Abstract
One hundred fifty-two private cases of hypertension were followed for periods of between 3 and 9 years. Of these, 90% were patients with essential hypertension. Teleoroentgenograms, electrocardiograms and blood pressure readings were taken at intervals of 6 months or longer. Definite progressive changes took place leading to a characteristic shape, size and position of the heart and aorta on the roentgen-ray picture and also leading to definite changes in the size and shape and sign of the Q R S-T waves in the electrocardiogram. These final changes are specific for long standing cases of hypertension.
The characteristic x-ray film in hypertension shows a sthenic or hypersthenic chest; a hypertrophied left ventricle, usually a concentrically hypertrophied left ventricle: an enlarged heart; a dilated and tortuous aorta. The development of this heart and aorta is gradual. At first the heart and aorta are of practically normal size, shape and position. (See Fig. 1a.) A left ventricular hypertrophy then develops and the heart enlarges. (See Fig. 1b.) This development proceeds until an enlarged heart, hypertrophied left ventricle with rounded apex, and dilated, tortuous aorta appear. These changes occurred over a period of 6 years in this particular case. (See Figs. 1a, b, c, d.)
Over a period of years a characteristic hypertension electrocardiogram commonly results. This specific electrocardiogram shows a left axis deviation of the Q R S group (left ventricular preponderance), an inversion of the T wave in lead I, high voltage of the R and S waves in which the amplitude is 20 mm, or more in at least one lead, and a diminished or absent S-T transition period. Figure 2a is a normal electrocardiogram taken from the records of a woman of 59 years of age, Dec. 23, 1921.
Get full access to this article
View all access options for this article.