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Biomedical subjects

W Grosse-Heitmeyer

Publications and source records attributed to W Grosse-Heitmeyer.

At least 19 recordsLinked to original sources
PubMed1999

Severe clinical expression in X-linked Emery-Dreifuss muscular dystrophy.

X-linked Emery-Dreifuss muscular dystrophy (EDMD) is a relatively rare benign neuromuscular disorder which can vary remarkably in onset, course and severity. In the present study, a TCTAC deletion spanning the nucleotides 631-635 of the emerin gene caused an unusually severe disease phenotype including loss of ambulation and severe muscle wasting in two affected brothers. The same mutation has been reported previously in an unrelated family showing a significantly milder phenotype. The interfamilial heterogeneity in distribution and in severity of the features in the two families point to environmental or genetic modification as the cause of clinical variability in Emery-Dreifuss muscular dystrophy.

Adolescent↗
PubMed1994

[Differences between women and men in the dipyridamole test. Symptomatic and electrocardiography findings in patients with coronary heart disease].

BACKGROUND: Problems are often encountered in evaluating the exercise stress ECG in women due to frequent false pathological findings. Besides the exercise ECG in the noninvasive diagnosis of coronary heart disease (CHD), the dipyridamole test is often used. As yet little is known about, whether a similarly high incidence of false positive test results occur under provocation with dipyridamole in women as in the exercise stress ECG. PATIENTS: In the present study the results of the dipyridamole test and of the coronary angiography in 218 patients, diagnosed as suspected of having CHD, were compared, especially allowing for specific sex differences. RESULTS: The prevalence of CHD in women was 17.8% and 56.1% in men. Under provocation with dipyridamole allowing for the indicator angina pectoris, the incidence of a false positive test results in relation to a significant coronary stenosis is higher in women with 80.5% than in men with 36.4% (p < 0.001). By contrast, men have a significantly higher rate of false negative test findings (40.9% to 11.1%; p < 0.001). Whereas the women obtained a sensitivity of 87.5%, the rating for men was 70.1%. Specificity was 21.6% for women and 48.7% for men. Test efficiency for men was 60.7% whereas for women 33.3% were calculated. The reaction of heart rate (significant increase of 33%) and systolic and diastolic blood pressure (no significant changes) did not reveal any relevant differences between men and women during the dipyridamole test. CONCLUSION: For patients with CHD similar diagnostic uncertainties occurred relating to specific sex differences in the results of the dipyridamole test, just like those known from the exercise ECG.

Adult↗
PubMed1993

[Reproducible ventricular flutter during programming of a DDD pacemaker].

A bipolar DDD pacemaker system was implanted in a 51-year-old woman with a 2 degrees (Mobitz type) atrioventricular block. The first postimplantation control was unremarkable, but she collapsed 9 weeks later with dyspnoea, tachycardia and profound perspiration. Ventricular flutter occurred twice during routine ambulatory pacemaker function tests one week later. The first episode was terminated by a precordial blow with a fist, but the second required electrical defibrillation. During the subsequent hospitalization abnormal electrolyte balance and digitalis intoxication were excluded. Left-heart catheterization with coronary angiography showed normal left-ventricular function at rest and normal coronary arteries. There was no evidence for an arrhythmogenic right ventricle. Electrophysiological testing with programmed ventricular stimulation provoked ventricular tachycardia with torsade de pointes and transition to ventricular fibrillation. Antiarrhythmic treatment with sotalol, 160 mg twice daily by mouth, failed to suppress the episodes of torsade de pointes. But further programmed ventricular stimulation was uneventful after the sotalol dosage had been increased to 160 mg three times daily.

Female↗
PubMed1993

[Behavior of the R-amplitude in ergometric and pharmacologic stress in comparison with coronary morphologic findings in patients with coronary heart disease].

The cause of R-wave amplitude changes in the ECG under load remain unknown. One of the possible aetiological factors is myocardial ischaemia. The aim of the present study was to investigate possible relationships between amplitude changes and transient myocardial ischaemia. In this retrospective study, 89 patients (74 men, 15 women) were investigated. The results of exercise ECG, a dipyridamole test and coronary angiography were available for all patients participating. The patients were divided into four groups (group I: patients with relevant coronary stenosis [n = 46], group II: patients with no relevant coronary stenoses [n = 43], group III: patients with pathological results in all three procedures [n = 29], and group IV: patients with unremarkable findings in all three investigations [n = 14] and the R-wave amplitude changes in various phases of ergometry and dipyridamole provocation were measured. All four groups showed a significance decrease in R-wave amplitude at maximum provocation as compared with baseline values. A qualitative analysis of the amplitude changes indicated a tendency for them to be dependent on the severity of coronary stenosis. A quantitative analysis, however, revealed no significant correlations between the R-wave amplitude and ST segment changes or angiographic findings. This means that R-wave changes during an exercise ECG or a dipyridamole test do not permit us to distinguish between patients with or those without coronary artery stenosis. Changes in the R-wave amplitude observed under loading must be due to factors other than myocardial ischaemia.

Coronary Angiography↗
PubMed1993

[Is there a specific response of the ECG R-wave amplitude to exercise-induced myocardial ischemia? Exercise test and dipyridamole test].

Changes in electrocardiogram R-wave amplitude are often noted during treadmill stress testing. The two main reasons for this phenomenon discussed in the literature are left ventricular dimension changes and myocardial ischemia. To evaluate the relation between myocardial ischemia and electrocardiogram R-wave amplitude changes, we investigated in a retrospective study the data of 99 patients (20 females/79 males) with clinical signs of coronary artery disease. All patients had undergone exercise ECG and dipyridamole test. Electrocardiogram R-wave amplitude changes and ST-segment alterations were measured before, during and after provocation by bicycle stress test and intravenous dipyridamole. In neither test was there a specific reaction of R-wave amplitude to myocardial ischemia. During myocardial ischemia there were patients with an increase as well as a decrease R-wave amplitude. There was no significant correlation between the reaction of the R-wave amplitude in the exercise ECG when compared with the Dipyridamole test. Quantitative analysis showed a reduction of R-wave amplitude during maximum provocation in both tests, which was statistically significant in almost every subgroup of patients. In both tests the ST-segment depression was statistically significant in all groups, but there was no significant correlation between the reaction of R-wave amplitude and the ST-segment depression. In conclusion, there is no specific reaction of R-wave amplitude to myocardial ischemia. It is very unlikely, that the often noted changes in R-wave amplitude during stress testing are caused by ischemic episodes of the myocardium. Other mechanisms must be sought to explain the observed R-wave alterations.

Adult↗
PubMed1993

[Molsidomine in chronic heart failure with liver congestion--oral or intravenous therapy?].

Patients suffering from congestive heart failure combined with gastrointestinal congestion often present irregular resorption and metabolism of orally applicated cardiovascular drugs. Intravenous therapy therefore is used very often for those patients. In this trial we compared the efficiency of molsidomine given either orally or intravenously in patients suffering from congestive heart failure. We investigated ten patients (54.6 +/- 13 years) with congestive heart failure (NYHA III and IV) and a central venous pressure > 10 mmHg. Five patients of group A were given 4 mg of molsidomine intravenously on the first day and an oral dose of 4 mg of molsidomine on the second day. The five patients of group B received the oral dose on the first day and intravenous treatment on the second day. Central venous pressure and plasma levels of molsidomine and of the effective metabolite SIN-1 were measured before as well as ten, 20, 40, 60 minutes, two, four and eight hours after application of molsidomine. Central venous pressure decreased significantly up to two hours after molsidomine in both oral and intravenous groups (p < or = 0.01). There was no relevant difference between the oral and the intravenous group. The hemodynamic parameters correlated with molsidomine plasma levels. According to our results the efficiency of oral molsidomine does not differ from intravenous molsidomine in patients with congestive heart failure.

Administration, Oral↗
PubMed1993

Transesophageal echocardiography: increased risk by repeated attempts to insert the transducer in patients with coronary artery disease?

The question of whether several attempts at transducer insertion increase the risk of performing transesophageal echocardiography (TEE) in patients with coronary artery disease (CAD) has not been addressed to date. In the course of performing TEE in 45 patients with CAD, two or more attempts to insert the transducer were necessary in 9 cases. During various attempts, heart rate, blood pressure and ST-segment depression were recorded and correlated with the findings of the exercise electrocardiogram (ECG) and coronary angiography. Insertion was successful in six patients after two attempts and in three other patients after three, four, and five attempts, respectively. Heart rate rose significantly (p < 0.005) with the increase of insertion attempts. In one patient, it continued to rise at the fourth attempt, reaching 216% compared with the initial heart rate. Systolic blood pressure rose by 5%, whereas there was hardly any change in diastolic blood pressure. As the number of insertion attempts increased, we recorded a continuous ST-segment depression in eight patients with angiographic changes of the coronary artery system. The depression was already significant at the first attempt (p < 0.05). Compared with the initial reading (0.053 mV), the increase was 335% (p < 0.01) after the second attempt (0.231 mV). One patient whose angiographic findings were normal had no ST-segment depression during TEE. In all eight patients with CAD ST-segment depression during TEE was > 0.2 mV. Since none of the patients complained of angina pectoris, the ST-segment depressions satisfied all the criteria of silent myocardial ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Congenital fistulas of the coronary arteries. A review with case presentations].

Coronary artery fistulas are rare atypical communications between a coronary artery and a cardiac chamber or other great vascular structure and usually congenital in origin. Many are detected accidentally by the use of coronary angiography. These fistulas often have minor hemodynamical significance and the course is primarily from the proximal left coronary artery to the pulmonary artery. Though symptoms are rare they should be observed carefully in aspect of possible complications. In contrast sometimes coronary artery fistulas are found when searching for the cause of cardiac murmurs or clinical symptoms. Great amounts of shunted blood can result in cardiac volume overload and myocardial ischemia may occur by coronary steal. Surgical closure of these fistulas is the treatment of choice. In our laboratory we found in a series of 3,000 coronary angiographies a 53 year old man with an abnormal communication from the right coronary artery to the right atrium and a 68 year old woman with a fistula from the proximal left anterior descending artery to the pulmonary artery.

Aged↗
PubMed1993

[What coronary findings predispose to premature termination of a strong positive dipyridamole test?].

Besides the exercise-ECG the dipyridamole-test is used in the noninvasive diagnosis of coronary artery disease (CAD). In many cases the test must be terminated due to angina or ST-segment depression before reaching the regular end point of the investigation. The test then is graded as highly positive. It was the aim of this study to answer the question what changes in the coronary angiogram one has to expect in patients with a highly positive dipyridamole-test. In 45 females and 173 males the dipyridamole-test was carried out giving 0.75 mg dipyridamole/kg bodyweight intravenously over a period of 10 min. In case of angina pectoris and/or ST-segment depression > 0.2 mV occurring within 12 min after beginning of injection the test was graded positive. The test was defined highly positive in the case of early termination during the injection period because of angina or ST-segment depression. All patients had undergone a coronary angiography. 70 out of 218 dipyridamole-tests had to be terminated before the regular end of the test. There was no correlation between the time of termination of the dipyridamole-test and the grade of CAD. The group of patients in which the test had to be terminated early because of angina and ST-segment depression more often had coronary stenoses > 75% in at least one major coronary artery (94.5%) compared with those patients in which only angina led to the termination of the test (69.6%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Transient complete AV block as a sequela of Borrelia myocarditis].

A 49-year-old man suddenly developed dyspnoea, sweating, fever (up to 38.5 degrees C), vertigo and angina. After emergency admittance to hospital the ECG showed 3 degrees A-V block, requiring temporary pacemaker insertion. The patient reported that a month before he had been bitten, probably by a tick. Serological tests demonstrated a recent Borrelia infection (rise of IgG antibody titre to 1:2048, IgM antibody titre to 1:128). Coronary angiography excluded any haemodynamically significant coronary heart disease as a cause of the conduction disorder. Myocardial biopsy showed changes pointing to a past myocarditis. This suggested Borrelia infection as the cause of the complete A-V block. Under treatment with broad-spectrum antibiotics for 15 days the fever subsided and the ECG became normal. Shortly before discharge, an elevated pulmonary wedge pressure on 150 W exercise indicated persistence of mild left-ventricular failure.

Antibodies, Bacterial↗
PubMed1988

Lack of association between haemostatic variables and the presence or the extent of coronary atherosclerosis.

Blood samples were taken for haemostatic analysis from 225 patients with angina pectoris who were admitted to hospital for coronary angiography. beta thromboglobulin, platelet factor 3, platelet factor 4, factor VII:C, factor VIII:C, von Willebrand factor antigen, activated partial thromboplastin time, fibrinogen, antithrombin III, protein C:Ag, plasminogen, and antiplasmin were measured before angiography. Patients who had had a myocardial infarction in the two months before the investigation were excluded from the study. Multiple linear regression analysis showed that none of the haemostatic variables contributed independently to the prediction of an angiographic score that indicated the extent of coronary atherosclerosis. History of myocardial infarction, male sex, worsening of angina pectoris, serum triglycerides, and ejection fraction were independently associated with the angiographic score. There were some significant correlations between haemostatic variables and conventional risk factors for coronary heart disease. Thus data obtained from haemostatic analyses of peripheral venous blood do not permit the presence or the extent of atherosclerosis in coronary arteries to be predicted.

Adult↗