PubMed Health⌕ Search

Biomedical subjects

H Neuss

Publications and source records attributed to H Neuss.

At least 19 recordsLinked to original sources
PubMed1989

The vasopressor system in patients with heart failure due to idiopathic dilated cardiomyopathy--influence of the clinical stage of disease and of chronic drug treatment.

Alterations in the vasopressor system found in cardiac failure are part of compensatory measures that may modify pharmacologic-therapeutic response. Therefore, in 64 patients with dilated cardiomyopathy, we investigated its enhanced activity in different clinical stages of the disease as compared to normal controls. Patients in NYHA class II (n = 20) demonstrated increased activity of the sympathico-adrenal, renin-angiotensin-aldosterone, vasopressin, and atrial natriuretic factor systems, while maximum values were found in patients of NYHA class IV (n = 24). In these patients, noradrenaline was enhanced by a factor of 7, adrenaline by a factor of 2, plasma-renin-activity by a factor of 7, angiotensin II by a factor of 2.5, aldosterone by a factor of 5, vasopressin by a factor of 1.5, and ANF by a factor of 4 as compared to normal controls. Clinical NYHA classes correlated to a certain degree with the various plasma hormones. Patients treated with an aldosterone inhibitor in addition to digitalis and diuretics revealed significantly higher values for aldosterone, vasopressin, and angiotensin II as compared to those who received digitalis and diuretics alone. The addition of ACE-inhibitor therapy resulted in a decrease of angiotensin II, aldosterone, and vasopressin. Plasma catecholamines and ANF, however, did not change under the influence of cardiac medication. Diuretic treatment in NYHA class II patients reduced plasma volumes (p less than 0.01). Plasma volume in NYHA class IV patients only was found to be higher than in normal controls. Thus, analysis of the neurohumoral system can aid both in the identification of the clinical degree of dilated cardiomyopathy and in its optimal therapy.

Adult↗
PubMed1988

Long-term efficacy and safety of flecainide for supraventricular tachycardia.

Eighty-three patients with paroxysmal supraventricular tachycardia (Wolff-Parkinson-White syndrome in 47 patients and atrioventricular nodal reentry in 36 patients) underwent electrophysiologic study before and after intravenous administration of flecainide. Sixty-seven of these 83 patients entered an open clinical trial to evaluate the efficacy and safety of long-term oral treatment with flecainide. Efficacy was evaluated by a patient diary of spontaneously occurring attacks during flecainide treatment and periods of withdrawal. In 24 patients, electrophysiologic study was repeated during oral therapy. During a mean follow-up of 22.8 months, the therapeutic response to flecainide (mean dose 263 mg/day) was good in 48 patients (71%) and fair in 7 patients (10%). In 8 patients (10%), an arrhythmogenic effect was seen (increased number and prolonged duration of supraventricular tachycardia episodes in 4 patients, spontaneous episodes of atrial fibrillation in 2 patients and sinoatrial block in 2 patients). No consistent abnormalities were seen in the laboratory tests. Extracardiac side effects were of minor importance and usually subsided spontaneously or disappeared after reduction of dosage. It is concluded that flecainide is a useful addition to the drugs already available for short- and long-term treatment of supraventricular tachycardia due to Wolff-Parkinson-White syndrome and atrioventricular nodal reentry.

Cardiac Pacing, Artificial↗
PubMed1987

[Neopterin in the serum and urine in the differential diagnosis of disorders of kidney function following kidney transplantation].

In a period of 10 months neopterin in serum and urine was determined by radioimmunoassay in 33 renal allograft recipients treated with cyclosporin A. While in allograft rejections the highest neopterin concentrations were found in the serum, patients with viral infections after renal transplantation showed the most elevated concentrations in the urine. For early diagnosis of allograft rejection the ratio of neopterin clearance and serum-neopterin was the most significant criterion of the parameters measured in this study. Patients without complications during the follow-up showed slightly elevated and stable neopterin levels in serum and urine. The presented results indicate that neopterin is a useful parameter for the follow-up after renal allograft transplantation and for the diagnosis of immunological complications.

Adult↗
PubMed1986

Electrophysiologic effects of an acute beta-blockade induced by bisoprolol in patients with supraventricular tachycardia as assessed by His-bundle electrograms.

The acute electrophysiologic effects of 10 mg bisoprolol (B, given intravenously) were evaluated during an electrophysiological study in 10 patients with a history of paroxysmal tachycardia. Drug administration resulted in a significant decrease of sinus rate (Control [C]; 70.8/min; B: 59.4), and in an increase in sinus node recovery time (+20%). AV-nodal depression was marked at high heart rates during incremental atrial pacing. A second-degree AV-block occurred at a pacing cycle length (CL) of 329 ms (182/min) before and at a CL of 378 ms (158/min) after drug administration. Depression of AV-nodal conduction was negligible at low heart rates; the AH-interval at sinus rhythm was not affected (C: 84 ms, B: 86 ms); and functional and effective refractory periods of the AV-node were only slightly prolonged. Conduction intervals and refractory periods on atrial and ventricular level did not change. In 5 of 6 patients with accessory AV-pathways, circus movement tachycardia (CMT) could be elicited prior to as well as after B. Due to AV-nodal delay, CMT CL was slightly prolonged after B. Echozone and refractoriness of accessory pathways were not affected. In 1 of 2 patients with ectopic atrial tachycardia, B prevented the induction of paroxysms. In one patient with paroxysmal atrial fibrillation, the ventricular response decreased from 128/min to 94/min. The findings suggest that the electrophysiologic effects of B are due to a selective beta-adrenergic antagonism. Therapeutic efficacy is only to be expected if an increased adrenergic drive is a prerequisite for induction and continuation of a tachycardia.

Adrenergic beta-Antagonists↗
PubMed1985

Analysis of the efficacy of the new cardiotonic agent TA-064.

TA-064 is a new cardiotonic agent which is also effective orally, according to investigations conducted in Japan. We analyzed computer-assisted alterations of pressure-volume relationships serially and of indirect myocardial oxygen consumption (MVO2) estimations on line during TA-064 influence in 16 patients with congestive cardiomyopathy: left ventricular function was moderately decreased in seven patients (group A) and drastically decreased in nine (group B). Results showed that TA-064, 8 micrograms/kg/min intravenously, exerted positive inotropic effects in both groups and induced mean maximal delta percentage changes at about 5 minutes of infusion as follows: left ventricular stroke work index +65% and +47%; dP/dtmax +61% and 59%; left ventricular efficiency +62% and 53%; MVO2 +31% and +11% (p less than 0.05). TA-064, 20 mg by mouth induced serum levels (group A = 23.8 +/- 12ng/ml and group B = 26.4 +/- 20 ng/ml) corresponding to the effects with dosages of 1 to 2 ng/kg/min intravenously (p greater than 0.05), thus implying that significant changes in left ventricular function require higher oral dosages. We conclude that TA-064 improves left ventricular function, primarily via a contractility increase, also in group B patients without toxic side effects. On-line indirect MVO2 assessment and analysis of serial pressure-volume relationships helped to provide a more complex definition of the mechanism and efficiency of the cardiotonic agent under study.

Administration, Oral↗
PubMed1985

Malignant ventricular tachyarrhythmias in association with propafenone treatment.

During treatment with the class Ic antiarrhythmic agent propafenone, the drug appeared to cause malignant ventricular tachyarrhythmias in five patients. Sudden cardiac death occurred in two of them. Three patients exhibited a transition from non-self-terminating ventricular tachycardia to ventricular fibrillation. In the other two patients electrocardiography during syncope revealed ventricular fibrillation. The observed malignant arrhythmias occurred within the first three days of treatment for chronic complex ventricular ectopic activity. Two of the five patients had markedly impaired left ventricular function. All patients received digoxin and low dose diuretic therapy. In contrast to drug induced arrhythmias encountered with other type I antiarrhythmic agents, the proarrhythmic effects of propafenone were not associated with marked QT prolongation. QRS duration was only slightly affected.

Adult↗
PubMed1985

Unusual mechanism of PR interval variation and nonreentrant supraventricular tachycardia as manifestation of simultaneous anterograde fast and slow conduction through dual atrioventricular nodal pathways.

Noninvasive recordings in a 69-year-old woman showed two distinct PR intervals of about 0.21 and 0.58 s, suggestive of dual AV nodal conduction. Various unusual mechanisms of transition from short to long and from long to short conduction intervals and phenomena of concealed conduction were due to the presence of two functionally separated intranodal pathways. Refractoriness of the slow pathway was associated with bradycardia. Episodes of tachycardia exhibited a one-to-two relationship between P-waves and ventricular activations as a consequence of simultaneous anterograde fast and slow conduction leading to double ventricular responses to single P-waves.

Aged↗
PubMed1985

Long term use of flecainide in patients with supraventricular tachycardia.

The acute effects of intravenous flecainide on electrically-induced paroxysmal supraventricular tachycardia and the safety and efficacy of long term prophylaxis with orally administered flecainide were assessed in 37 patients with paroxysmal supraventricular tachycardia refractory to treatment with 'conventional' antiarrhythmic drugs. Over a mean treatment period of 14.2 months, flecainide 200 to 400mg daily completely suppressed paroxysmal supraventricular tachycardia in 9 of 20 patients with paroxysmal supraventricular tachycardia due to Wolff-Parkinson-White syndrome, while 3 patients reported only transient episodes of paroxysmal supraventricular tachycardia, and 1 patient had a decreased ventricular response to chronic atrial fibrillation. Of 17 patients with paroxysmal supraventricular tachycardia due to atrioventricular nodal re-entry, flecainide 200 to 500mg daily for a mean period approaching 26 months totally prevented episodes of paroxysmal supraventricular tachycardia in 8, and reduced the frequency and duration of episodes of paroxysmal supraventricular tachycardia in 3 others. Flecainide prolonged action potential refractoriness in a few patients in each group; however, an increased frequency of occurrence of paroxysmal supraventricular tachycardia occurred due to a simultaneous decrease in the re-entry circuit conduction velocity. In both patient groups the acute electrophysiological effects of flecainide were often predictive of the long term efficacy of the drug in the prophylaxis of paroxysmal supraventricular tachycardia. Side effects usually involved the central nervous system and were most commonly manifested by disturbances in vision, balance, and taste and increased nervousness. These side effects generally subsided following 1 to 2 months' treatment with flecainide. No abnormal trends were observed in laboratory analysis of blood samples taken from patients during long term treatment with flecainide.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

[Tachycardias caused by double ventricular responses and unusual atrioventrio-ventricular relations in linear dissociation of the AV node].

Noninvasive recordings in a 69-year-old woman showed phasic shifts between two distinct PR intervals of about 0.21 and 0.58 s suggestive of dual AV nodal conduction in the presence of two intranodal pathways. Episodes of tachycardia exhibited a one to two relationship between P waves and QRS complexes, with the same short and long PR intervals interpreted as simultaneous anterograde fast and slow conduction via the two AV nodal pathways, leading to a double ventricular response to single P waves. Various mechanisms of transition from short to long or long to short conduction times and concealed conduction phenomena could be demonstrated supporting the concept of two functionally separated intranodal pathways.

Aged↗
PubMed1984

[Mechanically-induced intraventricular block caused by a right-heart floating catheter--frequency and electrophysiologic findings].

During the course of 2,434 right heart catheterizations with 2,019 floating 3F Grandjean catheters and 415 5F Swan-Ganz catheters we observed 7 patients (0.3%) with catheter-induced infranodal conduction impairment: right bundle branch block (RBBB) in 3 patients, left anterior fascicular block (LAFB) and subsequent RBBB in 1 patient, and complete heart block in 3 patients with pre-existing left bundle branch block (LBBB). There was no apparent difference regarding the incidence of blocks between the two types of catheters. Three patients (one with LAFB + RBBB and two with LBBB) underwent electrophysiologic studies. All three patients exhibited a prolongation of the HV-interval due to coexisting pathologic changes of the right bundle. LBBB patterns disappeared during distal His bundle pacing in two patients, indicating a proximal site of block and suggesting incomplete involvement of the right bundle. Additional mechanical trauma, probably in this region, produced the blocks. Thus, use of balloon tipped or flexible catheters does not provide complete protection against transient lesions of the conduction system.

Adult↗
PubMed1984

[Effects of the new cardiotonic agent TA-064: serial computer-assisted analyses of pressure-volume relations and online myocardial 02 consumption].

UNLABELLED: According to investigations conducted in Japan, TA-064 is a new cardiotonic agent, which is also effective orally. We analyzed computer-assisted alterations of pressure-volume relations serially and of MVO2 online (Bretschneider) during TA-064 influence in 16 patients with congestive cardiomyopathy: LV-function of 7 patients was only moderately decreased (group A) and in 9 patients massively (group B). RESULTS: 1) TA-064, 8 micrograms/kg/min, i.v. had positive inotropic effects in both groups and induced mean maximal delta% changes at about the 5th minute of infusion as follows: LVSWI + 65% and 47%; DP/DTmax + 61% and 59%; LV-efficiency + 62% and 53%; MVO2 + 31% and + 11% (p less than 0.05). 2) TA-064, 20 mg p.o. induced serum levels (A: 23.8 +/- 12 and B: 26.4 +/- 20 ng/ml) corresponding to the effects with the dosages 1-2 micrograms/kg/min, i.v. (p greater than 0.05), thus implying that significant changes in LV-function require higher p.o. dosages. 3) TA-064 i.v. on the 6th day of exposure to the medication produced less LV-function improvement than on day 1 (p greater than 0.05). CONCLUSIONS: In both groups A and B TA-064 improves LV-function primarily via increased contractility, without toxic side effects. For a more complex definition of the efficiency and mechanism of cardiotonic agents, the validity and importance of using on-line MVO2 assessment and analysis of serial pressure-volume relations is stressed.

Adult↗
PubMed1984

[Hemodynamic significance of the coordination of atrial and ventricular systole in tachycardia].

In 15 patients, aged 55.6 +/- 3.7 years with normal LV-function, the comparison of hemodynamic results as induced by ventricular pacing (VP) (at 110, 140 and 170 bpm) versus atrio-ventricular pacing (AVP) (AV-sequences: 30, 130 and 230 msec) revealed the following: VP with increasing rates inversely proportionally compromised AO-pressure by an average of -7, - 19 and -28% respectively, and cardiac output (CO) by an average of -2, -12 and -26% respectively. However, AVP with an AV-sequence of 130 msec, at the same 3 basic rates, clearly proved hemodynamically superior in comparison, in that AO-pressure dropped significantly (by an average of -13%) only at 170 bpm, an CO even showed tendencies to increase at 110 and 140 bpm (by an average of +17 and +7% respectively), finally decreasing by a mere -11% at 170 bpm only. Pacing, when using AV-sequences of 30 and 230 msec, resulted in an impairment of AO-pressure and CO of the same range as during VP at equal rates. Thus, beneficial hemodynamic results, AVP versus VP, have been proven also for rapid-rate pacing in normal ventricles, provided the AV-sequence is optimal (130 msec for the present patient group) but not in any incoordinate range of AV-sequences (as for instance 30 and 230 msec), with which beneficial atrial transport function cannot be achieved.

Blood Pressure↗
PubMed1984

[Regularization of ventricular intervals in atrial fibrillation--electrophysiologic findings on the underlying mechanism].

In 13 patients with chronic atrial fibrillation, programmed right ventricular pacing was performed before and after intravenous administration of 4 mg gallopamil. Application of the Ca-antagonist resulted in a marked decrease in the ventricular response in all and in a regularization of the ventricular response (variation coefficient of the ventricular cycle length: less than 10%) in 7 of 13 cases, while atrial fibrillation persisted. During regularization right ventricular extrastimulus testing showed a constancy of the postextrasystolic interval irrespective of the changes in the coupling interval of the extrasystole. The postextrasystolic cycle was slightly longer than the basic cycle; the difference amounts to a mean value of 107 +/- 22 ms. During the control period the postextrasystolic cycle showed the same irregularity as the basic cycle. The same random distribution was observed if the first 10 cycles of the spontaneous rhythm were analyzed after a short period of ventricular overdrive pacing. After regularization the first 2-3 postpacing cycles were markedly prolonged, and during the following cycles a gradual adjustment to the length of the basic cycles before overdrive pacing was seen, resembling the warming up of a pacemaker. It is concluded that regularization is most probably due to atrioventricular nodal depression and the occurrence of a junctional escape pacemaker.

Adult↗
PubMed1983

Thrombotic complications with pacemakers.

To analyze thrombotic complications, we performed brachial phlebographies in 100 consecutive patients (group 1), about 44 months after permanent pacemakers had been installed. Thirty-nine patients showed thrombotic lesions in the veins used to pass the stimulation electrode into the right ventricle. In 10 patients the medical history and in 12 patients clinical symptoms and signs indicated an impairment of venous flow. Fifteen of the 39 patients showed complete occlusion of one venous segment; collateral vessel formation was found dependent on the site and the extent of the occlusion. In the remaining 24 patients only partial occlusion without collateralization was demonstrated. Group 2 comprised 12 patients in whom the pacing lead originally inserted via right-sided veins had been severed and the free distal end left unsecured intraluminally when the second electrode was inserted via the left-sided cephalic vein. In all these patients phlebography about 19 months later revealed thrombotic complications, while 11 presented with clinical symptoms and signs. The incidence of thrombotic complications including segmental occlusion after the application of permanent pacer leads is only one-third of patients with segmental occlusion symptoms. However, since severed leads produce severe symptomatic complications in almost all cases their removal is mandatory.

Adult↗
PubMed1983

Effects of flecainide on electrophysiological properties of accessory pathways in the Wolff-Parkinson-White syndrome.

The effect of flecainide in 12 patients with the Wolff-Parkinson-White syndrome was analyzed with respect to the anterograde and retrograde conduction properties of the accessory pathway, the modes of initiation and termination of circus movement tachycardias, and the ventricular response during induced atrial fibrillation. The principal effect of this drug was to depress both anterograde and retrograde conduction of the accessory pathway. In 8/9 cases circus movement tachycardia was terminated by prolongation of the retrograde effective refractory period of the accessory pathway. Flecainide increased the shortest and the mean cycle length during induced atrial fibrillation. It is concluded that the drug may be of potential benefit in patients with paroxysmal supraventricular tachycardias in patients with the Wolff-Parkinson-White syndrome.

Adult↗
PubMed1983

[Modification of hemodynamics in tachycardiac atrial fibrillation by metoprolol and verapamil].

Hemodynamic effects of the beta-receptor-blocking agent metoprolol (100 mg orally) and the calcium antagonist verapamil (160 mg orally) were analyzed in 24 patients with atrial fibrillation of different etiology (idiopathic atrial fibrillation, 6 cases; congestive cardiomyopathy, 6 cases; mitral stenosis, 5 cases; mitral regurgitation, 6 cases). 2 h after the administration of either metoprolol or verapamil heart rate was reduced significantly both at rest and during exercise. Cardiac output during exercise was significantly diminished under metoprolol in all groups of patients, whereas no effects were noted under verapamil. Peripheral vascular resistance was significantly decreased by verapamil both at rest and during exercise. No change in total peripheral resistance was noted after metoprolol at rest, but an increase occurred during exercise. Different effects on peripheral circulation may explain the different patterns of cardiac performance observed after heart rate reduction in atrial fibrillation by a calcium antagonist and a beta-blocking agent.

Atrial Fibrillation↗
PubMed1980

[Lowering the heart rate in tachycardiac atrial fibrillation by beta receptor blockade].

The effects of the long-acting beta-receptor blocking agent Nadolol on ventricular rate was evaluated by Holter monitoring in 14 patients with chronic atrial fibrillation, in whom no effective control of heart rate could be obtained by digitalis only. There was a significant drop of heart rate after the treatment with 2 times 60 mg Nadolol daily to 70% of control values (ten patients treated for one week). Treatment with 120 mg Nadolol once daily proved to be equally effective in four patients. Reduction of heart rate was most marked in periods of physical activity, while there was only a small effect during periods of rest.

Adrenergic beta-Antagonists↗