[Long-term electrocardiography (quality standards and guidelines for the documentation of findings]

Indications for a Holter-ECG-recording are dizzy-spells, syncopes, ischemic attacks, dyspnoea, ischemia of the myocardium, arrythmias after myocardial infarction and with different types of cardiomyopathies, the sick-sinus-syndrome and a-v-blocks; furthermore recording of cardiac situations and the effect of drugs. The report should mention the basic rhythm, ventricular and supraventricular arrhythmias as well as temporary blocks and pauses.

[The prehospital period of acute myocardial infarct]

The duration of the prehospital phase in Austria seems to be in the high range in international comparisons. Various methods to reduce this interval have seen suggested: mobile coronary care systems and direct summoning of the ambulance systems by the patients. On the other hand it has been proposed to start relevant therapy (antiarrhythmic drugs, thrombolysis) before arrival in the hospital. Since a substantial percentage of patients experience premonitory symptoms before the acute infarction, it may be important to correctly diagnose this preinfarction syndrome including the various ECG anomalies.

[Celiprolol in acute myocardial infarct]

In a randomized trial the effect was studied of celiprolol, a cardioselective beta receptor blocker with strong intrinsic activity (ISA) on the incidence of ventricular arrhythmias in patients with acute myocardial infarction (AMI). All patients received the first (oral) dose of 100 mg celiprolol or placebo exactly 6 hours after the onset of symptoms. Arrhythmia analysis was carried out from Holter recordings using a Pathfinder system. The results in 10 patients receiving celiprolol and 11 patients receiving placebo show that there was no difference in the distribution of the Lown classes between the two groups. The hourly VPC rate was somewhat higher in the celiprolol group from the very onset of the study, but the trend toward a decrease in VPC with time was identical in both groups. There was not a single incidence of ventricular fibrillation in the study population. It is concluded that celiprolol - under the circumstances of this study - did not show a beneficial influence on ventricular arrhythmias in AMI. This may, in part, be due to the strong ISA of this substance, but possibly also to the fact that celiprolol levels in the blood (measured by HPLC) were significantly lower in patients with AMI than in healthy volunteers.

[Sulfinpyrazone-associated renal failure (author's transl)]

Three patients developed renal failure a few days after onset of sulfinpyrazone administration. In two the renal dysfunction was reversible, while the third died of a second myocardial infarction. The clinical picture of renal failure was uncharacteristic. It is recommended that renal function be tested two to four days after starting sulfinpyrazone, and to discontinue the drug immediately if there is a rise in blood urea nitrogen and creatinine. Since in two of the patients the creatinine values were elevated before sulfinpyrazone had been administered, it is clear that even minor pointers to impaired renal function should be considered as contraindications to the use of sulfinpyrazone.

[Routine serum digoxin determination on hospital admission (author's transl)]

The purpose of the present study was the collection of data concerning digitalis treatment of patients outside hospital. The investigation was carried out on 200 patients over 60 years of age, consecutively admitted to a 750-bed general hospital (35% ot a medical ward, 65% to other specialities). An ECG and serum creatinine and digoxin determinations were performed on the day of admission and a careful history taken of the drugs administered before admission. 30 patients reported the use of digoxin or other digitalis drugs, whilst another 48 patients reported taking cardiac drugs in general. The prevalence of digoxin levels exceeding 2 ng/ml was 11.5% in the group of patients known to have taken digitalis preparations, 18% among the 92 patients with positive serum digoxin levels and highest (30%) in the subgroup admitted due to cardiac failure. In patients with digoxin levels above 2 ng/ml the prevalence of elevated serum creatinine values (greater than 1.2 mg%) was markedly increased. Among patients with normal serum creatinine levels the mean age of patients with digoxin levels above 2 ng/ml was significantly higher than of those with digoxin levels below 2 ng/ml. A clear correlation between digoxin levels and ECG changes was not demonstrable; simultaneous administration of diuretics promotes the appearance of electrocardiographic signs of digitalis toxicity.

[Advances in non-invasive procedures to diagnose acquired and congenital cardiac valvular disease (author's transl)]

A review is presented, based upon the literature published mainly during the past 10 years and upon personal experience with these methods, of the use of non-invasive diagnostic procedures in congenital and acquired valvular disease of the heart and pericardial disorders. Special emphasis is placed on the possibility of obtaining a quantitative assessment of the severity of the disorder. It depends on the underlying disease whether mechanocardiography (phonocardiogram, external pulse recordings) or echocardiography provides optimum diagnostic information. Echocardiography is especially helpful in the diagnosis of pericardial effusion and hypertrophic cardiomyopathy.

[Precision in fixation and remounting of cast parts]

The exactitude of transferring castings was tested in two currently used methods of casting. Results showed that alginate casting from a remontage matrix and simple casting with IMPREGUM are sufficiently exact for clinical purposes. When the mixing relations between the casting substances is exactly maintained a transfer exactitude of +/- 0.11 is achieved by the methods tested. When there is a change in the relationship of the mixtures deviations of up to 0.20 mm occur.

[Arrhythmia analysis--arrhythmia control (comparative studies of 4 small computers for automatic electrocardiography control)]

Four arrhythmia computers presently available on the market were tested with respect to their efficiency in identifying abnormal QRS-complexes. A considerable variation for the calculated sensitivity and specificity has been found with a highest value for sensitivity (92.9%) combined with a low specificity (72.4%), and a highest value for specificity (100%) combined with a very low sensitivity (36.6%). The best results were obtained by a computer with a sensitivity of 90.9% and a specificity of 98.5%. For the routine use of these computers in the CCU common artifacts (e.g. muscle potentials) must influence their performance in a practical way: neither should minor artifacts stop the function completely nor should the computer continue to measure with a high level of "noise". Based upon the results of these test series suggestions for the concept of arrhythmia computers for CCU are presented.

[Attainment and preservation of normal exercise capacity after myocardial infarction (author's transl)]

Results of physical rehabilitation were studied in 2 groups of patients. Group A consisted of 16 men and at least 24 (mean 51.5) months had elapsed after myocardial infarction before they were entered into a training programme with supervised once-weekly classes in a school gymnasium. By contrast, the interval between infarction and onset of training was less than 12 (mean 7.0 months in the 21 patients of group B, who had exercise classes twice a week. Group A achieved an average increase in estimated aerobic capacity of 32% (p less than 0.001) in 10 months of training, group B of 33% (p less than 0.001) in 4.7 months. Further participation of group A for 26 more months resulted in an additional improvement of 11% (p less than 0.05). Differences between the groups in aerobic power and different methods of exercise testing and training are discussed. The results indicate that early physical training of groups of patients helps them to obtain a normal exercise capacity with a year after myocardial fixation. Without such intervention patients often remain restricted, but with supervised training their physical power may be improved significantly even if years have passed after the heart attack.

[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.