Zeitschrift für Kardiologie
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Early fluctuations of the ST-segment elevation indicating intermittent opening and reocclusion of the infarct artery has been well documented by angiographic monitoring in individual acute myocardial infarction patients undergoing thrombolytic therapy. However, the frequency of such episodes has not been studied in a consecutive patient group. Furthermore, it is not known what impact this finding has on the reinfarction risk during hospitalization and on left ventricular healing. ⋯ Episodes of re-elevation were more frequent during the first 4 h (0.25 episodes per hour) than in the late part of the observation period (0.04 episodes per hour). Most episodes were transient and short lasting; only nine patients showed persistent re-elevations longer than 60 min. During hospitalization, group 1 patients had a higher incidence of reinfarctions and severe ischemic events than those without episodes (group 1 12/34 (35%) vs. group 2 4/34 (12%) vs. group 3 1/11 (9%), p = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)
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We report on a case of partial anomalous pulmonary venous return in a patient (54 years old, female) examined for the cause of pulmonary hypertension. Biplane transesophageal echocardiography in conjunction with color-coded ultrasound technique revealed an aberrant vessel draining into the vena cava superior. ⋯ This malconnection was not accompanied by associated anomalies, or defects of the atrial septum in particular. Invasive examination confirmed the echocardiographic results; with an angiographic catheter the opening of the right upper pulmonary vein into the superior vena cava was located exactly and depicted.
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We report on a 54-year-old previously healthy man admitted to the emergency room with massive pulmonary edema and unstable cardiovascular condition. Coronary heart disease was ruled out angiographically. The pressures in the pulmonary circulation were within normal limits and no signs of congestive heart failure were found. ⋯ The aneurysm was verified on postmortem examination. In pulmonary edema of unknown origin the possibility of neurogenic pulmonary edema should be considered. Etiology, pathomechanism, and therapy of neurogenic pulmonary edema are discussed.
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Comparative Study
[Comparison of stress ECG and long-term ECG for detection of myocardial ischemia in patients with coronary heart disease].
Holter-monitoring and exercise-ECG can be employed for the detection of myocardial ischemia. Exercise-ECG is capable of detecting ischemias caused by physical activity. In contrast, Holter monitoring can detect episodes of myocardial ischemia independent of exertion, but possibly connected with other factors such as mental stress. ⋯ While both techniques could detect multi-vessel disease at a similar level, Holter monitoring was significantly more sensitive in detecting patients with single-vessel disease. Thus, exercise-ECG and Holter monitoring supplement each other in detecting myocardial ischemia. In the future, larger clinical trials will have to confirm these results.
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Randomized Controlled Trial Comparative Study Clinical Trial
[The use of digitalis glycosides in atrial fibrillation].
The role of cardiac glycosides for conversion of atrial fibrillation to simus rhythm is controversially discussed. In a prospective study, 45 patients with paroxysmal atrial fibrillation were randomly assigned to one of three treatment groups (of 15 patients each). ⋯ The use of digoxin remains a mainstay of treatment for rate control in atrial fibrillation. To convert atrial fibrillation to sinus rhythm, however, the addition of a type I or III antiarrhythmic agent is necessary.