HEART DISEASE IN OLD AGE

In a post-mortem analysis of 1,500 patients, aged 70 years or more, heart disease and malignancy were the two major causes of death. Coronary disease was exceedingly prevalent, almost one in five being subject to this form of heart disease, and 13% dying from its effects. The levelling of the sex ratio in coronary disease in the aged was a striking feature. The clinical manifestations of coronary thrombosis were often atypical. The incidence of demonstrable coronary thrombosis was as high as in younger age groups. The pathological findings and the incidence of local complications in coronary disease were similar to those in other age groups. Other causes of heart failure were relatively infrequent. Certain features of these conditions in old age are discussed. Cardiac amyloidosis, in the form associated with senility, occurred in a very few cases but did not contribute to heart failure.

PERSISTENT HYPOKALEMIA FOLLOWING OPEN-HEART SURGERY

Six patients who exhibited persistent hypokalemia after open-heart surgery with a dilute blood perfusion mixture are discussed. All these patients had acquired heart disease with heart failure as their predominant problem and had been on long-term diuretic treatment with oral potassium replacement. It was not possible to predict with any degree of certainty which patients would develop hypokalemia postoperatively, but the clinical points discussed indicated that frequent measurement of serum potassium was necessary until the value appeared stable. The authors think that the hypokalemia results from long-term tissue potassium depletion, and that hemodynamic improvement following open-heart surgery may facilitate the return of potassium into the cells and thus reduce the serum level.

EXCHANGEABLE SODIUM, BODY POTASSIUM, AND BODY WATER IN PREVIOUSLY EDEMATOUS CARDIAC PATIENTS: EVIDENCE FOR OSMOTIC INACTIVATION OF CATION

Measurements have been made of total exchangeable sodium, total body potassium, and total body water in a group of 13 previously edematous patients with heart disease, and in 20 "control" patients. The data show that while both groups have the same quantity of water as the per cent of body weight and the same body potassium concentration, the cardiac group has an excess of exchangeable sodium when compared with the "controls." Since the excess sodium in the cardiac group cannot be attributed to the loss of potassium or the accumulation of water, the results of these studies are taken as evidence that osmotic inactivation of a considerable amount of some cation, probably sodium, has taken place. It is suggested that a likely site for cation binding is in the polyanionic constituents of the connective tissues.

THE FATE OF THE PATIENT WITH PULMONIC STENOSIS

The prognosis for the patient with pulmonic stenosis was analyzed from a study of 100 current patients, with long-term observations on 58 of them. Congestive heart failure occurred in seven, all of whom had severe stenosis. Subacute bacterial endocarditis developed in another seven, even when the stenosis was less marked. With appropriate medical supervision of those with mild stenosis who have no cardiac disability, and open-heart surgery for those with more severe obstruction, the outlook for the patient with pulmonary stenosis should be a full and active life.