[Differential echocardiographic diagnosis of left ventricular types of hypertrophies].
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Adolescent↗
Biomedical subjects
J M Curtius
Publications and source records attributed to J M Curtius.
[The etiology, course and prognosis of dilated cardiomyopathy].
UNLABELLED: In order to study the etiology, the clinical course and the prognosis of patients with DCM, clinical, morphological (endomyocardial catheter biopsy), angiographic and hemodynamic data of patients with DCM were studied. The total number of patients was 396. In 258 patients definite DCM was diagnosed, in 138 patients DCM was suspected, e.g., because of an additional history of alcoholism. ETIOLOGY: In no case acute subacute or chronic myocarditis was found in myocardial biopsies (n = 114) and at autopsy (n = 18). However, from the history strong evidence was obtained for DCM being the late stage of diphtheric heart disease predominantly among patients with complete left bundle branch block. As far as the alcoholic etiology is concerned, the only significant difference between DCM and alcoholic heart disease was a higher proportion of women among patients with DCM (28% and 5%, resp.). Clinical course and prognosis: 221 patients were studied prospectively (mean follow-up time 3.1 +/- 2.3 years), 44% of patients died or deteriorated. However, in patients with normal cardiothoracic ratio this rate amounted only to 12%. The mean annual mortality rate was 9.8% and varied significantly in relation to different subsets of patients from 0% to 17%. A bad prognosis was significantly indicated by young age, high cardiothoracic ratio, pronounced elevation of enddiastolic volume index and of left ventricular enddiastolic pressure at rest and of mean pulmonary artery pressure at exercise, by severe morphologic changes of myocardial biopsies, severe ventricular arrhythmias, the absence of transient abnormal elevation of arterial blood pressure during follow up, of complete left bundle branch block and of a positive history of diphtheria. However, the wide scatter of data diminished the significance of them for the definite prognostic evaluation of individual case. The cumulative survival curves of patients with a history of alcohol abuse did not differ from that of patients with DCM. The data demonstrate that DCM in patients with the history of diphtheria together with left bundle branch block is possible caused by an inflammatory process. According to the analysis of the clinical course and the prognosis, DCM is one of the most severe heart disease. However, in different subsets of patients, the clinical course may be stable for long time and even normal longevity cannot be excluded.
Adult↗
[Exercise echocardiography in dilatative cardiomyopathy].
Using M-mode echocardiography under 2-D control at rest and during ergometer exercise (ex), we examined 15 patients (pat) with angiographically moderate diffuse left ventricular (LV) contraction impairment (mean enddiastolic volume index 115 ml/m2, mean ejection fraction 58%) (group DCM I). The aim of the study was to look for differences in LV behavior under exercise within this patient group, with a view to aiding diagnosis. These pat were compared to 10 normal subjects (N) and 10 pat with advanced dilatative (congestive) cardiomyopathy (enddiastolic volume index 135 ml/m2, ejection fraction 44%) (DCM II). Even at rest, the LV diameters and the fractional shortening (FS) in the group DCM I differed significantly from those in N, and in the case of the mean FS the difference increased on ex (rest p less than 0.05, exertion p less than 0.0005). In none of the three groups did the enddiastolic diameter undergo any significant change on ex. The endsystolic diameter decreased in N by an average of 5.2 mm (p less than 0.0005); at 2.8 mm (p less than 0.005), the decrease (DCM I vs N p less than 0.005) was distinctly slighter to be observed in DCM I; in DCM II it was no longer significant. Within the group DCM I, 4 pat showed a behavior on ex that was not what the values at rest would have suggested. 2 pat showed a physiological reaction on ex despite a restricted function at rest; however, in 2 patients with relatively good values at rest, the FS decreased on ex. According to these findings, a restriction of LV function is to be recognized echocardiographically more clearly on ex than at rest, especially in low-level dilatative cardiomyopathy (DCM). In individual cases, a varying increase in LV functional impairment is to be observed during ex, or even generalized physiological reaction, which would not be expected from the echocardiogram at rest. Thus the results of the examination present a differentiated basis for the observation of the course of the disease, especially in pat with a moderate DCM.
Adult↗
[Pulmonary oedema as a complication of tocolytic therapy (author's transl)].
Tocolytic treatment with fenoterol and additional administration of betamethasone and acetyl salicylic acid to a 19-year-old girl caused irreversible and finally fatal pulmonary changes. The clinical course in this and that of other published cases indicates a causal relationship between the tocolytic treatment and the onset of pulmonary oedema. The pulmonary arterial pressures in this patient, the poor therapeutic response and the shock-lung picture without corresponding myocardial changes suggest a non-cardiogenic cause of pulmonary oedema. Any of the three drugs administered could have been responsible.
Adult↗