Herz
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Cardiogenic shock in acute myocardial infarction patients is the most common cause of in-hospital death. Various studies showed, that 60 to 100% of patients in cardiogenic shock will die, if no early reperfusion of their coronary artery could be established. The incidence of cardiogenic shock has decreased during the last years, most likely due to early thrombolytic therapy and administration of nitroglycerin. ⋯ Results of early surgery in papillary muscle rupture or ventricular septal defects are much better than delayed interventions. Rupture of the free wall is usually a fatal event. In summary, the most successful therapy of cardiogenic shock is early emergency PTCA.(ABSTRACT TRUNCATED AT 400 WORDS)
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Both the hibernating and the stunned myocardium are characterized by reversible contractile dysfunction. In hibernating myocardium ischemia is still ongoing, whereas in stunned myocardium blood flow is fully or almost fully restored. Both the hibernating and the stunned myocardium retain an inotropic reserve. ⋯ Myocardial stunning per se requires no therapy at all, since by definition blood flow is normal and contractile function will recover spontaneously. If, however, myocardial stunning involves large parts of the left ventricle and thus impairs global left ventricular function, the extent of myocardial stunning can be reduced by inotropic stimulation, without inducing further damage to the myocardium. In the experimental setting, antioxidant agents, calcium antagonists and ACE inhibitors attenuate stunning, most effectively when administered before ischemia.
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We describe a 63-year old female patient presenting with increasing dyspnea on exertion. The chest X-ray was suggestive but not compelling for Ebstein's anomaly. Although Ebstein's anomaly is most often discovered first in childhood, rare cases, such as ours, are described in late adulthood, however. ⋯ No additional congenital or acquired cardiac disorder could be detected. Cardiac catheterization confirmed the echocardiographical findings, whereas magnetic resonance tomography did not show the abnormal insertion of the tricuspid valve leaflet. If Ebstein's anomaly is suspected and cannot be ascertained by transthoracic echocardiography, transesophageal echocardiography can be employed to definitely diagnose this fairly rare form of congenital heart disease in an adult population.
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Transesophageal echocardiography is an important diagnostic tool available to the critical care physician. Indications for the use of transesophageal echocardiography in the intensive care unite include: critical illness and circulatory shock, thoracic aortic dissection, pulmonary embolism and endocarditis. Probe insertion is easy and is successful in 98% of intensive care patients. ⋯ Right ventricular infarction: The transgastric view is usefull in detecting right ventricular wall motion abnormalities and dilatation. Hemodynamically significant right ventricular infarction occurs in the posterior wall, which makes the transesophageal approach ideal. We studied a group of 39 patients with right ventricular infarction.(ABSTRACT TRUNCATED AT 400 WORDS)
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Monoplane transesophageal echocardiography (TEE) is a well established diagnostic tool of examination of great value in determining pathological changes in both atria, atrioventricular valves, the left-ventricular outflow tract, and in the thoracic aorta (Table 1). With the monoplane technique, however, it is never possible to obtain more than parallel, or oblique transverse views of the heart and surrounding vessels. The only means with which to examine anatomic structures in their cranio-caudal dimension by way of this method is to make a composite of a number of transverse sections. ⋯ By using the longitudinal imaging plane left atrial appendage can be seen without additional anteflection of the probe, thus, reducing stress to the patient during examination. The loss of an infinite range of planes available to the multiplane technique is a disadvantage, but this can usually be compensated by appropriate flecting of the probe and adequate simultaneous lateral angulation. The range of rotation of the probe in the multiplane method allows better three-dimensional imaging of anatomic structures and regurgitant jets than do the mono- and biplane techniques, and comparable data are often only attained under much longer examination with the biplane instrument.(ABSTRACT TRUNCATED AT 400 WORDS)