Zeitschrift für Kardiologie
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Due to the increasing number of diagnostic heart catheterizations, especially in elderly patients, as well as the increase of percutaneous transluminal coronary angioplasties, we are confronted with a rise in peripheral complications evolving from difficulties in the procedure of the puncture of the femoral artery or vene. The development of greater hematomas in the area of the puncture, the formation of arterio-venous fistulas and aneurysma spuria are the foremost complications. It was the aim of the study to investigate in as far an improved puncture technique could reduce the rate of peripheral complications. ⋯ The number of patients with hematomas with diameters of more than 5 cm was twice as high in the conventionaly punctured group (28%) than in the "Smart Needle" group (14%). However, patients suffering from arterial hypertension or hemostatic disorders showed an increased risk of vascular complications. In regard to the cost-benefit relation an indication for the use of the new technique is to be seen especially in overweight patients and patients suffering to aortic stenosis or cardiogenic shock.
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In a prospective, non-randomised study, two atrial steroid-eluting screw-in leads were evaluated (CapSureFix 4068, Medtronic, n = 17; Accufix II DEC 033-812, Telectronics, n = 16); in the same way, measurements were obtained of three steroid eluting ventricular electrodes (two screw-in leads: CapSureFix 4068, Medtronic, n = 11; Accufix II DEC 033-212, Telectronics, n = 20 and one tined lead Encor DEC 033-448, Telectronics, n = 18). Measurements were performed during implantation (= acute), 7 +/- 3 days after implantation (= subacute) and during follow-up at 3 and 6 months. After atrial implantation, there were no significant differences of the stimulation thresholds (Accufix II DEC: 0.76 +/- 0.23 V-CapSureFix: 0.75 +/- 0.16 V). ⋯ In summary, the dexamethasone depots prevented the rise of the stimulation threshold in all the atrial electrodes with active fixation. There remained a small increase of the stimulation threshold after ventricular implantation, which did not reach clinical significance. Thus, the energy saving output of 2.5 volt could be programmed in almost every patient.
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Case Reports
[Increased serum concentration of myosin heavy chain in aortic dissection: discussion of 2 cases].
Despite the availability of diagnostic modalities such as transesophageal echocardiography, computed tomography or magnetic resonance imaging up to 30% of patients with acute aortic dissection remain undiagnosed before death. A novel immunoassay of serum smooth muscle myosin heavy chain was recently developed as a potential diagnostic tool for the detection of aortic dissection. The immunoassay was applied in two patients with an acute chest pain syndrome but no initial clinical suspicion of aortic disease. ⋯ The serum test 12 h after onset of pain revealed elevated (diagnostic) serum levels of smooth muscle myosin heavy chains. Both cases exemplify important gaps in the diagnostic strategy for the detection of acute aortic dissection. A novel immunoassay for smooth muscle myosin heavy chains provides rapid and reliable diagnostic information especially in patients without clinically suspected aortic dissection and may avoid limitations in the diagnostic work-up of patients with acute aortic disease, if used early in the evaluation of patients with chest pain syndromes.
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Dobutamine stress echocardiography (DSE) leads to strong hypercontraction, tachycardia, and peripheral vasodilatation. In previous studies systolic obstruction of the left ventricular outflow tract (LVOT) was observed as a result of these factors. To evaluate left ventricular function and morphology in patients (pts) with induced systolic LVOT obstruction, we used continuous wave (CW) doppler registrations in combination with quantitative 2-D-echocardiography in 100 pts during routinely performed DSE (5-40 micrograms/kg/min). In addition left ventricular wall thickness was measured. Symptoms were registered using a standardised questionnaire and cardiac arrhythmias were counted over a two minute interval at rest and during the maximal heart rate of each patient. During DSE dynamic flow acceleration with late systolic peak velocity above 2 m/second (s) was considered to represent LVOT obstruction in pts with normal flow profiles in the LVOT before infusion of dobutamine. For invasive studies pts were investigated with femoral catheterisation by the method of Judkins. A greater than 50% stenosis was judged to be significant. ⋯ Intraventricular obstructions during DSE are often observed in pts with normal systolic function at rest and during peak stress, especially in the case of left ventricular hypertrophy. (ABSTRACT TRU
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Patients with therapeutically refractory angina pectoris do not respond to adequate anti-anginal medication and are not suitable anymore for revascularisation procedures. This group of patients has a poor quality of life, since their exercise capacity is severely afflicted. A new additional therapy for patients with refractory angina is neurostimulation. ⋯ The mechanisms of action of SCS are unclear, although there is evidence of an increase in myocardial oxygen supply, as is shown in peripheral vascular disease. Sympathetic nervous activity, prostaglandins, and endogenous opiates may also play a role in pain suppression by SCS. As soon as the safety and the complication rate are established, SCS may be commonly used as an additional therapy in patients with so-called "intractable angina pectoris".