[A case of chronic pulmonary hypertension after fenfluramine intake]. / Ein Fall von chronischer pulmonaler Hypertonie nach Fenfluramineinnahme.

A case of primary vascular pulmonary hypertension (PVPH) in a 53-year old woman (160 cm, 90 kg) is reported. She first complained of symptoms of breathlessness on exertion 2-3 months after completion of three courses of fenfluramine (Ponderax). The courses began in October 1977 and ended in May 1978. Despite persisting symptoms no relevant clinical findings were obtained. The patient was admitted to this hospital after complaining of short syncopal attacks on exertion, in November 1981. Typical signs of PVPH were now demonstrable, with a resting pulmonary pressure of 98/45 mm Hg. Clinical findings showed a similarity to those obtained in patients suffering from aminorex-induced PVPH, although fenfluramine shows some biological differences to aminorex. A causality between the development of PVPH and fenfluramine intake is probable on the basis of the patient's history, but it cannot be proven.

[Assessment of the results of aorto-coronary bypass surgery with the technetium 99m pyrophosphate scintigram (author's transl)]. / Beurteilung der Operationsergebnisse nach aortokoronarem Bypass mittels der Technetium-99m-Pyrophosphat-Myokard-Szintigraphie.

In 40 patients with angiographically-documented coronary artery disease, technetium 99m pyrophosphate (99mTc-PYP) myocardial scintigrams were obtained prior to and four to six weeks after aorto-coronary bypass surgery. In the majority of patients, preoperative and postoperative exercise testing with simultaneous pulmonary artery pressure recordings was performed. In 22 of 30 patients with preoperatively increased 99mTc-PYP myocardial activity, no tracer accumulation could be found postoperatively. In the latter patients, there was also a significant increase in exercise capacity and lessening of ischemic ST-segment depression in the exercise ECG. In the remaining eight patients in whom increased tracer accumulation was found to persist postoperatively, there was no improvement in exercise capacity. In ten patients with no myocardial tracer accumulation preoperatively, unchanged myocardial scintigrams and a significant decrease of the ischemic ST-segment depression in the exercise ECG were seen postoperatively except in one patient with perioperative myocardial infarction. These results were also partially confirmed by repeated coronary angiography and ventriculography. Patent bypass grafts were associated with regional improvement in left ventricular function. The results indicate that postoperative absence of myocardial tracer accumulation appears due to amelioration of preexisting myocardial ischemia at rest. Thus, in the assessment of the results of aorto-coronary bypass surgery, the 99mTc-PYP scintigram offers an important diagnostic potential.

[99mTc-pyrophosphate myocardial scintigraphy in patients with chronic stable angina pectoris (author's transl)]. / Das 99mTc-Pyrophosphat-Myokardszintigramm bei der chronischen Angina pectoris.

In 66 patients suffering on chronic stable angina pectoris myocardial scintigrams with 99mTc-pyrophosphate were evaluated. Patients who had former infarcts or infarct signs in ECG were excluded. 16 normal subjects were used as controls. In all normal subjects and in 35 patients with chronic A.P. a normal myocardial scintigram could be obtained. In the remaining 31 patients a localized myocardial tracer accumulation could be seen. There was a correlation between the tracer accumulation and the limitted left ventricular function. No correlation was found between the severity and the number of involved coronary arteries and a positive scintiphoto. The mechanism of the tracer accumulation is discussed. The results of this investigation show that a positive myocardial scintigram does not prove a myocardial infarction. It is a sign for a insufficiency of the contractility of the left ventricle, probably due to under perfusion.

[Diastolic mitral regurgitation (author's transl)]. / Die diastolische Mitralregurgitation.

An analysis of left ventricular angiograms not seldom revealed a diastolic mitral regurgitation. There was neither a correlation between the diastolic mitral regurgitation and the anatomic situation in the coronary system nor with the left ventricular function. The diastolic regurgitation always occurred in a postextrasystolic pause at the end of the diastole. While the systolic mitral regurgitation produces a jet appearance of contrast material, the diastolic mitral regurgitation is seen as a floating of contrast material into the atrium. The cause of the diastolic mitral regurgitation appears to be an incremented left ventricular filling subsequent to repeated and incoordinately-occurring extrasystoles with diminished systolic ejection which leads to reversal of the pressure gradient between the left atrium and left ventricle and permits regurgitation over the incompletely closed valve.

[Measurement of pulmonary artery pressure at rest during volume loading for assessment of ventricular function in coronary artery disease (author's transl)]. / Pulmonalarteriendruckmessung in Ruhe während Volumsbelastung zur Beurteilung der Ventrikelfunktion bei koronarer Herzkrankheit.

Measurements of pulmonary artery (PA) pressure at rest with volume loading of the heart was carried out in a semirecumbent position by standardized positioning of the legs (Positioning test) in 44 patients with angiographically-proven severe coronary artery disease (CAD). The patients reacted differently and were accordingly assigned to one of the three following groups: Group I (23 patients) with normal PA pressures values showed normal results on ventriculography and accordingly, a normal ejection fraction. Group II (13 patients) showed a pathological increase in PA pressure by volume loading. Ventriculography showed hypo- or akinetic areas, with accordingly reduced ejection fraction already at rest. Group III (8 patients) showed pathological PA pressure values already at rest, in accordance with the ventriculographic existence of larger akinetic areas and a marked reduction in ejection fraction. Coronary morphology per se showed no correlation with PA pressure behaviour during volume loading at rest. Therefore, PA pressure measurement in the standardized positioning test can give a relatively accurate estimation of the functional state of the left ventricle, while statements about coronary morphology in CAD are not permissible.

[Long-time follow-up scintigraphy with 99m Tc pyrophosphate after myocardial infarction (author's transl)]. / Langfristige szintigraphische Verlaufskontrollen mit 99m-Tc-Pyrophosphat nach akutem Myokardinfarkt.

Follow-up scintigraphies with 99m Tc pyrophosphate 3--4 weeks and 6--12 months after a myocardial infarction revealed the possibility of persisting a myocardial tracer activity in cases in which reinfarction can be excluded. There was a relation between the persistence of the tracer activity and the pressure in the pulmonary artery under stress conditions. The diastolic pulmonary pressure was regular in those patients whose scintiphotos showed no tracer activity in the myocardial area in the follow-up scintigraphy. Patients who showed a persisting tracer activity in the infarcted areal had elevated pressures in the pulmonary artery under stress conditions or even at rest. The elevation of the diastolic pulmonary pressure is a sign of an elevated enddiastolic pressure in the left ventricle caused by a limited left ventricular function. This could be proved by left ventriculography. The results in follow-up scintigraphy 3--4 weeks and 6--12 months after the infarction were quite similar. Therefore we believe that the results of a follow-up scintigraphy 3--4 weeks after an infarction allows to draw prognostic inferences about the further course of the disease.

[Peripheral pulmonary stenosis due to tumour compression (author's transl)]. / Periphere Pulmonalstenosen durch Tumorkompression.

A report is presented of the occurrence of peripheral pulmonary stenosis due to tumour compression in a 12 year-old boy. The tumour was identified as a liposarcoma of the mediastinum, which caused complete occlusion of the left pulmonary artery and stenosis of the right pulmonary artery. This was followed by an extreme increase in prestenotic pressure with right heart failure.

[Report of a family with Holt-Oram syndrome (author's transl)]. / Bericht über eine Familie mit Holt-Oram-Syndrom.

Report of a family where the typical symptomatology of Holt-Oram syndrome can be documented over three generations. Holt-Oram syndrome is an autosomal-dominantly inherited disease, characterized by cardiac malformation, mainly septal defects, av-conduction disturbances, malformations of the upper limbs, mainly the radial ray and sometimes by vascular hypoplasia. According to the literature, these symptoms can be seen in variable expressivity in the family reported. Differential diagnosis of the entity and genetic counsel of symptomatic patients and their normal relatives are discussed.

[Prognostic significance of follow-up scintigraphy with 99m Tc-pyrophosphate in myocardial infarction (author's transl)]. / Prognostische Bedeutung der Verlaufsszintigraphie mit 99m-Tc-Pyrophosphat beim frischen Myokardinfarkt.

Using 99m Tc-pyrophosphate there is a positive visualization of a transmural myocardial infarction by a localized tracer activity outside of the skeletal system. The uptake of the tracer in the infarcted area is expressed as percentage of the accumulation over the sternum. It reaches a maximum 48-60 hours after infarct onset and then recedes gradually but not strictly linearly. On the occasion of a control scintigraphy 3-4 weeks after the myocardial infarction and after full mobilization 56 per cent of the investigated patients showed a variable decrease of the tracer activity. On 44 per cent the tracer activity in the infarcted area remained unchanged or even increased slightly, though the infarction could be excluded. At the same time performed haemodynamic investigations with measuring the pulmonary artery pressure at rest and under stress conditions showed a good correlation between the persistence of the tracer activity in the infarcted area and the amount of the pulmonary pressure at rest and during stress, manifesting left ventricular function. So the result of a control scintigraphy 3-4 weeks after myocardial infarction allows to draw prognostic inferences about the further course of the disease.

[The accuracy of 201 thalium scintigraphy of the heart under conditions of stress (author's transl)]. / Sensibilität des 201 Thalliumszintigramms des Herzens unter Belastungsbedingungen.

The results of 201 thalliumszintigraphy under stress condition in patients with coronary heart disease with or without myocardial scars have not been uniform. We could show that pathologic stress szintigrams were only found in patients with a singular stenosis in one branch of the left coronary artery. In all those cases who had similar stenosis in both branches of the left coronary artery the stress szintigram appeared to be unchanged or normal. Therefore an unchanged stress szintigram allows no conclusion on the condition of the coronary arteries. A normal stress szintigram can be found as well in patients with normal coronary arteries as in patients with severe coronary heart disease. The examination of 201 thallium szintigrams under stress conditions therefore needs some critical evaluation.

[Ventricular fibrillation under quinidine medication--quinidine syncope (author's transl)]. / Kammerflimmern unter Chinidinmedikation--Chinidinsynkope.

Ventricular fibrillation which may occur unexpected under quinidine medication--called quinidine syncope--is one of the most dangerous complications of quinidine application. These life threatening accidents occur in 0,5-4,4% treated cases. The quinidine syncope occurs mostly at the attempt to eliminate atrial fibrillation or flutter. This dangerous side effect is dose independent. The ECG shows an increased QT duration and large U-waves. It seems to be a reentry-tachycardia caused by unequal recovery times in different parts of the ventricular myocardium.

[Myocardial scintigraphy]. / Fortschritte der Medizine in Einzeldarstellungen, XVII.

A distinction can be made between invasive and non-invasive methods in myocardial scintigraphy. Myocardial perfusion scintigraphy as an invasive procedure always requires catherization of the coronary arteries and can be performed only in conjunction with coronary arteririography. The technique of this type of myocardial scintigraphy is described in detail and an explanation given of the normal scintigram and the results obtainable by this method in cases of coronary heart disease. In particular, the possibilities of "doulbe-radionuclide" scintigraphy are discussed. The non-invasive methods serve either to image the still-viable myocardium (cold-spot technique) or for direct visualization of recently-infarcted myocardial tissue (hot-spot technique). The diagnostic importance of these procedures is stressed, especially dual radionuclide investigation of recent myocardial infarct with technetium and thallium.

[Pacemaker failure due to postcardiotomy syndrome--case report]. / Schrittmacherfunktionsstörung durch Postkardiotomiesyndrom--ein Fallbericht.

A failure of the sensing function of a pacemaker with a sutureless myocardial lead caused by postcardiotomy syndrome, is reported. The pacemaker failure appeared on the sixth postoperative day and disappeared after healing of the syndrome. Attention is called to the possibility of a postcardiotomy syndrome causing a pacemaker failure.

[201-Thalium scintigraphy of the myocardium under conditions of rest and exercise (author's transl)]. / Die 201-Thalliumszintigraphie des Myokards unter Ruhe- und Belastungsbedingungen.

The results of 201-Thallium myocardial scintigraphy at rest and after stress conditions in 30 patients are discussed. Among those there were 4 patients without cardiac disease, 7 patients with anterior wall scars after transmural infarction, and 19 patients with coronary heart disease and at least one coronary stenosis greater than 75%. The obtained results were compared to findings in coronary angiography and perfusion scintigraphy. The noninvasive method of 201-Thalliumscintigraphy shows a good correlation to the results of invasive investigations when performed at rest and under stress conditions. It enables greater sensivity and specifity in selection of patients with coronary heart disease compared to stress electrocardiography alone.

[Technetium 99m-diphosphate as an imaging agent in acute myocardial infarction (author's transl)]. / Technetium-99m-Diphosphat in der Diagnostik des frischen Herzinfarktes.

To test the sensitivity and specificity of 99m-Technetium-Diphosphat myocardial scintigraphy in the diagnosis of acute myocardial infarction we examined the scintigrams of 53 patients admitted to our CCU. In all 38 patients with transmural myocardial infarction positive scintigrams with localized uptake of the tracer found. Myocardial imaging was performed 70--90 minutes after the intravenous injection of 15 mCi 99m-Technetium-Diphosphat in anterior and LAO position. The clinical value of the method for proving the presence or absence of a myocardial infarction is demonstrated on infarctions combined with bundle-branch block, pacemaker Ecg and on reinfarction. All normal cases in this group showed no tracer activity outside the bones. In unstable angina pectoris a faint but not localized tracer activity was found.

[Negative and positive imaging of myocardial infarct]. / Negative und positive Darstellung des Myokardinfarktes

In 41 patients myocardial scintigrams were performed using 2 mCi 201T1 and 15 mCi 99mTc-diphosphate. 9 healthy persons showed no myocardial imaging with 99mTc-diphosphate and normal 201T1 scintigrams. Transmural infarctions could be documented by both isotopes, excepted lateral and apical infarctions which could only be shown by means of 99mTc-diphosphate. Non-transmural infarctions could not be identified, myocardial scars however--as was to be expected--showed only activity defects within the 201T1 scintigrams without corresponding images in the 99mTc-diphosphate scans. One patient with severe coronary heart disease showed diffuse diphosphate uptake all over the myocardium with normal 201T1 scintigram. The combined myocardial scintigraphy provides a better diagnosis, enabling an improved localisation of infarction and avoiding misinterpretations.

[An improved exercise test in coronary-heart disease: effect of molsidomin on erogometrically controlled exercise (author's transl)]. / Zur Verbesserung der Arbeitsbelastung Koronarkranker. Wirkung von Molsidomin auf die ergometrisch gemessene Arbeitstoleranz

The protective effect of molsidomin (N-ethoxycarbonyl-3-morpholinosydnonimine) during ergometric exercise was tested on 40 patients with coronary insufficiency proven by preliminary exercise tests or coronary arteriography. Changes in arterial blood pressure, heart rate, pulmonary artery pressure, ischaemic S-T depression and maximal working capacity were used as criteria. The drug increased maximal working capacity and decreased S-T segment depression. In addition it caused a fall in systolic and diastolic blood pressure and pulmonary artery pressure, at rest and during exercise. Resting heart rate increased slightly but during exercise the heart rate was reduced at comparable load stages. The results suggest that molsidomon may be an effective drug in the treatment of angina pectoris.

[Propafenon, a new anti-arrhythmic drug (author's transl)]. / Propafenon--ein neues Antiarrhythmikum

Propafenon, at an initial oral dose of 900 mg, proved an effective anti-arrhythmic drug in 34 patients with frequent ventricular and(or) supraventricular extrasystoles at rest. Long-term ECG monitoring of seven patients revealed that this effect lasted about eight hours. It can be maintained by an oral dose of 300 mg propafenon at eight-hourly intervals, as demonstrated in 21 further patients. Rapid anti-arrhythmic action was achieved in six acute cases with 1.0-1.5 mg propafenon per kg body weight by quick infusion, and lasted for one to one-and-a-half hours. In such cases the drug should, therefore, be given synchronously by the oral route. Side effects related to the gastrointestinal tract, sinus automatism as well as atrio-ventricular and intraventricular conduction, but in no case were very serious.

[Scintigraphic studies on the influence of coronary-effective drugs on myocardial perfusion during rest]. / Szintigraphische Untersuchungen über den Einfluss koronarwirksamer Substanzen auf die Myokardperfusion in Ruhe

A hemodynamically effective coronary stenosis causes in the myocardial scintigram a maldistribution of the albumin particles within the corresponding myocardial regions. During exercise or after medicamental vasodilatation the differences in regional myocardial perfusion are amplified. Various scintigraphic pictures can be shown in a double-scintigram investigation using particles labelled by different radionuclides before and after vasodilatation. According to the method of double-scintigraphy the influence of coronary active media (dipyridamol, nitroglycerin, nifedipine) on regional myocardial perfusion is investigated. Because of its long-acting vasodilatation dipyridamol leads to a malperfusion in poststenotic myocardial areas. A similar vasodilatation effect combined with reduced activity in the second perfusion scintigram can be noticed after injection of contrast medium. In contrast to the drugs described above comparable scintigraphic changes after nitroglycerin and nifedipine are due to a different myocardial perfusion pattern, which is only showing a relative malperfusion in the poststenotic regions. At rest neither nitroglycerin nor nifedipine is able to normalize the regional myocardial perfusion.