Assessment of Regional Wall Motion in Coronary Artery Disease Using Radionuclide Methods

72 patients with CAD, 10 patients with congestive cardiomyopathies and 10 normal subjects were evaluated by radionuclide angiography. Comparison with contrast angiography showed good results for LVEF (r = 0.83). Regional asynergies observed in the radionuclide angiography correlated well with defects in thallium scintigrams. Extent of abnormal wall motion was measured and compared with normals, appreciating the deviation from the normal mean radial shortening. Good correlation could be demonstrated with radionuclide ventriculography. In 80% of congestive cardiomyopathies the right ventricle wall became visible in the thallium scintigram.

Pre-excitation of the ventricle associated with total intra His bundle block

A case with total intra-His bundle block and intermittent pre-excitation syndrome is presented. During A-V conduction there was a P-delta interval of 130 msec. with a P-A interval of 20 msec., an A-H interval of 60 msec. and an H-V interval of 50 msec. During rapid atrial pacing the P-delta interval increased primarily due to an A-H1 prolongation and a Mobitz type 2 block and total A-V block occured at increasing rates showing H1 following every A spike. The escape beats showed a normal width of the QRS complexes with preceding H2 spikes. After administration of Ajmaline the bypass tract was blocked and constant total A-V block occurred. It was concluded that there was a constant total intra-His bundle block and a nodoventricular or fasciculoventricular bypass tract with prolonged conduction to the ventricle. This bypass tract blocked sometimes spontaneously and could also be blocked by rapid atrial pacing and administration of drugs. The close anatomic proximity of the His bundle and Mahaim fibers is responsible for the simultaneous block resulting in total atrioventricular block.

[Behaviour of erythrocytes in patients with aortic of mitral stenosis (author's transl)]

The behaviour of red blood cells was studied in 17 patients with aortic stenosis and 14 patients with mitral stenosis. Anemia was present only in 1 out of 17 patients with highgraded aortic stenosis. 8 of the 17 patients showed a reduced survival time of the red blood cells indicating hemolysis in a compensated stage. 14 cases of mitral stenosis showed no evidence of hemolysis. There was a significant inverse relationship (r = --0,85) between the valve gradient and the survival time of the erythrocytes in patients with aortic stenosis; valve area and survival time were directly related (r = 0,75). In mitral stenosis, there was no significant correlation between gradient or valve area and survival time. This suggests that the gradient through the valve rather than the reduced valve area is responsible for the damage of the erythrocytes; in addition, hemolysis appears to be dependent on pressure gradient rather than on valve pathology or reduction of valve area per se.

[Two rare cases of neovascularity on coronary angiography (author's transl)]

The appearance of neovascularity on coronary angiography is described in two patients. A large thrombus was documented in one case at autopsy, whilst in the second case the presence of a thrombus was confirmed by two subsequent coronary arteriographic and ventriculographic studies. Thus, the observation of neovascularity of the left ventricle on angiography is indicative of thrombus formation rather than the presence of a neoplasm.

[Corelations between thrombocyte count, clinical diagnosis, and liver pathology in chronic liver diseases]

In 1488 cases of chronic liver disease thrombocyte content of peripheral blood, clinical diagnosis and histologic findings of the liver biopsy were correlated. Ranging from fatty infiltration to fatty cirrhosis or from slightly active chronic hepatitis to active postnecrotic cirrhosis, according to the extent of the liver injury a significant decrease of thrombocyte-count was evaluated. In case of non-active liver disease and posthepatitic status a thrombocytopenia also could be found. Cirrhotic transformation or proliferation of the connective tissue mainly in the periportal fields and inflammatory activity showed a significant correlation to the frequency of a thrombocyte decrease. A pathogenetic relation is ascribed to an increased thrombocyte storage in the spleen depending on the extent of the liver injury and the alteration of the portal blood stream up to a portal hypertension. Our results indicate such correlations of liver injury, portal pressure and platelet-pooling to thrombocyte-count even if the causal dependency cannot be proved.

Origin of anterior descending branch of left coronary artery from pulmonary trunk

Images

[The angiographic morphology of arterial injury (author's transl)]

The angiographic morphology for various arterial injuries is described and illustrated by means of 46 patients examined by us; these consisted of 13 socclusions, 21 arterial rupture and 12 arterial lacerations. The main angiographic feature is thrombotic occlusion of the damaged artery. Consequently, the pathology of the arterial lesion could be defined in only one third of the patients with arterial injuries. This, however, is not of major importance in planning vascular surgery.

[Diastolic murmurs in atrial septal defect (author's transl)]

No correlation was found between the presence of a diastolic murmur in about 50% of patients with artrial septal defect and the calculated shunt volume. A significant correlation was found in respect to the age of the patient, the majority of the murmurs being found in young patients and especially in young patients with tachycardia. Similar murmurs were found in healthy persons and, hence, a functional stenosis of the AV-valve ring could be the reason for this diastolic murmur, which may occur more frequently in patients with atrial septal defect on account of an alteration in the blood stream patterns.

[Influence of propafenon on hemodynamics of the left ventricle and atrioventricular conduction with special reference to the WPW syndrome]

15 patients were injected 2 mg/kg Propafenon intravenously in 3 minutes. In 10 patients the changes of the atrio-ventricular conduction and the sinus-node recovery time were measured. In 5 out of these 10 patients the influence on the left ventricular systolic pressure, the left ventricular enddiastolic pressure and the dp/dtmax was also measured. 4 patients had a WPW-syndrom and one patient an AV nodal tachycardia. There was a significant increase of the PQ-time (16,7%), the AH interval (9%), HV interval (33%) and the width of the QRS complex (13.8%). The intratrial conduction (PA-time), the heart rate and the sinus-node recovery time were not influenced. In 6 out of 7 patients the effective refractory period of the AV node was prolonged and in one it remained unchanged. There was a statistically significant decrease of the dp/dt, the heart rate staying the same. The systolic pressure decreased slightly and the enddiastolic pressure increased insignificantly. In 3 out of 4 patients with WPW syndrome the accessory pathway was blocked and in the 4th the effective refractory period of the pathway prolonged. In 3 out of these 4 patients a tachycardia could be initiated by the extra-stimulus method which was not possible after administration of the drug.

[Electric stimulation as a means for the diagnosis of atrioventricular conduction disorders]

A patient with 2 : 1-block and right-bundle-branch block is described, who developed a high-degree-AV block distal to the bundle of His during electrophysiological investigations. Rapid atrial pacing caused total AV block distal to the His bundle. Rapid pacing from the right ventricle also caused total AV block after sudden discontinuation of pacing. The duration of total AV block was 25 to 60 seconds and the preautomatic time 2300-4750 msec according to rate and duration of stimulation. These methods are considered as good tools to evaluate patients with severely diseased conduction system, who might develop total AV block or Adams-Stokes seizures.

[Indication for preventive pacemaker implantations in patients with severe disorders of atrioventricular conduction]

A method for the evaluation of patients with severe conduction disturbances who might develop Adams-Stokes attacks or total A-V block is described. In 9 patients with conduction disturbances a "stress test" of the conduction system with small dosis of Ajmalin was performed. In 2 patients a higher degree of A-V block developed (2: 1 block, total A-V block). These patients were considered as candidates for prophylactic pacemakerinsertion. During this procedure a temporary pacemaker electrode has to be put into the right ventricle to provide saftey for the patient.

[Effect of potassium-magnesium aspartate on hemodynamics and myocardial metabolism of coronary disease patient during beta receptor stimulation]

2 series of patients with angiographically proven coronary artery disease were studied under the influence of an infusion of a beta-receptor stimulating drug (heptaminole) and of kalium-magnesium-aspartate (KMA) in high (series: I: 1000 mg of heptaminole in 25 min) and low doses (series II: 200 mg of heptaminole in 25 min) of beta-receptor stimulation. The results confirm the finding that high dose beta-receptor stimulation in patients with severe coronary artery disease results in failure of the contractile mechanism of the heart with the beta-receptor angina. However, administration of KMA simultaneously with the beta-receptor stimulator seems to be able to prevent the expected decrease of lactate extraction and results in no change in lactate AVD in series I and even in an 11% increase in lactate AVD in series II. Experimental data concerning the biochemical effects of KMA suggest that its ability to provide adequate amounts of oxaloacetone and hence to improve the function of the bricarbonic acid cycle seems to be of special importance. For this action to become relevant in coronary artery disease a situation would have to be postulated, in which an additional limiting factor of oxydative metabolism would be an inadequate supply of Krebs-cycle intermediates.

[Angiography in acute gactrointestinal hemorrhage]

The indications for and diagnostic value of visceral angiography in 30 cases of acute gastrointestinal bleeding are discussed. In one third of these emergency angiograms the etiology of the bleeding could not be demonstrated. In two thirds of the cases the source of bleeding was successfully localized. In half the positive angiograms the bleeding site was shown directly in the form of extravasation of contrast, while in the remaining half pathological findings were demonstrated without evidence of contrast media extravasation.

[Radiological diagnosis of closed trauma to the aorta (author's transl)]

Closed injury to the thoracic aorta at the isthmus occurred after street accidents in eight persons (five males, three females, aged 17-55 years). The lesions ranged from isolated intimal rupture to complete loss of continuity of the aorta. Radiological diagnosis or thoracic surgical exploration took place in five patients within 48 hours of the accident, while in the remaining three--alle with a false aneurysm of the thoracic aorta-the time elapsed before accurate diagnosis ranged from three months to seven years. Five patients were successfully operated upon. It is stressed that successful surgical intervention depends on early and accurate radiological diagnosis (chest X-ray and, if necessary, aortogram).

Inefficacy of "therapeutic" serum levels of digoxin in controlling the ventricular rate in atrial fibrillation

Although therapeutic and toxic serum concentrations of digoxin have been established, there is sparse information permitting correlation of drug level with clinical effect. This study was undertaken to assess the radioimmunoassay serum digoxin levels in 30 patients with acute atrial fibrillation (38 determinations) and 30 patients with chronic atrial fibrillation (54 determinations). Those with chronic fibrillation were subdivided into those in clinically stable condition (14 patients), and those seriously ill and in clinically unstable condition (16 patients). Slowing of ventricular rate in patients with stable, chronic atrial fibrillation was accomplished in 10 of 16 instances by "therapeutic" and "subtherapeutic" levels of digoxin (less than 2 ng/ml). Ventricular rate was "controlled" (65 to 95 beats/min) with therapeutic levels of serum digoxin in only five instances of acute atrial fibrillation and seven of unstable chronic atrial fibrillation. In 43 studies (23 of acute atrial fibrillation, 20 of chronic atrial fibrillation), a rapid ventricular rate (95 to 140 beats/min) persisted in the presence of "therapeutic" or high levels of digoxin. Thirty-nine of these were in patients who were seriously ill with conditions such as infection, hypoxia or recent thoracotomy. Slowing of the ventricular rate required "toxic" concentrations of digoxin (2.5 to 6 ng/ml) in 15 instances. We conclude that sufficient amounts of digoxin to achieve "therapeutic" serum concentrations may fall to lower the ventricular rate in atrial fibrillation to less than 100 beats/min, especially when a serious, complicating illness coexists.

[Bloodgas changes during heart catheterisation in children under basal sedation (author' transl)]

A form of basic sedation for cardiac catheterisation in children with congenital heart disease is described. The drugs used (Toronto cardiac mixture, papaveretum--hyoscine respectively) offer a true alternative to general anesthesia. Blood gases and acid-base status of 32 children aged two days to twelve years were investigated. The observed tendency towards metabolic acidosis is believed to be related to the angiographic contrast medium.