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Biomedical subjects

K von Olshausen

Publications and source records attributed to K von Olshausen.

At least 19 recordsLinked to original sources
PubMed1998

[Coronary stent implantation without preliminary dilatation].

BACKGROUND: Extensive coronary dissections are rare but represent serious complications of percutaneous transluminal coronary angioplasty (PTCA). In order to prevent dissections in large coronary vessels (> or = 2.5 mm), we evaluated stent implantation without predilatation in 98 selected patients with favorable coronary anatomy and lesion morphology. METHODS: Coronary stenting without predilatation was performed 41 times in the LAD, 41 times in the RCA, 11 times in the RCx, and 5 times in a vein graft. Mean diameter stenosis was 83 +/- 3%. Thirty-six patients had type A lesions and 62 patients type B lesions. Patients with type C lesions were excluded. Only premounted stents were used. RESULTS: The clinical situation was stable angina in 68 patients, unstable angina in 18, and acute myocardial infarction in 12. Stenting without predilatation was successful in 92 patients (94%). In 6 cases (6%) it was not possible to cross the lesion with the premounted stent, and predilatation was necessary prior to successful stent implantation. Two out of 11 RCx-related lesions (18%) could not be stented without predilatation. However, ultimate success of PTCA was 100%. No stent was lost. Mean remaining stenosis amounted to 3 +/- 6%. Minor angiographically detectable dissections after stent deployment were noted in 8 patients (8%). Inflation time (30 +/- 22 s) and fluoroscopic time (4.5 +/- 2.1 min) compared favorably to standard procedures. During 30 d follow-up no subacute stent thrombosis, but 2 non-Q-wave myocardial infarctions due to lost side branches were reported. CONCLUSIONS: Coronary stenting with premounted stents without predilation is feasible and safe in selected patients in order to reduce fluoroscopic and procedural time and to save costs. Furthermore, this procedure might reduce the risk of hazardous coronary dissections.

Adult↗
PubMed1989

Cardiac arrhythmias and heart rate in hyperthyroidism.

The arrhythmia profile and heart rate (HR) were analyzed by 24-hour Holter monitoring in 37 hyperthyroid patients before (triiodothyronine [T3] hormone level = 331 +/- 108 ng/dl), during (T3 level = 202 +/- 98 ng/dl) and after an antihyperthyroid therapy of 8 to 89 weeks' duration (T3 level = 149 +/- 41 ng/dl). The data were compared with those of 50 control subjects free from cardiac disease. Only 12 hyperthyroid patients (32%) had complex ventricular arrhythmias (Lown grade 3 or 4) as compared with 6 normal subjects (12%, p greater than 0.05). Three patients (8%) had repetitive ventricular arrhythmias (Lown grade 4A/B) as compared with 4 normal subjects (8%, p greater than 0.05). Supraventricular premature complexes occurred more often in hyperthyroid patients than in normal subjects before and after therapy (p less than 0.001). The prevalence of supraventricular tachycardia decreased from 8 patients to 1 during therapy (p less than 0.002). The HR decreased from 95 +/- 13 to 79 +/- 9 beats/min after therapy, but was still increased as compared with the normal subjects (72 +/- 8 beats/min, p less than 0.001). A day/night difference in HR greater than 10% was found in 32 patients (86%) and was more pronounced than in the normal group (p less than 0.001). Compared with the normal HR profile, the HR curve of hyperthyroid patients was shifted to a higher level (about 20 beats/min). Serum T3 level correlated best with HR at night in hyperthyroid patients (r = 0.74, p less than 0.001). Thus, hyperthyroid patients show frequent supraventricular arrhythmias that might be reversible during therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Arrhythmias, Cardiac↗
PubMed1988

[Arrhythmia profile and heart rate in hyperthyroidism].

Arrhythmia profiles and heart rates, obtained by 24-hour ECG monitoring, were analysed in 48 patients with hyperthyroidism before (T3 level: 331 +/- 108 ng/100 ml, heart rate: 95 +/- 13/min), during (T3 level: 202 +/- 98 ng/100 ml, heart rate: 85 +/- 11/min) and after (T3 level: 149 +/- 41 ng/100 ml, heart rate: 79 +/- 9/min) antithyroid treatment. 50 persons in whom organic heart disease has been excluded by invasive and noninvasive tests served as controls. Only 6% of patients had repetitive ventricular arrhythmias (Lown group IV) before treatment (controls: 4%; P greater than 0.05). Supraventricular extrasystoles were common both before and after treatment (P less than 0.001), especially in elderly patients. The number of patients with supraventricular tachycardias decreased in the course of treatment from eleven to two. There was a clear correlation between the T3 level and nocturnal heart rate (r = 0.74; P less than 0.001). A day-night difference in heart rate (a ratio of greater than or equal to 1.10) was present in 43 patients and higher than in the controls (P less than 0.001). Thus with respect to ventricular arrhythmias hyperthyroid patients had a normal profile, but a marked tendency towards supraventricular arrhythmias which was partly age-related. Antithyroid treatment affected only the incidence of supraventricular tachycardias, while day-night differences in heart rate remained unchanged.

Adult↗
PubMed1988

[Effect of oral long-term enoximone therapy on the arrhythmia profile in chronic heart failure].

The arrhythmogenic potential of long-term treatment with Enoximone in patients with severe chronic heart failure has not been determined. We analysed retrospectively 24 h Holter recordings in 31 patients with chronic heart failure, predominantly NYHA functional class III and IV, before and during chronic Enoximone therapy between 4 and 52 weeks. At baseline ventricular couplets and salvos were found in 68% of patients. Ventricular arrhythmia response was variable with no significant overall change. During a mean follow-up of 28 weeks, however, 3 (10%) patients showed a significant increase and 4 (16%) patients a more than 90% decrease of repetitive ventricular arrhythmias. In another 10 (32%) patients a more than 70% decrease of singular ventricular arrhythmias was observed. There was no correlation between the change of the patient's arrhythmia profile, the degree of functional impairment of the underlying heart disease, and the clinical response to long-term Enoximone therapy. Two patients died suddenly, one with a significant increase, the other with a significant reduction of ventricular arrhythmias. Two patients died of pump failure with no change of the arrhythmia profile. Enoximone appears to have a low arrhythmogenic profile during long-term treatment. However, careful monitoring of ventricular arrhythmias is mandatory as the occurrence of proarrhythmic drug effects cannot be predicted.

Administration, Oral↗
PubMed1988

[Results of PTCA following thrombolysis in acute myocardial infarct].

The mortality in acute transmural myocardial infarction can be reduced by thrombolytic therapy administered within 6 hours after onset of symptoms. In patients with coronary angiography proven stenosis of less than 70% conservative therapy is recommended. In patients with one vessel disease PTCA in patients with suitable lesions should be used. Further studies have to elucidate, if the angioplasty has to be performed in the acute stage or on an elective basis. PTCA is recommended in patients with occluded coronary vessels and in patients with high grade stenosis and limited coronary blood flow. In patients with multi vessel disease aortocoronary bypass surgery is recommended to reduce high mortality. Long-term results demonstrate, that patients in whom PTCA or coronary bypass surgery was performed demonstrated the highest survival rate.

Angioplasty, Balloon↗
PubMed1987

[Basedow's disease and mitral valve prolapse].

The prevalence of mitral valve prolapse was investigated in 60 patients with Graves' disease (42 with ophthalmopathy) and in 20 patients with toxic nodular goitre. 2410 patients from the echocardiography laboratory served as controls. Standard M-mode, Doppler and two-dimensional echocardiography were performed. Mitral valve prolapse was defined as a systolic buckling greater than or equal to 3 mm. In patients with thyroid disease HLA antigens were determined. Patients with Graves' disease showed a significantly higher incidence of mitral valve prolapse (36/60, 60%) compared to the group with toxic nodular goitre (2/20, 10%) and to controls (238/2410, 9,9%) (P less than 0.0001). 16 of 36 patients had a prolapse of the anterior, in 3 of 36 the posterior leaflet was involved and 17 of 36 had both. Mean systolic buckling was 4.3 +/- 1.5 mm. 28 of 42 patients with ophthalmopathy (67%) showed a mitral valve prolapse. 20 of 60 patients (33.3%) with Graves' disease but none in the goitre group showed a thickened myxomatous valve (P less than 0.001). Thyroid function did not influence the incidence and intensity of the prolapse. The HLA phenotypes B8 were seen in 22 of 36 and DR3 in 24 of 36 patients with mitral valve prolapse. Since thyroid function was comparable in both groups an involvement of the mitral valve in an autoimmune process affecting several organs can be considered probable.

Adult↗
PubMed1987

Outcome of primary coronary recanalization and arrhythmia profile in survivors of acute myocardial infarction.

The purpose of this study was to assess the arrhythmia profile in survivors of acute myocardial infarction in whom recanalization of the infarct-related vessel was attempted. 127 patients with acute myocardial infarction were randomized to intravenous and intracoronary thrombolysis with or without transluminal coronary angioplasty. 84 of them, aged 54 +/- 9 years, had angiographic control, 24-hour Holter electrocardiographic monitoring and programmed electrical stimulation 4 weeks after infarction. The study protocol of programmed electrical stimulation included single and double extrastimuli at 2 driving cycle lengths. The end point was the induction of ventricular tachycardia with 10 and more beats. During infarction 28 patients had occlusion of the left anterior descending, 12 of the circumflex and 44 of the right coronary artery. Holter monitoring revealed both frequent (greater than 100 ventricular premature complexes per 24 hours) and repetitive (Lown IVA, IVB) ventricular arrhythmias in 23 patients (27%). Inducible ventricular tachycardia (greater than 6 beats) was found in 25 patients (30%), which was sustained in 4 patients. According to the angiographic results two groups of patients could be identified: group A consisted of 64 patients who showed primary recanalization of the infarct-related vessel with persistent patency at control. Group B consisted of 20 patients who showed late reopening (n = 5) or a closed infarct-related vessel (n = 15) due to late reocclusion in 9 of them. Frequent ventricular premature contractions occurred in 18 group A and in 5 group B patients (n.s.). Repetitive ventricular premature contractions were found in 21 group A and in 2 group B patients (P less than 0.05). Inducible ventricular tachycardia was observed in 17 patients of group A (27%) and in 8 patients of group B (40%) (n.s.). The incidence of spontaneous and stimulus-induced ventricular arrhythmias was not influenced by the type of recanalization procedure. Furthermore no relation to the time interval between onset of preinfarct angina and angiographically demonstrated reperfusion of the infarct-related vessel was found. The patients in the two groups did not differ with respect to left ventricular ejection fraction, number of abnormal contracting wall segments or site of infarction. It is concluded that reperfusion infarction does not differ from infarction due to permanent occlusion with respect to inducible ventricular tachycardia but may favor repetitive ectopic activity.

Angioplasty, Balloon↗
PubMed1987

Effects of intravenous disopyramide and quinidine on normal myocardium and on the characteristics of arrhythmias: intraindividual comparison in patients with sustained ventricular tachycardia.

Intraindividual comparison of the acute response to intravenous quinidine and to intravenous disopyramide was performed in 27 patients with sustained ventricular tachycardia (VT) who underwent serial electrophysiological studies. In each patient, sustained VT could be reproducibly initiated by programmed ventricular stimulation during control studies. Quinidine and disopyramide prevented inducibility of sustained VT in 7 and 8 of the 27 patients, respectively. Six patients were concordant responders to both drugs and 18 patients were concordant non-responders resulting in a total of 24 patients (89%) who had a concordant result (P less than 0.01). In the 18 non-responders with inducible sustained VT after both drugs, quinidine and disopyramide caused qualitatively and quantitatively similar changes in the characteristics of the VT: prolongation of the interval between the initiating extrastimulus and the first beat of VT by 36 and 39%, and an increase in VT cycle length by 21 and 29%, respectively. The QRS morphology of VT was concordantly altered in 13 of these 18 patients (72%). In all 27 patients, quinidine and disopyramide caused a quantitatively similar prolongation of ventricular refractoriness by 12 and 14%, of the QRS duration by 14 and 13% and of the QTc interval by 13 and 13%, respectively. The clinical data obtained at comparable plasma concentrations confirm the experimental presumption that quinidine and disopyramide have qualitatively and quantitatively similar electrophysiological effects not only on normal myocardium but also on the characteristics of VT, resulting in a significant concordance of antiarrhythmic responses.

Adult↗
PubMed1987

[Incidence and kind of reperfusion arrhythmias in thrombolytic therapy of acute myocardial infarct].

UNLABELLED: In 200 consecutive patients with acute myocardial infarction combined medical-mechanical recanalization was attempted. Coronary angiography revealed an occluded vessel in 150 patients. This vessel could be opened in 127 patients. There were 112 men and 15 women, aged 32 to 72 years (mean age 61.2 years); 60 patients had an anterior and 67 patients presented with an inferior myocardial infarction. 103 from 127 patients presented with arrhythmias during the ischemic phase and 112 from 127 patients during the reperfusion phase. The following arrhythmias had a significantly higher incidence in the reperfusion phase compared to the ischemic phase: sinus bradycardia (29 pts. - 22.8% - vs. 15 pts. - 11.8%; p less than 0.05), ventricular bigeminy (28 pts. - 29.9% - vs. 5 pts. - 3.9%; p less than 0.01), ventricular couplets (34 pts. - 26.8% - vs. 20 pts. - 15.7%; p less than 0.05) and accelerated idioventricular rhythm (32 pts. - 25.2% - vs. 5 pts. - 3.9%; p less than 0.01). Ventricular fibrillation occurred during the ischemic phase in 9 patients and during the reperfusion phase in 7 patients (n.s.). None of the patients presented with sustained ventricular tachycardia, neither in the ischemic, nor in the reperfusion phase. CONCLUSIONS: The following rhythm disturbances can be called reperfusion arrhythmias: sinus bradycardia, ventricular bigeminy, ventricular couplets and accelerated idioventricular rhythm. The observed reperfusion arrhythmias were short-living and did not need special therapeutic measures.

Adult↗
PubMed1987

[Differential diagnosis: right heart infarct or anteroseptal infarct?].

We report on the case of a patient with typical clinical symptoms and ST-segment elevation in V1-V4 who was diagnosed as having acute anteroseptal myocardial infarction. Coronary angiography revealed a proximal occlusion of the right coronary artery and a patent dominant left coronary artery. After successful thrombolysis with pro-urokinase a transluminal coronary angioplasty of the right coronary artery was performed. The exact analysis of the first electrocardiogram demonstrated that the decrease of ST-segment elevation in V1-V4 should have suggested the diagnosis of right ventricular infarction. This case report demonstrates the potential hazards in distinguishing right ventricular infarction from anteroseptal infarction by electrocardiogram only.

Adult↗
PubMed1986

[Myxoma of the right atrium. Rare differential diagnosis of fever of unknown origin].

Cholecystectomy had been performed in a 52-year-old woman because of upper abdominal pain with nausea, fever and accelerated ESR and known cholelithiasis. Attacks of fever up to 39.5 degrees C persisted and she lost 10 kg in weight, requiring re-admission after eight months. Transoesophageal echocardiography revealed an echo-dense space-occupying lesion, 3.0 X 3.5 cm, in the right atrium. Due to contrast medium allergy angiography was omitted. M-mode and 2D echocardiography and computed tomography of the heart failed to demonstrate any space-occupying body. Thoracotomy revealed a fibro-angio-myxoma attached to the right side of the interatrial septum, and it was removed in toto. The postoperative course was without complications and the patient left hospital free of symptoms. It is suggested that transoesophageal echocardiography should be considered in case of "fever of unknown origin".

Diagnosis, Differential↗
PubMed1986

Percutaneous transluminal coronary angioplasty after thrombolytic therapy: a prospective controlled randomized trial.

In 162 patients with acute transmural myocardial infarction, combined intravenous and intracoronary thrombolytic therapy with streptokinase was initiated. In vessels that remained occluded, mechanical recanalization was performed with a 3F recanalization catheter (group I, n = 79) or a 4F Grüntzig balloon catheter (group II, n = 83). After reperfusion, intracoronary streptokinase was administered superselectively. After termination of streptokinase infusion, angioplasty was performed only in patients in group II. There was no difference between the groups in relation to sex, age, infarct location, creatine kinase levels and time between onset of symptoms and start of treatment. Initial coronary angiography showed an open vessel in 27 (34%) of 79 patients in group I and 21 (25%) of 83 patients in group II. The final reperfusion rate was 90% (71 of 79) in group I and 86% (71 of 83) in group II. Angioplasty was attempted in 69 of the 71 patients in group II with a success rate of 65% and an occlusion rate of 3%. During the hospital stay, reocclusion occurred in 14 (20%) of 71 patients in group I. After thrombolytic therapy, coronary luminal narrowing in group I was 75 +/- 17% in patients without and 87 +/- 6% in patients with reocclusion (p less than 0.05). In group II, reocclusion was found in 10 (14%) of 71 patients. After angioplasty, the degree of coronary stenosis in group II was reduced from 82 +/- 12 to 51 +/- 30% (p less than 0.001). Reocclusion was found in 3 (7%) of the 45 patients with successful angioplasty and in 7 (32%) of the 22 patients with unsuccessful angioplasty (p less than 0.01). Improvement in regional left ventricular function was observed only in patients from group II with anterior myocardial infarction. In conclusion, by combined medical and mechanical recanalization, the rate of coronary reperfusion can be increased and infarct time shortened, providing the possibility of full revascularization by angioplasty, with improvement of regional wall motion and reduction of the rate of reocclusion.

Adult↗
PubMed1986

Stimulus-induced vulnerability in the early and late postinfarction phase.

In 45 survivors of myocardial infarction, cardiac catheterization was performed one and six months after the acute event. After completion of the angiographic investigation, ventricular vulnerability was assessed, using programmed right ventricular stimulation (rates 120 and 140 min-1, single and double premature impulses). In 27/45 patients the results of programmed electrical stimulation were comparable at one and six months. The overall incidence of repetitive ventricular response did not change. There was no correlation between the change of repetitive ventricular response and the change of effective right ventricular refractory period and the change of angiographic parameters (Gensini score, left ventricular ejection fraction and volume indices). It is concluded that between the first and the sixth month after infarction there is no relevant alteration in the propensity to repetitive ventricular response.

Adult↗