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Biomedical subjects

R Ensslen

Publications and source records attributed to R Ensslen.

17 recordsLinked to original sources
PubMed1978

[Vagal tone in symptomatic sinus node dysfunction (author's transl)].

Under investigation in this study were the role of vagal tone in symptomatic sinus node dysfunction and the relationship between hypersensitive carotid sinus reflex (HCSR) and sick sinus syndrome (SSS). In 168 symptomatic patients (pts) resting heart rate (HR), maximal corrected sinus node recovery time (CSRTmax) and maximal carotid sinus pressure results (CSPmax) were determined before and after Atropine, 1 mg i.v. (A). According to test results, 103 pts had HCSR (1), 33 had HCSR + SSS (II), 30 pts had isolated SSS (III) and 20 pts with normal test results served as controls (IV). Mean age was the same in groups I--IV (p greater than 0.05). Groups I--III had a HR less than or equal to 60 bpm, rising 31% after A in groups I--IV, but absolute values were below those in group IV. In groups I--III CSP normalized after A and CSRT remained unchanged (p greater than 0.05). We conclude that increased vagal tone plays but one role in groups I--III and the combination HCSR + SSS seems rather frequent. Specific testing clearly separated HCSR from SSS.

Adult↗
PubMed1978

[The significance of electrophysiologic findings and clinical course in symptomatic sinus node dysfunction (author's transl)].

Under investigation in this study were the relationship between hypersensitive carotid sinus reflex (HCSR) and sick sinus snydrome (SSS), the significance of clinical symptomatology versus electrophysiologic test results and the natural course of both syndromes. In 186 symptomatic patients (pts) resting heart rate, maximal corrected sinus node recovery time (CSRTmax) and maximal carotid sinus pressure results (CSPmax) were determined. According to test results, 103 pts had HCSR (I), 33 had HCSR + SSS (II), 30 pts had SSS (III), and 20 pts with normal test results served as controls (IV). Mean age was the same in groups I--IV (p greater than 0.05). Groups I--III had a heart rate less than or equal to 60 bpm. There was no correlation between patients test data and the occurrence of syncopes in each of groups I--III (p greater than 0.05). In 16 pts with SSS, test results remained unchanged 16 months later (p greater than 0.05). More pts (31%) in group II died in a shorter period of time after pacer application (1.4 +/- 1 year) than pts with AV III degrees block (25%, 1.8 +/- 1.6 years) after pacer application. We conclude that the combination HCSR + SSS seems rather frequent. Specific testing separated HCSR from SSS, but failed to predict syncopes and thereby cannot aid in the indication for pacer application. The 16 months prognosis of SSS proved unfavorable. Mortality after pacer application in HCSR + SSS seems less favorable than in AV III degrees block (p less than 0.05), but depends largely on the severity of associated diseases.

Adult↗
PubMed1977

Effects of nitroglycerin, postextrasystolic potentiation, and pacing-induced ischaemia on wall motion in patients with ischaemic heart disease.

The influence of nitroglycerin, postextrasystolic potentiation, and rapid ventricular pacing on total and regional ventricular function was studied in 32 patients with normal ventricular function and in 44 patients with left ventricular asynergy caused by obstructive coronary artery disease. Total ventricular function was assessed by ventriculography and regional ventricular function was analysed by use of 7 hemiaxes. Nitroglycerin increased ejection fraction and decreased left ventricular systolic and end-diastolic pressures in the normally functioning ventricles; apical wall motion increased, while basal wall motion remained unchanged after nitroglycerin in these ventricles. Pressures fell significantly in ventricles with asynergy after nitroglycerin; ejection fraction decreased while wall motion in asynergic areas was inconsistently influenced. Postextrasystolic potentiation augmented ejection fraction by a powerful and homogeneous increase of wall motion in normally functioning ventricles. Asynergic areas and normal areas in diseased ventricles showed identical augmentation of wall motion after a premature beat. Rapid venticular pacing produced a significant increase in end-diastolic pressure and a fall in ejection fraction in patients with obstructive coronary artery disease. Wall motion in normal areas perfused by arteries with critical stenoses was dramatically depressed after pacing, while asynergic areas and normal areas perfused by normal arteries remained unchanged. The results show that normal contractile behaviour can be detected by postextrasystolic potentiation in asynergic areas, suggesting that some normally perfused muscle exists in these areas. Pacing stress does not further deteriorate function in asynergic areas, which suggests the presence of viable and well perfused muscle (within scar tissue) whose function may not profit from revascularization. Pacing-induced asynergy identifies the functional significance of coronary stenoses and suggests that bypass surgery might be beneficial.

Cardiac Volume↗
PubMed1977

[Left ventricular ejection and ejection reserve during isoproterenol infusion in hypertrophic obstructive cardiomyopathy (author's transl)].

In 10 patients with hypertrophic obstructive cardiomyopathy (HOCM) and in 10 patients without heart disease (normals) left ventricular function and myocardial reserve under isoproterenol (Iso) infusion (0.3 microgram/kg B.W./min) were measured. From the monoplane cineangiography of the left ventricle diastolic wall thickness as well as ejection phase contractile indices, ejection fraction (EF) mean velocity of fiber shortening (VCF) and mean normalized systolic ejection rate (MNSER), were calculated. Maximum total load (TL) served as measure for afterload. Wall thickness in HOCM was higher by 73% as compared to normals (p less than 0.001). Hemodynamic values for normals at rest were as follows: EF 68.9 +/- 8.0%, VCF 1.22 +/- 0.19 circ/sec, MNSER 2.25 +/- 0.25 vol/sec and TL 228.6 +/- 37.4 dynes . 10(5). Values for HOCM at rest were as follows: EF 77.4 +/- 7.71% (p less than 0.05), VCF 1.53 +/- 0.3 circ/sec (p less than 0.05); MNSER 2.66 +/- 0.35 vol/sec (p less than 0.01) and TL 288.5 +/- 55.5 dynes . 10(5) (p less than 0.01) as compared to normals. The values under Iso in normals resulted in a significant fall of the TL (p less than 0.05), the enddiastolic volume (EDV, p less than 0.05) and of the enddiastolic pressure (EDP, p less than 0.05), VCF rose by 89% (p less than 0.001), MNSER by 66% (p less than 0.001) and EF by 23% (p less than 0.001). In HOCM under Iso TL rose by 45% (p less than 0.05), EDV and EDP did not change (p less than 0.05), VCF and MNSER rose by 23% (p less than 0.05 respectively p less than 0.01). VCF and MNSER in HOCM with Iso were reduced by 17% respectively by 13% (p less than 0.01) as compared to normals, the EDP was increased by factor 4, while EDV showed no significant difference (p less than 0.05). Our results indicate that the left ventricle in HOCM in spite of its marked hypertrophy is unable to adequately compensate for an acute gain of afterload as induced by the effect of catecholamines. Therefore, we assume stress-related congestive symptoms in HOCM to be caused--aside from other mechanisms--by diminished ejection reserve.

Adult↗
PubMed1977

Evaluation of implanted faulty demand pacemakers by magnet waving and electrical chest wall stimulation. A report of clinical experience.

15 different models of implanted demand pacemakers (61% Cordis models) in 156 patients were scrutinized owing to an announcement that had identified 3 faulty Cordis series and, as a consequence, had provoked considerable uncertainty among all pacemaker patients in the community. Malfunctions of the sensing, and reed switch mechanisms as well as changes in pacers' refractory periods were excluded by the electrical chest wall stimulation (ECWS), magnet waving (MW) or a combination of both. That those models suspected of malfunction show merely a drop in rate was verified. Established patterns of early rate drop guided the exchange for new units: no abrupt or complete rate drop occurred and no patient was lost. The application of indirect overdrive revealed that the blocking capacity for rapid rates was in Omni-Ectocor units less reliable than in Ectocor units. The characteristic reactions to MW and ECWS of the 15 demand pacemaker models were determined. Because both methods proved to be as easy to apply as they were beneficial for the follow-up, also in the uncommon situation created by the Cordis announcement, the application of both of these methods on a routine basis in pacemaker clinics is advocated.

Aged↗
PubMed1976

[The effect of the collateral circulation on the total and regional myocardial function in coronary disease].

The cinecoronarograms, ventriculograms and electrocardiograms of 164 consecutive patients (32 patients without heart disease and 132 patients with coronary artery disease) have been analyzed. Total left ventricular function was assessed by the ejection fraction. Regional myocardial function was determined by a system of hemiaxes. 89 patients with complete obstruction of the right coronary artery (RC) and/or the anterior descending branch of the left coronary artery (LAD) were divided into subgroups with good, poor and no coronary collaterals. Total and regional left ventricular function was normal in patients with well collateralized coronary occlusions. Patients with poorly collateralized or non-collateralized occlusions had impaired left ventricular function. Patients with poorly collateralized coronary occlusions showed no difference in left ventricular function when compared to patients with coronary occlusions without collaterals. Combined occlusions of the RC + LAD without collaterals were not found. Good coronary collaterals have a protective effect on total and regional myocardial function, thus improving the prognosis in complete coronary artery obstruction.

Cardiac Output↗
PubMed1976

[Function and reserve of the hypertrophic left ventricle in aortic valve disease].

Left ventricular function was analyzed by angiography in 31 patients with aortic valve disease and in 12 patients without heart disease (control group). Ejection fraction, percentage shortening of minor equator, mean velocity of fiber shortening and men left atrial pressure were considered as parameters of left ventricular function. Contractile reserve was tested by a single postextrasystolic beat. Patients with pure aortic stenosis and an increase of left ventricular muscle mass to 220% of the normal value showed no impairment of left ventricular function. Patients with pure aortic regurgitation and a left ventricular muscle mass of 260% of normal showed no significantly impaired function. Both groups increased ejection fraction and percentage shortening of the minor equator after premature beat comparable to the control group. Patients with combined lesions of the aortic valve had a left ventricular muscle mass of 360% of normal. This group showed decreased ejection fraction, percentage shortening of minor equator and mean velocity of fiber shortening as compared to the control group while mean left atrial pressure was significantly elevated. After premature beat all parameters remained depressed as compared to control group. We conclude that the degree of hypertrophy determinates cardiac function in aortic valve disease. Moderate hypertrophy shows normal function at rest, while severe hypertrophy shows impaired function.

Adult↗