Identification of dissection or aneurysm of the descending thoracic aorta by conventional and transesophageal two-dimensional echocardiography.
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Adult↗
Biomedical subjects
H U Bramann
Publications and source records attributed to H U Bramann.
Long-term ECG in pheochromocytoma.
In 13 patients with pheochromocytoma (in all but 2 cases localization by scintigraphy) investigations using Holter long-term ECG were performed under medication with alpha- and beta-sympathicolytic drugs under bed rest conditions. The incidence of ventricular dysrhythmias hardly exceeded the extent of a normal control group. In 1 case alpha-methyltyrosine caused a first to second degree AV block and beyond this a stable high frequency sinus rate without any adaptation to the environmental requests. In 12 patients the frequency profile showed sudden and inadequate rises of heart rate up to 200% of very short duration, reaching their maximum within about 20 s of the onset of muscular activity. Although less pronounced, these characteristics were still found 1-2 weeks after operation. In our opinion the heart rate profiles described reveal a dysfunction of the entire autonomus nervous system in pheochromocytoma.
Adolescent↗
[Typical spontaneous changes in heart rate in pheochromocytoma].
Investigations in 13 hospitalized patients with pheochromocytomata showed peculiar characteristics of heart rate variation at rest, when compared with normals. All patients were given alpha- and beta-sympatholytic drugs. In one case alpha-methyl-Tyrosine caused I-II degree AV blocks and a stable high frequency sinus rate without physiological variations. Resting heart rate in pheochromocytoma varied interindividually from 55-105/min, in the absence of clinical attacks of the underlying disease. The frequency profile was characterized in 12 patients by sudden and inadequate rises of heart rate (200%) of short duration, which were often recorded within 20 seconds of the onset of muscular activity. A similar but less pronounced heart rate modulation was found 1-2 weeks after operation in 3 cases. Our observations indicate that the heart rate profile described may be a sensitive parameter of dysfunction of the autonomous nervous system in pheochromocytoma. Whether the heart rate characteristics are of diagnostic value has to be assessed by further studies.
Adolescent↗
[Long-term therapy with flecainide].
The effect of the new antiarrhythmic drug Flecainide was examined in a controlled long-term study (1 to 44 months [x = 17.7 +/- 12.4]) in 36 patients, aged 18 to 76 years (x = 44 +/- 16.3), suffering from ventricular arrhythmias. In 12 cases coronary heart disease, in 11 cases myocarditis, in 2 cases each of dilatative cardiomyopathy and mitral valve prolapse syndrome, and one in case each of combined aortic and mitral valve disease and postoperative condition of Fallot Trilogy was present. In 7 cases the etiology of the dysrhythmias could not be elucidated. 18 patients had been treated before by more than 3 other antiarrhythmic drugs without sufficient result. The daily dose administered was assessed by the degree of the dysrhythmias and the response to the drug. In most cases 300-400 mg Flecainide was given. The therapeutic success was assessed by 24 h Holter-ECG before and during therapy. In most cases two registrations were performed before and three registrations during therapy. In 29 patients (81%) a rate reduction of VES over 70% could be observed. Rate reduction of VT (n = 8) was total in 5 cases, in one case over 90%, in two cases over 70%. Salvos (n = 10) were abolished in 7 cases and reduced over 90% in two and over 70% in one of the cases. R-on-T-phenomena (n = 2) disappeared completely. An increase of rate or degree of the dysrhythmias was never observed. In no case had therapy to be interrupted due to severe side effects. Changes of laboratory values were not observed.(ABSTRACT TRUNCATED AT 250 WORDS)
Administration, Oral↗
[Specificity of cold in the provocation of angina pectoris].
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Angina Pectoris↗
[How dangerous is the dipyridamole test?].
In 203 patients with clinical symptoms of coronary artery disease, cardiac and extracardiac side effects of the dipyridamole test were investigated. Following dipyridamole (0.75 mg/kg body wt. i.v.), heart rate increased significantly, whereas arterial blood pressure remained almost constant. Dyspnea was noted in 80 cases (40.5%). In 48 patients (23.6%) rhythm disturbances were recorded; 58.1% suffered from extracardiac side effects such as congestion in the head, vertigo, heaviness of arms and legs, sensations of heat, upper abdominal pain, and nausea. A detailed report is given of 4 cases with extraordinary symptoms during or after the injection of dipyridamole. A life-threatening status anginosus with dyspnea, ST-segment elevation, and cardiac arrhythmia was observed in one of these cases. High-dose dipyridamole cannot be considered to be harmless. The test should not be performed without continuous ECG monitoring and other safety measures.
Adult↗
[Transbrachial angiography--arteriotomy or percutaneous puncture?].
In 102 patients transcutaneous right brachial artery catheterizations were performed. The sequelae of the brachial artery lesion were investigated 22.43 +/- 22.26 months after catheterization, and data obtained by bilateral Doppler ultrasound technique, oscillography, and strain gauge plethysmography were compared. In ten patients minor obstructions of peripheral blood flow were noted. One patients suffered from longer-lasting ischemic symptoms, which were successfully treated with drugs. In another case an embolectomy had to be performed with an almost complete relief of the obstruction. In our view, the transcutaneous approach may be preferred to the dissection of the artery because the procedure is followed by a low incidence of sequelae for the patient and saves time for the investigator. The rate of obstruction to peripheral flow in our study was lower, in comparison to controls than after dissection of the brachial artery as reported in the literature.
Adolescent↗
[Cold-induced angina pectoris--threatening myocardial ischemia or psychoautonomic dysfunction?].
10 male patients with angina pectoris and a history of increased severity of angina under cold conditions were investigated. The coronary angiograms of all patients showed severe stenoses of coronary arteries. Observations were made by continuous ECG monitoring (Holter ECG) during rest and exercise under normal (room temperature) and cold conditions (-6 degrees C). In addition to ECG changes only anginal attacks occurring spontaneously were of interest in this study. Therefore, the patients were not informed about the purpose of the investigation. In spite of a history of increasing angina during exposure to cold, no patient spontaneously complained of cardiac symptoms while changing from a normal to a cold environment. In none of the patients did exposure to cold lead to ECG alterations such as arrhythmias or ST-segment depression. There was no significant difference in ST-segment changes during and after exercise under normal or cold conditions. The history of cold intolerance in patients with angina pectoris is a nonreproducable, nonspecific parameter. We conclude that angina pectoris under cold conditions is not due to myocardial ischemia, but is very likely to be induced by psychovegetative factors.
Adult↗
[Combination treatment of atrial arrhythmias with quinidine-verapamil].
Between 1977 and 1979, a combined antiarrhythmic therapy with Quinidine and Verapamil was used to treat 66 patients (aged 16 to 69 years) with chronic atrial arrhythmias of different etiology. In 60% of the 43 cases with atrial fibrillation the combined therapy was effective in reversing atrial fibrillation to regular sinus rhythm. The frequency of successful responses to Quinidine - Verapamil amounted to more than twice compared with earlier therapeutic results with Quinidine only. In 65% of the 23 cases with atrial extrasystoles or atrial tachycardias a significant reduction of the ectopics could be achieved or a regular sinus rhythm could be established. Thus, the combined therapy with Quinidine - Verapamil is very effective in abolishing chronic atrial arrhythmias, especially atrial fibrillation.
Adolescent↗
[Cardiovascular diseases in the aged].
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Aged↗
[Changes in autonomic cardiovascular control in biological aging--studies using orthostatic provocation and analysis of heart rate profiles in long-term ECG].
We compared the reactions of heart rate in long-term ECG as well as the heart rates and the blood pressures in orthostatic provocation tests using pharmacological blockades in 14 young human subjects aged 19 to 33 years (mean age = 22 +/- 2.2 years) with those of 16 healthy subjects between 67 and 89 years (m = 74 +/- 9.4 years). The blockades were carried out (following the schedule of Jose) first with only propranolol (0.2 mg/kg BW), then propranolol plus atropine (0.04 mg/kg BW), and, finally, only atropine was applied. For the interpretation of the frequency profiles in the long-term ECG prestudies were carried out with dogs, whose high vegetative tension provided us with essential knowledge about the specific type of the autonomous stimulation underlying the respective frequency reaction. Comparing the profiles between old and young human subjects the complete loss of instant reactions in the elderly can be stated. Variations of the heart rate result only from the modulation of the sympathetic stimulation. The "intrinsic heart rate (IHR)" after propranolol plus atropine is still below resting heart rate in the elderly, whereas IHR exceeded the resting heart rate in the younger subjects by nearly 50%. Thus, the basically initial vegetative situation is that, in the younger subjects, their resting heart rates are reached by a permanent parasympathetic slow-down of the IHR, whereas the elderly have to accelerate their slow IHR by permanent sympathetic stimulation in order to reach their "resting" heart rates. The orthostatic provocation tests with the respective blockades prove an age-dependent decrease in the sympathetic system and in the parasympathetic control. A down-regulation of the beta-receptors as a consequence of the permanent sympathetic drive is probable.
Adult↗
[Autonomic neuropathy in diabetes mellitus and advanced age].
The reactions of cardiac frequencies of 10 diabetic persons, seven of them dependent on insulin, aged 45.5 +/- 11.8 years, having had diabetes for 12.5 +/- 7.2 years, were investigated with the aid of provocations by a tilting table under selective pharmacological blockades of 1) the parasympathetic system (atropine 0.04 mg/kg body-weight), 2) sympathetic system (propranolol 0.2 mg/kg body-weight), and 3) of both systems (autonomic blockade). These reactions were compared with the reactions of 13 healthy subjects of comparable age (31.6 +/- 9.4 years), as well as with a group of elderly but healthy persons of 74.5 +/- 8.6 years. The well-known age-dependent disturbance of the vegetative control-system, characterized by the loss of sympathetic as well as parasympathetic efficiencies, was demonstrated by our study of different ages of subjects. Remarkable was that, in the group of diabetics, in principle, identical patterns of disturbance could be demonstrated in the sympathetic as well as in the parasympathetic systems, but also in the course of cardiac frequency after autonomic blockades. The only difference was that these patterns of disturbance already occur at younger ages. Therefore, one can possibly describe the harmful effect of diabetes on the autonomic nervous system as an acceleration of the process of degeneration, which we also find in connection with "biological aging".
Aged↗
[Heart rate and contractile reserve of the aging heart].
In standardized experiments on both conscious and anaesthetized young (n = 11) and old (n = 7) dogs differences in haemodynamics, contractility and myocardial oxygen consumption correlated to age were evaluated. Under resting conditions no significant differences were observed. Following stimulation with catecholamines young (n = 6), and old (n = 6) dogs displayed an almost parallel increase in (dp/dt) max. After administration of orciprenalin, the maximum increase in heart rate was similar in both groups of animals; however, a significant difference in the maximum heart rate following atropine was observed, which was significantly lower in old than in young animals. The decreased performance of the aged myocardium does not appear to be predominantly due to an age-dependent reduction of the contractility reserve. It could result from a deficient sympathetic stimulation of the heart.
Aging↗