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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Journal of molecular medicine 50 (1972), S. 725-731 
    ISSN: 1432-1440
    Keywords: Atrial myxoma ; clinical manifestation ; auscultatory findings ; pressure curves ; angiography ; Vorhofmyxom ; Klinische Manifestation ; Auskultation ; intrakardiale Drucke ; Angiographie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Bei einem 25jährigen Patienten hatte ein vom rechten Vorhof ausgehendes Myxom, das durch den rechten Ventrikel in den Anfangsteil der Pulmonalarterie und durch ein spaltförmig offenes Foramen ovale in den linken Vorhof vorgewachsen war, zu einer rasch zunehmenden therapieresistenten Einflußstauung mit akuten abdominellen Beschwerden geführt. Klinisch und bei der Herzkatheteruntersuchung waren eine Tricuspidalinsuffizienz und -stenose sowie eine Pulmonalstenose nachweisbar. Die Ventrikelangiographie erbrachte einen ausgedehnten Füllungsdefekt im Vorhof und Ventrikel. Entsprechend zeigte die Obduktion eine fast völlige Ausfüllung des rechten Herzens durch den weichlichen hämorrhagischen Tumor. Die durch Füllungsbehinderung und Störung der Funktion der Atrioventrikularklappe hervorgerufenen klinischen Besonderheiten einschließlich der außergewöhnlichen auskultatorischen Befunde, die EKG-Veränderungen und die bei der Herzkatheterisierung gewonnenen hämodynamischen Daten einschließlich der angiographischen Bilder werden an Hand des eigenen Falles erörtert.
    Notes: Summary In a 25 year old male a right atrial myxoma had extended through the right ventricle into the pulmonary artery and through a patent foramen ovale into the left atrium, leading to refractory right heart failure with acute abdominal pain. Clinical and catheter data showed tricuspid insufficiency and -stenosis as well as pulmonary stenosis. Right ventricular angiography demonstrated a huge filling defect in the ventricle and atrium. Correspondingly, autopsy showed almost complete obstruction of the right heart by a myxomatous tumor. The clinical and hemodynamic findings caused by obstruction and disturbance of the av-valve as well as the unusual auscultatory phenomena, ECG changes and cardiac catheter data with angiographic findings of intracavitary tumors are discussed.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Journal of molecular medicine 54 (1976), S. 323-332 
    ISSN: 1432-1440
    Keywords: Pulmonary gas exchange during exercise ; Myocardial infarction ; Late period of recovery ; Pulmonaler Gaswechsel unter Belastung ; Myokardinfarkt ; Späte Rehabilitationsphase
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung In der späten Rehabilitationsphase nach Myokardinfarkt (13–24 Monate p. infarctum) wurde der pulmonale Gaswechsel neben hämodynamischen Parametern bei 23 Patienten unter Belastung untersucht. Der Belastungsverlauf der gemessenen Parameter gleicht dem Herz- und Lungengesunder. Die arteriellen Blutgaspartialdrucke ( $$Pa_{O2} , Pa_{CO2} $$ ) bleiben gegenüber den Ruhewerten unverändert oder zeigen nur geringe statistisch nicht signifikante Änderungen. Die alveoläre Ventilation $$\dot V_A $$ zeigt im Belastungsverlauf bei allen Patienten keine Unterschiede. Herzzeitvolumen $$\dot Q$$ , Atemminutenvolumen $$\dot V_E $$ , die Toträume, alveolo-arterielle Partialdruckdifferenzen der Atemgase ( $$AaD_{O_2 } , aAD_{CO_2 } $$ ) und Ventilations-Perfusionsverhältnis der Gesamtlunge $$\dot V_A /\dot Q$$ lassen jedoch erkennen, daß entsprechend der unterschiedlichen Arbeitskapazität der Patienten diese Parameter einen differenten Belastungsgang zeigen. Da sich die unterschiedliche Arbeitskapazität nach dem Verhalten von Herzzeitvolumen $$\dot Q$$ und gemischtvenösen Blutgaspartialdrucken aus der verschiedenen kardialen Funktion der Patienten erklären läßt, erscheint die Pathologie des pulmonalen Gaswechsels von der jeweiligen linksventriculären Funktion des Patienten abhängig. 12 der 23 untersuchten Patienten, die nach hämodynamischen Kriterien eine Belastungsinsuffizienz des Herzens zeigten, wiesen die ausgeprägtesten Änderungen des pulmonalen Gaswechsels auf. Die unterschiedliche Arbeitskapazität der Patienten ist allein von der kardialen Funktion begrenzt. Eine Leistungslimitierung durch Störung der Lungenfunktion ließ sich nicht beweisen.
    Notes: Summary After myocardial infarction in the late period of recovery (13–25 months p. infarctum) pulmonary gas exchange in 23 patients was measured besides as hemodynamic parameters during exercise. The parameters take a course similar to that of subjects without lung and heart diseases. Arterial blood gas tensions ( $$Pa_{O_2 } ,Pa_{CO_2 } $$ ) remain unchanged compared to resting values. Alveolar ventilation did show no difference in any of the patients. Minute ventilation $$\dot V_E $$ , the various dead spaces, alveolar-arterial gas differences ( $$AaD_{O_2 } , aAD_{CO_2 } $$ ) and ventilation-perfusion ratios of the whole lung $$\dot V_A /\dot Q$$ suggest however that these parameters show different courses according to the physical capacity of the patients. As the physical capacity of each patient is due to different cardiac functions taken by cardiac output and mixed venous blood gas tensions alterations of pulmonary gas exchange seemed to be dependent on the respective left ventricular function of the heart. Of the twenty-three patients, twelve with cardiac failure under exercise showed the most pronounced alterations in pulmonary gas exchange. Therefore, the different physical work capacity of the patients are determined only by cardiac function. No limitation of the productivity due to impeded lung function could be proved.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Journal of molecular medicine 53 (1975), S. 288-291 
    ISSN: 1432-1440
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1432-1440
    Keywords: Myocardial infarction ; Late recovery period ; Cardio-pulmonary data at rest and during exercise ; Myokardinfarkt ; Späte Rehabilitationsphase ; Kardio-pulmonale Funktionsparameter in Ruhe und unter Belastung
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung 22 Patienten, die 1–2 Jahre zuvor komplikationslos einen Myokardinfarkt durchgemacht hatten, wurden bis an die Grenze ihrer Leistungsfähigkeit stufenweise ergometrisch belastet. Entsprechend der Belastbarkeit wurden die Patienten in vier Leistungsgruppen eingeteilt und die Anpassung der wichtigsten kardio-pulmonalen Funktionsparameter in jeder Gruppe getrennt verfolgt. Dabei waren in der Hälfte der Fälle bereits in Ruhe diskrete Insuffizienzzeichen nachweisbar. Bei der folgenden Ergometerbelastung stellten sich auch bei den übrigen Patienten in der ersten Belastungsstufe Insuffizienzzeichen ein.
    Notes: Summary From 22 patients in the late period of recovery from myocardial infarction, cardio-pulmonary data were recorded at rest and during exercise. The physical work was increased stepwise until patients reached their individual limit of exercise. According to the different work capacity four groups of patients were formed with the aim to demonstrate the adaption processes of cardio-pulmonary parameters until reaching the peak of work capacity. In one half of the patients we still found signs of cardial insufficiency at rest. After only slight physical work signs of cardiac insufficiency appeared also in the other half of patients.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Journal of molecular medicine 56 (1978), S. 551-557 
    ISSN: 1432-1440
    Keywords: Dobutamine ; Contractility ; Low output cardiac failure ; Low output state ; Dobutamin ; Kontraktilität ; Herzinsuffizienz ; low output Syndrom
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die kardiovaskulären Effekte von Dobutamin, einem Derivat des Dopamin, wurden an 7 Patienten mit chronischer Funktionsstörung der linken Kammer bei koronarer und myokardialer Herzerkrankung untersucht. Dobutamin wurde in steigenden Dosen von 2,5–5,0–7,5–10,0 und 15,0 µg/kg/min infundiert. Gemessen wurden der Druck in der zentralen Aorta, im linken Ventrikel (Kathetertipmanometer; LVEDP, LVdp/dtmax) und in der Pulmonalarterie sowie das Herzminutenvolumen (Farbstoffverdünnungsmethode). Der positiv chronotrope Effekt von Dobutamin war gering und erst bei 15,0 µg/kg/min statistisch auffällig. Der systolische Aortendruck nahm im gesamten Dosisbereich mäßig stark zu. Dagegen war die Zunahme des mittleren Aortendruckes mit 11 mm Hg, die des Schlagvolumens mit 22% und der Schlagarbeit mit 49% bei 5,0 µg/kg/min am größten (p〈0,05). Die positiv inotrope Wirkung von Dobutamin führte dosisabhängig zu einer Zunahme des Herzindex und von LVdp/dtmax um maximal 63 bzw. 193% (p〈0,01). Dabei sanken der LVEDP und der periphere Widerstand signifikant ab. Arrhythmien traten unter Dobutamin nicht auf. Nach 15 min war die Wirkung der Substanz abgeklungen. Die Befunde zeigen, daß Dobutamin keine streng kardioselektive Wirkung besitzt. Jedoch überwiegt im Dosisbereich von 2,5–15,0 µg/kg/min die positiv inotrope Wirkung. Weitere klinische Untersuchungen mit dieser Substanz an Patienten mit schwerer Herzinsuffizienz und low output Syndrom erscheinen erfolgversprechend.
    Notes: Summary The cardiovascular effects of dobutamine, a derivative of dopamine have been investigated in seven patients with chronic left ventricular dysfunction. The patients were either suffering from coronary heart disease or from cardiomyopathy. Dobutamine was administered at doses of 2.5–5.0–7.5–10.0 and 15.0 µg/kg/min. The following parameters were measured: aortic pressure, left ventricular pressure (LVEDP, LVdp/dtmax) by using a Millar tip manometer, pulmonary artery pressure and cardiac output (dy-dilution technique). The positive chronotropic effect of dobutamine was small in the lower dosage range and reached significance only with the highest dose of 15.0 µg/kg/min. Systolic aortic pressure was increased moderately over the whole dosage range (p〈0.05). However the increment of mean aortic pressure (+11 mm Hg), of stroke volume (+22%) and of stroke work (+49%) was already maximum (p〈0.05) at a dose of 5.0 µg/kg/min. The positive inotropic action of dobutamine caused a dose related increase of cardiac index and of LVdp/dtmax of +53% and of +193% respectively. This effect was accompanied by a continuous and significant decrease of LVEDP and of peripheral resistance. Dobutamine induced arrhythmias have not been observed. 15 min after infusion stop, no dobutamine effect could be detected. These findings demonstrate that the actions of dobutamine are not merely cardioselective. However, in the dose range between 2.5 and 15.0 µg/kg/min a positive inotropic effect is predominant. Further clinical trials with dobutamine on patients with severe myocardial dysfunction and low output syndrome may yield promising results.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Journal of molecular medicine 63 (1985), S. 193-204 
    ISSN: 1432-1440
    Keywords: Suprasternal M-mode echocardiography ; Cardiovascular diseases
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The suprasternal approach can be used to image the aortic arch, the right pulmonary artery and the left atrium. Dilatation or dissections involving the aortic arch were detected echocardiographically from the suprasternal notch. The echocardiogram of the right pulmonary artery is altered in cases of acute and chronic pulmonary hypertension. Intrapulmonary thrombi in patients with acute pulmonary embolism were visualized with this technique. A volume overloading of the pulmonary circulation due to a congenital left to right shunt, as well as a decreased pulmonary blood flow due to a congenital right to left shunt causes characteristic changes in the wall motion pattern of the right pulmonary artery. Hypoplasia or aplasia of the central pulmonary arteries can be diagnosed as well. Imaging of the left atrium from the suprasternal notch may help to differentiate between supraventricular and ventricular rhythm disturbances. The suprasternal approach is therefore recommended to be used as a routine part of each echocardiographic examination.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Journal of molecular medicine 64 (1986), S. 301-306 
    ISSN: 1432-1440
    Keywords: Myocardial infarction ; Fibrinolysis ; Plasminogen activators
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The early treatment of acute myocardial infarction has changed rapidly in recent years. Given the fact that an occlusive coronary thrombus can be found in most infarct patients within 4 h after clinical symptoms, the idea of instituting medical or mechanical recanalization of the occluded vessel is intriguing. However, invasive measures are time consuming, expensive and not freely available to a great number of patients. Thus, only i.v. fibrinolytic therapy of acute myocardial infarction will gain wider application in the near future. Several concepts have been worked out, one of which uses a high-dosage streptokinase or urokinase regimen. A different therapeutic alternative has been made possible by the development of selective fibrinolytic substances, such as the tissue-type plasminogen activator (t-PA) or the anisoylated plasminogen-streptokinase activator complex (APSAC). Preliminary clinical data have shown that the coronary artery patency rate achieved after i.v. administration of t-PA or APSAC is higher than that after conventional treatment with streptokinase or urokinase. The incidence of severe bleeding complications is low and comparable in these studies. However, until myocardial salvage has been demonstrated with early i.v. fibrinolytic therapy in acute myocardial infarction in a placebo-controlled randomized trial, this therapeutic concept will still be unsettled.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1432-1440
    Keywords: Captopril ; Diltiazem ; Regional blood flow ; Experimental heart failure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The present study examined the regional vascular effects (radioactive microspheres) of converting-enzyme inhibition (captopril, 1mg/kg) and calcium-antagonism (diltiazem, 1 mg/kg) in a rat model of cardiac failure due to large myocardial infarction (n=18, infarct size 40% of the left ventricle) both at rest and during submaximal tread-mill exercise. Diltiazem increased renal, gastrointestinal, coronary and cutaneous blood flow at rest by 29%, 28%, 26% and 37% (p〈0.05 each) and enhanced skeletal muscle blood flow during exercise by 16% (p〈0.05). Captopril improved primarily renal and coronary blood flow at rest (by 59% and 23%, respectively,p〈0.05) and reduced vascular resistance in the gastrointestinal bed by 25% (p〈0.05) without significant effects in other circulatory beds. We conclude that the regional vascular effects elicited by converting-enzyme inhibition and calcium antagonism differ considerably in this animal model of congestive heart failure and may be clinically important. The favourable regional vascular profile of diltiazem deserves further clinical investigation.
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    Journal of molecular medicine 64 (1986), S. 993-1002 
    ISSN: 1432-1440
    Keywords: Congestive heart failure ; Calcium antagonists ; Hemodynamics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Although beneficial acute hemodynamic effects of calcium antagonists in heart failure have been reported, their use in this setting is still controversial because of the negative inotropic effects produced by these agents. The direct actions of calcium antagonists, that is direct depression of myocardial contractility and coronary and peripheral vasodilatation, are modulated by systemic hypotension-induced baroreceptor activation of autonomic reflexes. Thus, at clinically relevant dosages, the baroreceptor-mediated cardiac stimulatory effects may counterbalance or override the direct negative-inotropic effects, as usually observed with nifedipine or diltiazem. By contrast, with verapamil significant depression of contractility may occur. Newer calcium antagonists with higher vasoselectivity such as nisoldipine or felodipine may be particularly interesting in the setting of congestive heart failure because of pronounced arterial vasodilatation and their additional effects on coronary blood flow, LV-regional wall motion and diastolic function and peripheral blood flow distribution with negligible myocardial effects. Due to their marked vasodilatating properties, newer derivatives may be advantageous in the treatment of heart failure due to coronary artery disease and hypertension. Although limited data concerning long-term efficacy are available, preliminary studies suggest long-term benefit in selected patients. It appears that verapamil should not be used for vasodilator therapy of severe heart failure, since deterioration of LV function may occur.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1432-1440
    Keywords: Levodopa ; Inotropic drugs ; Congestive heart failure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary To evaluate the long-term effects of orally administered levodopa, 11 patients with chronic congestive heart failure (NYHA III–IV) were studied during maintenance therapy (30±1 days) and after withdrawal from levodopa. The daily levodopa dose was 4 g in six patients; because of side effects the levodopa dose was reduced to 2–3 g in the remaining patients. After withdrawal of levodopa, mean pulmonary capillary wedge pressure and mean right atrial pressure increased significantly (from 19±2 to 24±3 and from 7±2 to 9±2 mmHg, respectively). Effective renal plasma flow was 329±57 during levodopa therapy and decreased significantly to 252±27 ml/min after withdrawal of levodopa. The number of ventricular premature contractions and couplets increased during levodopa therapy and decreased again significantly after withdrawal of levodopa. No significant differences between on and off levodopa were observed in resting heart rate, arterial blood pressure, cardiac index, stroke work index, systemic vascular resistance, sodium and water excretion, or creatinine clearance. Seven patients improved on levodopa therapy by one NYHA class; four of these seven patients deteriorated again by one NYHA class after withdrawal of levodopa. Regarding both clinical and hemodynamic changes after withdrawal of levodopa, three patients were classified as responders to long-term levodopa therapy. All three responders received 4 g levodopa per day. Average dopamine plasma level was 5.3±0.8 ng/ml in the responder group and 2.0±0.5 ng/ml in the nonresponder group. Long-term administration of oral levodopa is associated with beneficial clinical and hemodynamic response in only a minority of patients with chronic congestive heart failure.
    Type of Medium: Electronic Resource
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