One hundred and fifty patients with chronic severe anemia were studied to determine the nature of cardiac enlargement and its relation to various factors.
Enlargement was present in 120 patients. It showed no consistent relation to the hemoglobin level on admission. A significant increase in the cardiac size and incidence of failure was observed with increased severity of anemia, and in female as compared to male patients. The incidence of enlargement showed no relation to the age and sex of the patient and the duration or the etiologic factor of anemia.
With correction of the anemia, enlargement disappeared rapidly in 92 patients, indicating that it was due to dilatation alone. Some enlargement persisted in 28 patients, and it is believed to be associated with cardiac hypertrophy.
Pericardial effusion due to heart failure in 2 patients contributed to a small extent to the enlargement of the cardiac shadow.
Cardiovascular manifestations have been studied in 11 patients with argemone oil poisoning.
Tachycardia, alterations in the heart sounds, cardiac enlargement, or electrocardiographic and ballistocardiographic changes indicated myocardial involvement in every case. The latter was suggestive of a nonspecific type of myocarditis and was considered to be of a minor nature. The prominent manifestations included dyspnea, edema, hepatic enlargement, and pulmonary congestion. The last 3 were probably due to capillary dilatation, whereas the cause of dyspnea was uncertain.
These manifestations suggested the presence of cardiac failure, which, however, was considered unlikely except in 1 case.
Cardiovascular disturbances in 60 patients with chronic severe anemia have been studied. Although in a majority the classical hyperkinetic syndrome of anemia was seen, 40 per cent of the patients showed a different pattern that was characterized by absence of tachycardia, comparatively diminished velocity of the blood flow, and a normal or diminished cardiac output even in the presence of congestive failure. Other differences in the manifestations have been evaluated. No cause could be discovered for this difference and for the high incidence of congestive failure seen in this series.
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