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  • 1
    Electronic Resource
    Electronic Resource
    Bildgebende Verfahren in der Diagnostik des Herzens (2000)
    Springer
    Der Radiologe 40 (2000), S. 103-110 
    Details
    ISSN: 1432-2102
    Keywords: Schlüsselwörter ; Kardiale Bildgebung ; Angiographie ; Nuklearmedizin ; Magnetresonanztomographie ; Computertomographie ; Key word ; Cardiac imaging ; Angiography ; Nuclear imaging ; Magnetic resonance tomography ; Computed tomography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Purpose: Cardiac imaging includes determination of the size and structure of the cardiac chambers, valves, great vessels and the coronary arteries, chamber and valvular function, myocardial perfusion, viability and metabolism. Material and methods: Chest roentgenography, angiography, echocardiography and nuclear imaging are commonly used but computed tomography and magnetic resonance imaging also offer a promising potential. Results: Coronary angiography is the gold standard in assessing coronary anatomy. Fast CT technologies such as electron-beam and multi-row-CT are promising non-invasive imaging modalities in the assessment of coronary artery disease. With intravascular ultrasound early stages of coronary atherosclerosis can be detected. For the assessment of myocardial perfusion and viability as well as cardiac function, scintigraphic methods are widely accepted. However, MRI methods have also reached a high degree of accuracy. Evaluation of chamber and valvular function is, due to its wide availability, the field of echocardiography. Conclusions: In clinical routine chest roentgenography, angiography, echocardiography and nuclear imaging are well established. The value of computed tomography and magnetic resonance imaging in the evaluation of coronary artery disease, myocardial perfusion, viability and metabolism is yet to be defined.
    Notes: Zusammenfassung Zielsetzung: Anforderungen an die kardiale Bildgebung sind die Darstellung der Anatomie der Herzhöhlen, Herzklappen, Koronararterien und der großen Gefäße, Parameter der Ventrikel- und Klappenfunktion, der Myokardperfusion, Myokardvitalität und des myokardialen Stoffwechsels. Material und Methode: In der Bildgebung kommen neben den etablierten Standardverfahren wie Röntgen, Angiographie, Echokardiographie und nuklearmedizinischen Methoden auch neuere Verfahren der Computer- und Magnetresonanztomographie zum Einsatz. Ergebnisse: Die Koronarangiographie ist der Goldstandard in der Darstellung des gesamten Koronarsystems. In der Diagnostik der koronaren Herzerkrankung zeigen schnelle CT-Verfahren wie die Elektronenstrahltomographie (EBT) und die Mehrzeilendetektor-CT (MDCT) Vorteile gegenüber der Kernspintomographie. Frühstadien der koronaren Arteriosklerose können nur mit dem intravaskulären Ultraschall (IVUS) erkannt werden. Nuklearmedizinische Methoden sind in der Untersuchung der Myokardperfusion und -vitalität etabliert. Mit der MRT scheint eine qualitative und quantitative Bestimmung der regionalen Perfusion, Funktion und Vitalität möglich zu sein. Die Untersuchung der linksventrikulären Funktion und der Herzklappen ist die Domäne der Echokardiographie. Schlussfolgerung: In der klinischen Routine sind die Angiographie, Echokardiographie und die Nuklearmedizin etablierte Methoden. Der Stellenwert der Magnetresonanz- und Computertomographie in der Diagnostik der koronaren Herzerkrankung und der Herzfunktion, Perfusion und Vitaltät ist noch nicht definiert.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001170050017
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  • 2
    Electronic Resource
    Electronic Resource
    Jede Synkope bedarf der Abklärung mit Kipptischuntersuchung: Die Contraposition (2000)
    Springer
    Herzschrittmachertherapie & Elektrophysiologie 11 (2000), S. II73 
    Details
    ISSN: 1435-1544
    Keywords: Key words tilt table test – neurocardiogenic syncope
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The neurocardiogenic mechanism is the most frequent reason of syncope. Tilt table testing is the standard procedure to prove diagnoses and guide therapy. However, tilt testing has limitations, which will be discussed in this review. First of all, the methodological validation of the test is incomplete: there are several protocols, which differ in the combination of passive testing and pharmacological provocation, the drugs used for provocation and factors such as tilt angle and in general, passive testing without pharmacological intervention is less sensitive (mean value about 40%) than fairly specific (specificity in the range of 80%). High tilt angles (80°) as well as drugs to provoke syncope on the tilt table increase sensitivity (up to 70%) at the expense of specificity (as low as ≤ 50%). There is a substantial number of patients with typical signs of neurocardiogenic syncope, whose symptoms cannot be provoked by tilt testing even with pharmacological provocation. Many factors influence the test result: age of the patient, fasting period and instrumentation during the test (i. v. needles, etc.), circadian variability, time interval until the spontaneous episode of syncope and cardiovascular drugs. Patients with or without positive tilt table testing turned out to have the same prognosis with respect to the frequency of syncopal spells. Patients with tilt table inducible syncope, who are given β-blockers, do not differ from untreated patients. Most interestingly, the procedure itself significantly reduces the number of syncopes without any form of treatment. Thus, the test is not very helpful to guide therapy. Unfortunately, prospective studies are missing and definite conclusions are difficult at this stage of knowledge. In patients with significant cardiac diseases, the neurocardiogenic mechanism is frequently involved as one factor of syncope, although the positive result (= syncope on the tilt table) does not exclude a serious or life-threatening course of syncope (i. e., malignant ventricular arrhythmias). Thus, the first step in diagnoses of patients with syncope is to evaluate cardiac disease. Without organic heart disease, a first episode of syncope does not require tilt table testing, especially if symptoms are typical of neurocardiogenic mechanism. Without any doubt, tilt table testing is indicated and valuable in the evaluation of unexplained recurrent syncope.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003990070013
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    Paper (German National Licenses)
    Fulltext
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