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1.1. The authors briefly present the unicist classical theory which considers Starling's mechanism as a compensatory mediator both for primarily diastolic and for primarily systolic overloadings. 2.2. The theoretical possibilities that Starling's mechanism could be of no important value for primarily systolic overloadings are presented. 3.3. A brief review is made of clinical, x-ray, and autopsy evidence in favor of this theoretical viewpoint. 4.4. It is concluded that the theory of a dualistic compensatory mechanism of a heart which confronts a diastolic overloading or a systolic one is of great advantage over the unicist theory which reduces both to Starling's law. 5.5. The authors will show in a paper to follow that it is also possible to discover a different electrocardiographic behavior for different types of overloadings.

After the study of the electrocardiograms of fifty cases of chronic cor pulmonale, we consider that the principal diagnostic signs (see Fig. 11) are: (1) high and peaked P waves with prominent auricular T waves in Leads II, III, and V F ; (2) negative P waves in V L ; (3) right deviation and a decreased value of  QRS ; (4) a small ventricular gradient (frequently deviated); (5) signs of clockwise rotation of the heart (S 1 -Q 3 ) and backward position of its apex (S 1 ,S 2 , and S 3 ; S 1 and S 2 with right deviation of  QRS ); (6) diphasic (of the − + type) or negative T waves in Leads III, II, and V F ; (7) small R waves in the precordial leads; (8) deep S waves in the left precordial leads; (9) diphasic (of the + − type) or negative P waves in the right precordial leads; and (10) negative T waves in the right precordial leads. In the differential diagnosis, we emphasize that: 1. (1) The delay of the intrinsic deflection in the right precordial leads is frequently attended (36 per cent) by a complication which gives rise to further strain on the right ventricle. 2. (2) The absence or diminished amplitude of the S wave in the left precordial leads is frequently attended (75 per cent) by a complication of the “ cor aortale ” type (Fig. 12). 3. (3) A QS complex, usually in the right precordial leads, a W-shaped complex, or a deep Q wave in these leads is a frequent finding (36 per cent) in chronic cor pulmonale, without clinical signs suggestive of a myocardial infarct or a dead zone.

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Los Sistemas de Gestión son en la actualidad el desarrollo de los estándares de eficiencia, eficacia y efectividad aplicados al Desarrollo Organizacional. Calidad, Ambiente, Inocuidad, Seguridad y Salud entre otros, se han estandarizado con la finalidad de ser homogéneos y flexibles en la integración de los Sistemas. En Ecuador, el Instituto Ecuatoriano de Seguridad Social ha cumplido su objetivo planteado hace aproximadamente una década: dejar de ser un ente de recomendación y pasar a ser un organismo auditor de los cumplimientos técnico legal en materia de Prevención de Riesgos Laborales para las empresas sujetas al régimen del IESS. El SART, es ahora, un cumplimiento legal obligatorio en Seguridad y Salud para las empresas a nivel nacional.