[Pulmonary embolism: clinical relevance, requirements for diagnostic and therapeutic strategies]. / Lungenembolie: Klinische Bedeutung, Anforderung an die Diagnostik und Behandlungsoptionen.

In the population the annual incidence of pulmonary embolism amounts to 1.3-2.8 per 1000 at the age of 65-89 years. Mortality reaches about 17% within the first 3 months. Acute pulmonary embolism is characterized by an increase in pulmonary arterial pressure and an impairment of the pulmonary gas exchange. Elevation of the right cardiac pressure up to right heart decompensation may follow. In addition, hypoxemia, hyperventilation, dead space ventilation, right to left shunting, bronchoconstriction, and vasoconstriction may occur. Clinical examination, ECG, laboratory findings such as elevated D-dimer, blood gas analysis, ultrasound examination of the veins of the lower extremities, and transthoracic echocardiography are acutely available diagnostic methods of an emergency department. In addition, extensive diagnostic procedures like pulmonary scintigraphy and pulmonary angiography may be required. The aim is to get a definite diagnosis as quickly as possible to direct therapy. In acute pulmonary embolism with cardiac shock, monitoring and stabilization of the circulatory function as well as an appropriate anticoagulant therapy are essential. In some cases surgery or a local fibrinolytic intervention is indicated.

[Form fruste of long QT syndrome]. / Forme fruste eines langen QT-Syndroms.

The long QT syndrome (LQTS) is an inherited disorder associated with recurrent syncope and sudden death from ventricular arrhythmias. It is characterized by a prolonged QT interval on the ECG. A case is discussed in which a patient presented with recurrent syncopal episodes on exertion associated with a slightly prolonged QT interval. Family history revealed an increased incidence of sudden deaths in two generations. Some reports on similar patients suggest that there may be a forme fruste of the long QT syndrome. The additional diagnostic values of exercise stress test, Valsalva maneuver and genetic testing are evaluated. After analysis of the patient's and mother's ECGs the diagnosis of a forme fruste of LQTS is made. This case is presented to emphasize the importance of diagnosis of borderline cases of LQTS because of the high risk of sudden death for untreated patients.

[Positive inotropic effects of doxaminol in congestive heart failure]. / Positiv-inotrope Akuteffekte von Doxaminol bei Herzinsuffizienz.

The hemodynamic effects of doxaminol, a new, orally applicable beta-agonist, chemically dissimilar to catecholamines, were studied in comparison to those of dobutamine by means of thermodilution. After single-dose application of doxaminol in cases of congestive heart failure, cardiac output and stroke volume increased, heart rate increased slightly, pulmonary and systemic arterial pressure remained constant, and peripheral vascular resistance decreased. No arrhythmias appeared, but one patient suffered an attack of angina.

Antiarrhythmic effect of the calcium antagonist tiapamil (Ro 11-1781) by intravenous administration in patients with coronary heart disease.

Twenty coronary patients with a median age of 76 years were treated in the coronary care unit with tiapamil, a new Ca2+ antagonist, by intravenous infusion (until December, 1979, the generic name was dimeditiapramine). The following arrhythmias were identified: atrial fibrillation with ventricular rate greater than 95 beats/min (5 patients); supraventricular premature complexes (SVPC) (4 patients); and ventricular premature complexes (VPC), Lown grades 2-4 (15 patients). Electrocardiograms and hemodynamic parameters were continuously monitored prior to, during, and after the therapy. In patients with atrial fibrillation, sinus rhythm was not restored, but tiapamil decreased the ventricular rate by 54%. In patients with VPC, the median frequency of VPC decreased from 310.5 before tiapamil to 32.5 beats/h at the fourth hour of therapy (p less than 0.01). The median ectopic/sinus beat ratio decreased from 0.083 (pretreatment) to 0.008 at the fourth hour of infusion (p less than 0.10). In one of the patient with an insufficient decrease in the number of VPC, the VPOC changed from class 4a (pretreatment) to class 2 (during the therapy), returning to class 4a after the infusion was stopped. Tiapamil reduced the median systolic and diastolic blood pressures by 8.3 and 7.1%, respectively (p less than 0.05), the third hour. Hypotension and bradycardia were observed in 5/20 patients. The results show that tiapamil is effective against both supraventricular and ventricular arrhythmias, and thus its spectrum of action differs from that of other calcium antagonists.