Early diagnosis of subacute free wall rupture complicating acute myocardial infarction.

Of 2608 consecutive patients with acute myocardial infarction, 24 developed subacute free wall rupture (= 0.92%; 95% C.I.

[Presumed "successful" fibrinolysis in unrecognized acute aortic dissection].

Thrombolysis (1,500,000 IU streptokinase during 60 minutes and 500 mg acetylsalicylic acid was started in a 43-year-old woman with Turner's syndrome who had chest pain lasting for more than 45 min accompanied by ST elevations of 0.2 mV or more in leads II, III, aVF and V1-V5. Pain disappeared within an hour and the ST segments became isoelectric.

Are admission plasma fibrinogen levels useful in the characterization of risk groups after myocardial infarction treated with fibrinolysis?

The aim of our study was to prove or disprove the independent prognostic importance of fibrinogen after myocardial infarction. Plasma fibrinogen levels were determined on admission in 135 patients with an acute myocardial infarction and symptoms up to 4 h (mean: 1.8 h) immediately before starting fibrinolytic treatment with 1.

Influence of minimal angiographic visible collateral circulation on myocardial function during PTCA.

The potential protective role of angiographically visible minimal collateral circulation in diagnostic angiograms, not reaching or filling the target vessel (RENTROP class 1), on myocardial function during percutaneous transluminal coronary angioplasty (PTCA), was studied in two groups of patients undergoing elective PTCA of the left anterior descending artery (LAD). In the first study group consisting of 22 patients, influence of collateral circulation class 1 on left ventricular regional function was evaluated. In this group, 14 patients showed no angiographic collaterals and 8 patients showed collateral circulation class 1 in diagnostic angiograms.

Rapid changes of atrial natriuretic peptide concentration during percutaneous transluminal coronary angioplasty.

In 34 patients undergoing routine coronary angioplasty, concentrations of atrial natriuretic peptide (ANP), plasma renin (PR), and plasma aldosterone (PA) were estimated before, during, and after vessel occlusion and were correlated with hemodynamic changes. For the group as a whole, averaged right atrial pressure rose significantly (p less than 0.001) from 4.

Acute occlusion of left main coronary artery without ventricular damage.

We report a patient with acute occlusion of left main coronary artery with only a small increase of cardiac enzymes but without electrocardiographic signs of acute myocardial infarction. Normal global and regional left ventricular function could be documented angiographically. Damage of myocardium was prevented by extensive collateral circulation from a large dominant right coronary artery.

Apolipoprotein A and prognosis after myocardial infarction in non-diabetic men.

The implications of apolipoproteins A-I and A-II for the prognosis of 178 non-diabetic men after acute myocardial infarction were studied. During a mean follow-up period of 4 years, one or more "coronary events" (nonfatal myocardial infarction, fatal coronary heart disease, coronary artery bypass graft surgery, deterioration of exercise ECG) were recorded in 37 patients. Serum levels of apolipoproteins A-I and A-II did not discriminate between patients with and without coronary events.

Acute mitral regurgitation due to short periods of ischemia during percutaneous transluminal coronary angioplasty: an angiographic study.

The frequency and severity of mitral regurgitation were investigated during a short period of ischemia (60 seconds) in patients undergoing elective percutaneous transluminal coronary angioplasty of single vessel disease. Thirty patients showed stenoses in the left anterior descending artery, 3 patients in the circumflex artery and 1 patient in the right coronary artery. Only patients with global and regional normal left ventricular function, and without collaterals reaching or filling the target vessel, were enrolled in the study.

[Changes in left ventricular hemodynamics and contractility and significance of various reperfusion phase times in recurrent short duration ischemia in the human].

The time courses of left ventricular systolic (LVSP) and enddiastolic (EDP) pressures as well as changes in peak dp/dtmax and peak dp/dtmin using high-fidelity-tip catheters were studied in 35 out of 179 consecutive patients undergoing elective percutaneous transluminal angioplasty (PTCA) of the left anterior descending artery (LAD). Only patients with global and regional normal left-ventricular function and without collateral filling of the target vessel in the diagnostic angiograms were included. Occlusion time of the LAD was 50 and 60 s during each cycle.

Long-term prognosis of patients with silent ischemia, symptomatic ischemia and without ischemia after acute myocardial infarction.

The prognosis of 55 patients with silent ischemia (group I: asymptomatic ST segment depression of greater than or equal to 0.1 mV on symptom-limited ergometer exercise) was compared with that of 25 patients with angina and ST depression (group II), 22 patients with angina but without ST depression (group III) and 94 patients without angina and without ST depression (group IV) on ergometer testing in the first post-infarction month. Patients for whom PTCA or coronary artery bypass graft surgery was planned for the next months following discharge were excluded.

[Reduction of radiation exposure by protective measures in heart catheter studies and interventional cardiology].

To estimate scatter radiation exposure of physicians and radiologic assistants, phantom measurements were made in different projections during coronary angiography and angioplasty. Scatter radiation was reduced by using a protective glass (1.5 mm) and a shield (1.

Iatrogenic left main coronary artery stenosis following aortic valve replacement.

A case of severe iatrogenic fibrous left main coronary artery stenosis following aortic valve replacement (Hall-Kaster prosthesis) is documented clinically, angiographically and histologically. Reported histological data of this rare complication of valve replacement are reviewed. The onset of ischaemic symptoms in the first six months after valve replacement is highly suggestive of iatrogenic coronary artery stenosis, and urgent coronary angiography is recommended.

[Acute myocardial infarct in patients over 70. Results of a 2-year survey].

581 consecutive patients admitted to hospital for acute myocardial infarction between January 1983 and June 1985 were divided into two groups. Group A (286) patients were aged 70 years or over (76 +/- 4 years); those in group B (246) were 65 or younger (56 +/- 8 years). Group A patients had a significantly higher incidence of anterior-wall infarction (30% vs.

[Intra-aortic balloon pulsation in diagnostic coronary angiography].

Percutaneous intraaortic balloon counterpulsation was established during diagnostic cardiac catheterization in 24 patients (ten patients with impending cardiogenic shock and 14 patients with unstable angina pectoris IIIa refractory to maximal medical therapy). Hemodynamic stabilization was obtained and pain disappeared in every patient within a short time. There was no myocardial infarction before surgical intervention.

[Course and blood coagulation findings following systemic short-term fibrinolysis in acute myocardial infarct].

Unlabelled: A series of 16 consecutive patients with acute myocardial infarction was investigated with respect to changes in coagulatory parameters after intravenous short-term treatment with 1,500 000 IU streptokinase (SK) over a period of 90 minutes. Samples for coagulation assays (fibrinogen, thrombin, time activated partial thromboplastin time (aPTT), normotest, thrombin-coagulase time, platelets, antithrombin III, plasminogen and antiplasmin activity, alpha 2-macroglobulin, alpha 1-antitrypsin, factor X a were collected before and immediately after iv SK, and after 4, 8, 12, 24, 36, 48 and 72 hours. Platelets, antithrombin III, factor X a, alpha 1-antitrypsin and alpha 2-macroglobulin showed no changes over the observed period.

[Prognostic value of symptom-limited ergometry 3 weeks after acute myocardial infarct].

96 patients, under 70 years of age, underwent symptom-limited (maximal) exercise testing in the 3rd week after an acute myocardial infarction when neither cardiac insufficiency, angina pectoris (post-infarction) nor malignant arrhythmias were present. A further 29 patients, who could not be exercised because of the reasons mentioned, had a significantly higher frequency of coronary events during the 14 month observation period than those patients who could be exercised (55% vs. 23%, P = 0.

[Possibilities of systemic fibrinolysis in acute myocardial infarct].

Recanalisation of the infarct-related coronary artery could be achieved in 60 to 80% of patients with acute myocardial infarction by means of systemic fibrinolysis, if the interval between the onset of symptoms and the admission to therapy was less than 3 (maximal 6) hours. Fibrinolytic therapy should be combined with an exact conventional treatment in form of sedation, analgesia, oxygen delivery and optimisation of hemodynamics and metabolism with nitroglycerin, calcium antagonists and beta-blockers. Coronary angiography should be performed as soon as possible to decide about further therapy like percutaneous transluminal coronary angioplasty, coronary bypass surgery or medical treatment.

[Serum digitoxin levels in pacemaker patients].

In most cases pacemaker patients represent a diverse geriatric group in which ECG and clinical signs are of minor usefulness in diagnosing digitalis toxicity. We therefore determined serum glycoside concentrations in 200 consecutive patients attending our pacemaker clinic (with a mean maintenance dose of 0.093 mg digitoxin per day) and tried to correlate these to clinical, ECG and chemical findings.

[Moducrin--a new combined preparation in the treatment of hypertension (author's transl)].

A product combining 25 mg hydrochlorothiazide, 2.5 mg amiloride hydrochloride and 10.0 mg timolol maleate (Moducrin) was tested in 20 previously untreated hypertensive persons.

[Importance of risk factors in myocardial infarction (author's transl)].

Importance of risk factors as hypertension, hyperlipidaemia, diabetes mellitus and cigarette smoking because of hemodynamic and complication during acute myocardial infarction and influence of live quality during the first year after myocardial infarct was pointed out in this study. No risk factor was found in 12.1% out of 248 patients.

[Influence of isosorbiddinitrate on hemodynamics at rest and during exercise (author's transl)].

23 patients with acute transmural myocardial infarction were exercised (4 min. 30 Watt) at the end of the hospital period (14-26 days after administration) (probatory exercise). This test was repeated identically after 5 mg of ISDN; again hemodynamic measurements were done (heart rate, arterial pressure, pulmonary artery pressure, cardiac output).

[The efficacy of the intra-aortic balloon pump for patients with heart failure complicating acute myocardial infarction (author's transl)].

Assisted circulation was carried out with the help of an intra-aortic balloon pump in 22 patients with acute transmural myocardial infarction and heart failure (despite medication). Two patients died in hospital. The combination of the balloon pump and nitrates proved to be particularly effective.