Cardiovascular Findings in Children with Sickle Cell Anemia Manuel L. Ng, M.D., Jerome Liebman, M.D., Joseph Anslovar, M.D., Samuel Gross, M.D.  Diseases of the Chest  Volume 52, Issue 6, Pages 788-799 (December 1967) DOI: 10.1378/chest.52.6.788 Copyright © 1967 The American College of Chest Physicians Terms and Conditions

Figure 1 Average age of the group, 8.5 years. Diseases of the Chest 1967 52, 788-799DOI: (10.1378/chest.52.6.788) Copyright © 1967 The American College of Chest Physicians Terms and Conditions

Figure 2 A 13-year-old boy (Hb 7.3 gm per cent) with wide splitting (0.04 sec.) of S1 (11) at the apex, prominent systolic ejection murmur (SM), split S2 (22), prominent S3 (3), and prominent mid-diastolic rumble (DM). MF—medium frequency; 2LIS—second left interspace; JVP—jugular venous pulse. Paper speed 100 mm/sec. and time interval 0.1 sec. in all phonocardiograms. Diseases of the Chest 1967 52, 788-799DOI: (10.1378/chest.52.6.788) Copyright © 1967 The American College of Chest Physicians Terms and Conditions

Figure 3 A 13-year-old boy (Hb 9.6 gm per cent) with wide splitting (0.07 sec.) of S2 with wide splitting (0.04 sec.) of S1 (1), and prominent systolic ejection murmur. 2LIS, 4LIS—2nd and 4th left interspace: HF—high frequency; CAR—carotid pulse. Diseases of the Chest 1967 52, 788-799DOI: (10.1378/chest.52.6.788) Copyright © 1967 The American College of Chest Physicians Terms and Conditions

Figure 4 A five-year-old girl (Hb 8.4 gm per cent) with prominent S3 (3) best recorded in the apex in low frequency (LF) phonocardiogram. A prominent systolic ejection murmur and a mid-diastolic rumble are also shown. S1 and S2 are narrowly split. CAR—carotid arterial pulse. Diseases of the Chest 1967 52, 788-799DOI: (10.1378/chest.52.6.788) Copyright © 1967 The American College of Chest Physicians Terms and Conditions

Figure 5 A 17-year-old boy (Hb 10.4 gm per cent) with a prominent holosystolic murmur (HSM) and mid-diastolic rumble (DM) at the apex. A fourth heart sound occurring 0.11 sec. after the onset of the P wave on ECG is shown more prominently in 2LIS (upper tracing). JVP—jugular venous pulse. A cineangiogram demonstrated marked mitral regurgitation. Necropsy one year later showed no evidence of rheumatic heart disease. Diseases of the Chest 1967 52, 788-799DOI: (10.1378/chest.52.6.788) Copyright © 1967 The American College of Chest Physicians Terms and Conditions

Figure 6 Chest roentgenogram of a 12-year-old boy (Hb 8.4 gm per cent) with prominent aortic arch, moderate cardiomegaly and increased pulmonary vascular markings. ECG and VCG showed left ventricular hypertrophy. Diseases of the Chest 1967 52, 788-799DOI: (10.1378/chest.52.6.788) Copyright © 1967 The American College of Chest Physicians Terms and Conditions

Figure 7 Vectorcardiographic pattern of left ventricular hypertrophy (Hb 8.4 gm per cent). Note that the angle of the maximal vector in the horizontal plane is well posterior (275°). The posterior projections on the Z axes of horizontal and sagittal QRS loops are large at 1.38 mv. This is seen on the ECG as large S waves in V1 and V2. (Horizontal and sagittal planes one-half standardized). Diseases of the Chest 1967 52, 788-799DOI: (10.1378/chest.52.6.788) Copyright © 1967 The American College of Chest Physicians Terms and Conditions

Figure 8 Vectorcardiographic pattern of right ventricular hypertrophy (Hb 7.1 gm per cent). Note the large terminal rightward vector of 1.10 mv. Nonetheless, there is no terminal r' in lead V1 though there is one in V4R. This is because the terminal rightvvard vector is quite posterior at 1.10 mv. Note also that the S wave is not registered in lead V6 of the electrocardiogram. Additional left ventricular hypertrophy is possible. Diseases of the Chest 1967 52, 788-799DOI: (10.1378/chest.52.6.788) Copyright © 1967 The American College of Chest Physicians Terms and Conditions

Figure 9 Vectorcardiographic pattern of combined ventricular hypertrophy (Hb 7.3 gm per cent). Note the remarkable terminal rightward force of 1.45 mv, which was anterior enough to register an r' on the right chest leads because it was only 0.45 mv posterior. Nonetheless, RVH could be read on the EGG as no more than probable. Diseases of the Chest 1967 52, 788-799DOI: (10.1378/chest.52.6.788) Copyright © 1967 The American College of Chest Physicians Terms and Conditions