Circulation
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As improvements in the prehospital care of traumatically injured patients have paralleled advancements in cardiovascular surgery, changing concepts in the management of the patient with blunt and penetrating injuries of the heart have occurred. More critically injured patients now arrive at a hospital facility still alive than in former years. Between 1951 and 1974, 350 patients with heart injuries were treated at Harris County Hospital District facilities. ⋯ Thirteen patients had rupture of the heart secondary to blunt trauma. Patients arriving with cardiac arrest and cerebral signs of preterminal activity had a 67% survival rate when cardiorraphy was performed in the Trauma Center. In the last four years, 50 patients without cardiac arrest, but frequently with pericardiocentesis as a preoperative adjunct, had an 87% survival rate.
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Failure of the pulse pressure to increase in the post-premature beat is considered characteristic of idiopathic hypertrophic subaortic stenosis (IHSS). The sensitivity and specificity of this response were compared to the change in left ventricular ejection time (LVET) in 12 patients with IHSS, in ten control patients with valvular aortic stenosis (AS) and in five normal subjects. The post-PVC pulse pressure increased in all normals and in nine of the ten patients with AS. ⋯ A positive Brockenbrough sign was seen in only 33%. On the other hand, LVET increased greater than 20 msec in eleven of twelve patients with IHSS, whereas all normal subjects and all patients with AS showed either decreases in LVET or increases smaller than 20 msec. Prolongation of the LVET during the post-PVC beat greater than 20 msec appears, therefore, to be a more sensitive sign of IHSS than the corresponding change in pulse pressure.