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Biomedical subjects

W Kasper

Publications and source records attributed to W Kasper.

At least 145 records · Page 8Linked to original sources
PubMed1983

[Arrhythmias in subjects with a healthy heart].

Of 350 patients who had extensive non-invasive and invasive cardiological diagnostic tests, 56 had completely normal results. 24-hour ECG monitoring of the latter revealed the following ventricular arrhythmias-ventricular extrasystoles (VES): 36% without, 23% with rare ones (less than 30/h), 5.4% with more than 30/h, 25% with polytopic VES, 7.1% with paired VES and 3.6% with ventricular tachycardia. There was no preferential VES pattern. Mean duration of VES was 0.15 s. There were no VES with a prematurity index of less than 1. Extending ECG monitoring to 96 hours (10 persons without heart disease) did not reveal any more significant VES, but registering for less than 24 hours definitely underestimated the frequency of VES in persons without heart disease. In those without angiographic evidence of heart disease 36% had complex and 5.4% frequent VES. Complex arrhythmias, however, are rare in the individual subject and generally not accompanied by frequent VES. Frequent complex arrhythmias or both frequent and complex arrhythmias, as well as VES with a prematurity index less than 1, are suggestive of organic heart disease.

Adult↗
PubMed1983

[Incidence and clinical significance of ventricular arrhythmias in dilated cardiomyopathy].

The diagnosis of dilated (congestive) cardiomyopathy was made in 75 patients on the basis of clinical, ECG, echo and angiographic-haemodynamic findings. Ambulatory 24-hour monitoring was undertaken in all patients. Nearly all of them (93%) had ventricular extrasystoles (VES), 35% more often than 1000/24 h. In 15% VES occurred in pairs, in 44% as ventricular tachycardia. In general, frequent VES (greater than 30/h) also came in pairs and/or as ventricular tachycardia. On the other hand, not all patients with such complex arrhythmias also had frequent VES. In about 70% of all patients with ventricular tachycardia such episodes were registered repeatedly, in more than 40% more than five tachycardia episodes per 24 hours. In the majority of patients the tachycardia consisted of three (33%), four (12%) or five (18%) consecutive ventricular complexes. All episodes of ventricular tachycardia ended spontaneously and were clinically largely silent. Apparently there was no clinically relevant correlation between frequency and severity of the arrhythmia, on the one hand, and extent of abnormal ventricular function, on the other. These findings indicate that frequent and complex ventricular arrhythmias are a characteristic feature of dilated (congestive) cardiomyopathy. If they occur in heart disease of seemingly unknown aetiology, dilated cardiomyopathy should be suspected. Preliminary findings of long-term observation indicate that patients with frequent ventricular tachycardias have a higher risk of sudden death.

Adolescent↗
PubMed1983

Congestive cardiomyopathy and the selenium content of serum.

A deficiency of selenium is suspected to be involved in the pathogenesis of congestive cardiomyopathy. Therefore the serum selenium content of 20 patients with proven congestive cardiomyopathy was measured and compared to that of a healthy control group. The serum selenium content of the patients with cardiomyopathy was found to be different from that of the healthy control group. The mean value of selenium in serum for the control group was 80.1 micrograms Se/1 (SD +/- 13.2) within a range of 53 and 117 micrograms Se/1. From the 20 patients with congestive cardiomyopathy six patients showed selenium concentrations in the normal value range of the control group; in the serum of 14 patients a distinct lower selenium content was found (mean value 47.8 micrograms Se/1 (SD +/- 16.2)) within a range of 23 and 70 micrograms Se/1. A positive correlation was found between serum selenium content and the left ventricular ejection fraction. Our results suggest that a deficiency of selenium may be present in a number of patients with congestive cardiomyopathy.

Adult↗
PubMed1983

Electrophysiologic effects of lorcainide on the accessory pathway in the Wolff-Parkinson-White syndrome.

The electrophysiologic effects of lorcainide, a class I antiarrhythmic agent with local anesthetic properties, were studied in 20 patients with the Wolff-Parkinson-White syndrome. After intravenous administration of lorcainide (2 mg/kg), the sinus cycle length decreased in all patients from 705 +/- 117 to 636 +/- 94 ms (p less than 0.001). The atrioventricular conduction time lengthened from 84 +/- 22 to 94 +/- 22 ms (p less than 0.01) and the QRS duration increased from 92 +/- 19 to 120 +/- 29 ms (p less than 0.001). The effective refractory period of the atrium increased from 230 +/- 27 to 243 +/- 35 ms (p less than 0.05), whereas the ventricular refractoriness was unaffected. Retrograde conduction over the accessory pathway was blocked in 5 of 18 patients after lorcainide; in the remaining 13 patients a prolongation from 107 +/- 32 to 162 +/- 57 ms (p less than 0.001) was found. Anterograde conduction over the accessory pathway was blocked in 6 patients, and in all other patients it increased considerably. Circus movement tachycardia could be induced in 14 patients before and in 10 patients after the drug. The shortest R-R interval during tachycardia lengthened from 326 +/- 40 to 364 +/- 67 ms (p less than 0.05). The tachycardia zone was unaffected by lorcainide. In 15 patients atrial fibrillation was induced. After lorcainide anterograde conduction during atrial fibrillation was blocked (n = 5). The shortest R-R interval over the accessory pathway during induced atrial fibrillation increased from 228 +/- 35 to 304 +/- 103 ms (p less than 0.05). Intravenous administration of lorcainide produced a pronounced negative dromotropic effect on the conduction properties of the accessory pathway. Lorcainide appears to be a promising new antiarrhythmic agent in patients with the Wolff-Parkinson-White syndrome.

Adolescent↗
PubMed1983

The suprasternal approach to recording aortic valve prostheses: a comparison with the precordial and subxiphoid approaches.

We evaluated 56 consecutive patients echocardiographically 9 days to 104 months after aortic valve replacement by the precordial, subxiphoid and suprasternal approach. In 11 patients, the mitral valve had also been replaced. For comparison, a subjective grading system (score 1 up to 3) was applied to the records obtained from each approach. Disc valves (n = 41) were equally scored from the precordial and suprasternal approach (score 2.6). Ball prostheses (n = 6) were best imaged from the suprasternal approach (score 3.0), whereas bioprostheses (n = 9) were best visualized from the precordial (1.8). Simultaneous imaging of both valves was possible in 6 out of 11 patients with a double prosthesis using the suprasternal approach but not from precordial and subxiphoid approaches. Six patients presented prosthetic valve dysfunction. Five patients had paravalvular insufficiency; 4 of these patients had a Björk-Shiley valve and one patient a Lillehei-Kaster valve. The echograms of 4 out of 5 patients with a paravalvular leak were normal from each approach. In another patient an obstructed Björk-Shiley prosthesis was found. The pre- and postoperative echograms demonstrated that the suprasternal approach was best to visualize the obstructed valve. The study shows that the suprasternal technique is superior for evaluation of most patients with aortic valve prostheses.

Adult↗
PubMed1983

Hepatic extraction of isosorbide dinitrate in cardiac patients.

Hepatic extraction of organic nitrates, including that of isosorbide dinitrate (ISDN), has been thought to be nearly complete in man but has never been directly measured. We examined the time course of plasma ISDN and metabolite concentrations in arterial and hepatic venous blood in four cardiac patients receiving an intravenous ISDN infusion. Apparent hepatic extraction of ISDN was high (90%) at the beginning of infusion but fell to about 44% 1 hr after termination of infusion. The decrease in ISDN concentration gradient across the liver correlates with an increase in plasma isosorbide-5-mononitrate concentration, but a cause-and-effect relationship resulting from metabolite inhibition cannot be established. The time-averaged hepatic extraction of ISDN, at about 70%, agreed with its oral bioavailability in patients.

Biological Availability↗
PubMed1983

Alinidine in angina.

Alinidine--N-allyl-clonidine--reduces heart rate without blocking beta adrenoreceptors. It may be used in patients with angina without inducing the adverse effects of beta-adrenergic blockers. We therefore evaluated alinidine efficacy in patients with angiographically proven coronary artery disease and stable angina during a 10-wk placebo-controlled randomized double-blind trial. Alinidine (40 mg three times a day) reduced the number of anginal attacks and the average number of nitroglycerine capsules consumed. The double product was slightly lowered during rest but more pronounced during exercise. This effect was mainly due to decreased heart rate. The ischemic S-T segment depression was diminished. Exercise tolerance was clearly improved in six, slightly improved in two, and unchanged in four subjects.

Adult↗
PubMed1983

[Beta-adrenergic stimulation with prenalterol in sick sinus syndrome].

The effect of beta-adrenergic receptor stimulation on sinus node function in patients with sick-sinus syndrome was investigated. Electrophysiological studies were performed in 14 patients (5 males and 9 females) aged 18-81 years before and after intravenous administration of 50 micrograms Prenalterol per kilogram body wt. Prenalterol decreased spontaneous cycle length by 26% (p less than 0.01), which corresponded to an increase in heart rate of 21 beats/min. The corrected sinus node recovery time was shortened by 23% (n.s.) in 10 patients, and was abnormal in 12 patients before and in 10 patients after Prenalterol. Secondary pauses occurred in 8 patients at control and in 9 patients after drug administration, in 2 of them for the first time after Prenalterol. In the sick-sinus syndrome the pronounced chronotropic response to beta-adrenergic receptor stimulation with Prenalterol doses not indicate improvement of impaired sinus node function.

Adolescent↗
PubMed1983

[Effect of nifedipine on sinus node and atrioventricular node function following autonomic blockade in the human].

The effect of intravenously administered nifedipine (7.5 micrograms/kg) on sinus node and atrioventricular (AV) node function was evaluated in 17 patients, 9 of whom had sinus node disease after autonomic blockade (propranolol 0.2 mg/kg and atropine 0.04 mg/kg i.v.). The patients' ages ranged from 18 to 77 years. After nifedipine there was a nonsignificant increase in the median values for sinus cycle length from 750 ms to 760 ms, for sinus node recovery time from 1150 ms to 1240 ms, for corrected sinus node recovery time from 440 ms to 460 ms, and for sinoatrial conduction time from 63 ms to 75 ms. Nevertheless, nifedipine produced a significant increase in the AV node refractory periods (median values): the effective refractory period lengthened from 300 ms to 305 ms (rate 100/min) and from 290 ms to 300 ms (rate 120/min) respectively. The functional refractory period increased from 380 ms to 400 ms (rate 100/min) and from 385 ms to 410 ms (rate 120/min) respectively. The Wenckebach period was significantly prolonged from 370 ms to 390 ms. We conclude, therefore, that in the absence of autonomic control intravenous administration of nifedipine exerts a mild depressive effect on AV node but not on sinus node function.

Adolescent↗
PubMed1983

[Diagnosis of restrictive cardiomyopathy in the hypereosinophilia syndrome by 2-dimensional echocardiography].

The cardiac manifestation of the hypereosinophilic syndrome was diagnosed by means of echocardiography in a 36-year-old man. The following two-dimensional echocardiographic characteristics indicated a restrictive cardiomyopathy in this patient: Enlargement of the left atrium. Thrombotic obliteration of the left ventricle from the apex up to the subvalvular region. Embedding of the chordae tendineae and papillary muscles by the thrombotic mass. Normal left ventricular ejection fraction. The echocardiographic findings were verified by autopsy.

Adult↗
PubMed1983

[Repetitive ventricular response and left ventricular wall motion in patients with coronary heart disease].

As the first results of a prospective study on the value of programmed ventricular stimulation, the incidence of repetitive ventricular response with 3 or more consecutive beats (RVR3) in 136 patients (122 males, 14 females, age 51 +/- 8 years) with coronary artery disease is reported. 38 patients (group A) had no evidence of previous myocardial infarction, 31 patients (group B) had myocardial infarction less than 3 months and 67 patients (group C) more than 3 months before entry into the study. Programmed electrical stimulation included single (S2) and double (S2 S3) ventricular premature beats following ventricular drive at 3 cycle lengths (500, 600 and 430 msec) and was defined as positive (+PES) when RVR3 was induced. +PES was related to the extent and the degree of abnormal left ventricular wall motion, determined by left ventricular angiography (30 degrees RAO view) and quantified by a wall motion score. After single premature stimuli no RVR3 was observed in group A, but in 7% of group B and in 19% of group C (p less than 0.01). After double premature stimuli RVR3 occurred in 17% of group A, 42% of group B and 34% of group C (p less than 0.1). All 3 groups differed with respect to mean wall motion score and number of akinetic wall segments (p less than 0.001). Patients with positive (+PES) or negative (-PES) results could not be separated when the extent of wall motion abnormalities (wall motion score, number of akinetic segments) was considered. However, a relation (p less than 0.01) to the degree of abnormal wall motion classified according to the presence of normokinesis, hypokinesis, akinesis or dyskinesis could be demonstrated for +PES after single but not after double premature stimuli.

Coronary Disease↗
PubMed1983

[Separation of the left atrium from the right pulmonary artery in the suprasternal echocardiogram: a parameter of left atrial pressure].

A separation of the left atrium from the right pulmonary artery during atrial contraction may be observed in the suprasternal echocardiogram. In 280 catheterized patients with sinus rhythm, we investigated whether left atrial separation is a parameter from which an estimate of the left atrial pressure can be obtained. In 239 of the 280 patients, the suprasternal echograms were of a quality such that it could be seen whether there was, a left atrial separation. In 182 patients, a normal left atrial pressure (greater than or equal to 12 mm Hg) was found; in 57 patients, the left atrial pressure was elevated. An atrial separation was observed in 183 patients, and in 56 patients it was lacking. Lack of left atrial separation indicates a left atrial pressure elevation with a sensitivity of 73.7% and a specificity of 92.3%. If a left atrial pressure above 18 mm Hg was considered elevated, the sensitivity of this echoparameter amounted to 90.3%, and the specificity was 86.5%. The study shows that the left atrial separation from the right pulmonary artery separation from the right pulmonary artery in the suprasternal echocardiogram is a parameter valuable in providing a rough estimate of the left atrial pressure.

Blood Pressure↗
PubMed1982

[Importance of echocardiography for the assessment of left-ventricular function and cardiac complications in dilative cardiomyopathy].

One- and two-dimensional echocardiographic findings in 17 patients with dilated cardiomyopathy were compared with haemodynamic and angiographic results of cardiac catheterization. In a further 52 unselected patients with dilated cardiomyopathy, who had been seen as out- or in-patients over a period of two years, the frequency of intracardiac thrombi was investigated echocardiographically. A significant correlation (r = 0.66 and r = 0.68) was found between echocardiographically determined left-ventricular end-diastolic and end-systolic volumes on the one hand and volumes determined angiographically on the other. However, ventricular volumes were clearly underestimated by echocardiography. In contrast, both methods showed good agreement for the magnitude of the ejection fraction (r = 0.79). The aortic valve opening surface estimated with one-dimensional echocardiography correlated with left-ventricular ejection volume (r = 0.93). Thrombi were demonstrated in 7 out of 52 patients: 5 were located in the left, one in the right and a further one in the central pulmonary vascular system. Considering the aforementioned limitations, echocardiography is a useful method for evaluation of left-ventricular function and for demonstration of intracardiac thrombi in dilated cardiomyopathy.

Adolescent↗
PubMed1982

Estimation of pulmonary arterial pressure by measuring the size of the right pulmonary artery in the suprasternal echocardiogram.

We studied 175 patients within 24 hr before cardiac catheterization with suprasternal echocardiography to evaluate whether pulmonary arterial hypertension can be derived by measuring the size of the right pulmonary artery. Group I consisted of 103 patients without pulmonary arterial hypertension (enddiastolic less than or equal to 12 mm Hg; mean pressure less than 20 mm Hg) and group II consisted of 72 patients with pulmonary arterial hypertension. The right pulmonary artery could be imaged in 91.2% of the patients studied. The size of the right pulmonary artery at the end of diastole in group I measured 17.9 +/- 0.2 mm (mean +/- SEM) and correlated best to the body surface area in this group (r = 0.63; p less than 0.001). The respective index size amounted to 9.9 +/- 0.1 mm/m2, and was different from that in group II with 14.1 +/- 0.4 mm/m2 (p less than 0.001). The systolic percent expansion of the right pulmonary artery in group I was 21.2 +/- 0.8% and in group II 9.2 +/- 0.8% (p less than 0.001). The index size of the right pulmonary artery for both groups correlated best to the pulmonary enddiastolic pressure (r = 0.82; p less than 0.001). The systolic per cent expansion showed a negative log linear relationship to the pulmonary enddiastolic pressure (r = 0.67; p less than 0.001). Thus, pulmonary arterial pressure can be derived by measuring the size of right pulmonary artery with suprasternal echocardiography.

Adult↗
PubMed1982

Comparison of the antiarrhythmic activity of mexiletine and lorcainide on ventricular arrhythmias.

In a blind cross-over study, 12 patients with ventricular arrhythmias (VPC's; Lown Grades II-IVB) resistant to a daily dose of quinidine 1.2 g, disopyramide 0.8 g, N-propyl-ajmaline 0.1 g were randomly given, each dose for one week, placebo (PL), mexiletine (MEX; 400, 600, 800 mg daily) and lorcainide (LOR; 200, 300, 400 mg daily). On the last day of each treatment period, patients were evaluated by 24-h continuous ambulatory monitoring, 6-channel surface ECG, plasma concentrations and side-effects. During PL I (before) and PL II (after drug treatment), the mean number of VPCs per hour was 670 and 701. VPCs were reduced in 5 of the 12 patients with MEX by 43% (400 mg), 74% (600 mg) and 91% (800 mg). VPCs were reduced in 10 patients with LOR by 60% (200 mg), 78% (300 mg) and 93% (400 mg). Log. lin. plasma conc. effect relationships were constructed for MEX and LOR. Vomiting, nausea, and abdominal pain were seen in 2 patients with MEX; insomnia and feeling heat in 10 patients with LOR. At the end of the LOR-treatment, these side-effects were less in 5 and absent in 5 patients. In this study, LOR seems superior to MEX in refractory ventricular arrhythmias.

Adult↗
PubMed1982

[Transient sinus node arrest-a dysregulation of the autonomic nervous system (author's transl)].

Electrophysiologic studies had been performed before and after pharmacologic autonomic blockade (propranolol 0.2 mg/kg and atropine 0.04 mg/kg body weight) in a 23-year-old female patient with documented sinus arrest of 27 sec duration. Normal electrophysiologic findings before and after autonomic blockade excluded intrinsic sinus node dysfunction. Sinus arrest is therefore though to be due to an intermittent dysregulation of the autonomic nervous system.

Adult↗