Biomedical subjects

W Bleifeld

Publications and source records attributed to W Bleifeld.

At least 109 records · Page 6Linked to original sources

PubMed1986

Thallium-201/technetium-99m pyrophosphate overlap in patients with acute myocardial infarction after thrombolysis: prediction of depressed wall motion despite thallium uptake.

Intracoronary thallium-201/technetium-99m pyrophosphate planar scintigraphy was performed in 60 patients with acute myocardial infarction undergoing intracoronary thrombolysis to predict salvage of myocardium immediately after thrombolysis. In eight patients a significant overlap of new thallium uptake and technetium pyrophosphate accumulation was found after thrombolysis. Intravenous planar thallium scintigraphy revealed thallium uptake in the region of overlap in all patients; circumferential profile analysis showed no difference in the thallium scintigrams before and after technetium injections. Both findings indicate that overlap is not the result of scattering of technetium into the thallium window. Emission computed tomography revealed thallium/technetium pyrophosphate uptake in identical slices and regions. Regional wall motion in the area of overlap remained depressed in all patients, in contrast to patients with similar thallium uptake without overlap. These data suggest that thallium/technetium pyrophosphate overlap reflects the close proximity of viable and necrotic myocardial cells and predicts depressed wall motion after thrombolysis.

Adult↗

PubMed1986

Effect of encainide and flecainide on chronic ectopic atrial tachycardia.

In the treatment of chronic ectopic atrial tachycardia, standard antiarrhythmic therapy has been shown to be ineffective in the majority of patients. The intravenous and oral effects of two class IC antiarrhythmic drugs, encainide and flecainide, in five patients with chronic ectopic atrial tachycardia were studied using exercise testing, 24 hour long-term electrocardiography and programmed electrical stimulation. All patients had been treated unsuccessfully with at least four antiarrhythmic drugs. In two patients tachycardia was persistent, and in three patients tachycardia occurred intermittently for more than 12 hours/day. Intravenous encainide and flecainide at doses ranging from 0.3 to 2.0 mg/kg and from 0.5 to 1.5 mg/kg body weight, respectively, terminated atrial ectopic tachycardia in all patients. Oral encainide, 150 to 225 mg/day, completely suppressed ectopic atrial activity in four patients during a mean follow-up period of 8 +/- 3 months. In the remaining patient encainide markedly reduced the number of episodes of tachycardia. In three patients encainide had to be withdrawn because of intolerable side effects. These patients were well controlled with oral flecainide, 200 to 300 mg/day, without side effects. On the basis of these results, the efficacy of encainide and flecainide in the treatment of chronic ectopic atrial tachycardia appears to be not drug-specific but rather a general class IC property.

Adult↗

PubMed1986

Transesophageal two-dimensional echocardiography for the detection of left atrial appendage thrombus.

Thrombi located in the left atrial appendage are frequently not detected with conventional two-dimensional echocardiography. The transesophageal echocardiographic approach readily visualizes left atrial morphology and may be used as an alternative. In 6 of 21 patients with mitral valve stenosis, a left atrial appendage thrombus was diagnosed by transesophageal two-dimensional echocardiography when transthoracic echocardiography had failed. The transesophageal echocardiographic findings were confirmed at surgery for mitral valve replacement in all cases.

Adult↗

PubMed1986

Development of pulmonary aneurysm in primary pulmonary hypertension: a case report.

Selected cases of severe primary pulmonary arterial hypertension and associated pulmonary vascular disease have been related to the oral ingestion of aminorex fumarate, an anorexigen obviously responsible for an epidemic of primary pulmonary hypertension in Western Europe between 1967 and 1970. This report describes a fifteen year follow-up of a female patient with aminorex fumarate related pulmonary hypertension and the uncommon finding of the formation of an excessive fusiform pulmonary trunk aneurysm in the late stage of the disease process. The progressive clinical course was followed by serial chest x-ray films and repeat right heart catheterization. The diagnosis of a main stem pulmonary artery aneurysm was noninvasively established by two-dimensional echocardiography and confirmed by contrast-enhanced computed tomography and radionuclide blood pool imaging. The patient is alive, thus no histologic correlate of this entity is available at present.

Aminorex↗

PubMed1986

[Early noninvasive detection of reperfusion and infarct by intravenous technetium 99m pyrophosphate scintigraphy following thrombolysis].

To determine whether technetium-99-pyrophosphate accumulation immediately after intravenous thrombolysis can serve as a marker of reperfusion and infarct size, 17 patients with acute myocardial infarction were studied. Immediately after thrombolysis 10 mCi of technetium-99m pyrophosphate were injected intravenously. Coronary and left ventricular angiography were then performed in all patients, revealing patent coronary arteries in 13 patients. In all patients, 0.3 and 0.5 mCi of thallium-201 were injected into the right and left coronary artery, respectively, followed by planar scintigraphy. 6 patients with patent coronary arteries and a large thallium-201 defect had massive (more than one third of the cardiac silhouette) pyrophosphate accumulation (group A), whereas 7 patients with a small or no thallium-201 defect in the presence of a patent infarct artery had either focal or no pyrophosphate accumulation (group B). In contrast, 4 patients with an occluded infarct artery showed no acute pyrophosphate uptake despite a large thallium-201 defect (group C). Emission computed tomography confirmed the planar scintigraphic data in group A patients and revealed small thallium-201 defects and focal pyrophosphate accumulation in group B patients with negative planar scintigrams. Global and regional ejection fractions in the infarct area, measured from the acute and follow-up left ventricular angiograms, were higher in group A than in group B and C patients. It is concluded that early intravenous technetium-99m pyrophosphate scintigraphy in patients with acute myocardial infarction undergoing intravenous thrombolysis may serve as an indicator of reperfusion and infarct size.

Adult↗

PubMed1986

[Localization and quantification of ischemic myocardial areas in the postinfarct phase by dipyridamole 201thallium emission computerized tomography].

In 41 patients with a history of an acute myocardial infarction, the location of myocardial ischemia was studied by 201Tl emission computed tomography immediately and 3 h after intravenous dipyridamole. Distant ischemia was distinguished from peri-infarctional ischemia by the presence of transient thallium defects in, or slow thallium washout from myocardium not supplied by the infarct-related coronary artery. Ischemia at a distance occurred in 13 patients and was always accompanied by peri-infarctional ischemia. Peri-infarctional ischemia without distant ischemia was observed in 15 patients. The occurrence of distant ischemia was found to be dependent on the severity of stenosis in non-infarct coronary vessels. 12 (86%) of 14 patients with non-infarct stenosis of 75% or greater had distant ischemia, but only 1 (4%) of 27 patients with a stenosis of less than 75% in another vessel. In the presence of distant ischemia, peri-infarctional ischemia was in 11 patients (85%) associated with collaterals supplying the infarct zone, whereas in 13 (87%) of the patients with peri-infarctional ischemia only, incomplete obstruction of the infarct-vessel was observed. It is concluded that, by the distinction between peri-infarctional and distant ischemia, the presence of a significant stenosis in non-infarct vessels can be non-invasively predicted from tomographic thallium scintigraphy with dipyridamole.

Angina, Unstable↗

PubMed1986

[Anti-angina action and tolerance of isosorbide-5-mononitrate or nifedipine in retard form].

Twelve patients with stable angina and reproducible depression of the ST-segment during bicycle exercise of at least 0.15 mV were assessed in a double-blind randomized cross-over study. Patients were treated either with 50 mg isosorbide-5-mononitrate (IS-5-MN) daily or 2 X 20 mg nifedipine retard daily or the combination of both drugs for 2 weeks. The sum of ST-segment depression at maximal exercise was reduced by nifedipine and IS-5-MN to the same amount, while ST-segment reduction was highest during treatment with the combination of both drugs. The best exercise duration and maximal working capacity were also recorded during combination treatment. However, patient appreciation concerning efficacy and side-effects was best with nifedipine, slightly worse with IS-5-MN, and only one patient judged the combination of both drugs as good.

Angina Pectoris↗

PubMed1986

[Pleural and mediastinal fibrosis with involvement of the external pericardium as a cause of decompensated heart failure].

Symptoms of cardiac failure were observed in a 60-year-old man 38 years after the therapy of cavernous tuberculosis of the right upper lobe with a paraffin oil plomb. The irritation by the paraffin oil induced a pleural and mediastinal fibrosis involving the pericardium. The rigid pericardium enclosed the heart and caused biventricular cardiac failure by the impaired diastolic filling. Possibilities of medical and surgical treatment are discussed.

Fibrosis↗

PubMed1985

Spontaneous termination of reciprocating tachycardia owing to interaction of dual atrioventricular nodal pathways in patients with an accessory pathway.

Retrospective analysis of the electrophysiologic recordings from 125 consecutive patients with reciprocating tachycardia involving an accessory atrioventricular (AV) pathway suggested, by the mode of spontaneous termination of reciprocating tachycardia, the coexistence of dual AV nodal pathways in 7 patients. Three different modes of spontaneous tachycardia termination were observed. In 2 patients with antidromic tachycardia, termination was a result of AV nodal reentry, preceded by a decrease in retrograde AV nodal conduction. In 3 other patients with antidromic tachycardia, termination occurred after a sudden switch from a slow to a fast AV nodal pathway, leading to conduction block in either the accessory pathway or the His-Purkinje system. In 2 patients with orthodromic tachycardia, termination was caused by a sudden change of anterograde conduction from a fast to a slow AV nodal pathway, eliciting an AV nodal echo beat. The interaction of dual AV nodal pathways within the reentry circuit incorporating the accessory pathway always inhibited sustained reciprocating tachycardia.

Adult↗

PubMed1985

Double-blind randomised trial of intravenous tissue-type plasminogen activator versus placebo in acute myocardial infarction.

In a double-blind randomised trial 129 patients with first myocardial infarction of less than 6 h duration were allocated to treatment with human recombinant tissue-type plasminogen activator (rt-PA) given intravenously over 90 min, or to placebo infusion. Coronary angiography at the end of this infusion showed that the infarct-related vessel was patent in 61% of 62 assessable coronary angiograms in the rt-PA-treated group compared with 21% in the control group. Treatment with rt-PA was not accompanied by any major complications. In the rt-PA group the circulating fibrinogen level at the end of the catheterisation was 52 +/- 29% (mean +/- SD) of the starting value.

Adult↗

PubMed1985

[Time dependence of myocardial preservation after thrombolysis. Consequences for indication and procedure].

To examine whether the limitation in infarct size after effective thrombolytic therapy is time-dependent the relationship between left ventricular wall motion in the infarct region and the time interval between onset of symptoms and intracoronary streptokinase infusion was investigated. The relationship was significant: When intracoronary thrombolytic therapy was begun within 2 hours, wall motion was almost always within normal limits, whereas the probability of wall motion improvement fell to less than 50%, when treatment was begun later. As a further step a lysis procedure was examined which took account of these findings: the intravenous bolus injection of urokinase. Approximately one hour after bolus injection coronary patency could be demonstrated angiographically in 60% of the infarct patients. A clinically relevant limitation of the infarct size was found in those patients in whom lysis therapy could be begun within 2 hours. On the basis of these findings, a thrombolytic therapy seems to be indicated in all patients with acute myocardial infarction when lysis treatment can be begun within 2 hours. The intravenous urokinase therapy, by virtue of its simplicity, is an alternative to intravenous streptokinase therapy.

Angiography↗

PubMed1985

[Selective coronary angiography via flashing tomosynthesis].

To assess the value and significance of short-term tomosynthesis in judging the pathological condition of coronary vessels, the authors examined 34 patients with coronary heart disease. In comparison with 35 mm cinecoronary angiography, all angiographically determined vascular occlusions and stenoses were identified via short-term tomosynthesis. Comparison of the degrees of stenoses yielded good correlation (r = 0.85). Short-term tomosynthesis offers the advantage of employing smaller amounts of contrast medium to be injected; furthermore, the examination period is shorter, and exposure to radiation is also significantly less.

Cineangiography↗

PubMed1985

Prevention of reentrant tachycardia by single beat or repetitive stimulation.

Eleven patients with an atrioventricular accessory pathway were studied by programmed electrical stimulation to determine if reentrant tachycardia could be prevented by delivery of either a single atrial extrastimulus, applied at a critical time after the tachycardia-initiating stimulus (or stimuli), or a train of stimuli. In all 11 patients, reentrant tachycardia was reproducibly induced from the high right atrium with a single premature beat, and in all patients initiation of tachycardia was prevented from the same site by a second premature beat. This second extrastimulus was effective if delivered within a zone which began 10 ms outside the effective refractory period of the tachycardia-initiating stimulus and averaged 61 ms in width. This was termed the 'preventive zone'. In 7 patients the effect of train stimulation to the high right atrium was studied. In all 7, the results were concordant with those obtained by single-beat stimulation. Any train which achieved single atrial capture within the preventive zone was effective in preventing tachycardia. Prevention was always possible with a single atrial extrastimulus or with single-capture train stimulation, whereas termination of an ongoing tachycardia required at least 2 atrial extrastimuli, or stimulation from the right ventricle.

Adolescent↗

PubMed1985

Coronary angiography with flashing tomosynthesis.

Thirty-four patients with coronary artery disease were studied with standard 35 mm coronary cineangiography and flashing tomosynthesis, to assess the value of the latter technique to detect stenotic coronary arteries. All occluded vessels and all coronary stenoses seen by cineangiography were also found by flashing tomosynthesis. A correlation coefficient of r = 0.85 (P less than 0.001) was determined between the degrees of stenosis obtained by the two techniques. With flashing tomosynthesis, less contrast medium was needed, the investigation time was shorter, and the radiation exposure markedly reduced. At present, dynamic events, such as collateral blood flow, cannot be evaluated. We conclude that coronary arterial stenoses and occlusions can be reliably evaluated by flashing tomosynthesis. Further technological developments are necessary for the technique to gain clinical acceptance.

Adult↗

PubMed1985

Personal view: In-hospital patient management strategies after acute myocardial infarction.

The coronary patient after the striking experience of a myocardial infarction faces a completely new situation possibly affecting lifestyle, occupation and life expectancy. A dedicated post-infarction diagnostic strategy for the evaluation of the individual risk of suffering from a future coronary event, or of dying, requires profound knowledge of the impact of medical and surgical therapies on the survival rate and on the quality of life after infarction.

Angina Pectoris↗

PubMed1985

Scintigraphic evidence that the right ventricular myocardium tolerates ischaemia better than the left ventricular myocardium.

To study the incidence of right ventricular infarction and the effect of intracoronary thrombolysis on the ischaemic right ventricular myocardium, we performed intracoronary myocardial thallium scintigraphy in 18 patients with complete occlusion of the right coronary artery who underwent intracoronary thrombolysis. In 15 of these patients, intracoronary thallium-201 and technetium-99 m pyrophosphate scintigrams were performed simultaneously. All 18 patients had a right ventricular thallium defect before thrombolysis, and all had new thallium uptake after thrombolysis. 17 out of 18 patients had a left ventricular thallium defect before thrombolysis, but only 10 of them showed new thallium uptake after thrombolysis. 14 out of 15 patients had a left ventricular technetium-99 m pyrophosphate spot after thrombolysis and some diffuse pyrophosphate accumulation in the area of the right ventricle. In one patient pyrophosphate accumulation was found only in the area of the right ventricle. Thus, right ventricular thallium defects were detected by intracoronary thallium scintigraphy in the majority of patients with inferior acute myocardial infarction due to right coronary artery occlusion. Right ventricular thallium defects were always reversible in contrast to left ventricular thallium defects in the same patients, suggesting that right ventricular myocardium tolerates ischaemia better than left ventricular myocardium.

Adult↗

PubMed1985

Lysis of left ventricular thrombi with urokinase.

In 16 patients with recent myocardial infarction (3 to 12 week old) and with large left ventricular thrombi systemic thrombolysis with urokinase was performed. Left ventricular thrombi were diagnosed by two-dimensional echocardiography; in all patients the mural thrombus was located in the area of recent myocardial infarction. Each of three patients suffered an embolic episode before the initiation of thrombolytic therapy and the episode caused a stroke in one. Urokinase was infused intravenously at a rate of 60,000 U/hr for 2 to 8 days in combination with intravenous heparin (200 units/kg X 12 hr). Left ventricular thrombi were successfully lysed in 10 of 16 patients, as determined by two-dimensional echocardiography. In four of the six remaining patients only partial thrombolysis was achieved and in two thrombolytic treatment failed. There was no evidence of embolic events during thrombolysis in any of the 16 patients. The success of thrombolysis seemed to depend on the age of the thrombus: the thrombus was dissolved in eight of nine patients undergoing thrombolysis within 4 weeks of the acute myocardial infarction vs in two of seven patients receiving treatment later (p = .057). The presence of a left ventricular aneurysm or depressed left ventricular function also appeared to reduce the likelihood of successful thrombolysis. All patients were discharged on oral anticoagulants. At 6 months follow-up (n = 9) no recurrence of left ventricular thrombus was found. These results show that left ventricular thrombi can be safely lysed by intravenous urokinase. However, for better definition of the risk and benefit of this new therapy further investigation is necessary.

Adult↗

PubMed1985

[Prevention of reciprocal tachycardia by programmed electrostimulation].

10 patients with an accessory atrioventricular pathway were studied by means of programmed electrical stimulation to test the feasibility of tachycardia prevention with an extrastimulus delivered after the tachycardia-initiating beat. Reciprocating atrioventricular tachycardia was reproducibly initiated from high right atrium in all 10 patients with a single extrastimulus. A second extrastimulus delivered to the same site resulted in prevention of tachycardia in all patients, when this extrastimulus was given within a "preventive zone" which started 10 ms after the effective atrial refractory period of the tachycardia initiating beat. The average width of the preventive zone was 50 ms in our patients, independent of the initial tachycardia interval or tachycardia cycle length. Tachycardia prevention was always successful with a single atrial extrastimulus, whereas termination of an ongoing tachycardia required at least two atrial or ventricular extrastimuli.

Adolescent↗