ABSTRACT
The diagnostic pathway for the evaluation of patients with dyspnea requires a thorough history taking and physical examination. Based on the results of these basic steps a broad variety of additional diagnostic tests are available. Each test can contribute valuable information when correctly indicated and performed. Among these are electrocardiography (ECG), laboratory parameters, X-ray examination, echocardiography, spirometry and whole body plethysmography and finally spiroergometry. This article presents a focused review of what each of these diagnostic modalities can contribute to the diagnostic process for dyspnea.
Subject(s)
Dyspnea/diagnosis , Echocardiography/methods , Physical Examination/methods , Plethysmography, Whole Body/methods , Respiratory Function Tests/methods , Tomography, X-Ray Computed/methods , Diagnosis, Differential , Dyspnea/etiology , Humans , Medical History Taking/methodsABSTRACT
A report is given on a 39-year-old man, who developed, after a tick bite, erythema, progressing symptoms and, after 3 years, showed the typical clinical and echocardiographic signs of a dilative cardiomyopathy. A serological test for Lyme Borreliosis was positive. Most of the symptoms disappeared after high-dose penicillin therapy.
Subject(s)
Cardiomyopathy, Dilated/etiology , Lyme Disease/complications , Adult , Antigens, Bacterial/isolation & purification , Borrelia burgdorferi Group/immunology , Cardiomyopathy, Dilated/drug therapy , Humans , Lyme Disease/drug therapy , Lyme Disease/immunology , Male , Penicillins/therapeutic useABSTRACT
A 43-year-old woman was hospitalized for fulminant pericarditis. During diagnostic work-up, an as yet unknown bronchial carcinoma was detected. In the pericardial exudate Legionella pneumophila serogroup 3 was demonstrated by direct fluorescent antibody technique and by culture. In a lung biopsy L. pneumophila serogroup 3 was found, too. Using an antigen-ELISA for L. pneumophila serogroup 1, antigenuria was demonstrated. In cases of pericarditis negative for common bacterial pathogens, all diagnostic tests for legionellae, e.g. culture, antigen detection in pericardial, pleural effusion and urine and antibody detection should be included in the diagnostic programme.
Subject(s)
Carcinoma, Bronchogenic/complications , Carcinoma, Squamous Cell/complications , Legionella/isolation & purification , Legionnaires' Disease/microbiology , Lung Neoplasms/complications , Pericarditis/microbiology , Adult , Female , Humans , Legionella/classification , Legionella/pathogenicity , Legionnaires' Disease/complications , Legionnaires' Disease/diagnosis , Pericarditis/complications , Pericarditis/diagnosis , SerotypingABSTRACT
It is reported on methods of positioning our former described flow directed thermodilution (TD) catheter by the intracardiac ECG derived from two electrodes, one at the tip of the catheter near the temperature sensor and the other six centimeter proximally of it. The typical criterion of the intracardiac ECG in the outflow tract of the right ventricle and in the pulmonary artery are listed, especially the amplitudes, the QRS-splits, T-wave inversion and P-wave configuration.
Subject(s)
Cardiac Catheterization/instrumentation , Electrocardiography/instrumentation , Thermodilution/instrumentation , Electrodes , Heart Ventricles , Humans , Pulmonary ArteryABSTRACT
Of the parameters in consideration for control of physiological rate responsive pacing special interest is directed to stroke volume. In search of indirect parameters which are correlated to stroke volume it is demonstrated on principle that systolic time intervals could be used. From the relation ejection time versus pre-ejection time (LVET/PEP) which is known for its correlation to stroke volume a simple algorithm is derived which is based on the realization that PEP is related to the reciprocal of cardiac output. First investigations with patients demonstrated the possibility of the computation of heart rate from PEP only, with good physiological significance.
