Biomedical subjects

U Stierle

Publications and source records attributed to U Stierle.

46 records · Page 3Linked to original sources

PubMed1990

Right ventricular endomyocardial fibrosis. Diagnosis and management.

The clinical course, noninvasive and invasive diagnostic findings in 4 patients (pt) with endomyocardial fibrosis are reported. All patients (16-50 years) were in functional class III-IV (NYHA). Central venous pressure with large a- and v-waves was elevated in all; liver enlargement and peripheral edema were also noticed in all pts, and ascites in 3. An apical 2/6 systolic murmur was present in 2, and a right parasternal pansystolic murmur 2-4/6 with positive Carvallo's sign in all pts. ECG was non-specific and chest x ray showed right atrial enlargement in every case. A right-sided diastolic plateau which was higher than left ventricular end-diastolic pressure was present in all pts. Echo-, angiocardiography and computed tomography of the heart revealed obliteration of the right ventricular cavity, predominantly localized at the apex. Two pts who underwent endocardial resection and tricuspid valve replacement are alive and well after 9 and 8 years, respectively. One pt died early in the postoperative period and one died waiting for surgical therapy. In conclusion, echo-, angiocardiography and computed tomographic findings are diagnostic. A satisfactory differentiation from other cardiac disorders with restrictive hemodynamics and right-sided heart failure is possible.

Adolescent↗

PubMed1987

Right ventricular obstruction in various types of hypertrophic cardiomyopathy.

Hypertrophic cardiomyopathy (HCM) is most probably a genetically transmitted disease with different clinical and hemodynamic features. In hypertrophic obstructive cardiomyopathy (HOCM) the obstruction is predominantly in the left ventricular outflow tract (IHSS). In a minority of cases the obstruction is strictly located in midventricle (midventricular obstruction, MO). Hypertrophic nonobstructive cardiomyopathy (HNCM) includes asymmetric septal hypertrophy (ASH) and apical hypertrophy (AH). Right ventricular hypertrophic obstruction (RVHO) is an uncommon type of HCM and is almost always combined with other types of left ventricular HCM. We describe in the present report 1 case of RVHO with IHSS, 2 cases with MO and, to our knowledge, the first case with AH.

Adult↗

PubMed1987

[Right ventricular endomyocardial fibrosis].

The clinical course, non-invasive and invasive diagnostic findings from a 50-year-old patient with endomyocardial fibrosis are reported. The patient died in cardiogenic shock. In Europe, endomyocardial fibrosis is a rare event. An exclusively right ventricular involvement is a seldom manifestation. The clinical, echocardiographic and computed tomographic features are diagnostic; therefore a satisfactory differentiation from other cardiac disorders with restrictive hemodynamic signs is possible. An echodense mass as cavity obliteration, with predominantly apical localization, was present at echocardiography; the computed tomography showed a hypodense area instead of the right ventricular cavity.

Echocardiography↗

PubMed1986

Midventricular obstruction--a form of hypertrophic obstructive cardiomyopathy--and systolic anterior motion of the mitral valve.

Hypertrophic cardiomyopathy (HCM) has various manifestations with respect to the localization of the hypertrophy. In this study we report clinical, electrocardiographic (ECG), echocardiographic (echo), and hemodynamic findings in midventricular obstruction (MO), an uncommon form of hypertrophic obstructive cardiomyopathy (HOCM) in 9 patients. The prevalence of systolic anterior motion of anterior mitral leaflet (SAM) in MO, an echocardiographic diagnostic hallmark in HOCM, was another purpose of this study. All patients had complete clinical, ECG, echo, and hemodynamic workup, including left ventricular (in 4 patients simultaneous biventricular, SBVA) and coronary angiograms. All patients had dyspnea and palpitations, chest pain, 2 had syncope. In the ECG, atrial fibrillation was present in 2, and left ventricular hypertrophy in 9 patients. Septal and left ventricular free wall thickening was significantly present in all patients in echo, and SAM in 1 patient. The intraventricular gradient (IVG) was 40-176 mmHg, in 1 case 40 mmHg by provocation, Brockenbrough was positive in all patients. Two patients had right ventricular IVG. A positive beta-blocking agent effect was present in 6 cases. The best localization of the obstruction was possible with SBVA and 2D-echo. We conclude that MO has all the signs of HOCM, but SAM in echocardiography is uncommon. SAM is occasionally present and is not a necessary factor to produce an intraventricular pressure gradient in HOCM, especially in MO. It seems that hypertrophic right ventricular obstruction is relatively common in MO (2 of 9 cases), and may have the same obstructive mechanism.

Adolescent↗

PubMed1986

Generalized coronary arterio-systemic (left ventricular) fistula. Case report and review of literature.

A coronary artery-to-left ventricular fistula is a rare finding; to the best of our knowledge, a total of only 35 cases have been reported. Only 5 cases of a generalized arterio-systemic fistula with three vessel involvement have been reported in the literature. We describe another case involving all major coronary arteries. A review of the literature is presented and the data of the reported cases are analyzed. A 55 year old woman was examined because of recurrent chest pain which had persisted for 2 years. On physical examination, the only abnormal finding was a fourth heart sound. Exertional chest pain, a positive exercise stress test, and the results of a lactate extraction study suggested severe myocardial ischemia. Thallium myocardial scintigraphy showed no evidence of a perfusion defect. Cardiac catheterization revealed an irregular left ventricular endocardial pattern (Thebesian veins). Selective coronary angiography showed communicating fistulae of all three major coronary arteries with the left ventricular cavity. We assume that this vascular anomaly causes a coronary steal phenomenon and subsequent myocardial ischemia.

Angina Pectoris↗

PubMed1985

[Left ventricular ejection dynamics in apical hypertrophy, a form of hypertrophic nonobstructive cardiomyopathy].

The left ventricular (LV) cineangiograms of ten patients with apical hypertrophy (AH, group I) as a form of hypertrophic nonobstructive cardiomyopathy (HNCM) were analyzed. The left ventricular ejection dynamics, the extent and pattern of left ventricular contraction were compared with eight patients with secondary myocardial hypertrophy due to arterial hypertension (group II) and eight normal subjects (group III). End-diastolic, end-systolic and stroke volumes were significantly lower in group I. The analysis of left ventricular ejection dynamics with frame-by-frame-analysis revealed the typical ejection pattern of hypertrophic nonobstructive cardiomyopathy: Left ventricular ejection was completed within two thirds of the systolic ejection period. This ejection pattern is of diagnostic value when compared with the dynamics in group II. Although the apical segment in group I shows a good fiber shortening, the overall contribution to systolic performance is low; systolic function in apical hypertrophy is maintained by a compensatory increase in regional wall motion of the basal and midzonal part of the left ventricular free wall. There is no striking difference between apical hypertrophy with and without giant negative T waves with respect to the ejection pattern. Within these subgroups, the only difference was the greater left ventricular mass in patients with giant T wave inversion. Thus, the ejection dynamics in apical hypertrophy is typical of hypertrophic nonobstructive cardiomyopathy. Global parameters of systolic left ventricular performance revealed supernormal values even though systolic function is impaired. Segmental analysis of ejection phase was most sensitive in establishing the diagnosis.

Angiocardiography↗

PubMed1985

[Noninvasive and invasive study procedures in hypertrophic cardiomyopathy].

Noninvasive and invasive diagnostic procedures permit a differentiated insight into the hypertrophic cardiomyopathies. For a better understanding of the disease, classification according to morphologic and functional criteria was introduced. It has proven useful to subdivide hypertrophic obstructive cardiomyopathy into two types: idiopathic hypertrophic subaortic stenosis and midventricular obstruction; hypertrophic nonobstructive cardiomyopathies can be subdivided into two forms designated as asymmetrical septal hypertrophy and apical hypertrophy. Combined forms can also be recognized. With a high degree of accuracy, it is possible to differentiate between hypertrophic obstructive and hypertrophic nonobstructive cardiomyopathy by means of noninvasive procedures such as clinical examination, electrocardiography, mechanocardiography and, above all, echocardiography. Experience has shown that two-dimensional echocardiography, in particular, has assumed an especially important role, the value of which approaches that of cardiac catheterization. In this overview, emphasis is placed on the diagnostic peculiarities of idiopathic hypertrophic subaortic stenosis as well as the findings in midventricular obstruction and apical hypertrophy. In the past, only relatively little attention has been focused on the latter subgroups even though they can be diagnosed with a high degree of accuracy with noninvasive as well as invasive procedures.

Angiocardiography↗

PubMed1983

Effect of buccal nitroglycerin on pulmonary artery pressure at rest and during exercise: a comparison with sublingual nitroglycerin in patients with coronary artery disease.

60 patients with ischemic heart disease and angina pectoris, aged 42 to 74 years (mean 59), were included in this randomized study. All suffered from coronary disease demonstrated by ECG changes and/or positive exercise test results. Twenty percent of the patients had coronary angiograms revealing significant CAD. All patients had had typical angina pectoris episodes for a period of 22 +/- 10 months at a frequency of 4 +/- 2 attacks a week. A positive response to sublingual nitroglycerin was observed in all patients. The patients were randomly assigned to four groups (1 mg, 2.5 mg, or 5.0 mg buccal nitroglycerin and a control group with 0.8 mg sublingual nitroglycerin). Exercise testing was done by bicycle ergometer in the recumbent position at maximal work loads in 3-min periods; hemodynamic measurements were performed using a pulmonary artery catheter (Grandjean). Pulmonary artery pressure, heart rate, systemic blood pressure, and ST-segment changes in the ECG were recorded before administration of the drug as well as 5, 15, 30, 60, 120, and 180 s after administration. Exercise tests were performed 3, 30, and 180 min after administration. The study demonstrates that buccal Synchron nitroglycerin has immediate hemodynamic and clinical effects, documented by the reduction in pulmonary artery pressure values at rest and exercise and the increase in exercise tolerance and cardiac output. The best antianginal effects were achieved with the dosage of 2.5 mg buccal nitroglycerin. We conclude that buccally administered nitroglycerin has early effects similar to those of nitroglycerin administered sublingually; the hemodynamic and clinical effects, however, persist over a minimum of 180 min.

Blood Pressure↗

PubMed1980

Gas chromatography-mass spectrometry of saturated and unsaturated dicarboxylic acids in urine.

Saturated and unsaturated dicarboxylic acids in urine are analyzed within the total profile of organic acids, using the methyl ester derivatives. Twenty-three acids with two carboxyl groups were identified. The method is employed for comparative studies of the excretion of dicarboxylic acids by individuals with normal and with increased fatty acid oxidation. In the group of the unsaturated acids, the cis-trans isomers mesaconic acid and citraconic acid, the two isomers of 3-methylglutaconic acid and muconic acid are characterized by the mass spectra of their methyl esters. The saturated unbranched and even-numbered dicarboxylic acids are elevated during fasting and diabetic ketoacidosis. In the total profile of the organic acids, succinic and adipic acid are indicators for ketoacidotic states.

Diabetic Ketoacidosis↗

PubMedDate not supplied

[Recent aspects of cardiologic therapy in advanced age].

The aging heart differs in several aspects from the heart in younger people: Cardiac muscle mass, systolic and diastolic wall stress increase, the velocity of electrical conduction decreases in different anatomical structures. Supraventricular and ventricular arrhythmias appear more frequently than in younger people. Heart rate and cardiac index tend to diminish, especially under work load. Work capacity is reduced. In the treatment of coronary heart disease drugs are preferred which lead to a reduction of preload. Nitrates and molsidomine are followed by calcium channel blockers and--afterwards--by beta-blockers. Bypass surgery is performed in elderly patients more often for therapeutical than for prognostic reasons, similarly in the case of valvular surgery. Typical tachyarrhythmias are treated only in case of hemodynamic relevance, whereas pacemaker therapy is not limited by greater age. The choice of the most suitable pacemaker model, however, has to be based upon the overall circumstances in each individual case. For the treatment of congestive heart failure, vasodilators, especially angiotensin-converting enzyme inhibitors, seem to be superior, in elderly patients, to diuretics and digitalis glycosides.

Aged↗