlarged in 7 cases.Calcification, when present, was always seen in the right anterior oblique position (Fig. 1.) but in the left anterior oblique in only seven cases.There was no clinical or radiological evidence of mitral stenosis in any case.Two patients have died, both of them suddenly.Calcified coronary arteries were detected, by screening, in 14 cases (Fig. 2, 3, and 4).They were significantly older than the patients without coronary calcification (see Table ' II).The clinical histories showed nothing significant except for a patient with effort dyspncea whose blood pressure was 270/160.There was hypertension in four patients (diastolic over 100).There was a systolic murmur in seven, of whom three were hypertensive.Calcification was seen in the left coronary artery in 10 cases (circumflex 9, descending 1), in the on July 12, 2023 by guest.