[A case of surgically treated septum perforation associated with acute myocardial infarct]. / Acut myocardialis infarctushoz társuló septum perforatio operált esete.

The authors present the case-history of an elderly female patient with acute myocardial infarction complicated by ventricular septal defect (VSD). She was operated on in order the VSD to be corrected but--probably because of sutural insufficiency--it temporarily reopened, later closed spontaneously. The significance of certain tests in the differential diagnosis of systolic murmur after acute myocardial infarction is discussed, and the importance of these findings compared to the clinical picture is emphasized.

Study of the effect of Tensiomin (captopril) in chronic heart failure.

Tensiomin (captopril) was tested in 23 patients with chronic heart failure for 7.5 months on the average. In 9 outpatients suffering from congestive cardiomyopathy the effect of Tensiomin as an adjuvant to digitalis, diuretic, vasodilator etc. was evaluated by non-invasive methods. During the 3-month follow-up period the heart rate was decreased and the PEP/LVET ratio was improved. The parameters calculated from the X-ray examination (cardiothoracic index, cardiac volume index) indicated the regression of cardiomegaly. Radioisotopic circulatory examinations (systolic volume index, cardiac output index) indicated an increase in cardiac performance. In addition to the significant changes of these parameters the patients' clinical state was also improved in all cases as assessed according to the NYHA classification. Significant side effects were not observed during the treatment.

Circulating blood volumes in diabetic patients.

To examine the mechanism of cardiac dysfunction in diabetes, total circulating blood volume, cardiac and stroke volumes were measured by radioisotope method in 44 patients with type 1 and type 2 diabetes. Considerable difference in actually circulating blood volume could be demonstrated in diabetic patients, which seemed to be dependent on the control of the carbohydrate metabolism. The achievement of well controlled carbohydrate metabolism in diabetics has a great importance with special respect also to the blood volumes.

Serum-"free"-thyroxine and triiodothyronine levels: their significance in preclinical hyperthyroidism and subclinical hypothyroidism.

A study was performed to establish whether the serum-"free" T4 and T3 levels contributed to the diagnosis of latent thyroid disease. The results suggested that in case of autonomous adenoma an increase in the serum free T3-level is the most reliable indicator of the transformation of the thyroid nodule, and that this hormone concentration, in addition to the TSH--IRMA procedure contributed to the differentiation between euthyroid and hyperthyroid state. In subclinical hypothyroidism, regarded as a heterogeneous subgroup, the mean "free" T4 levels, though still within the normal range, were below those of the controls. Measurement of "free" T4 alone was, however, not sufficient for the diagnosis of subclinical hypothyroidism, but contributed to the differentiation of subclinical from manifest hypothyroidism. Subclinical hypothyroidism raised the possibility that a reduction in the serum hormone levels, though still within the normal limits, may be perceived by the peripheral tissues. Preliminary studies indicated that measurement of the systolic time interval may offer information on this issue.

Hyperthyroidism and the heart: study of left ventricular function in preclinical hyperthyroidism.

To study the response of the target organs to minor increments of thyroid hormone levels, left ventricular ejection fraction (LVEF) the primary indicator of left ventricular function, was measured in patients with preclinical hyperthyroidism and the results were compared with those obtained in euthyroid subjects and in patients with toxic adenoma. In euthyroid subjects and in patients with preclinical hyperthyroidism LVEF in response to exercise involving an isometric static work load revealed a minor increase, whereas in manifest hyperthyroidism (toxic adenoma) an opposite response with an impairment of left ventricular functional capacity was found. The results showed that the pituitary responds more sensitively to minor changes in the circulating thyroid hormone levels than does the heart and indicated that the typical hyperthyroid heart changes associated with the evolution of toxic adenoma develop gradually.

Myocardial systolic alterations of insulin-dependent diabetics in rest.

Left ventricular systolic function was tested in 27 insulin-dependent diabetic patients by measuring the systolic time intervals. In diabetics longer pre-ejection period, and higher PEP/LVET quotient were found showing a good correlation with the values of glycosylated haemoglobin. These findings emphasize the importance of metabolic control in the development of cardiac dysfunction.

Clinical-pharmacological evaluation of a new beta blocker, GYKI-41099 (tobanum).

The acute and chronic circulatory effects of a new beta adrenergic blocking drug, dl-1-(2,5-dichlorophenoxy)-3-tertiary-butylamino-2-propanol hydrochloride, GYKI-41099, have been assessed in patients with hyperkinetic circulation/or mild hypertension. The acute effects of GYKI-41099 2.5, 5 and 10 mg have been compared with those of propranolol 10, 20 and 40 mg using a cross-over design in 18 patients with elevated cardiac index. Each dose of both drugs produced a significant reduction in sitting and exercise heart rate. The potency of GYKI-41099 compared with propranolol proved to be 3:1. 13 patients with hyperkinetic circulation on GYKI-41099 5-15 mg daily for 2 months exhibited a significant reduction in resting heart rate and cardiac index. In 13 patients with mild hypertension the drug exerted marked antihypertensive effect. Side effects were minimal and short-lived.

Increase of intravascular blood volume in Ischaemic heart disease.

Circulating blood volume, cardiac index, heart rate, and ejection rate were measured in patients with angina pectoris. The controls and the patients were divided in sub-groups of those under 45 and over 45 years of age. The investigation was carried out using the isotope method. A significant difference was observed in the value of intravascular blood volume at rest between the controls and patients with ischaemic heart disease unrelated to anginal attack. The blood volume was 5.6 litre in the control group and 6.4 litre in patients with ischaemic heart disease. Exercise tests produced further increases during attack in the blood volume of angina patients. A significant increase of blood volume after moderate exercise was also observed in patients under 45 with ischaemic heart disease but without angina. It is suggested that the increase of intravascular blood volume plays a part in the pathogenesis of angina pectoris.