Search PubMed⌕ Search

Biomedical subjects

G Ertl

Publications and source records attributed to G Ertl.

At least 217 records · Page 12Linked to original sources
PubMed1989

[Angiography in intensive care medicine].

Angiography is rarely performed in the intensive-care ward. Indications are: pulmonary embolism, unstable angina pectoris or myocardial infarction, gastrointestinal haemorrhage, acute arterial occlusion, traumatic vascular lesions, aneurysms and if a foreign body has to be extracted. It will always be necessary to weigh the pros and cons, that is to say the risks and danger involved in transporting the patient and in performing an invasive diagnostic procedure on the one hand, and the possible therapeutic gain on the other.

Angiography↗
PubMed1989

[A successful procedure in mitral valve rupture accompanied by rupture of the papillary muscle and the chordae tendinae following multiple injuries and blunt thoracic trauma].

In a considerable number of cases, blunt chest trauma also involves cardiac lesions including myocardial contusion or disruption pericardial effusion, or valve rupture. Definite cardiac trauma poses a challenge to everyone involved in intensive care, as early diagnosis and prompt treatment may be necessary to prevent a fatal outcome. We report a 32-year-old patient with fractures of the humerus, forearm, left clavicle and 2nd rib, and right ribs 4-6 after an 8 m fall. He was intubated in the emergency room because of arterial hypoxemia. Despite fluid administration the blood pressure deteriorated and the patient rapidly developed congestive heart failure that required huge doses of catecholamines. A systolic murmur was heard in the apex and left axilla. Conventional transthoracic echocardiography showed mitral valve prolapse and was suggestive of a flail mitral valve. Transesophageal echocardiography confirmed the diagnosis of mitral valve rupture, which proved to be grade IV by angiography. Because of continuous deterioration with low cardiac output and critical blood pressures and heart rates, surgery was carried out on the day of admission. Complete rupture of the anterolateral papillary muscle was found with laceration of the ventricular muscle, rupture of the secondary chordae tendineae, partial rupture of the valve base and partial dissection of the valve leaflets from the base. As expected from the echocardiography, there was no pericardial effusion. The destroyed valve was replaced by a Duromedics prosthesis. Operative stabilization of the subcapital humeral fracture followed 3 days later.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

The effects of atrial fibrillation on coronary blood flow and performance of ischaemic myocardium in dogs with coronary artery stenosis.

1. Atrial fibrillation may impair coronary blood flow by tachycardia and reflex vasoconstriction. It has not been documented, however, whether in the presence of coronary stenosis atrial fibrillation exceeds the effects of rhythmic atrial tachycardia. 2. The effects of experimentally induced atrial fibrillation compared with atrial tachycardia, therefore, were tested in 22 anaesthetized dogs. Stenosis of the left anterior descending coronary artery was induced to reduce coronary blood flow by about 40%. 3. In the presence of coronary stenosis, atrial fibrillation (ventricular rate: 234 +/- 21 beats/min) reduced coronary blood flow from 58 +/- 7 to 44 +/- 8 ml min-1 100 g-1 (P less than 0.001, mean +/- SEM) and subendocardial segment shortening (ultrasonic crystals) from 12 +/- 2 to 4 +/- 2% (P less than 0.0025), and resulted in a lactate production of 30 +/- 11% (P less than 0.005 vs sinus rhythm). 4. Atrial tachycardia (heart rate: 216 +/- 21 beats/min, NS vs atrial fibrillation) did not significantly change coronary blood flow and reduced segment shortening to 7 +/- 3% (P less than 0.05 vs atrial fibrillation). Significant lactate production did not occur. 5. Since mean arterial pressure fell from 100 +/- 4 mmHg at sinus rhythm to 89 +/- 3 mmHg (P less than 0.01) during atrial fibrillation but not during atrial tachycardia, it was held constant in 13 dogs by a pressurized blood reservoir. Coronary blood flow, however, fell from 43 +/- 6 to 36 +/- 5 ml min-1 100 g-1 (P less than 0.0025). 6. Thus atrial fibrillation may reduce coronary blood flow and induce myocardial ischaemia in the presence of coronary stenosis in excess of atrial tachycardia.

Animals↗
PubMed1987

Coronary vasoconstriction in experimental myocardial ischemia.

The possibility of a coexistence of coronary arteriolar constriction mediated by the renin-angiotensin system and myocardial ischemia was evaluated. Left anterior descending coronary artery was cannulated and perfused at normal (mean aortic), intermediate (50 mm Hg), and low (30-40 mm Hg) pressure in analogy to a progressive coronary stenosis. Lactate production was present at low coronary pressure indicating myocardial ischemia. In control animals (n = 18), mean coronary conductance was higher (p less than 0.005) at intermediate than at high coronary pressure consistent with autoregulation at coronary flow. Coronary conductance was lower (p less than 0.05) at low than at intermediate coronary pressure, indicating coronary constriction during myocardial ischemia. Adenosine (20 micrograms/kg per min i.c., n = 6) resulted in higher coronary conductance, suggesting coronary vasodilator reserve even at low coronary pressure. Indomethacin (5 mg/kg i.v., n = 12) resulted in low coronary conductance; however, the increase at intermediate (autoregulation) and the decrease (constriction) at low pressure was maintained. Plasma renin activity increased, and saralasin (0.1 microgram/kg per min i.c.) and captopril (0.25 mg/kg i.v.) acted as coronary vasodilators in various models of myocardial ischemia. Captopril limited myocardial infarct size at 6 hours of coronary occlusion, diminished flow repayment and prevented lactate production after 30 s of coronary occlusion, and abolished the deterioration of myocardial function during myocardial ischemia induced by coronary hypoperfusion and atrial pacing. Thus, myocardial ischemia does not generally represent a state of maximal coronary dilatation. The renin-angiotensin system is activated by myocardial ischemia and may exert a coronary constrictive tone. Captopril was beneficial in experimental myocardial ischemia.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1987

Nocardial endocarditis of an aortic valve prosthesis.

The organism responsible for endocarditis of a prosthetic aortic valve was identified as Nocardia asteroides. The patient was treated with intravenous amikacin (250 mg four times a day) and intravenous imipenem (1.5 g four times a day). The valve was replaced under this new antibiotic regimen. This is the first report of survival after prosthetic valve nocardiosis.

Amikacin↗