[Serum myoglobin: clinico-diagnostic importance].
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Female↗
Biomedical subjects
H Kreuzer
Publications and source records attributed to H Kreuzer.
Antiinflammatory agent BW 755 C in ischemic reperfused porcine hearts.
The effect of the antiinflammatory compound BW 755 C on myocardial infarctions was evaluated in regionally ischemic reperfused hearts of 35 pigs. The left anterior descending coronary artery was occluded distally in 23 anesthetized pigs for 45 min and was reperfused for 24 h. The BW 755 C (10 mg/kg) was intravenously injected prior to ischemia in seven pigs (group A). A second dose of BW 755 C (5 mg/kg) was given after 4 h of reperfusion. Group B consisted of eight animals. They were treated with BW 755 C immediately before (10 mg/kg i.v.) and after 4 h of reperfusion (5 mg/kg). Another eight pigs served as controls. At the end of the experiments, infarct size was determined as the ratio of the infarcted myocardium (tetrazolium stain) over the risk region (fluorescent dye). Leukocyte infiltration of the risk region was histologically quantitated in one slice of each experiment. In a second set of experiments recovery of regional myocardial function of the risk region was determined by sonomicrometry during 2 weeks of reperfusion. The BW 755 C (10 mg/kg) was injected intravenously in six pigs before ischemia and at a dose of 5 mg/kg after 4 h of reperfusion. Six pigs served as controls. Hemodynamic parameters and total leukocyte blood count did not differ between the groups. Treatment protocol of group A reduced the infarct size from 72 +/- 13% (control group) to 50.9 +/- 12% (p less than 0.005). Infarct size of group B (65 +/- 16%) did not differ from control experiments. Leukocyte infiltration of the risk region was only attenuated in group A (p = 0.01) compared with the control group.(ABSTRACT TRUNCATED AT 250 WORDS)
4,5-Dihydro-1-(3-(trifluoromethyl)phenyl)-1H-pyraz↗
Occurrence and clinical significance of endocardial late potentials and fractionations in idiopathic dilated cardiomyopathy.
In order to assess the occurrence and clinical significance of abnormal electrograms in idiopathic dilated cardiomyopathy, endocardial electrode mapping during sinus rhythm and programmed ventricular stimulation were performed in 52 patients with or without clinical ventricular tachycardia. Abnormal endocardial electrograms were recorded in 77% of the patients and were diffusely distributed over the entire left ventricular endocardium. No relation could be established between the occurrence of late potentials or fractionations and clinical or induced arrhythmias. Endomyocardial biopsy samples were taken from 20 patients and showed that reduced myofibril volume fraction was related to the occurrence of abnormal endocardial electrograms. Neither induced arrhythmias nor the presence of late potentials or fractionations identified patients who died of sudden cardiac death during the mean (SD) follow up of 33 (11) months. Thus abnormal endocardial electrograms recorded during sinus rhythm in idiopathic dilated cardiomyopathy may only be interpreted as being a sign of damage to the myocardial cells.
Action Potentials↗
[Increased primary success rate in coronary angioplasty using a guide wire with attached balloon (microprobe)].
In 15 cases of 350 consecutive coronary angioplasties conventional low profile balloon catheters did not traverse the stenosis or occlusion over the guide-wire. A balloon on a wire device ("Microprobe", 2 mm) passed the stenosis or occlusion easily with a good primary result in 14 cases. The angioplasty procedure could then be completed with a larger standard balloon catheter. Use of the balloon on a wire device expands the technical facilities of angioplasty and increases the primary success rate in technically difficult cases.
Angioplasty, Balloon↗
[The cardioprotective effect of verapamil in acute percutaneous transluminal coronary angioplasty].
Verapamil improved the ischemic tolerance of the myocardium in experiments in animals. Therefore, 20 patients were examined during percutaneous transluminal coronary angioplasty (PTCA) of a proximal LAD stenosis in order to evaluate the ability of verapamil to improve the ischemic tolerance in man. Before the second dilatation, 1 mg verapamil was given intracoronarily to 10 patients, the other 10 patients received placebo ic. Before and after each of the three inflations, blood samples were obtained from the coronary sinus in five patients of each group to analyze the contents of lactate, pyruvate, and pH. Verapamil caused a significant prolongation of the inflation from 58 +/- 12 s to 83 +/- 20 s. This effect was persistent also during the following inflation (96 +/- 19 s). The onset of angina was delayed (p less than 0.05). ST-wave elevations and T-wave amplitudes were smaller after verapamil, in spite of the increased duration of inflation, as compared with the control group. The time until ST elevations of 0.1 mV occurred was increased from 17 +/- 3 s to 57 +/- 18 s (p less than 0.05). The increase in lactate in coronary sinus blood was less pronounced after verapamil (48% of control; p less than 0.05). Intracoronary verapamil before PTCA of the LAD improved the ischemic tolerance of the poststenotic myocardium significantly as evaluated by measurements of electrocardiographic and metabolic parameters. No side effects occurred during the injection of verapamil into the left coronary artery.
Adult↗
[Coronary fistula of the right ventricular outflow tract as a complication of combined transaortic-trans-right ventricular myectomy in hypertrophic obstructive cardiomyopathy].
We report on a patient who showed a fistula between the first septal branch of the left anterior descending coronary artery and the right ventricular outflow tract, as a complication of combined trans-aortic right ventricular myectomy for treatment of hypertrophic obstructive cardiomyopathy (HOCM).
Aorta, Thoracic↗
A case of valproate intoxication with excessive brain edema.
A 29-year-old man, who had been treated with sodium valproate for 3 years because of generalized cerebral seizures, ingested a large amount of this drug in an attempt to suicide. The exact amount he had swallowed could not be determined. The patient arrived in the intensive care unit in a deep coma, was intubated, and artificially ventilated. He developed a massive cerebral edema, as proved by computerized tomography (CT). This was supported by electroencephalography (EEG). The measured value for the concentration of valproate in serum was markedly elevated on the day of admission (2300 mumol/l; therapeutic range 350-700 mumol/l). Treatment with sodium thiopental, glycerol, and glucocorticoids was initiated. A second CT scan performed 9 days after admission showed a complete normalization and the EEG yielded a markedly improved pattern. At this point the patient slowly regained consciousness. We conclude that in patients with an acute sodium-valproate intoxication, care should be taken with regard to the development of a severe cerebral edema, which in the reported case could be treated successfully.
Adult↗
Acute effects of the new angiotensin converting enzyme inhibitor ramipril on hemodynamics and carotid sinus baroreflex activity in congestive heart failure.
The hemodynamic effects of a single dose of 5 mg of ramipril, a new angiotensin converting enzyme inhibitor, were investigated in 10 patients with chronic congestive heart failure. Arterial blood pressure and total peripheral resistance were decreased by approximately 12% without causing reflex tachycardia. A highly significant decrease occurred in mean pulmonary artery and pulmonary capillary wedge pressures. These hemodynamic changes were equally pronounced at rest and during exercise on a bicycle ergometer; the effect was of the same magnitude 5 and 24 hours after medication. Angiotensin converting enzyme activity in plasma was nearly completely inhibited after 5 hours and remained at about 12% of control after 24 hours. Cardiac index, which was normal before treatment, remained unaffected. Thus, ramipril induced a balanced reduction of left ventricular pre- and afterload. The activity of the carotid sinus baroreflex was investigated in 8 of the patients using the neck suction technique before and 24 hours after ramipril. The reflex bradycardia during stimulation of the baroreceptors was significantly increased by ramipril, whereas the decrease in blood pressure remained essentially unaffected. Ramipril induced a selective sensitization of the parasympathetic baroreceptor heart rate reflex without influencing the sympathetically mediated peripheral vasodilatation. This effect may be responsible for the lack of reflex tachycardia in spite of the decrease in blood pressure.
Angiotensin-Converting Enzyme Inhibitors↗
Programmed ventricular stimulation in coronary artery disease and dilated cardiomyopathy: influence of the underlying heart disease on the results of electrophysiologic testing.
In order to evaluate the clinical and prognostic significance of programmed ventricular stimulation (PVS), 100 patients were investigated. Twenty-four of 51 patients with coronary artery disease and 22 out of 49 with dilated cardiomyopathy had clinical ventricular tachycardia (VT). The study protocol included 24-h Holter ECG, cardiac catheterization and angiography, and PVS employing 1 and 2 premature extrastimuli and incremental pacing. In patients with coronary artery disease, VT was induced in 67% with prior VT and in 18% without such episodes (p less than 0.01). In dilated cardiomyopathy, however, patients with and without clinical VT did not differ with regard to VT inducibility (18% vs. 15%, NS). The inducibility of monomorphic sustained VT--most frequently induced in VT patients--was significantly higher in patients with coronary artery disease (p less than 0.05). Polymorphic nonsustained VT (in both coronary artery disease and dilated cardiomyopathy) was only initiated in patients without clinical VT. In patients with coronary artery disease, left ventricular ejection fraction could be correlated to clinical arrhythmia (p less than 0.001), while induced VT could only be correlated to depressed left ventricular function in patients with left ventricular aneurysm. Neither clinical nor induced VT could be correlated to left ventricular ejection fraction in patients with dilated cardiomyopathy. During a mean follow-up of 21 months, 7 patients died from sudden cardiac death. Six of them had clinical VT, but in only 1 patient with coronary artery disease was VT initiated. There was no apparent difference in the antiarrhythmic therapy of the patients with sudden death with respect to the surviving population. In conclusion, the response to PVS with the stimulation protocol applied is different in patients with coronary artery disease and dilated cardiomyopathy. The prognostic significance of the results obtained from PVS remains uncertain.
Adult↗
Precision velocimetry with digital cross-correlation for flow measurements during thrombus growth.
A precise velocimetry with good frequency response is an indispensable prerequisite to studying hemodynamic effects. The need to monitor minute changes of velocity prompted the development of a software-driven velocimeter that uses a laboratory computer without implementation of specialized arithmetic hardware. Without an on-line output, this setup offers high precision (6000 time shifts), extension of the measuring range to lower velocities by nearly two orders of magnitude, an excellent temporal resolution, and resistance to bad signal-to-noise ratios. The system is described and its characteristic parameters are demonstrated. Velocimetry was performed during experiments on thrombogenesis with and without pretreatment with antithrombotic agents and was found to be valuable in assessing thrombus growth and thrombus stability in vivo.
Animals↗
Changes in left ventricular diastolic function during exercise in patients with coronary artery disease.
In 10 controls and 43 patients with coronary artery disease (CAD) left ventricular (LV) diastolic pressure-volume (P-V) curves were obtained from biplane ventriculograms and simultaneous high fidelity pressure measurement at rest and during bicycle exercise. During exercise ventriculography 20 patients had angina pectoris, and 16 patients were asymptomatic. At rest there were no akinetic segments in 28 patients, and at least one akinetic segment was found in 15 patients. Shifts in the diastolic P-V relationship with exercise were quantitated from the constants a and b of the linear log P-V relationship. In the control group a and b did not change significantly, but in all CAD groups a significant decrease in a and a significant increase in b were observed during exercise. While no patient with angina had an unchanged diastolic P-V relationship, as many as 12 patients had significant P-V shifts in the absence of angina. A similar correlation was found for the diastolic P-V alterations and the exercise ECG. Fourteen patients without any ST-segment change during exercise showed significant P-V shifts, while no patient with signs of ischaemia in the ECG had an unchanged P-V curve. In another 20 patients with CAD the relative contribution of the Frank-Starling mechanism, diastolic compliance and the pericardium to the filling pressure rise during exercise was analyzed. Left ventricular and right atrial pressures--as an index of pericardial pressure--were measured simultaneously during rest and exercise ventriculogram. This was done when filling pressures exceeded 30 mmHg or when angina pectoris occurred.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Acute haemodynamic effects of a specific bradycardic agent in patients with coronary heart disease and impaired left ventricular function.
Alinidine is a bradycardic agent, which appears to be of potential value in the therapy of coronary heart disease. It might be useful in patients with impaired left ventricular function, where use of other bradycardic agents such as beta-blockers is limited due to their negative inotropy. To assess if alinidine has the potential to worsen haemodynamics in patients with strongly reduced left ventricular function we have examined acute haemodynamic changes after alinidine (0.5 mg kg-1 i.v.) both in a group of patients with mildly and in a group with strongly reduced left ventricular function. A significant reduction of resting heart rate and cardiac index was observed in both groups. All other haemodynamic parameters, especially left ventricular filling pressures (LVEDP, PC) and enddiastolic volume index did not show any significant change; dp/dtmax was not significantly influenced by alkinidine, when the influence of heart rate lowering was eliminated by pacing. We conclude that administration of alinidine in the dosage used does not lead to a significant deterioration even in patients with strongly impaired left ventricular function.
Anti-Arrhythmia Agents↗
Influence of heparin, aspirin, streptokinase and factor VIII (AHF) on amorphous electron-dense substance, a mediator of platelet and thrombus adhesion in vivo.
Platelet adherence and aggregation on vessel walls are the first crucial steps in thrombogenesis and atherosclerosis. Whether platelets can be activated on damaged endothelial cells or their activation is achieved only when subendothelial structures are exposed was controversially discussed in the past. Recently, an electron-microscopic study has revealed an amorphous electron-dense substance (AEDS) after endothelial cell damage and has discussed its role as a possible trigger of thrombogenesis. The aim of the present study is to elucidate the role and origin of this substance and to investigate the influence which inhibitors of platelet function (acetylsalicylic acid), coagulation (heparin), stimulation of fibrinolysis (streptokinase) and addition of factor VIII (AHF) have on AEDS.
Adhesiveness↗
Inhomogenous capillary flow and its prevention by verapamil and hydralazine in the cardiomyopathic Syrian hamster.
There is clinical evidence that human dilated cardiomyopathy is related to microcirculatory disorders. We used an experimental preparation of the disease that consisted of a study of the microcirculation of 45 cardiomyopathic Syrian and 18 control hamsters with timed plasma staining. To investigate dynamic vascular disorders a double injection technique was used that permitted demonstration of all permanently and temporarily perfused capillaries in the same animal. The results showed a total capillary density of 3423 +/- 470 capillaries/mm2 in the cardiomyopathic hamster during the premyocytolic phase (30 days of age) and that of 3289 +/- 506 capillaries/mm2 during the myocytolytic phase (44 days). These values were not significantly different from those in the control group (3349 +/- 473 capillaries/mm2 at 30 days and 3383 +/- 556 capillaries/mm2 at 44 days). However, tissue areas with extended coronary transit times were detected only in the cardiomyopathic hamsters. These areas were of the same individual and cumulative size at 30 days (diameter approximately 200 micron, 4% of the tissue) as the myocytolytic zones at 44 days. In cardiomyopathic hamsters verapamil and hydralazine prevented both hypoperfusion and myocytolysis. The results favor the view that microcirculatory disorders generate tissue damage in the cardiomyopathic hamster and that these disorders can be prevented through treatment with the calcium antagonist verapamil or with the vasodilator hydralazine.
Animals↗
[Spontaneous and stimulus-induced arrhythmia behavior in dilated cardiomyopathy].
To assess the incidence and significance of spontaneous and induced ventricular arrhythmias in idiopathic dilated cardiomyopathy, 24 h ambulatory electrocardiographic monitoring and programmed ventricular stimulation were performed in 52 patients. The mean left ventricular ejection fraction was 38 +/- 13%. Ventricular arrhythmias were present in 94%: 56% had non-sustained ventricular tachycardia with 3-20 consecutive VPCs and 17% ventricular pairs. In 56% of patients, more than 10(3) single VPCs/24 h were seen. Repetitive ventricular response was induced by programmed stimulation in 28 patients (54%): in 39%, 2-4 VPCs and in 15%, greater than or equal to 5 VPCs. In three patients (6%), sustained ventricular tachycardia (greater than or equal to 30 s) was initiated, which was of a monomorphic configuration in two of them. The incidence of induced ventricular arrhythmias could neither be correlated with the Lown grade of spontaneous arrhythmias nor with the total number of single VPCs/24 h. The inducibility of sustained ventricular tachycardia, however, was only seen in patients with arrhythmias of Lown grade IVb. No clear correlation could be determined between the impairment of left ventricular function and spontaneous or induced arrhythmias. During the 9-48 (median 34) months' follow-up, nine patients (17%) died, three of them died suddenly and five in congestive heart failure. All sudden cardiac death victims and three out of the five who died of congestive heart failure had non-sustained ventricular tachycardia during 24 h ambulatory electrocardiographic monitoring, but no higher incidence of single VPCs than the survivors. All patients who died had a significantly reduced left ventricular ejection fraction as compared to those who survived. In none of the patients who died were there more than three consecutive VPCs induced by programmed ventricular stimulation.
Adult↗
[Doppler echocardiography determination of the minute heart volume in ergometric stress].
To prove the use of Doppler-echocardiography in the determination of cardiac output during supine bicycle exercise, 14 patients suffering from dilatative cardiomyopathy were studied. Cardiac output was simultaneously determined by Doppler-echocardiography and with radionuclide ventriculography. In some cases, cardiac output was additionally measured using the thermodilution technique. In 12 patients (success rate 86%) flow velocity signals from the ascending aorta could be recorded with sufficient quality. Both methods were closely correlated, the r-value was 0.91 and the standard error of estimate was found to be 2.09 l/min. Mean deviation was 1.50 l/min (0.09-5.45 l/min) or 13% (1%-64%) respectively. For changes in cardiac output with exercise, the correlation was r = 0.88 with a mean deviation of 69% (2%-453%). The coefficient of variation for exercise measurements was 19% and did not differ from the resting value of 20%. Comparing the mean values of the whole group, no differences between the two methods could be found at rest, during exercise or for changes from rest to maximal exercise. Using the suprasternal approach, aortic flow velocities can be assessed by Doppler-echocardiography during exercise. Gross estimation of cardiac output during exercise seems possible; judgement of changes in cardiac output in individual cases appears to be uncertain.
Adult↗
[Clinical and hemodynamic effects of nisoldipine and captopril in heart failure: a double-blind comparative study of long and short-term effects].
Afterload reduction with angiotensin-converting enzyme inhibitors (ACE-inhibitors), such as captopril, is an established therapeutic measure in the adjunctive treatment of severe chronic heart failure. Unfortunately, several side effects and adverse reactions are related to this form of therapy. Calcium antagonists of the dihydropyridine group can also induce a similar afterload reduction, and substances of this group exhibit only a few adverse reactions. In the present double-blind study, the acute and chronic hemodynamic and clinical benefits of the calcium antagonist nisoldipine (= BAY K 5552) were compared with captopril in the adjunctive treatment of patients with heart failure (NYHA III or IV). The study group consisted of 17 patients. After randomization, 9 were treated with captopril (25 mg orally t.i.d.) and 8 with nisoldipine (3 were given 20 mg orally t.i.d., and 5 were given 20 mg b.i.d.). The following hemodynamic variables were obtained in the control phase after 3 days and 3 months' duration of treatment: heart rate, LVEF, SVI, ESVI, EDVI, PSP/ESVI (ratio of peak systolic pressure and end-systolic volume index), CI and systemic vascular resistance. The clinical status of the patients was assessed by means of seven criteria on an arbitrary scale. The following results were obtained: for the nisoldipine group, the average LVEF increased significantly from 0.26 to 0.31 within 3 days of treatment, but after 3 months, this increase had disappeared. All other hemodynamic parameters did not change significantly within either 3 days or 3 months of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Budd-Chiari syndrome as a late complication following closure of an atrial septal defect].
A case of a Budd-Chiari syndrome in a 19-year-old female patient is reported who had undergone surgical closure of a secundum atrial septal defect 13 years before. 8 months before the development of the Budd-Chiari syndrome she started to take oral contraceptives. The clinical picture of the Budd-Chiari syndrome developed within several days. The inferior vena cava did not fill with contrast dye when an angiography was performed using the right vena iliaca approach. The contrast dye disappeared through collateral veins (vena azygos, vena hemiazygos). After 4 days of treatment with systemic streptokinase she underwent open-heart surgery. The orifice of the inferior vena cava was occluded to a diameter of 6 mm. No thrombi were found. The lesion was corrected with two patches, one in the right atrium and the other in the inferior vena cava. This case report demonstrates that a Budd-Chiari syndrome is a possible late complication after closure of an atrial septal defect which should be treated by surgery.
Adult↗