Zeitschrift für Kardiologie
-
Cheyne-Stokes respiration (CSR) during sleep is common in patients with severe congestive heart failure induces repetitive oxygen desaturation with arousals, and impairs sleep. This causes daytime symptoms and likely an increase in sympathetic activity. It has, therefore, been suggested that CSR is independently related to mortality. ⋯ Nocturnal oxygen reduces CSR and improves exercise tolerance as well as sleep. This and its apparent safety makes oxygen an appropriate treatment for nocturnal CSR. Whether successful treatment of nocturnal CSR has any impact on the natural course of heart failure needs to be determined in further studies.
-
Embolic complications are a major prognostic determinant in the clinical course of infective endocarditis (IE) with an incidence of about 30-50%. In order to analyze risk factors leading to embolism in native (NVE) and prosthetic valve endocarditis (PVE), we reviewed 177 consecutive patients; 43% were female, 57% male, PVE occurred in 24% of all patients all left-sided, among the NVE were 11% right-sided IE. Major embolic complications occurred in 40% of all patients. ⋯ However, the low number of patients on aspirin (9%) does not allow recommendations regarding a potential benefit. In conclusion, identification of risk factors leading to embolism in IE may be useful in considering early surgical therapy. However, the high rate of embolic complications before hospital admission indicates a need for improving the diagnostic delay in the prehospital phase.
-
Pulmonary thromboendarterectomy (PTE) leads to an acute decrease of right ventricular (RV) afterload in patients with chronic thromboembolic pulmonary hypertension. We investigated the changes in right and left ventricular (LV) geometry and hemodynamics by means of transthoracic echocardiography. The prospective study was performed in 14 patients (8 female, 6 male; age 55 +/- 20 years) before and 18 +/- 12 days after PTE. ⋯ LV diastolic filling returned to normal limits: (E/A ratio: 0.62 +/- 0.34 vs. 1.3 +/- 0.8; p < 0.05); Peak E velocity: 0.51 +/- 0.34 vs. 0.88 +/- 0.28 m/sec, p < 0.05; Peak A velocity: 0.81 +/- 0.36 vs. 0.72 +/- 0.42 m/sec, ns; E deceleration velocity: 299 +/- 328 vs. 582 +/- 294 cm/sec2, p < 0.05; Isovolumic relaxation time: 134 +/- 40 vs. 83 +/- 38 m/sec, p < 0.05). We could show a marked decrease in RV afterload shortly after PTE with a profound recovery of right ventricular systolic function--even in case of severe pulmonary hypertension. A decrease in paradoxic motion of the interventricular septum and normalization of LV diastolic filling pattern resulted in a significant increase of cardiac index.
-
A quick and exact diagnosis of a ruptured aorta can be achieved by different imaging methods (CT, TEE, NMR). In this case report, we describe a 36-year-old patient, who suffered rupture of the thoracic aorta in the isthmus region during a car accident. ⋯ The high mortality of aortic rupture could possibly be lowered by early application of TEE. Preoperative angiography seems not to be necessary.
-
The aim of the study was to evaluate the effect of a conventional pressure dressing on arterial and venous blood flow of the legs after cardiac catheterization. ⋯ A conventional pressure dressing caused a significant reduction of arterial as well as venous blood flow of both the punctured leg and the contralateral leg. This is of clinical relevance especially in patients with known peripheral arterial disease or patients at risk for deep venous thrombosis.