Zeitschrift für Kardiologie
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Assessment of transmitral flow by Doppler echocardiography allows measurement of changes in left ventricular filling patterns in patients with cardiac disease. Typically a decrease in early diastolic flow velocity and increase in late diastolic flow velocity is found in various cardiac diseases. In order to assess the influence of overt heart failure on transmitral velocity profiles these were measured in 20 patients with a history of myocardial infarction and in 10 normal controls (group I). ⋯ Deceleration halftime was significantly shorter in group II as compared to the other two groups (p less than 0.05). These results can be interpreted as masking of the pathological flow patterns of the underlying heart disease (E/A ratio) by elevated left atrial filling pressure that leads to inversion of the pathologically altered velocity profiles of the underlying heart disease. These results might gain practical value for the care of patients in congestive heart failure if follow-up studies should demonstrate conversion of the flow pattern of group II to that of group III under treatment.
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Clinical Trial
[Electrophysiologic properties of cibenzoline in Wolff-Parkinson-White syndrome and atrioventricular nodal reentry tachycardia].
The electrophysiologic effects of the new class-1 antiarrhythmic drug cibenzoline (1.5 mg/kg within 10 min, followed by an infusion of 0.5 mg for 30 min) were investigated in six patients with atrioventricular (av) nodal reentrant tachycardia and nine patients with atrioventricular tachycardia. Sinus cycle length, sinus node recovery time, effective refractory period (ERP) of the atrium and the ventricle as well as the ERP of the av node were not significantly affected by cibenzoline. Retrograde conduction via the av node was prevented by cibenzoline in 6/15 patients, retrograde ERP was increased in 4/15 patients and in 5/15 patients determination of the retrograde ERP of the AV node was impossible. ⋯ AV nodal reentrant tachycardia was not inducible, after cibenzoline in 4/6 patients and in 5/9 patients with AV reentrant tachycardia. If tachycardia remained inducible, an increase in tachycardia cycle length from 333 +/- 46 ms to 402 +/- 24 ms was observed (p less than 0.01). In conclusion the electrophysiologic effects of cibenzoline make it a suitable drug for the treatment of av nodal reentrant tachycardia and atrioventricular tachycardia.
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Passive tilt is an effective means to manipulate cardiodynamic processes. While there is a large amount of literature available concerning cardiac function with upright tilt, passive tilt into the supine position is poorly investigated. There is evidence that adapting processes to the new position do not show analogy in both conditions. ⋯ In the 30 degrees position both cardiac output and Heather index were minimal; this may be due to decreased sympathetic output. Systolic time intervals showed volume dependancy. Correlations between the first and second part of the study were high for all variables.
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In a 27-year-old woman, struck by lightning behind the left ear, the ECG showed signs of an acute posterior-lateral myocardial infarction after 1 h of unconsciousness and loss of memory. Her serum enzymes were increased as is typical of myocardial infarction, but the patient did not complain of cardiac symptoms. ⋯ In the course of two months, the ECG revealed a regression to unspecific ST-T-deviations and serum enzymes became normal. TI-201-myocardial-scintigraphy (SPECT), done six days and two months after lightning injury, excluded reversible and irreversible perfusion defects.
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Invasive data about the frequency and associated factors of tricuspid regurgitation in normals and in patients with aortic and mitral valve disease are still rare. Thus, right ventricular biplane angiograms (RAO/LAO projection), the mean pulmonary artery pressure and the presence of atrial fibrillation were analyzed with regard to tricuspid regurgitation in 30 normals and 165 patients with pure mitral regurgitation, mitral stenosis, aortic regurgitation, aortic stenosis, combined mitral valve disease or combined aortic valve disease. Patients with tricuspid stenosis or coronary artery disease were excluded. ⋯ Only in patients with pure mitral regurgitation tricuspid regurgitation was associated with an elevated mean pulmonary artery pressure (p less than 0.02). Differences in the right ventricular size and function did not occur between normals and patients with mitral or aortic valve disease. Therefore, the mean pulmonary artery pressure, atrial fibrillation and the size and function of the right ventricle are not major determinants for the occurrence of tricuspid regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)