Zeitschrift für Kardiologie
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Obstructive sleep apnea syndrome (OSAS) is the most important form of sleep-related breathing disorders due to its high prevalence and its potential for developing cardiovascular diseases. The increased morbidity of these patients is explained by the coincidence with cardiovascular diseases, and the increased mortality of untreated patients is due to cardiovascular complications, which depend on the degree of the breathing disorder. Heavy snoring, as a partial obstruction of the upper airways, and OSAS are independent risk factors for the development of cardiovascular diseases and stroke. ⋯ OSAS is frequent in patients with coronary heart disease and these patients must be classified as a particular risk group because of apnea-associated silent myocardial ischemia and electric instability of the myocardium. The occurrence of arrhythmia in patients with OSAS is closely related to the apnea and hyperventilation events and depends on the sympathovagal balance. Early diagnosis and suitable therapy of patients at risk not only abolishes the sleep-related breathing disorder but also improves long-term outcome.
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Aortic dissection without entry and blood-flow in a false lumen was recently identified at necropsy and in vivo as intramural hemorrhage in the aortic wall (IMH). It was the purpose of the study to elucidate clinical signs and prognosis in this rare and poorly understood condition. Among 360 prospectively evaluated patients with clinical suspicion of aortic dissection, 195 patients presented with evidence of aortic disease. ⋯ IMH progression to overt dissection, rupture and/or acute tamponade occurred in 8/25 cases (32%) within 24 to 72 h, indicating the need for urgent surgical repair. The 30-day mortality of IMH inflicting the ascending aorta was 80% (4 of 5) with medical treatment in contrast to none (of 7) with early surgical treatment (p < 0.01). One-year survival was 71% in surgically treated patients and 20% with medical treatment (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)