Theoretically there should be two possibilities of recording His-Bundle potentials from the body surface. Extensive amplifying and signal averaging can improve the signal to noise ratio of the His-Bundle potential. Random noise can be filtered and the periodic signal of the His bundle can be selected. On the other hand improvement of the noninvasive leading conditions could be achieved by positioning of the recording electrodes close to the structure to be investigated and by direction of the surface leading according to the anatomical axis of the bundle of His. For this purpose these new oesophagosternal and oesophagoapical leadings have been developed. The different oesophageal electrode is placed nar the upper cava-right atrial border close to the heart. The indifferent electrode is situated at the xiphisternum or at the apex of the heart. The direction of this lead is close to the direction of the anatomical axis of the His-Bundle. By this means a positive wave within the PR-segment can be registered, which we have called the "HP-wave". In a total of 17 patients these bipolar oesophageal leads were employed, in 12 cases simultaneously with the intracardiac HBE as a reference method. At rest the peak of the HP wave correlated to the maximal amplitude of the intracardiac His spike in more than 90% of patients. 4 patients were investigated by atrial pacing, in 3 cases this correlation could be found, too. Apparently the true His bundle signal can be obtained from the body surface by this new leading system. For improvement of the surface His bundle recordings, we reflect the combination of our noninvasive oseophageal lead with a modified signal averaging system with lesser amplication of the original signal.

Adolescent↗

PubMed1977

Changes of the CO-diffusing components of the lung in patients with coronary artery disease (author's transl).

In 32 patients with angiographically proved CAD the diffusion parameters of the lung (intracapillary pulmonary blood volume, Vc, and diffusion capacity of the alveolo-capillary membrane, Dm, respectively the reciprocal value membrane resistance) were measured. As reference the pre-a-LVDP was used, as it represents more adequately than the LVEDP the pressure acting on the alveolo-capillary membrane. There was a significant positive correlation between the Vc and the pre-a-LVDP as well as a highly significant positive correlation between the diffusion resistance of the alveolo-capillary membrane and the pre-a-LVDP. This corresponds to a pulmonary congestion with an increase of Vc and an interstitial edema with an increase of the diffusion resistance of the alveolo-capillary membrane. The Dco may be unchanged in spite of a marked increase of LVDP, since the decrease of the membrane component is accompanied by an increase of the blood component of diffusion. Only the differentiation of the CO-transfer in its components Vc and Dm gives an information about changes of the hemodynamics in CAD.

Blood Pressure↗

PubMed1976

[A new pharmacological test for diagnosing coronary artery disease (author's transl)].

In 45 patients with coronary artery disease, proven by coronary arteriography, and 15 patients without such disease 0.5 mg dipyridamole (Persantin) per kg body weight was injected i.v. over ten minutes. In 40 of the 45 patients with coronary artery disease anginal pain occurred during or immediately after dipyridamole injection and ceased immediately after intravenous administration of 0.24 g aminophylline (positive test), while in three it had stopped spontaneously without aminophylline (questionable positive test). Only in two of the 45 patients with confirmed coronary artery disease was there no anginal pain (false-negative result). None of the 15 patients without coronary artery disease had anginal pain during the test. It is concluded from these results that the "dipyridamole test", which is simple to perform and does not stress the patient significantly, is at least equivalent diagnostically to the exercise E.C.G. test.

Adult↗

PubMed1976

[Cinematographic and clinical findings from simultaneous two-plane coronary angiography (author's transl)].

Simultaneous cine-angiographic examination of the coronary arteries in two planes is now possible, due to technical advances, without losing any of the information that may be obtained by a single-plane technique. This method shortens the examination, reduces the radiation dose when compared with a large film technique and significantly reduces the risk to the patient. Our experience in 67 examinations is recorded.

Angiocardiography↗

PubMed1976