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Proceedings of the British Cardiac Society Br Heart J: first published as 10.1136/hrt.34.2.201 on 1 February 1972. Downloaded from British Heart Journal, I972, 34, 20I-209. Proceedings of the British Cardiac Society THE AUTUMN MEETING of the in Dublin on 23 March I972 were pro- mittee that the utmost flexibility re- British Cardiac Society was held at the ceeding satisfactorily. garding the training schedules must be Royal College of Physicians, London, maintained with regard to the order in on Thursday and Friday, 4 and 5 5 The Secretary reported that arrange- which training should be taken, and the November 197I. The President, SIR ments had been made to hold the next background oftrainees. No training pro- JOHN McMICHAEL, took the Chair Autumn Meeting on 9 and I0 November gramme should be so rigid that its at 9.30 a.m. during Private Business. At I972 at the Royal College of Physicians, requirements would permit people with the Scientific Session which followed, but the possibility was being explored unorthodox backgrounds but of special the Chair was taken by ALASTAIR of holding the dinner elsewhere. brilliance to be excluded. HUNTER. The recommendations had been pre- 6 The Secretary reported that the sented to the members of Council, who Private Business Annual General Meeting in 1973 would had added their comments and suggest- I The President reported with deep be held on I2 April in Glasgow, im- ions, and the report had been discussed regret the deaths of Twort and Doris mediately before the meeting of the and agreed provisionally at the meeting Baker. Association of Physicians. of the full Committee for Higher 2 The Minutes of the Annual General Medical Training in October. Meeting having been published in the Journal (I97I, 33, 607-6I6) were taken 7 Goodwin reported that the findings as read and confirmed. of the Cardiology Committee of the 9 Davison and Oram reported on the Royal College of Physicians on Career results of discussions they had had with 3 The Treasurer reported that the Structure in Cardiology had gone to the Dr. Lees of the Department of Health Society's investments stood at nearly Department of Health, but no official and Social Security on cardiological £12,ooo. In line with stock market reaction to the report had been received. technicians' pay and conditions. They prices there had been some recent felt that they had had a full opportunity appreciation in value. He had recently 8 Goodwin, as Chairman of the to explain the position and they were reviewed the holdings with the Society's Specialist Advisory Committee on hopeful that a sympathetic view would Broker who was generally satisfied with Cardiology of the Joint Committee on be taken of the need for appropriate the behaviour of the shares and recom- Higher Medical Training, reported that salary scales for cardiological tech- mended no change at this time. the Committee had now formulated nicians. http://heart.bmj.com/ £i,ooo had been taken out of the provisional recommendations for train- Deposit Account and invested in 8J% ing programmes for Groups I and II Bass Charrington Debentures for the cardiological consultant work, and for 10 The Secretary informed the Society Sinking Fund, bringing this to £I,5OO, paediatric cardiology. It seemed likely that a memorandum had been received with s500 left on deposit, on Broker's that the Groups II and III outlined in from Dr. Lees of the Department of advice, for easy availability. the Report ofthe Cardiology Committee Health and Social Security with regard Expenses of all kinds were rising of the Royal College of Physicians on to the possibility of interference with inexorably, and though he was exploring Cardiological Staffing and Career Struc- the function of demand pacemakers. ways and means of getting work done ture could in future be merged. The Dr. Lees was anxious to establish a on September 26, 2021 by guest. Protected copyright. more cheaply most increases had to be Specialist Advisory Committee had register of demand pacemakers, and accepted. Members' subscriptions just recommended 8 years training for members were requested to notify Dr. about covered current expenses; but Group I and II and Paediatric Car- Lees of the name and address of any the actual position would be known diology, which included i year pre- patient, and the make and model of the when the books for 197I were closed at registration jobs, 3 years general medical pacemaker being used. the end of the year. training, and 4 years (in the case of Following the Scientific Meeting on The financial accounts of the VI Group I) and 3 years (in the case of the Thursday, the Thomas Lewis World Congress of Cardiology had now Group II) in specialist training in Lecture - 'Function of Nerves of the been closed and the Society had re- a Special Cardiac Medical-Surgical Heart' - was given by Linden. ceived a further kI,967-26. It had been Centre. The 4th year for Group I After the Scientific Meeting on the agreed that £5oo should be given from should include some general medicine. Friday, the National Heart Hospital St. the Society to the Lord Alexander Paediatric Cardiology presented addi- Cyres Lecture - 'The Skeleton in Heart Appeal Fund of the British Heart tional difficulties, but should include 2 Disease' - was given by Jefferson. Foundation; that £i,ooo should be held years' adult cardiology and 2 years' The Society dined together at the in reserve to assist members with some paediatric cardiology in addition to Royal College of Physicians, with of their travelling expenses to attend the general paediatrics and neonatal paedi- McMichael in the Chair. The guests VII World Congress; and the remainder atric training, probably to be taken in included Professor J. N. Morris. The be put into the Society's general fund. the 3 years of general professional President spoke about recent develop- training. ments including progress in the creation 4 The Secretary reported that arrange- Goodwin emphasized most strongly of chairs of cardiology by the British ments for the Annual General Meeting the firm recommendation of his Com- Heart Foundation. Br Heart J: first published as 10.1136/hrt.34.2.201 on 1 February 1972. Downloaded from 202 Proceedings of the British Cardiac Society Nitrous oxide analgesia in acute patient the thrombus extended to the with acute myocardial infarction. High myocardial infarction popliteal vein. When such extension was frequency phonocardiograms were re- noted these patients were given anti- corded from the left atrial border and F. Kerr, D. J. Ewing, J. B. Irving coagulants. Over 50 per cent of the apex on several occasions in all patients. (all introduced), and B. J. Kirby thrombi were found in the first 72 Pulmonary artery pressures were mea- hours. No patient in this series sus- sured with a flow guided catheter. Many drugs used for pain relief in myo- tained a major pulmonary embolus. The Simultaneous electrocardiograms were cardial infarction have circulatory incidence found in these patients is very also obtained. effects. An agent that relieves pain with- similar to that recorded in patients who Atrial sounds were present in all out major haemodynamic effect would have recently undergone surgery. cases. The interval between the P wave be advantageous. In IS patients with of the electrocardiogram and the initial acute myocardial infarction we studied deflexion of the atrial sound of the the analgesic and cardiorespiratory pro- Atrial gallop in diagnosis of early phonocardiogram (PG interval) was perties of a 50 per cent nitrous oxide 50 coronary heart disease measured. The ratio of PG interval to per cent oxygen mixture (Entonox, the PR interval of the electrocardio- B.O.C.). During a control period the P. G. F. Nixon and H. J. N. Bethell gram progressively increased from 8i patients breathed air via an air force (introduced) per cent on the first day to 89-3 per cent mask connected to a demand valve. on the fourth day, demonstrating that With a three-way tap, transfer to Ento- The clinical diagnosis of early coronary with resolution of the infarction, the nox, breathed through a similar assem- heart disease traditionally depends upon atrial sound moved towards the first bly, was accomplished without the the history and the electrocardiogram, heart sound. Those patients with a com- patient's knowledge. In 5 patients the little of importance being expected or plicated clinical course had a signifi- cardiac index was measured with indo- obtained from the examination of the cantly smaller PG/PR ratio than those cyanine green and intra-arterial pres- heart sounds and pulsations. patients whose course was entirely sures recorded at 5-minute intervals. The purpose of this communication uncomplicated. After a 20-minute control period Enton- is to report findings from a series of I59 There was a significant correlation ox was administered for 30 minutes: cases of coronary heart disease without between this ratio and the pulmonary mean heart rate fell 5/minute, mean evidence of myocardial infarction, hy- artery diastolic pressure, suggesting arterial pressure remained constant, car- pertension, or valvar disease. that those patients with the greatest diac index fell 0o4 I./min per m2n, and One hundred and eleven patients had degree of left ventricular dysfunction systemic vascular resistance rose 334 classical angina pectoris and the resting had the shortest PG intervals (r=o052, dynes sec cm-5/m2. Blood gases in 6 electrocardiogram was abnormal in 21 y=37-I 4x, P < OcOOI). patients showed a rise in arterial Po2 of (i8%). In the remaining 48 patients, It is concluded that in acute myocar- 35 mmHg during Entonox administra- the diagnosis of coronary heart disease dial infarction an atrial sound is univer- tion, returning to the control level on was made from abnormalities of the sally present and that the PG interval http://heart.bmj.com/ withdrawal.
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