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Bereits vor mehr als 100 Jahren wurde die Wirksamkeit von Nitraten bei der Angina pectoris entdeckt.

A review of 1097 consecutive coronary angiograms performed for evaluation of angina pectoris or valvular dysfunctions showed 3 patients with arteriovenous fistulas (0.25%), 6 patients with malpositions (0.55%), 29 patients with aneurysms (2.65%) and 59 patients with myocardial bridging (5.4%). The clinical significance of coronary artery anomalies as variation or malformation was evaluated. A malformation has been found in Bland-White-Garland syndrome, arteriovenous fistulas, congenital coronary stenosis and atresia. In case of clinical symptoms surgical correction should be considered. There is a controversy on the clinical significance of muscular bridging. Further clinical investigations are needed for a better understanding of coronary artery anomalies.

Sixty-six hip arthroplasties in 55 patients were reviewed to specifically study cemented versus noncemented procedures, as related to heterotopic bone formation (HBF). Other factors considered included the type of arthroplasty, surgical approaches, preoperative and postoperative medicines, preoperative predisposing diagnoses, range of motion, and pain. The overall percentage of heterotopic ossification was 64%. There was no significant difference between cemented (67%) and noncemented (55%) procedures. Except for an increased percentage (80%) of ossification after a trochanteric osteotomy, there were no significant differences between the three reviewed surgical approaches. Male osteoarthritics had the highest overall HBF. Eighty percent of patients who previously had developed HBF also did so with a contralateral hip surgery. Surprisingly, all patients with gout (100%) developed HBF. Acetylsalicylic acid used prophylactically for anticoagulation had no significant effect. Resurfacing arthroplasty procedures accounted for half of the severe grades of HBF. A decreased range of motion occurred with more severe grades of HBF.

In invasive diagnostics of coronary heart disease (CHD), three each DSA examinations of the left coronary artery were performed at 2-minute intervals in ten patients subsequent to conventional examination by means of a left-side cardiac catheter and coronary angiography. While placing the patient in left anterior oblique (60 degrees) position, 6 ml each of ionic contrast medium were injected mechanically with a flow of 4 ml/sec at a pacemaker-induced heart rate of 100/min. Examinations were performed according to a standard mode and were evaluated via the image analysing computer APU of the Philips DVI-DSA system. The purpose of this approach was to analyse the examination conditions and a new improved evaluation algorithm in respect of stability, feasibility and sensitivity. 17 series were evaluated by two examiners who were independent of each other. The interobserver differences obtained were between 5% at the time of maximum density (Tmax) and 25% with exponential downward slope of the curve (lambda), with reference to the median value in each case. Scatter of the individual examinations around the median value of all the three DSA runs is 11 to 17% with the exception of lambda. A significant rise can be proven in the RCX region for the curve slope rise parameters "slope" and "RFL2". We interpret this as a genuine 1.2 to 1.3 fold regional flow increase due to the residual effect of the contrast medium. At the same time, this can be interpreted as an indicator for the good sensitivity of the method.(ABSTRACT TRUNCATED AT 250 WORDS)

The aim of the method presented is the quantitative description of the perfusion of the myocardium. In the framework of the invasive diagnostics of the coronary heart disease with catheterization of the left heart, ventriculography and coronarography in Seldinger's technique in 50 patients (35 of them well to be evaluated) subsequently DSA-investigations of the left coronary artery (LCA) were performed by means of the DVI-2 CV system (Philips) and densitometrically evaluated with the help of the analytic processing unit (APU). In injection by hand of 4 and 6 ml, respectively, visotrast 370 in each case 10-15 DSA-pictures in LAO 60 degrees-projection were possible. For a differentiated evaluation the total myocardium was subdivided into 12 partial areas. The densitometric analysis consisted in the calculation of time-density curves over all areas and their description by suitable parameters: density maximum (DMAX) and its moment TMAX, elevation of the curve SLOPE at 50% of DMAX, the elevation time AZEIT as well as measure for the exponential decrease of the curve after the maximum LAMBDA. For special questioning the parameters of the 12 areas were concentrated according to the main supply areas of the anterior interventricular branch (RIVA), the circumflex branch (RCX) and the apex of the heart, respectively. In the interobserver comparison the statistical analysis of the results showed deviations lower than 10% (except LAMBDA). Significant correlations were found between the body-weight and the applied quantity of contrast remedies, respectively, and the parameters DMAX and AZEIT.(ABSTRACT TRUNCATED AT 250 WORDS)

Before operation as well as over a mean postoperative period of 8.9 years 222 adults with atrial septal defects underwent a follow-up examination concerning frequency and clinical significance of supraventricular dysrhythmias. Thereby disturbances of the formation of stimuli were found before the operative procedure in 60 patients and after the correction in 115 patients. Disturbances of the sinoatrial and atrioventricular conduction were registered preoperatively in 53 cases and postoperatively in 81 cases. Within these statistically significant increases in particular the significant forms of dysrhythmia elevated after the atrial septal defect closure. Thus the tachycardiac atrial dysrhythmias increased from 7 to 28%, complex arrhythmias even from 2 to 16%. Of dysrhythmias to be taken seriously patients with IAVC and supraventricular defect are significantly more frequently affected than those with interatrial septal defects. Size of the defect, shunt volume and pressure of the pulmonary artery did not show any connections with the frequency of dysrhythmia. On the other hand, when accompanying cardiac anomalies, symptoms of a manifest heart insufficiency were present and at an operation age over 40 years arrhythmias were proved more frequently. The complaints of the patients did not correlate with the endangering, but are imprinted by the haemodynamics and its postoperative normalization. By the established profile of complaints and a decrease of frequency from 76% pre- to only 40% postoperative the patient with atrial septal defect cannot estimate his individual risk and needs an adapted long-term concept for his cardiological care.

In 42 patients with coronary heart disease within a left heart catheterization by means of coronarography and conventional angiocardiography in each case before and after GTN digital subtraction angiographies of the left ventricle were performed with central venous injection of 20 ml visotrast with a flow of 16-18 ml/s. A DVI2-CV system of the firm Philips served as investigation device. In general between the angiocardiography and the digital subtraction angiographies the following results were obtained for EF 0.81, EDV 0.71, and ESV 0.88. When evaluating only the finally examined 22 patients the correlations improve for all parameters (EF: 0.89, EDV: 0.82, ESV: 0.90). Furthermore is was shown that the volumes are underestimated by 8-10%. The quantification of the regional movement of the wall according to the radial axis method did not results in any significant differences between the digital subtraction angiographies and the angiocardiography. The effects of GTN on the global and regional functional parameters appear somewhat more distinct in the digital subtraction angiographies than in the angiocardiography and are partly significant only in the first one. The influence of the experience of the investigator, the cardial state of the patient and other influential factors on the quality of the digital subtraction angiocardiographies are described and discussed. Therefore we regard the digital subtraction angiography as method of choice in indications to right heart catheterization without coronary angiography.

1. 1. The pH-activity curves of the proteolytic enzymes from sera and exudates withdrawn by puncture from inflammatory, non-inflammatory and malignant tissue were examined in the pH range 0.9–4.4. Casein was used as substrate, and a sensitive copper complex method was employed. 2. 2. The proteolytic activity in sera and in exudates showed great quantitative and qualitative differences. The pH-activity curves of sera had a plateau between pH 1.2 and 2.0, and a single peak, between pH 2.2 and 2.6. The curves pertaining to exudates showed up to 4 peaks of greatly variable height, lying within a narrow range. 3. 3. The activity curves of the exudates derived from the three groups showed only quantitative differences, while peak distribution and the general aspect of the curves were similar. Fluids and sera of malignant origin had a higher catheptic activity than those from the other two groups. 4. 4. The results are discussed in connection with the problem of inflammation. The course of the pH-activity curves led to the conclusion that qualitative changes in the pH range 3.7–4.0 are only caused by processes accompanied by extensive cellular breakdown. The qualitative differences between the curves for sera and exudates are interpreted as representing nonspecific signs of cell damage caused by the effusion. An attempt is made to correlate the individual activity peaks with known proteolytic enzyme systems.

Leucine aminopeptidase was tested as an indicator for exopeptidases which are able to split polypeptides, having an inflammatory effect, into harmless amino acids. Exudates were provoked in experiments on 67 rabbits of both sexes by intraperitoneal injection of a mechanically acting irritant. After this lesion the animals were killed by exsanguination at fixed time intervals, and in the two body fluids leucine aminopeptidase was examined with the substrate l -leucine-p-nitroanilide. In addition in the exudates total protein content, total number of cells, and the differential cell count were examined. In serum of healthy, untreated animals the value of 11.4 ± 6.0 mU/ml was determined as average leucine aminopeptidase activity by 133 single measurements on 52 rabbits. In an isotonic saline solution, used to wash the uninjured peritoneal cavity, 1.7 ± 0.6 mU/ml were demonstrable. 30 min after the experimental lesion in serum there occurred an initial decrease, followed by an increase to maximal enzyme activity with values about 24.2 ± 6.3 mU/ml after the first hour. Thereafter, from the 2nd to the 8th hour of inflammation the activity in serum tended insignificantly to subside, but did not reach normal level even after 48 h. On the other hand in the exudates the enzyme activity increased during the first hour attaining a maximal value of 31.3 ± 9.3 mU/ml. After this period, in the inflammatory exudates the activity tended to subside slowly, too. The results were compared with the findings of protein and cell content, and are discussed in connection with the participation of exopeptidases in the inflammatory process.

The effect selenium in the form of sodium selenite on central hemodynamic conditions and coronary artery flow was studied in pig hearts infarcted by a ligature of the ramus interventricularis anterior. Infusions of sodium selenite solutions at levels of 1-3 mg/kg body wt improved the survival of infarcted pigs. Both short-term and long-term protective effects of selenite could be demonstrated. It is of potential therapeutic importance that sodium selenite administration suppresses the electrical vulnerability of the cell membrane, notably the occurrence of ventricular late potentials in the ischemic border zone. Coronary blood circulation, as evidenced by an increase of heart rate and coronary artery dilatation and peripheral vasodilation was also improved. The pulsatile coronary blood flow thus is altered, increasing total perfusion of the infarcted heart. Initial observations with human subjects suggest that selenium deficiency is a factor in the pathogenesis of ischemic and arteriosclerotic heart disease. In 54 hospitalized patients with clinical diagnosis of acute myocardial infarction, serum selenium levels were 670 +/- 266 nmol/L, as compared to 981 +/- 209 nmol/L in 93 healthy controls. In 32 patients with general arteriosclerosis, the serum Se level was 375 +/- 85 nmol/L, in 64 patients with arteriosclerotic occlusional disease in the leg region, 366 +/- 85 nmol/L, respectively. Serum selenium levels of healthy subjects were found to be age- and sex dependent. In men, the selenium concentrations reached maximum levels of 1083 nmol/L in the 41-50 y age group. In women in the same age group, the serum Se level was 1385 nmol/L. Evidence is presented to suggest that selenium is preventing oxidative damage of heart cell membranes by lipid peroxidation.

In spite of the retrogression of the acute rheumatic fever the acquired valvular defects still play an essential role for the morbidity and mortality above all for the younger and middle decenniums of life. In the preliminary diagnostics it is the task of the family doctor to diagnose the valvular defect, to differentiate it from non-organic findings and to estimate its degree of severity. The diagnosis of a carditis renders special difficulties, particularly in its chronic recurrent form. Certain situations of life do not demand only an actual analysis of the findings, but also an individual prognostic estimation. For the choice of profession, the ability for military service and driving a car general references and regularities must be taken into consideration. The indication to operation of the valvular defect is generally given in degree of severity and with restriction also in stage IV. A mitral stenosis is operated already in stage II, when stronger complaints and haemodynamic changes are present. Patients with degree of severity III and IV should avoid a pregnancy, in stage I and II under common control by the internist and obstetrician the pregnant patient may not have any scruples to carry to full term.

The severity of the functional obstruction of the outflow tract of an idiopathic hypertrophic subaortic stenosis is essentially determined by the contractility of the myocardium, the left-ventricular volume and the peripheral vascular resistance. Though in the acute experiment a clear reduction of the degree of stenosis by beta-receptor-blockers may be proved the long-term results of such a therapy are unsatisfactory, particularly in patients with obstruction in rest. The use of calcium antagonists seems to promise more favourable results. The progression of the disease is, however, scarcely influencible by pharmacological measures alone. Nitrobodies are not suitable for treatment and glycosides should be used only within a manifest insufficiency of the left heart. An effective reduction or removal of the ventriculo-ventricular pressure gradient as well as a decrease of the left-ventricular telediastolic pressure may be achieved on operative way. There is an indication to this, when the complaints increase despite medicamentous therapy. At present the transaortic myotomy under use of the heart-lung-machine is regarded as most favourable method. A simultaneous or only substitute of the mitral valve should be restricted only to those cases which, apart from the functional, still show an organically conditioned insufficiency of the mitral valve. The early and late results of the palliative surgical interventions are very favourable in experienced centres. However, secure long-term prognoses may not yet be derived from this.

By means of coronarography in the most favourable case only the morphology and function of the vessels up to a diameter of 0.1 mm may be established. By the selective coronary perfusion scintigraphy this gap is closed, for it allows a judgment also of the terminal vascular system of the myocardium. The basis of this method is an occlusion of the arterioles and capillaries by radioactively labelled microspheres, in which case, however, only every 10,000th to 20,000th vessel is embolized for a short time. Thus the proper selective perfusion scintigraphy is for the patient a procedure which is not stressing, which, however, demands a sounding of the coronary vessels. On the basis of our own previous results this investigation method is indicated in the diagnostics of the ischaemic heart disease also in its atypical form, in the indication to the vascularisation operation with aortocoronary bypass and its postoperative control as well as in the cardiomyopathies. Also in load examinations and in pharmacological tests by their use as double nuclide method an enlarged information can be got. The importance of the perfusion scintigraphy is among others shown in patients with normal coronarogramme, but with perfusion disturbances which can be proved by means of this method. The most comprehensive invasive diagnostics in the diseases mentioned is at present achieved by the combination of coronarography, ventriculography and selective perfusion scintigraphy.

The pacemaker therapy of tachycardiac disturbances of rhythm used a great number of different methods which are applied according to the kind of disturbance of rhythm. A specialised intracardiac diagnostics is frequently necessary in order to select the suitable stimulation technique. A short survey of the different technical stimulation methods is given which are known from literature and for which own experiences are present. In the perspective a high value is ascribed to the pacemaker therapy in tachycardias.

The findings of the scintigraphy of the myocardium with Technetium-99m-diphosphonate (Tc-99m-DP) of 45 patients with nearly exclusively ischaemic heart disease were compared with those of the selective coronary angiography and those of the selective coronary perfusion scintigraphy. 12 patients exhibited an enlargement of the activity in the myocardium (positive scintigramme). These cases were particularly described in this paper. The levocardiogramme proved disturbances of the motility of the walls in 6 patients. In 5 patients a positive scintigramme of the myocardium was registered. Therefore, the scintigraphy of the myocardium with Tc-99m-DP is regarded as a supplementing, non-invasive method for the diagnosis of more pronounced disturbances of the motility of the heart wall. Furthermore, positive scintigrammes of the myocardium were registered in angina pectoris, condition after aorto-coronary bypass-operation, cardiomyopathy and myocarditis. Since the scintigraphy of the myocardium with Tc-99m-DP is a sensitive method for the poor of cell lesions of the myocardium, it allows a judgment of the floridity of the myocardial process. From this among other results that the scintigraphy of the myocardium may be a help for the indication to the aorto-coronary bypass operation. Clear relations between the scintigraphy of the myocardium, the number of the coronary-sclerotically changed heart vessels and the development of stenosation are not to be established. An immediate connection between the size of the disturbance of the perfusion and the results of the scintigraphy of the myocardium is also not to be recognized.

Locally retarded depolarizations of the ischaemic myocardium are regarded as frequent trigger mechanisms of dangerous ventricular arrhythmias. Up to now, however, there are scarcely systematic investigations concerning their concrete developmental conditions in man, since late potentials can be made evident only by means of expensive invasive methods or signal mediation techniques. Therefore, an animal model should be built, which is suitable for the control of new therapy conceptions with antiarrhythmic drugs. The investigations were performed on 22 pigs in whom under insufflation anaesthesia altogether 10 pressure, flow and contractility parameters as well as 6 epicardial ECG signals were continuously recorded. The episodes of ischaemia were caused by LAD occlusions of different duration and intensity. Typical late potentials could be registered in 5 animals who all had survived complete interruptions of the coronary blood flow of longer than 10 min. The mean duration of the late potentials was 20 +/- 9.2 ms, their amplitudes reached from 150 to 600 microV. Also with regard to time and cycle constancy, the delay of the late Q-potential and the morphology they corresponded to the homogeneous phenomenon, known from man. They always could be derived only from electrodes outside the immediate zone of ischaemia. Neither partial occlusions nor complete interruption of the coronary blood flow in intervals shorter than 10 minutes led to the development of a late potential. The animal model used altogether appears very suitable to investigate the medicamentous influencibility of arrhythmogenic areas of the myocardium under direct control of the dynamic behaviour of ventricular late potentials.

In Lyell's syndrome a toxic skin erythema is concerned which leads to the epidermal necrolysis and desquamation. An infantile and an adult form are differed; the latter is usually induced by medicaments. Two patients with apparently medicamentously induced Lyell's syndrome are presented. The evoking medicaments were penicillin and thioacetazone. The two patients showed a severe course with an extensive affection of the body surface. The therapy with glucocorticosteroids, electrolyte substitution and local treatment of the skin lesions was successful in the two cases.

For the hypertrophic obstructive cardiomyopathy with left-ventricular pressure gradient in rest a causal therapy is nowadays not yet known. Therefore, it should be tested, in what respect from former observations over reductions of the pressure gradient by an untimely foreign excitation of the ventricles from the apex of the right ventricle a therapy principle can be derived. For this purpose out of a group of 84 patients by left-right heart catheterization, coronarography, computer cardio-tomography and scintigraphy of the myocardium 23 test persons with typical hypertrophic obstructive cardiomyopathy and a left-ventricular gradient in rest greater than or equal to 30 mm Hg were selected for the transitory electrostimulation. After placing of one electrode in the right atrium and another one in the right ventricle one after another a VOO-, VAT- and DOO-pacing were used. For the two last mentioned forms of stimulation as electronic atrio-ventricular retardation times 100, 40, 20, 10 and 5 ms were selected. With all three kinds of stimulation in 5 of the patients (group A) reductions of gradients greater than or equal to 51% and in 12 cases of hypertrophic obstructive cardiomyopathy (group B) diminishments between 30 and 50% could be obtained. Only in 6 patients (group C) reductions of less than or equal to 29% were registered. The optimum of prematurity necessary for obtaining maximum pressure reductions is individually different, but is almost in every case between 5 and 20 ms. Further seven parameters measured during the stimulation phases showed that these reductions are not caused by a decrease of the stroke volume, but by an enlargement of the effective opening of the outlet. Apparently, in a part of the patients with hypertrophic obstructive cardiomyopathy by the foreign excitation from the apex of the ventricle a temporary and spatial course of excitation can be induced, by means of which the degree of functional stenosing is decreased. Since for several patients the removal of the disturbance of the systolic function is to be regarded as therapeutically reasonable partial success, the transitory diagnostic pacing is recommended for all patients with typical hypertrophic obstructive cardiomyopathy and a gradient in rest greater than or equal to 30 mm Hg. The indications and technical prerequisites for a permanent electrostimulation with suitable systems are represented.

It is reported on the selective coronary perfusion scintigraphy in 47 patients with angina pectoris and condition after myocardial infarction, which was performed simultaneously with the coronary angiography. For the paper were interesting the cases with normal coronarogram, but pathological perfusion scintigram. 3 of 25 patients with condition of infarction showed coronarographically inconspicuous vessels. In all cases the perfusion scintigram shows disturbances of regional perfusion, which corresponded with the electrocardiographic localisation of the infarction. In 3 of 22 patients with angina pectoris with normal coronarogram in the scintigram regional changes of the terminal vascular system were established. In 2 cases simultaneously a disturbance of rhythm and stimulus conduction was present, which showed a conspicuous correlation to the perfusion lesions in the septum. In the small intramural vessels haemodynamically effective changes take place which are below the coronarogram. Therefore, the only coronarography is not enough to confirm or to refuse a genuine angina pectoris or an infarction. The selecitve coronary perfusion scintigraphy gives the possibility to prove disturbances of the distribution of regional blood supply without a greater additional load of the patient as to coronary angiography. However, it cannot give evidence on the genesis of disturbances in the terminal vascular system in the normal coronarogram

On the basis of 6 own cases, 5 of which were observed during one year, the clinical picture, the diagnostics and the therapy of the arteriovenous pulmonary fistula are described. Of decisive diagnostic importance is the angiography of the pulmonary artery which should always be used for the clarification of unclear pulmonary foci as well as clinically unclear cyanosis. For the removal of this shunt connection in the lesser circulatory system therapeutically only the operation comes into question. On account of the threatening complications and the inclination to the dilation of the fistula with growing age it is indicated also in cases with only slight haemodynamic effect. Dependent on the anatomical position of the fistula the ligature of the afferent artery is recommended.

The usability of the continuous ultrasonic Doppler-method for the measurement of the blood flow in the haemodynamic animal experiment was tested. For this purpose measurements at the ascending aorta and the commune carotid artery were performed on different current conditions and compared with the electromagnetically registered blood flow. The causes for the non-conformity are discussed.

For the reduction of the functional obstruction of the left-ventricular outflow in hypertrophic obstructive cardiomyopathy since 1978 in selected cases conventional VAT cardiac pacemakers with shortened AV retardation time have been implanted. On the basis of 4 casuistics the insufficient adaptation of these systems to unexpectedly appearing disturbances of the cardiac rhythm is demonstrated. Thus already extreme sinus bradycardias lead to parasystole by the unchangeably given asynchronous basic frequency of the pacemakers. Furthermore, all tachycardiac supraventricular arrhythmias and retrograde atrium activations evoke haemodynamically unfavourable and partly even threatening ventricular tachycardies caused by the pacemakers. Control ECG made under these conditions are frequently inexactly interpreted by the continuing intact natural AV conduction and technical defects of the pacemakers are assumed. The individual diagnostic steps necessary for the assessment of the function of the devices and the inevitable immediate therapeutic measures are, therefore, explained. Finally the demands to more modern differentiated physiological pacemaker systems are derived which should be used in patients with hypertrophic obstructive cardiomyopathy.

In the last three years, of a total of 617 patients undergoing surgery for ischemic heart disease, 53 were women (8.6%). With one exception, all were in or shortly before the menopause. As compared with men, the women were found to have a preponderance of risk factors. The most unfavorable combination, that of hypertension and hypercholesterolemia, was present in one-third of the patients. Hospital mortality for isolated revascularization was higher in women at 4.9% than in men at 1.5%. The one-year survival rates, however, of 94.4% and 95%, respectively, did not differ between the two sexes. In women, the number of grafts per patient was 2.1 as compared with 2.9 in men. Complete revascularization was achieved less frequently in women than in men; similarly graft patency rate at one year of 66% in women was less than the 84% observed in men. The more marked coronary sclerosis as well as morphologic characteristics of coronary arteries in women construe a special challenge to the surgeon and prerequisite a high degree of technical skill.

The influence of hyperthyreosis on the cardiac function was investigated by means of non-invasive methods (radiocardiography, echocardiography, Tc-99m- und Tl-201-scintigraphy of the myocardium) and invasive methods (coronary angiography). Independent of age an increase of the frequency was always existing, a significant increase of the filling of the ventricle, of SI and HI was shown only by younger patients. With the help of the echocardiography local and global disturbances of kinetics, by means of the Tl-201-scintigraphy of the myocardium disturbances of the myocardial perfusion could be proved. For the circulating plasma catecholamines noradrenalin, adrenalin and dopamine values were established lying in the lower region of the normal. The effects of an increase of the thyroid hormone on the number and/or sensitivity of the membrane-bound beta-adrenoceptors of the heart as well as the independent of its effect of the SDH on the obtaining of myocardial energy are discussed.

For the practicing physician the medicamentous treatment of the patients with infarction is the main problem of the secondary prevention in the prehospital phase as well as in the after-treatment. In these cases in the acute phase not the myocardial insufficiency is in the centre of the out-patient care, but the therapy of the disturbances of cardiac rhythm, which mainly cause the high lethality in the early phase. Therefore, uncomplicated infarctions, in whch care must be taken only for a sedation of sympathico-adrenergic reactions and a volume reduction of the heart, should be differed from complicated cases. However, an immediate transport to the hospital must be guaranteed. If there appear a contraction insufficiency of the left ventricle or threatening disturbances of the rhythm, additionally glycosides and saluretics must be administered as well as an aimed antiarrhythmic therapy must be initiated. The necessary medicamentous measures are described dependent upon the diagnosis of brady- and tachycardiac disturbances of the rhythm. The author enters briefly the problems of volume substitution, treatment of acidosis as well as the administration of beta-sympathicolytics and gluco-corticoids. - In the after-treatment of infarctions anticoagulants are the only medicaments to be prescribed, when findings completely without complications are present. If, however, there are signs of activity of the coronary heart disease in the post-infarction phase, a basic therapy with a glycoside and anticoagulants as well as an individually to be varied additive therapy with nitro-preparations, beta-sympathicolytics, saluretics, anti-hypertensive agents and antiarrhythmic agents are necessary.

10 patients with hyperlipoproteinaemia and 4 normolipaemic smokers with angiographically proved arteriosclerosis of different degrees of severity were infused in 2-week intervals 100 ml HDL-rich Cohn-IV-1 fractions each. After the infusion for 5 days essential phospholipids were injected and a permanent medication with cholestyramin and a choleretic drug were prescribed. In the patients with HLP increases of concentration, decreases of concentration, constancy of the plasma lipids and apoproteins independent of the phaenotype of the HLP as well as an improvement of the state of the antioxidant state were observed. In 6 of 10 patients in reproducible vascular areas regressions of athero- und arteriosclerotic findings could be made evident. Progressions were not observed also in extremely changed arteries in contrast to the normolipaemic smokers and the patients of the control group.

Idiopathic hypertrophic subaortic stenosis is a noncompensatory hypertrophy of the myocardium which above all concerns the ventricular septum in its upper part near to the basis. The etiology is not yet sufficiently clarified, though a genetic component is regarded as ascertained on account of the proved familial accumulations. Haemodynamically the morphologic changes effect a systolic obstruction of the left-ventricular outflow, an insufficiency of the mitral valve and an aggravated diastolic filling of the left ventricle. Further pathophysiological symptoms of the functional subaortic stenosis are an extremely rapid ejection of blood in the early, not obstructive phase of the systole as well as a pathological forward movement of the mitral valve beginning in the midst of the systole. The disease has a bad prognosis. To be sure, the natural course is usually characterized only by a slow progression of the complaints, however, particularly in adolescents frequently sudden cases of death appear by disturbances of the cardiac rhythm or a relative coronary insufficiency. The disease which is already frequently to be diagnosed according to anamnesis, auscultation, ECG and form of the pulse curve may be ascertained using the ultrasound echocardiography as well as heart catheterization including angiography. Apart from a direct measurement of the ventriculo-ventricular pressure gradient during wuch examinations the size of the functional obstruction may further be characterized by certain pharmaca or physical methods which influence the volume of the ventricle or the afterload.

Among 2,353 coronary angiographies (from 1.10.1984 until 30.9.1987) four lethal cases were seen. In two cases there was evidence for a causal relationship between coronary angiography and the lethal outcome (0.9%). Possible mechanisms of death are discussed. The clinical course and the time sequence between coronary angiography and the death are considered to be important criteria of a causal relationship.

Left heart catheterisation, coronarography and conventional angiocardiography of the left ventricle (ACG) [30 degrees right anterior oblique; 45 ml contrast medium (Visotrast) with a flow of 12 ml per sec.] was performed in 86 patients with coronary heart disease. Additionally intraventricular digital subtraction angiography (DSA) was performed, using a Philips-device (DVI 2 CV). For DSA 15 ml contrast medium (Visotrast) was injected with a flow of 8 ml per sec. 73 examinations were selected for the study. The aim of the study was to compare the usefulness and applicability of ACG und DSA for ventriculography. There were no significant differences between enddiastolic (EDV) and endsystolic (ESV) volumes as well as ejection fractions (EF) determined by ACG and DSA. Results of the analysis of correlation were rEDV = 0.85;rESV = 0.93;rEF = 0.80. The increase of the end-diastolic pressure after ACG was determined with 7 Torr (mean), after DSA with less than 2 Torr (mean). According to these results we would prefer intraventricular DSA to conventional ACG, provided the technical equipment is available. This is concluded despite the fact that in single cases considerable differences were found between the volumes estimated by ACG and those determined by DSA. These differences were analysed in detail. The main advantages of the DSA are the by far smaller inconvenience for the patients, the rare occurrence of provoked extrasystoles and the fast and easy analysis of the ventriculographies by means of the implemented image processing programmes.