Biomedical subjects
Publications and source records attributed to C Weser.
iv-DSA is an excellent method for detecting suspected stenosis of the renal arteries. In essential hypertension among 19 patients a frequency of 15.8% was found, in patients with accelerated hypertonus (n = 23) the percentage of renal artery stenosis was twice this rate (30.4%). In case of a positive or unclear outcome of iv-DSA, intraarterial angiography with ever ready PTRA is advisable.
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Out of 46 patients who had undergone acute coronary angiography in 41 a definitive acute myocardial infarction was present. In 31 complete and in 10 cases subtotal obliterations of the infarct-related coronary artery were found. 14 patients had a one-vessel-disease, 8 a two-vessel-disease, but 19 a three-vessel-disease. In these 41 patients with acute myocardial infarction a subsequent intracoronary fibrinolysis therapy with streptokinase or urokinase immediately followed, which was successful in 33 patients (80.5%). Coronarographically neither a recanalization or a marked improvement of luminal patency of the infarct-related coronary artery could be proved. In 4 patients an additional guidewire thrombus perforation was necessary. The intracoronary fibrinolysis lasted maximally 2 hours (average total dosage 121.000 +/- 45.000 U streptokinase) and was essentially well tolerated. Only 3 patients of the treatment group died. 20 patients underwent a repeated angiography on average 8 1/2 months after fibrinolysis therapy, out of this group in 10 successfully treated patients comparable quantitative angiographic investigations are present. Heart index, stroke volume and systolic ejection fraction improved significantly. The percental size of the non-contracting area of the myocardium decreased statistically significantly. The recanalized coronary arteries were still patent at control.
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Quantitative angiocardiographic examinations concerning the regional contraction of the left ventricle in 16 patients with acute myocardial infarction were performed. In comparison to a control group of 6 healthy male patients the determination of the speed of the medium regional shortening (MVRF) of 12 different ventricle segments resulted in typical findings deviating from the normal. On the second day after beginning of the infarction in the area of the myocardium affected by an acute infarction there existed as a rule severe hypokinetic and akinetic disturbances of the contraction (13 times), only in three cases slight paradoxical movements of the ventricular wall (dyskinesias) could be observed. The average speed of shortening of all segments together (MVRF) excellently represents the momentary global function of the ventricle. It comprises in the same way acutely and chronicly disturbed areas as well as also the function of regions of the myocardium which are not disturbed. MV/RF and systolic ejection fraction (SEF) show statistically a highly significant correlation of r = 0,797 (p less than 0.001). On the basis of the findings got considerations are performed concerning a proved differential therapy in the acute stage of the myocardial infarction.
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In the acute phase of myocardial infarction in 22 patients intraventricular pressure measurements (left and right heart catheters) were performed. In addition to this in 17 cases a qualitative and quantitative angiocardiographical judgment of the function of the left ventricle was done. A group of 9 patients with healthy heart served as control group. The group with infarction showed typical findings deviating from the normal. Stroke volume, cardiac output and stroke work of the left ventricle were significantly decreased. The systolic ejection fraction which was highly significantly reduced in contrast to the normal value proved as a particularly sensitive index. The contractility parameters dp/dt max. and VCE(dp/dt max.) were also highly significantly reduced; aortic mean pressure and heart rate did not show any significant changes. A compensation of the decrease of the heart function depending on contractility is achieved in the acute phase of the myocardial infarction by a significant increase of the wall stiffness, in which case apparently the ventricle practically exclusively by this means strives for an optimum filling pressure in order to maintain a sufficiently large stroke volume. The practically unchanged enddiastolic ventricle volume excluded at least for the uncomplicated infarction in the acute stage an essential participation of Frank-Starling's compensation mechanism.
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A report is given on the incidence-rate of the angina-pectoris-syndrome in the reception ward of a multidisciplinary intensive care unit. In the course of 6 years a total of 83,048 patients was examined. 36,076 of them were patients with internal diseases, 28 per cent having cardio-circulatory disturbances. In only 25 per cent of the cases being admitted with the tentative diagnosis of myocardial infarction this could be confirmed. Complaints of arthrogenous or vertebrogenous character or hypertonic crises as causative factors for cardialgias must especially be taken into consideration differential-diagnostically.
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