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Biomedical subjects

S Effert

Publications and source records attributed to S Effert.

At least 145 records · Page 8Linked to original sources
PubMed1977

[Sodium nitroprusside in the treatment of left-sided heart failure in acute myocardial infarction (author's transl)].

27 patients (8 women, 19 men) aged 39-79 (mean 61) years with acute transmural mycoardial infarction and limitation of left ventricular function were treated in the acute stage for 24-72 (mean 55) hours with intravenous infusions of sodium nitroprusside in concentrations of 10-200 microng/min. Haemodynamic measurements before and 12 hours after onset of treatment showed a significant reduction in mean arterial pressure by 19%, in end-diastolic pressure in the pulmonary artery by 33% and in the total peripheral resistance by 32%, whereas stroke volume and cardiac index rose by 12% and 17%, respectively. The percentage improvement was most marked in those patients most severely affected. The mortality rate of cardiogenic shock was reduced to 25%. In a control group with haemodynamically similar left ventricular failure the mortality rate was 55%. However, the total mortality was nearly unchanged as the number of sudden unexpected deaths after the fourth day rose from 23 to 50%. Further investigations will show how these sudden deaths, mainly due to arrhythmias, can be prevented.

Adult↗
PubMed1977

[The vulnerability of the right atrium. II. Correlations between vulnerability and the atrial refractory periods (author's transl)].

The vulnerability of the right atrium to single electrical stimuli was investigated in 100 non-selected patients. According to the response pattern to extrasystolic stimulation of the right atrium during the relative refractory period, the patients could be divided in 3 groups: Group A: no signs of vulnerability. Group B: 1 to 5 additional atrial extrasystoles after the premature atrial stimulus. Group C: runs of atrial flutter or fibrillation for at least 8 s. The 3 groups were compared with respect to the duration of the effective and relative refractory period of the right atrium. From group A to group C the effective refractory period showed a tendency to shorten, while the relative refractory period showed a tendency to prolong. These results are interpreted as supporting a reentry as the underlying mechanism of the here described atrial vulnerability.

Arrhythmias, Cardiac↗
PubMed1977

Left ventricular hemodynamics and function in acute myocardial infarction: studies during the acute phase, convalescence and late recovery.

The left ventricular hemodynamics of 70 patients with acute myocardial infarction were determined from measurements of pulmonary arterial end-diastolic pressure, cardiac index, mean arterial pressure and heart rate during the acute phase(first study, 5 hours after admission), 4 to 6 weeks later (second study, during convalescence) and in 35 percent of all subjects 6 to 12 months after the acute infarction (third study). Serial analysis of serum creatine kinase was carried out during the acute phase. The peak CK value normalized for body surface area was used as a rough index of the extent of the acute myocardial necrosis. The condition of all survivors of the acute stage improved. Patients with only slightly reduced left ventricular performance during the acute stage recovered to nearly normal during convalescence. The condition of patients with greatly reduced left ventricular function also improved but remained impaired during convalescence. In all patients the main changes in left ventricular hemodynamics occurred within the first 4 to 6 weeks; there was almost no further alteration during the following 9 months.

Acute Disease↗
PubMed1977

[Detailed analysis of systolic and diastolic parameters in aortic valve disease (author's transl)].

The on-line computer-system for the analysis of cathlab data developed by us allows the immediate evaluation of the conventional pressure- and valve-opening as well as a new hemodynamic parameters. In addition the volume-analysis is performed by the videometry-program. In simultaneous pressure-volume-registrations the complementary calculation of important energetic items is possible. This expanded analysis by the aid of the computer-system enables a detailed pre- and postoperative study of great clinical-practical and scientific importance.

Aortic Valve↗
PubMed1977

Infarct size estimated from serial serum creatine phosphokinase in relation to left ventricular hemodynamics.

In 50 patients with proven acute myocardial infarction (AMI), left ventricular hemodynamics (pulmonary end-diastolic pressure [PAEDP]; cardiac index [CI]; stroke volume index [SVI]; and SVI/PAEDP were related to the size of the acute infarct. Acute infarct mass was calculated from serial determinations of serum creatine phosphokinase (CPK) every two hours, using a computer program. In 15 cases postmortem measurement of acute infarct size after staining with Nitro-BT was made and correlated with calculated infarct size. Correlation in this limited number of cases was good with a mean difference of 7 g. Acute infarct mass in 38 survivors was 46 +/- 5 g and was significantly smaller (P less than 0.05) than in the 12 nonsurvivors (76 +/- 12 g.) PAEDP in surviving patients was significantly lower (17 +/- 1 mm Hg) and SVI (36 ml/m2) and SVI/PAEDP (2.4 ml/m2/mm Hg) significantly higher than in the nonsurvivors (PAEDP: 24 mm Hg; SVI: 23 ml/m2; SVI/PAEDP: 0.86 ml/m2/mm Hg) (P less than 0.001 for all differences). Similar significant differences were observed between patients not in shock and those in cardiogenic shock. Although in 39 patients, in whom the infarction was their first, infarct mass was larger (58 +/- 6 g) than in 11 patients with repeat infarctions (37 +/- 8 g), left ventricular hemodynamics were slightly more impaired in reinfarctions (PAEDP: 21 +/- 3 mm Hg; CI:2.60 L/min/m2) than in first infarctions (PAEDP: 18 +/- 1 mm Hg; CI:2.82 L/min/m2). The occurrence of cardiogenic shock was a strong predictor of death; however, the wide scatter of the data for the parameters cardiac index, PAEDP, and acute acute infarct mass precluded their usefulness, when taken individually, in predicting survival. When a relationship between hemodynamics and infarct size was looked for, four constellations of individual patients were identified. These groups were defined by PAEDPs of above or below 18 mm Hg and infarct sizes above or below 65 g. Class A patients (N = 22) had a small infarct (29 +/- 4 g) and good pump function (PAEDP: 13 mm Hg; SVI: 40 ml/m2; SVI/PAEDP: 3.27 ml/m2/mm Hg); prognosis was good for these patients. In class B (N = 13) the infarct was large (96 +/- 8 g) and pump function markedly impaired (PAEDP: 26 mm Hg; SVI: 24 ml/m2; SVI/PAEDP: 0.98 ml/m2/mm Hg); 54% of these patients died. Five patients in class C had, in the presence of a large infarct (84 g), only a slightly elevated PAEDP of 17 mm Hg and an almost normal SVI of 37 ml/m2. In contrast, the ten class D patients had an infarct size (34 g) similar to that in class A, but high PAEDP (23 mm Hg) and moderately reduced SVI (31 ml/m2). In this group a high incidence of reinfarctions (six out of ten) occurred. It is concluded that infarct mass calculated from serial CPK analysis, as a single parameter, cannot be used to predict mortality or development of cardiogenic shock in an individual patient.

Acute Disease↗
PubMed1977

[The electrophysiologic constellation of the so-called "sick sinus syndrome" (author's transl)].

A comparative investigation of the electrophysiological properties of the sino-atrial node, the right atrium, the AV-node, and the intraventricular conduction system was performed in 37 patients. 18 patients had a sino-atrial block, 8 a persistent bradycardia and 11 a brady-tachy syndrome. There are the following conclusions: 1. The greatest dysfunction of the sino-atrial node was observed in the group of patients with sino-atrial block. This can be derived from the determination of the sinus node recovery time and from the occurrence of secondary pauses. 2. The vulnerability of the right atrium, investigated by the extra-stimulus-technique, is enhanced in the brady-tachy syndrome. Measuring the duration of the P-wave and the PA-interval does not give any information about the atrial dysfunction. 3. Patients with a sino-atrial block often have a disturbed AV-node conduction. In most patients it is latent only and easily can be detected by atrial incremental pacing. 4. A hemiblock or bundle branch block is found more often in patients with sino-atrial block and sinus bradycardia than in patients with the brady-tachy syndrome. By the registration of a His-bundle-electrogram a trifascicular block can be uncovered in half of these patients. 5. In the sick sinus syndrome, there is always the possibility of additional dysfunctions in the conduction distal to the sino-atrial node. With special regard to therapeutic measures, a complete evaluation can only be made by of both endocardial recording and stimulation methods.

Adult↗
PubMed1977

[Multiple chest leads to evaluate the course of acute myocardial infarction (author's transl)].

At present, precordial mapping is the only reliable method to define the course of myocardial ischemia in patients with acute myocardial infarction. To improve registration technique and evaluation an elastic synthetic plate with 48 electrodes and a computer program for calculation of the different ecg-changes have been developed. Registration and evaluation require an average period of 15 minutes (+/-3 minutes) thus allowing repeated application within time intervals.

Acute Disease↗
PubMed1976

[Significance of the size of an acute infarct for left ventricular haemodynamics (author's transl)].

Acute infarct size was estimated from serial determinations of creatine-kinase (CK) activity. In 15 patients the infarct size was obtained post-mortem, using nitro-blue-tetrazolium stain. There was good correlation between the two measurements (r = 0.98). The relationship between the calculated infarct size and haemodynamic values was obtained in 50 patients (end-diastolic pulmonary arterial pressure [PAEDP], cardiac output, stroke volume, stroke volume/filling pressure of left ventricle [SVI/PAEDP]). On average there was a tendency towards impaired left ventricular haemodynamics with increasing infarct size. Among the survivors the infarct size (51 g) was significantly less (P less than 0.05) than that of those who had died (83 g). PAEDP at 24 mm Hg was significantly higher in those who died than in the survivors (17 mm Hg), cardiac index was 2.95 l/min-m2 in the survivors compared with 2.14 l/min-m2, while SVI/PAEDP was 2.4 ml/m2-mm Hg in the former and 0.9 ml/m2-mm Hg in the latter. However, in individual cases the infarct size sometimes did not correlate with haemodynamic values. Taking into account infarct size and haemodynamics, four classes could be distinguished: (a) infarct size less than 65 g with good haemodynamics (PAEDP less than 18 mm Hg, normal cardiac index); (b) infarct size greater than 65 g with PAEDP greater than 18 mm Hg and markedly reduced cardiac index). Only 10% of those a to c had previously had infarcts, compared with 60% of those in class d (infarct less than 65 g, PAEDP above 18 mm Hg). Small infarcts with markedly impaired haemodynamics thus indicate that there has been previous damage to remaining myocardium.

Acute Disease↗
PubMed1976

[The vulnerability of the human atrium. I. Correlations between vulnerability, sinus node recovery time and intraatrial conduction time (author's transl)].

Using the extrastimulus method in 100 patients, premature impulses were applied during the relative refractory period of the right atrium. Depending on the atrial response to these impulses we divided our patients in the following 3 groups: Group A: no repetitive firing (61 patients); group B: 1 to 5 additional atrial extrasystoles with a total duration of maximum 1.5 s (27 patients); group C: runs of atrial flutter or fibrilation for at least 8 s (12 patients). The statistical analysis of the following parameters: age, PA interval, absolute and corrected sinus node recovery time did not show any significant difference between the 3 groups. These results suggest that the investigated parameters are of no great importance in the genesis of the atrial vulnerability.

Adolescent↗
PubMed1976

[Changes of left ventricular transverse diameter and of contractility after haemodialysis (author's transl)].

In 26 patients (8 women, 18 men; mean age 47 +/- 3 years) who participated in a regular dialysis programme twice weekly the left ventricular diameter, the mean velocity of fibre shortening, the ventricular wall thickness, and the muscle mass were determined echocardiographically. Left ventricular muscle mass (187 +/- 13 g), left ventricular posterobasal wall thickness (14,7 +/- 0,6 mm) and septal thickness (16,4 +/- 0,8 mm) were pathologically increased due to chronic pressure and volume overloading. After an average dialysis time of 12 hours the body weight was reduced by 2,6 +/- 0,4 kg (+ 1,0 to -7,8 kg). The left ventricular transverse diameter changed from 55,3 to 50,2 mm (P less than 0,001) which correlated with a decrease of the enddiastolic volume from 160 +/- 11 to 125 +/- 10 ml (P less than 0,01(. Despite increased cardiac frequency and unchanged diastolic and systolic pressure no significant increase of the mean velocity of fibre shortening (0,93 +/- 0,06 vector 1,13 +/- 0,09 circ/s) occurred. The results show that loss of fluid during haemodialysis led to a significant decrease of the enddiastolic transverse diameter and the enddiastolic left ventricular volume. However, dialysis does not lead to an increase of the mean velocity of fibre shortening as a parameter of improved contractility.

Adult↗