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Discusses the diagnostic approaches of coronary artery disease. Tests utilized to examine the capability of electrocardiogram to detect latent impairment of the coronary circulation; Efficiency of exercise electrocardiogram test in the detection and monitoring of coronary heart disease; Capability of the test to reflect the behavior of an intact circulation during stress.

1. A survey throughout the United States demonstrated the frequency of occurrence of vascular accidents associated with bowel function. 2. A study of the effects of therapeutic agents in causing drug-induced constipation revealed this to be an important factor which deserves serious attention by the clinician. 3. The administration of the neuroperistaltic constipation corrective, Senokot, successfully corrected the constipation when encountered, and when administered concomitantly with the therapeutic agent it prevented its onset. There was no interference with the pharmacodynamic activity of the principal therapeutic agent by this procedure. 4. The administration of this agent together with drugs capable of causing constipation is recommended in order to reduce the stress to the circulatory system arising from the straining efforts associated with bowel function. [ABSTRACT FROM AUTHOR]

1. The effect of bowel function on the peripheral circulation was investigated in a group of normal and constipated subjects by observing the changes in arterial and venous pressure as well as in segmental blood flow. A study was also made of the effects of controlled straining on segmental blood flow, digital blood flow and peripheral vascular resistance. 2. The peripheral circulation is subjected to a variety of stresses during normal bowel function release of the strain there was a transient return of the blood flow toward control levels followed by a second diminution, after which a vasodilation occurred before the return of the resting state. In response to controlled straining efforts, the venous pressure rose proportionately to the magnitude of straining. 4. During controlled exertions, the digital blood flow and pulse volume showed a pattern of change similar to that of the segmental circulation. Again, a. vasoconstriction and a vasodilation were observed after the strain period. 5. Controlled straining efforts produced a marked rise in peripheral segmental and digital vascular resistance. The response was greater in the legs and toes than in the arms and fingers. This increased resistance terminated at the conclusion of the strain only to be followed by a sharp increase during the poststrain period. 6. Throughout the study, the fluctuations among the constipated group were of a greater magnitude and frequency than those observed among the normal subjects. This was a reflection of the greater and more profound straining efforts of the former group. 7. The implications of these findings with respect to the mobilization of peripheral thrombi and production of pulmonary embolism are discussed. The present findings emphasize the conclusion of our earlier study14 that, if tragic cardiovascular episodes associated with defecation are to be avoided, the immediate correction of constipation is of particular importance. [ABSTRACT FROM AUTHOR]

1. The effect of bowel straining on the cardiopulmonary system was studied in a group of normal and constipated subjects by observation of changes in the heart rate, electrocardiogram, heart sounds, pulmonary circulation and circulation time. 2. The presence of either a tachycardia or bradycardia occurring in connection with certain straining efforts of defecation as they affect the heart rate was confirmed. These alterations of the rate are reflexes principally associated with the Valsalva phenomenon. 3. The Valsalva maneuver initiated electrocardiographic changes in 2.5 per cent of the 209 healthy persons studied. These changes most often consisted of marked T-wave lowering and ST-segment depression. Other alterations included extrasystoles, partial heart block, slurring of the QRS-complex and T-P fusion. It was concluded that reduced coronary perfusion was the most likely causative factor for the abnormalities described. 4. The effect of bowel straining on heart sounds and murmurs appears to conform to the known dynamic results of straining at stool and the physiologic mechanism accountable for the acoustic phenomena. 5. The entire pulmonary circulation is a low tension system, indicating large channels of flow with low resistance. The effects of straining on the venous return to the heart from the pulmonary circuit, as well as the results of straining on pulmonary arterial, left atrial and pulmonary ‘capillary’ pressures are discussed and related to the four phases into which the circulatory system's response to the Valsalva maneuver has been divided. 6. The effect of straining on the circulation time was studied in terms of strains of periods shorter than 10 seconds, along with the possible additive effects of individual strains of less than 6 seconds' duration would grossly affect the circulation time. However, sustained efforts exerted at pressures in excess of 10 mm Hg for more than 6 or 8 seconds would prolong circulation time in rough approximation to the duration of the strain. 7. The straining efforts in constipated individuals are greater and more profound than in normal individuals. The implication of this fact with respect to the cardiopulmonary dynamics of bowel function is discussed and the hazards involved are indicated. 8. The present findings emphasize the conclusion that physiologic changes after straining at stool may result in serious consequences, and, if tragic episodes are to be avoided, the immediate correction of constipation assumes special significance for persons who suffer from serious organic heart disease. [ABSTRACT FROM AUTHOR]

1. In normal dogs and monkeys, the Valsalva maneuver was found to produce a marked fall in carotid blood pressure with a simultaneous rise in jugular vein and cerebrospinal fluid pressures, parallelling the rise in intrathoracic pressure. In two human subjects without cerebrovascular disease, performance of the Vulsalva maneuver resulted in a brief rise in brachial and carotid arterial pressure, followed rapidly by a precipitous fall. 2. Electroencephalographic as well as angiographic studies in normal dogs demonstrated that performance of the Valsalva maneuver produces circulatory stasis sufficient to result in anoxic changes in the cortical cells. 3. It is emphasized that a transient fall in cerebral blood pressure, resulting in fluctuations in cerebral oxygen supply, may be particularly hazardous to patients with existent cerebrovascular disease. In such individuals, reduction of stresses to the cerebral circulation is of utmost importance. Since straining at stool is perhaps the most common source of such circulatory stress, and since the magnitude and duration of straining efforts are greatest among constipated patients, the correction of constipation becomes an essential part of the therapeutic regimen of patients with cerebrovascular or vascular disease. [ABSTRACT FROM AUTHOR]

1. The physiology of defecation is discussed and the contribution of intrathoracic, intraabdominal and intestinal intraluminal pressures to the straining forces of bowel function is explored. 2. Exertion at stool may effect an intraabdominal pressure increase of up to 200 mm Kg and also tends to produce excessive intraluminal and intrathoracic pressures. Various techniques for recording intraluminal pressures are described. 3. The duration and magnitude of elevated intrathoracic pressures during straining episodes in normal and constipated subjects were studied and classified according to the criteria of the Valsalva maneuver. It was found that use of the lied pan (in normal individual) and the presence of constipation markedly increase the frequency, intensity and duration of straining during defecation. More than half of the efforts of the constipated group met the Valsalva criteria, whereas only 12 per cent of the exertions of the normal group fell into this category. 4. The use of a constipation corrective reduced the number of strains exceeding 40 mm Hg from a pretreatment level of 93.9 per cent ot 38.8 per rent, and the incidence of exertions lasting longer than 8 seconds was reduced from 03.3 per cent before therapy to 12.2 per cent after therapy. The use of such agents, therefore, is indicated to reduce the incidence of these stressor effects. [ABSTRACT FROM AUTHOR]

The proposed mechanisms of the symptomology for Raynaud's disease and Raynaud's phenomenon have been reviewed, and these have been extended to include the role of serotonin in both the initiation and propagation of the digital symptoms. [ABSTRACT FROM AUTHOR]

Examines a clinical approach to the management of intermittent claudication or angina cruris. Consideration of plethysmographic studies in judging the effect of vasodilating drugs on the peripheral circulation; Importance of supplementing vasodilators with tranquilizers; Description of the efficacy of a vasodilating drug, Cartrax.

Focuses on the conclusion of a study that neurogenic vasospasm can result in symptoms which may simulate those of organic arterial and occlusive disease. Physical examinations of patients with neurogenic vasospasm; Clinical diagnosis of the disorder; Indication of centrally directed therapy to combat anxiety tension stage when peripheral blood flow reduction is primarily due to neurogenic vasospasm.

Focuses on the effect of the continued administration of sublingual heparin in treating athersclerosis on the fat tolerance test. Capabilities of heparin in treating atherosclerosis; Pros and cons in the therapeutic use of heparin; Clinical ability of heparin that triggers the difficulty in finding the accurate result of the fat tolerance test.

Discusses the clinical considerations for venous thrombosis. Characteristics of the disease; Etiology; Citation of possible therapies for the disease.

Exploratory studies of the role of monoamine oxidase inhibition with Nardil in patients with peripheral circulatory disturbances are described. This drug is effective in relieving the pain of claudication, although confirmatory increase in peripheral blood flow was not observed (during the period of study) unless supplemental vasodilation was included. Vasomotor disturbances, however, were virtually completely eliminated by the drug. It is hoped that continued study will elaborate the essential mechanisms for this drug and, thereby, help to define its exact therapeutic role in the management of peripheral arterial disease. [ABSTRACT FROM AUTHOR]

Examines the ability of sublingual heparin to clarify lipemic serum in a series of 36 patients under an acute experimental design. Determination of a base line curve of the serum turbidity after the ingestion of a standard fat test meal and after the administration of sublingual heparin; Inability to detect any effect of sublingual heparin on blood coagulation; Clarification of lipemic serum in parents after fat ingestion and therapy.