PubMed Health⌕ Search

Biomedical subjects

W Angehrn

Publications and source records attributed to W Angehrn.

At least 19 recordsLinked to original sources
PubMed1998

[Therapy of acute myocardial infarct (1994-1996) at non-university hospitals in Switzerland (CHAMI Study)].

The CHAMI study (Confederatio Helvetica Acute Myocardial Infarction) recorded the therapies administered for acute myocardial infarction in 520 consecutive patients between October 1994 and February 1996 at 10 non-academic hospitals in Switzerland. The patients in this group consisted of 363 men and 157 women with an average age of 63.2 years. The prescribed medications administered from the day of hospital admission until the day of discharge were recorded. In the acute phase, the patients were given the following therapy: thrombolytic agents 40%, i.v. nitrates 65%, i.v. beta-blockers 22%, aspirin 95%, oral beta-blockers 36%, ACE inhibitors 14%. Impressive was the lower distribution of thrombolytic agents and beta-blockers among the older patients (age > 70) (thrombolytic agents 52.1% vs 28.4%; oral beta-blockers 44.0% vs 29.1%) and in particular among women (thrombolytic agents 26.8% vs 46%; oral beta-blockers 29.3% vs 39.7%) in men. Therapy at hospital discharge consisted, inter alia, of aspirin (73%), beta-blockers (54%), ACE inhibitors (3%), and lipid lowering agents (10%). The hospital mortality was 12.6%. The CHAMI study provided the participating hospitals with a quality control comparison with other participating centers and impressively demonstrated with the example of the lipid lowering agents, that the significance of secondary prophylaxis is assigned too little importance in contrast to acute therapy.

Adult↗
PubMed1998

[Acute myocardial infarct in Switzerland: results from the PIMICS Heart Infarct Register. PIMICS Project (Prospective Ischemia Myocardial Infarction Captopril Survey)].

The aim of the PIMICS project was to create, for the first time in Switzerland, a registry of data concerning epidemiology and therapy in patients hospitalised for acute myocardial infarction covering all regions of the country. During 1995/96 73 Swiss hospitals of all categories took part in the PIMICS project. The ratio between males and females in the 3877 registered patients was 2.6:1 (2791 men vs. 1086 women). Female patients were significantly older than males (70.4 +/- 12.0 years vs. 63.4 +/- 12.6 years; p < 0.0001). The prevalence of risk factors differed between men and women: significantly more women had hypertension or diabetes, whereas smoking was more prevalent in males. The median delay between onset of symptoms and arrival at the hospital was 5.5 hours. Thrombolysis and primary angioplasty were more frequently performed in men (40.4% vs. 31.2% in women, p < 0.0001, and 5.7% in men vs. 3.5% in women, p = 0.005 respectively). During the acute phase males were treated more frequently with betablockers. The overall in-hospital mortality was 9.1%. It was significantly higher in female patients (13.5% vs. 7.4% in men; p < 0.0001) and in patients with reinfarction (14.5% vs. 7.1%; p < 0.0001). The mean hospital stay was 12.6 +/- 5.3 days. Only 7.7% of all patients with acute myocardial infarction were discharged within 6 days. At discharge, 51.7% were treated with betablockers and 69.3% with aspirin; 44.8% received ACE-inhibitors and only 13.8% lipid-lowering drugs. Follow-up measures such as coronary angiography and/or angioplasty or bypass surgery were performed significantly more often in males (45.0% vs. 32.9%; p < 0.0001). Likewise, men were more frequently assigned to a rehabilitation program than women (38.2% vs. 32.9%; p = 0.0004). The pre-hospital delay in patients with acute myocardial infarction remains too long. Primary and secondary prevention should be intensified in high risk groups, particularly in females. Thrombolysis and primary angioplasty as mainstays of treatment in acute myocardial infarction are generally used too sparingly, especially in women. With such measures the hospital stay could be shortened further.

Adult↗
PubMed1997

[Myocardial rupture after acute myocardial infarct: 2 cases with an unusual clinical presentation].

Myocardial rupture is the second most common reason for in-hospital mortality in patients with acute myocardial infarction, accounting for 8-17% of deaths. The clinical presentation varies due to the possibility of rupture in three main locations: free left ventricular wall (85%), interventricular septum (10%), and papillary muscle (5%). Hypotension, long persisting or repeated chest pain, syncopes, new heart murmurs or weak action should draw attention to the possibility of myocardial rupture, apart from the classical sign of upper inflow congestion. In about 48% of cases immediate surgical intervention can save life. We present two unusual cases of myocardial rupture. Case 1 shows left ventricular free wall rupture with additional rupture of an accessory posterior papillary muscle but without changes in hemodynamic parameters; case 2 involves a rupture of the free left ventricular wall which the patient survived without surgical intervention.

Aged↗
PubMed1996

[Perioperative myocardial infarction and cardiac complications after noncardiac surgery in patients with prior myocardial infarction. II: Perioperative long-term ECG--clinical relevance practicability].

UNLABELLED: Perioperative, mostly silent ischaemia in patients with coronary heart disease is difficult to detect by clinical examinations. METHODS: During the clinical evaluation (part I of this study) we monitored patients with prior myocardial infarction (MI) by continuous electrocardiographic (ECG) recording from the evening before until the first 24 h after operation. Excluded from Holter ECG studies were patients with a bundle branch block, pacemaker, valvular heart disease, cardiomyopathy, severe hypokalaemia, and digitalis treatment. Data were recorded with a Holter 8500 recorder (Marquette Electronics) using modified V2, V4, and V5 leads (Fig. 1). Holter tapes were analysed twice with a Holter computing system (Software 5.8, Marquette Electronics), first by a blinded technician and then by the authors themselves. We defined the following criteria as pathological ST segment changes and as ischaemic episodes [7]: horizontal or down-sloping ST depression of at least 1 mm or elevation of 2 mm of at least 1 min duration measured at the J-point plus 60 ms. To quantify individual levels of ischaemia we used the definition "ischaemic load" [3]: ischaemic min/h monitored per patient. The statistic evaluation did not differ from that used in part I. RESULTS: Out of 160 patients, 100 could be examined by Holter monitoring. Because of technical problems we could not record a Holter ECG in 2 of 6 patients with reinfarction. We found one or more perioperative episodes of ST-segment depression in 25 patients (25%). Ischaemic episodes were detected in 15 patients preoperatively, in 12 intraoperatively, and in 10 postoperatively. Three patients had ischaemic episodes during all periods. Patients with pathological ST segments suffered significantly more reinfarctions (3 of 25 vs. 1 of 75 patients) and were older (mean age difference 7 years, P < 0.05). Patients with ischaemic episodes and a clinical diagnosis of reinfarction (n = 3) demonstrated a dramatic postoperative increase in ischaemic load. Preoperative use of beta-blocking agents did not influence the incidence of ischaemic events. The sensitivity of postoperative Holter ECG monitoring in the diagnosis of reinfarction was 50%, the specificity 92%. CONCLUSIONS: Perioperative Holter ECG monitoring is time-consuming, expensive, not very sensitive, and therefore not generally applicable for all patients with prior MI.

Adrenergic beta-Antagonists↗
PubMed1993

[Right ventricular involvement in infero-posterior myocardial infarct: clinical significance of ECG diagnosis].

Right ventricular infarction accompanies acute inferoposterior myocardial infarction in 25 to 53% of cases, the frequency depending on the diagnostic method used. Involvement of the right ventricle can be reliably diagnosed in the right precordial leads of the ECG. Sensitivity and specificity are above 90% and the positive predictive value is over 80%. To assess the clinical value of this extended ECG diagnosis, we retrospectively studied 144 patients with acute inferoposterior myocardial infarction. Right precordial ECG leads V2R to V6R were registered routinely in all of these patients immediately after their admission to the hospital. We found characteristic ECG changes of right ventricular infarction in 31 (22%) of these 144 patients: ST elevation of > or = 0.5 mm in the right precordial leads, especially in lead V4R. In this group of patients the following hemodynamic parameters were registered in a significantly higher percentage: biventricular heart failure (29% vs 4%, p < 0.001), isolated right ventricular failure (23% vs 0%, p < 0.002), arterial blood pressure < 90 mm Hg (48% vs 23%, p < 0.001), cardiogenic shock (13% vs 4%, p < 0.05). Furthermore, the following arrhythmias were found significantly more frequently: sinus bradycardia (42% vs 24%, p < 0.05), AV block II type Mobitz 2 and AV block III (22% vs 5%, p < 0.005). Because of hemodynamic disturbances we had to substitute volume more often (39% vs 1%) or employ catecholamines more frequently (39% vs 6%, p < 0.01). Following high degree AV block we inserted a temporary pacemaker in a higher percentage (13% vs 5%) without reaching statistical significance.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Atrioventricular block in Lyme carditis].

Lyme disease, due to infection with Borrelia burgdorferi transmitted by ticks, is most frequently manifested by arthritis and neurological complications. In approximately 8% of cases, however, carditis, usually reflected in AV block, is the leading symptom. The case histories of 2 males and 1 female aged 23 to 37 years with AV block caused by Borrelia burgdorferi are presented. Main symptoms were exertional dyspnea, palpitations, dizziness and syncope. One patient was treated with diclofenac and two with penicillin. The course was uniformally benign and cardiac abnormalities disappeared within 1-3 weeks.

Adult↗
PubMed1988

[The clinical significance of ECG exercise testing at hospital discharge of patients with acute myocardial infarction].

330 patients were admitted to the intensive care unit of our hospital from January 1985 to December 1986. 141 of the 150 patients aged below 65 years underwent symptom-limited maximal exercise testing on a bicycle ergometer before discharge. No severe complications were noted. 61 of those tested showed a pathological reaction such as angina pectoris, ST-segment depression or ventricular ectopic activity (couplets, ventricular tachycardia). Coronary angiography was performed in 33 patients (23.4%). The outcome of this examination led to coronary bypass surgery in 15 cases and to PTCA in 2. For 9 of these 17 patients exercise testing soon after myocardial infarction was the essential investigation that led to angiography and surgery. Symptom-limited exercise testing before discharge is a safe method of distinguishing patients at risk, requiring further investigations for possible coronary bypass surgery, from those that do not need additional work-up. We conclude that every post-myocardial infarction patient should be exercise-tested before leaving hospital.

Adult↗
PubMed1987

[Severe poisoning with a cholinesterase inhibitor].

We report on a case of severe intoxication in an 18-year-old female who had ingested an insecticide with suicidal intent. The insecticide (thionacine) is a cholinesterase inhibitor used in gardening and agriculture. The resources of modern intensive care permitted successful treatment with artificial respiration and atropine. Treatment with oximes is controversial and may be dangerous. We suggest hospitalization even in mild cases of intoxication, in view of danger of changes in the course of the illness.

Adult↗
PubMed1986

[Malignant pericardial effusion--a sign of unfavorable prognosis?].

Malignant pericardial effusion (MPE) resulting in cardiac tamponade is a rare complication in neoplastic disease. From January 1975 to December 1984 the authors observed 22 patients with cytologically verified malignant pericardial effusion. The most frequent primary tumors were non-small cell lung cancer (6), breast cancer (5), non-Hodgkin lymphoma (4) and mesothelioma (4). 50% of the patients presented with MPE as the initial manifestation of the tumor. In the other group of patients MPE appeared after an average of 11 months following the diagnosis of malignant disease. The most frequent symptoms and clinical findings were dyspnea (100%), jugular venous distention (91%), and tachycardia (82%). During the first 24 hours after pericardiocentesis a median volume of 675 ml of predominantly serosanguinous effusion was drained. Besides intrapericardial drug instillation, patients also received local radiotherapy and systemic chemotherapy. At the time when MPE was diagnosed 77% of the patients exhibited advanced malignant disease. Mean survival time was 140 days. Malignant pericardial effusion is therefore regarded as an unfavorable prognostic factor.

Cardiac Catheterization↗
PubMed1985

[Long-term experiences with 2-chamber pacemaker systems].

During the period October 1981 to December 1984, 54 physiologic pacemaker systems were implanted in this department. 21 relevant complications were observed in 18 (33%) of the 54 patients. 11 of the complications were directly related to the AV-sequential system. The higher risk of complications must be taken into account when physiologic pacemaker systems are implanted.

Aged↗
PubMed1985

[Transcutaneous application of nitroglycerin and isosorbide dinitrate versus placebo: effect in myocardial ischemia].

The effect of nitroglycerin ointment (30 mg) and isosorbide dinitrate ointment (100 mg) versus placebo on exercise capacity has been investigated in 12 patients. All had angina pectoris and coronary artery disease documented by coronary angiography. Nitroglycerin and isosorbide dinitrate ointment produced a significant increase in exercise capacity, without any significant difference in the beneficial effect of the two. Stress-induced changes of the ST-segment in the electrocardiogram decreased by 65% after nitroglycerin ointment and by 41% after isosorbide dinitrate ointment, compared to placebo. These results indicate that nitroglycerin and isosorbide dinitrate ointment reduce stress-induced myocardial ischemia at similar work loads.

Administration, Topical↗
PubMed1983

[Therapy of primary pulmonary hypertension with phentolamine].

The effect of phentolamine was studied in 5 patients with pulmonary hypertension, of whom 3 had primary pulmonary hypertension and 2 had secondary pulmonary hypertension after pulmonary embolism. They received intravenous phentolamine in doses of 0.5 mg/min to 2 mg/min (i.e. up to a total dose of 27.5 mg in 25 minutes) during diagnostic cardiac catheterization. Under phentolamine infusion only 2 of the 3 patients with primary pulmonary hypertension showed a significant rise in cardiac index, from 1.4 to 2.0 and from 1.8 to 2.2 l/min/m2 respectively, a fall in pulmonary artery mean pressure from 100 to 93 and from 42 to 33 mm Hg respectively, and a decrease in pulmonary vascular resistance from 2950 to 1900 and from 1160 to 725 dyn X sec X cm-5 respectively. In 1 patient with primary, and 2 patients with secondary pulmonary hypertension, infusion of phentolamine had no effect. Interestingly, in the two patients with primary pulmonary hypertension who responded well to phentolamine the condition was very severe. It appears that even in cases with very advanced primary pulmonary hypertension there is a vasospastic component which can be influenced by vasodilators.

Adult↗
PubMed1982

[Long-term digitalis therapy of elderly patients. Is digitalization unnecessary in the majority of cases?].

More than 40% of patients hospitalized in the Wald Altitude Clinic of Zürich are already on long-term digitalis therapy upon admission. During a 6 month period long-term digoxin therapy was discontinued in 97 patients (age 74 +/- 9 years) with stable cardiac insufficiency (NYHA class I-III) and sinus rhythm. During the hospitalization (37 +/- 20 days), clinical signs and symptoms, body weight, radiological heart size, and systolic time intervals were monitored. After an observation period of one week, digoxin was discontinued in all patients. Body weight, cardio-thoracic ratio and left ventricular ejection time remained unchanged after cessation of digoxin therapy during hospitalization. The pre-ejection period showed a significant increase from 89 +/- 17 to 95 +/- 19 msec. Six patients were re-instituted on digoxin therapy, 3 due to progressive cardiac insufficiency, 2 due to atrial fibrillation, and 1 at his own request. After telephone follow-up six months later with the family physician an additional 20 patients were put back on digitalis. Among the total of 26 patients requiring further digitalization an absolute indication was found only in 12 (14%), 8 due to progressive cardiac insufficiency and 4 due to atrial fibrillation. In this study digitalis therapy could be discontinued without ill effects in 86% of elderly clinically stable patients in sinus rhythm. The authors therefore recommend a more cautious use of long-term digitalis therapy and, in already digitalized patients in sinus rhythm, a controlled trial period of discontinuation.

Age Factors↗
PubMed1982

[Acute lung embolism: pathophysiology, clinical aspects and therapy].

Cautious estimates reveal that the diagnosis of pulmonary embolism is missed in approximately 60-70% of cases. The outcome in these patients is poor, mainly due to a tendency to relapsing embolism. Knowledge of pathophysiological contexts is important for clinical diagnosis and for evaluating degree of embolism. In most cases consistent conservative treatment is sufficient. Emergency embolectomy is indicated in cases with severe central pulmonary embolism. Operation mortality has dropped considerably since the introduction of cardiopulmonary bypass.

Bradykinin↗