[Traumatological risk in ambulatory cardiological rehabilitation].

Background: In Israel in 1956 Gottheiner introduced outpatient rehabilitation programs in patients who had survived a myocardial infarction. In Germany one decade later these WHO phase III activities were established as well. At present any patient with cardiovascular disease is included unless suffering from acute illnesses or presenting with symptoms at rest.

Myocardial infarction in an adult resulting from coronary aneurysms previously documented in childhood after an acute episode of Kawasaki's disease.

Coronary aneurysms resulting from a previous episode of Kawasaki's disease are considered an important cause of myocardial infarction in children. A case of a 19-year-old man presenting with an acute myocardial infarction associated with coronary aneurysms is described. These coronary lesions were previously evaluated angiographically and echocardiographically at the age of 13 years, 5 months after the acute episode of a Kawasaki's disease.

R peak time prolongation and R peak delay in leads I, V5, or V6. Diagnostic values as signs of myocardial dysfunction in chronic mitral incompetence.

On the assumption that maximum R peak time prolongation in the left-sided leads I, V5, or V6 and its time relationship to the S peak time of the maximum S amplitude in leads V1, V2, or V3 (representing dorsally directed forces of ventricular depolarization) could indicate the extent of left ventricular volume overloading and possibly left ventricular systolic function, these variables and the preoperative findings of angiocardiography were compared between patients with chronic mitral incompetence who, late after corrective valve surgery, had either well-preserved radionuclide left ventricular ejection fraction (group 1, n = 36) or radionuclide left ventricular ejection fraction below 50% (group 2, n = 30). Before surgery, group 2 patients had a highly significant lower mean left ventricular ejection fraction, a highly significant greater mean end-systolic volume index, a significantly greater mean end-diastolic volume index, a significantly greater mean maximum R peak time in leads I, V5, or V6, and a significantly greater prolongation of the maximum R peak time above the S peak time in the right precordial leads, as compared with group 1. R peak times greater than 50 ms or the presence of R peak delay (maximum R peak time greater than the S peak time of the maximum right precordial S amplitude) yields less sensitive but highly reliable results in predicting radionuclide left ventricular ejection fraction below 50% with both specificity and positive predictive values of 100%.

PTCA in elderly patients: acute results and long-term follow-up.

Acute results and long-term follow-up of percutaneous transluminal coronary angioplasty (PTCA) in 125 patients aged 75 to 90 years (79 men; 46 female; mean age 78 +/- 3 years), with mainly unstable angina (102 patients) are reported. Successful PTCA was achieved in 96 out of 108 patients (89%); occlusions could be reopened in eight out of 17 patients (47%). Thirty-eight procedures were multiple vessel or multiple lesion PTCA, so that the lesion-related success rate of PTCA was higher (91%).

[Percutaneous transluminal coronary angioplasty in patients with clearly restricted left ventricular pump function].

Among nearly 2000 consecutive PTCA-patients 42 (36 male, six female; mean age 60 +/- 11 years) had ejection fractions < or = 35% (mean 30 +/- 5%). 34 patients suffered from unstable and eight from stable angina. All had previous myocardial infarction and of these 23 had recent myocardial infarction.

Percutaneous transluminal coronary angioplasty in patients with severely depressed left ventricular function.

Among nearly 2,000 consecutive percutaneous transluminal coronary angioplasty (PTCA) patients, 42 patients (36 male, 6 female; mean age 60 +/- 11 years) with mainly unstable angina had ejection fractions of < or = 35% (mean 30 +/- 5%). All patients had previous myocardial infarctions; 31 (= 74%) had multivessel disease. Successful procedure was achieved in 35 of the 42 (= 83%) patients, 31 of 35 (= 89%) stenoses could be successfully dilated and 9 of 15 (= 60%) occlusions reopened.

[Rate of success and restenosis of PTCA in patients over 75 years of age].

In 82 patients (pts), ages 75-90 years (52 m, 30 f; mean age 77 +/- 3 years) with mainly unstable angina (59 pts) or acute myocardial infarction (7 pts) a PTCA or recanalization was attempted. Successful PTCA was achieved in 57 of 69 pts (83%); occlusions could be reopened in all six pts with myocardial infarction and totally occluded infarct related artery, and in three of seven pts with stable or unstable angina pectoris. The primary success rate of PTCA alone in pts with unstable angina was 81%, and improved to 92% in pts with stable angina.

Hemodynamic and coronary vasodilative action of two nitroglycerin oral spray formulations.

This study compared glycerol trinitrate (NTG) oral spray in a new hydrophilic formulation with a reference aerosol in a lipophilic base with respect to the time to onset of action on hemodynamics and on the coronary vasomotor tone. Differences in the profile of action between the two spray formulations were assessed in two groups of ten patients each. In each of the two groups the patients were randomly assigned to receive 0.

[Acute isolated ischemia of the right ventricle with ST elevation in V1 to V4].

An acute anteroseptal infarction was diagnosed in a 51-year-old man whose ECG showed ST elevations in leads V1-V4 after acute retrosternal pain for about 20 min. Angiography revealed proximal occlusion of the right coronary artery, while the dominant left coronary artery was fully patent. After successful recanalization of the right coronary artery with intracoronary infusion of urokinase, the ST elevations quickly disappeared and impending right-heart infarction was avoided.

Dilatation of epicardial coronary arteries and attenuation of provoked coronary vasoconstriction by nisoldipine.

By using quantitative coronary angiography, this study evaluated the coronary artery dilative action of intravenous nisoldipine and furthermore examined the efficacy of the agent to prevent an ergonovine-provoked increase in the coronary arterial tone. Ten patients suspected of either vasospastic or mixed form of angina pectoris underwent coronary angiography under resting conditions, after 3 micrograms kg-1 of intravenous nisoldipine and finally after a cumulative dose of 0.7 mg of ergonovine maleate.

R peak delay in V6. Diagnostic implications in coronary heart disease.

Epimyocardial excitation is delayed in areas overlying infarcted myocardium. On the assumption that a delayed R peak in V6 could indicate anterior myocardial infarction (AMI) in the absence of diagnostic Q waves, the findings of angiocardiography (n = 148) and thallium scanning (n = 46) of 194 patients with suspected coronary heart disease (CHD) were compared with regard to two criteria: A (R peak in V6 precedes S peak in V2, or both peaks occur simultaneously, n = 158) and B (R peak in V6 is later than S peak in V2 [R peak delay in V6], n = 36). Of 92 patients with unconfirmed CHD, 4 fit criterion B, and 3 of these had hypertensive heart disease.

Assessment of left ventricular function from the electrocardiogram in left bundle branch block.

The QRS duration, maximum right precordial S amplitude, sum of amplitudes of the maximum right precordial S and T wave and T wave polarity in lead I have been analyzed in order to identify electrocardiographic predictors of left ventricular end-diastolic volume index and ejection fraction in 165 patients with complete left bundle branch block and various forms of heart disease. Multivariate analysis selected the duration, maximal amplitude of the S wave and polarity of the T wave in decreasing order of discriminatory power, which correctly identify 76.6% of the patients with a normal end-diastolic volume index less than or equal to 90 ml/m2 and a normal ejection fraction greater than or equal to 60% (n = 64) and 73.

Electrocardiographic markers of impaired left ventricular ejection performance in aortic stenosis.

To determine whether the ECG would be useful in the prediction of impaired left ventricular ejection performance in aortic valve stenosis, the authors evaluated 121 patients according to (1) the time relationship of the R peak in V6 to the S peak in V2; and (2) the negative P wave terminal force in V1 (Morris index, n = 109). Left ventricular ejection fraction (LVEF) was significantly depressed in patients with the R peak in V6 later than the S peak in V2 (R peak delay in V6, n = 24), compared with those with the R peak in V6 preceding the S peak in V2 or with both peaks occurring simultaneously (n = 97) (LVEF 40.8 +/- 11.

Nitroglycerin oral spray: evaluation of its coronary artery dilative action by quantitative angiography.

Twenty patients were studied angiographically before and after administration of glyceryl trinitrate (NTG) spray at a single oral dose of 0.8 mg in either a hydrosoluble (NTG-h) or liposoluble (NTG-I) solution. The assessment was by a randomized double-blind trial involving quantitative coronary angiography and pharmacological stress testing using ergonovine maleate.

[Severe forms of mycoplasma pneumonia (author's transl)].

Respiratory tract infections with mycoplasma can cause severe infiltrating pneumonia (with pleuritis), associated with marked inflammatory reactions (maximal E.S.R.