[Early and late results after local streptokinase administration in massive lung embolism]. / Früh- und Spätergebnisse nach lokaler Streptokinaseanwendung bei massiver Lungenembolie.

In a total number of 44 patients with acute massive lung embolism 42 patients survived the acute phase. The treatment was carried out by thrombolysis with streptokinase. The application was performed as near to the thrombus as possible, in several patients after preceding balloon dilatation or also as multiphase treatment using urokinase. We altogether obtained favourable early results concerning the recanalisation got as well as also with regard to the clinical state and the subjective condition, particularly for patients with single acute occurrence and a latency period of less than 72 hours up to the beginning of the treatment. In follow-up examinations of 17 patients after more than 9 months (on an average after 32 months) without exception a good and further on ameliorated condition, respectively, was stated. Under long-term anticoagulation with phenprocoumon no recidivation embolisms appeared. Ergooxytensiometric investigations had as result a clear to extreme hypoxia on exertion as limiting factor for 12 out of 17 patients. Apart from this the majority of the patients a hyperdynamic regulatation of the circulation was to be observed. Therefore the ergooxytensiometry is recommended for the judgment of the result of the treatment as to the demandable exercise tolerance.

[Deglutition-induced supraventricular tachycardias]. / Schluckinduzierte supraventrikuläre Tachykardien.

We describe the cases of two patients who exhibited a supraventricular tachycardia induced by swallowing. In both cases we found a systemic hypertension, other cardiac or gastroesophagic abnormalities were absent. The electrophysiologic studies demonstrated in the first case a supraventricular tachycardia with 1 : 1 AV-conduction and an origin in the right atrium, in the second case an atrial tachycardia with AV-block originating in the right atrium too. The pathogenetic mechanism is discussed. In both cases after treatment with amiodarone a complete cessation of the tachycardias was reached.

[Acute beta blocker poisoning]. / Akute beta-Blocker-Intoxikationen.

It is reported of acute beta-blocker intoxications in 34 patients (16 with talinolol, 18 with propranolol ingestion). The mean ingestion dose was for talinolol 2.5 g, for propranolol 1.55 g, the mean time of latency up to the appearance of intoxication symptoms 116 min after intake of talinolol, 79 min after intake of propranolol. The picture of intoxication was characterized in the two substances by the antiadrenergic effects, there was no more a cardioselectivity in the high ingestion doses. In talinolol were in the first place dysrhythmias, hypotension and vomiting and nausea, respectively, in propranolol central-nervous symptoms and hypotension. Substance-specific intoxication symptoms are also possible. In mixed intoxications alcohol accelerated the beginning of the effect, sedatives prolonged the latency. Threatening of life is to be expected in ingestion doses over 2 g. In 6 patients the course was lethal after extreme doses of talinolol - according to the present experiences due to the too late beginning of therapy and/or insufficient intensity of therapy. Distinct intoxication symptoms need extremely high applications of antidotes of beta-stimulants, in their inffectiveness glucagon. Furthermore, treatment with cardiac pacemakers and 24-hour control in an intensive care unit proved necessary.

[Combined use of talinolol and beta adrenergic stimulants in status asthmaticus. Report on 3 patients]. / Kombinierte Anwendung von Talinolol und beta-adrenergen Stimulatoren beim Status asthmaticus. Ein Bericht über 3 Patienten.

Experiences in combined use of beta-adrenergic stimulants and cardioselective beta-receptor blocker Talinolol are reported in 3 patients in Status Asthmaticus. High dose Aminophyllintreatment in these 3 severe cases was insufficient, in 1 case it had to be finished because of toxic side effects respectively. For adrenergic stimulation in two cases Orciprenalin i.v. was given initially, in one case Terbutalinsulfat i.v. By cardioselective adrenergic blockade with low dose Talinolol it became possible to prevent cardiotoxic side effects in preexisting tachycardia and premature ventricular contractions. This combination treatment was continued successfully with Terbutalin and Talinolol p.o.

[Esophageal electrocardiography--new variants in derivation technics]. / Osophaguselektrokardiographie--neue ableitungstechnische Varianten.

Oesophageal electrocardiography provides for an analysis of heart rhythm that must be considered more accurate than the one obtained in a conventional electrocardiogram. Bipolar intraoesophageal and oesophagosternal or oesophagoparasternal leads, using adequate electrode cables, permit recordings, satisfactory from a technical point of view, even when applying the methods of provocations (ergometry).

[Treatment of severe hypertension and hypertensive crises with nitrates]. / Die Behandlung schwerer arterieller Hypertonien und hypertensiver Krisen mit Nitrokörpern.

Taking into consideration the frequent combination of hypertension, ischaemic heart disease and heart insufficiency the effect of blood pressure as well as the influence of pre- and afterload gain increasing importance, when nitrates are used. It is the question, whether the blood pressure reducing effect may be used with a certain aim or not. In own investigations acute haemodynamic experiments with glycerol trinitrate were carried out on 10 patients with arterial hypertension (catheterization, estimation of HMV and so on) in rest and under ergometric load, clinical therapeutic experiments on 10 patients with crisis of hypertension with cerebral and/or cardiac complications as well as long-term experiments with pentaerythrityl tetranitrate on 6 patients with in most cases severe arterial hypertension. The acute effects on the haemodynamics correspond to those in normal blood pressure, in which case the reduction of blood pressure and resistance is more expressed. The favourable effect of glycerol trinitrate in the crisis of hypertension with cardiovascular complications can be regarded as proved. First own experiences with the long-term application of nitrates do not yet result in a clear estimation of effectivity and indications.

[Myocardial infarction without coronary artery changes]. / Myokardinfarkt ohne Koronararterienveränderungen.

Since 1972 6 patients (4 males and 2 females) at the age from 18 to 44 years with myocardial infarctions could be observed whose coronary system in the subsequent coronarographic examinations proved to be unconspicuous. The diagnosis of the infarction was anamnestically, laboratory-chemically, electrocardiographically and partly scintigraphically ascertained. Issuing from features of infarction and pseudoinfarction, respectively, in the ECG other differential-diagnostically important cardiac and extracardiac causes could be excluded. In comparison to patients with coronary sclerosis typical symptomatology could not be delimited. Peculiarities of the clinical picture are the juvenile age, the in most cases short or lacking angina pectoris anamnesis, the frequent lack of factors of risk and the inclination to disturbances of rhythm. Up to now a satisfying etiologic clarification could not be rendered. The relevance of the different possibilities of the disturbed equilibrium between O2-offer and -need concerning the clinical course of our patients is discussed. Here on the side of the O2-offer the spasm of the big and small vessel and the disease of the small vessels are regarded as decisive factors of the development of the infarction, where as the coronary embolism with subsequent lysis is less to be taken into consideration. Other pathogenetic mechanisms, such as the pathologic Hb-O2-dissociation and the metabolic changes influencing the O2-need must be included into the causal chain of this presumably polyetiologic process. Prognostic and therapeutic aspects which closely correlate with the etiologic explanation are discussed.

[Exertion-electrocardiographic and hemodynamic studies with oral verapamil in chronic ischemic heart disease]. / Belastungselektrokardiographische und hämodynamische Untersuchungen mit Oral-Verapamil bei chronisch ischämischer Herzkrankheit.

The effect of the Ca++ -antagonist Verapamil on the ECG, the haemodynamic parameters and the systolic time intervals was investigated in the long-term experiment on 12 patients with ascertained chronic ischaemic heart disease at reat and during exercise. The dosage was 3 x 80 mg/die during 4 weeks. The tolerance was not increased. The load-induced decrease of the ST-T-distance in the ECG was improved under load and in the recreation phase. The function of the myocardium, measured on the quotient LVET/ICT, improved under load with simultaneous decrease of the double product and the TTI, the pulmonary pressure, however, remained uninfluenced. Side-effects were not observed.

[69. Significance of work load electrocardiographic studies with reference to coronarographic findings]. / Die Aussage belastungselektrokardiographischer Untersuchungen unter Berücksichtigung koronarographischer Befunde

The electrocardiography after work is assumed as an essential diagnostic aid in the evaluation of the chronic ischaemic heart disease. Differences in the diagnostic relevance of the results are related to the test method used. Therefore, comparison with the findings of selective coronary angiography is necessary, though the subject of ECG after work are functional changes, but that of coronary angiography are morphological ones. This study gives the comparison of both methods in 84 patients. In patients with coronary artery construction (greater than 75%) the diagnostic possibilities of ECG after work are limited. With regard to these patients it is pointed out that except of the obstruction of coronary arteries, as it is to be documented by selective coronary angiography, there are several further factors favourising coronary insufficiency, such as diminished perfusion of the peripheral coronary vessels, high levels of catecholamines, metabolic disturbances, diminished oxygen transport capacity or oxygen delivery. This may also explain the relatively low specifity of 60% of the ECG after work in the recognition of obstructive coronary artery disease.

[Clinico-pharmacological studies with Nifedipine--a new coronary substance]. / Klinisch-pharmakologische Untersuchungen mit Nifedipine--einer neuen koronarwirksamen Substanz

On 19 test persons (10 healthy persons, 9 patients with heart diseases) mechanocardiographic and haemodynamic examinations were carried out with the new preparation Nifedipine (05-072) which effects on the coronary vessels. Insignificant positively inotropic effects with invariable heart rate and cardiac output, decreasing heart action and decreased oxygen consumption were found. Arterial blood pressure and peripheral resistance were only slightly diminished. Own results and reports from literature show that the application of Nifedipine in the ischaemic heart disease appears to be successful.

[Mechanocardiography as a screening method in chronic ischemic heart disease]. / Mechanokardiographie als Screening bei chronisch ischämischer Herzkrankheit

On 121 patients with ischaemic heart disease mechanocardiographic examinations were carried out on conditions of rest and partly under conditions of ergometric load and were compared with a group of healthy persons. It was shown that in the patients with ischaemic heart disease there appeared a significant shortening of the ejection time (LVETk), prolongation of the frequency-corrected preejection time (PEPk) as well as of the isovolometric contraction time (ICT and ICTk), an enlargement of the quotient (see article) and reduction of (see article) in rest. Under load the differences between healthy persons and patients with ischaemic heart disease became more clearly with regard to the quotients (see article) as well as (see article) and proved as favourable for the judgment of the cardiomechanics. With the help of the above mentioned mechanocardiographic parameters in connection with the usual diagnostic methods according to our opinion patients with ischaemic heart disease may be diagnosed for the greatest part.

[Value of the propranolol test in the differential diagnosis of repolarization disorders in the ECG]. / Zur Wertigkeit des Propranololtestes bei der Differentialdiagnose von Repolarisationsstörungen im Ekg

The propranolol-test was inaugurated as a simple method for the differentiation, whether repolarisation disturbance in the ECG is based on an organic or a functional cause. In order to determine the value of this test, in this study ECG-strips were done at rest and under bicycle exercise before and after assessment of beta-adrenergic receptor blockade on 41 patients with organic heart disease (most of them with chronic ischaemic heart disease [CIHD]) and 20 patients which had no evidence of heart disease. 19 of 26 patients with heart disease and ST-segment changes already in the ECG at rest had a false positive propranolol-test. Ischaemic ECG-responses under exercise conditions were diminished by the beta-adrenergic receptor blockade, too. These results are in coincidence with findings that give evidence of considerable sympathetic component in the multifactorial origin of coronary insufficiency and of protective therapeutic efficiency of beta-adrenolytic substances. It is concluded that the propranolol-test brings no further information--at least with regard to CIHD--whether repolarisation changes in the ECG are organic or not.