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Transthoracic echocardiography (TTE) is a practical and widely used tool for risk stratification in pulmonary arterial hypertension (PAH). We hypothesized that right atrial (RA) reservoir function, represented by peak RA systolic strain, correlates with invasive hemodynamic measurements and clinical outcomes in PAH. Patients with group 1 PAH who had TTE within 6 months of index PAH clinic visit and right heart catheterization were included in this retrospective study. Peak RA strain in the 2D apical 4-chamber view was measured with speckle-tracking software. The primary endpoint was a composite of prostacyclin initiation, lung transplantation, and death. RA strain was also measured in healthy control subjects. Among the 37 patients studied, 25 (68%) met the primary endpoint. RA strain was significantly lower among patients who met the primary endpoint than among those who did not (mean 20% vs. 33%, P = 0.002). Strain was lower in PAH patients than in controls (mean 24% vs. 35%, P = 0.0001). RA strain correlated negatively with hemodynamic data including RA pressure (R = -0.31), mean pulmonary arterial pressure (R = -0.33), and pulmonary vascular resistance (R = -0.39), and positively with cardiac index (R = 0.44). In receiver operating characteristic analysis to distinguish between patients meeting the primary endpoint and event-free survivors, RA strain was not significantly different from RA volume, right ventricular (RV) fractional area change, RV basal diameter, or right ventricular systolic pressure (area under the curve 0.82, 0.81, 0.83, 0.86, and 0.97, respectively). Our results demonstrate that RA strain is predictive of clinical outcomes in PAH. Further research is needed to determine if RA strain is independently associated with outcomes in this population.

In 450 patients of a guarded ward for coronary diseases apart from the 15 conventional ECG-leads three corrected orthogonal leads after Frank were registered. In 141 cases an infarction could be confirmed. Using an observation of the course a recognition of the infarctions was always possible in the conventional as well as the corrected orthogonal ECG. In not penetrating infarctions a very careful analysis of the electrocardiograms and of the controls of the course is necessary, since the changes of the final ventricular deflection in the corrected orthogonal deviation system are less expressed than in the conventional leads. Thus, the corrected orthogonal electrocardiogram seems to be suitable for screening investigations concerning the recognition of a myocardial infarction.

It is reported on a left-atrial myxoma in a 20-year-old patient with atypical symptomatology of the mitral stenosis, unspecific general symptoms and lethally finishing embolisms and on the basis of the course the problems of the differential diagnosis and of the complications are shown.

A longitudinal (time series) study was performed (N = 20 students; T = 16 points of observation during 8 weeks) on a considerable number of psychological and physiological variables to investigate the suitability of these parameters for general and individual state change description. Some problems of correlational analysis and the generality-individuality-dilemma of this kind of research are discussed.

On 9 patients with acute myocardial infarction the influence of talinolol (cordanum) on haemodynamic parameters in intravenous administration and after this in oral application was examined. Talinolol led to a slight decrease of the heart rate, of the arterial blood pressure and of the cardiac output as well as to a more distinct reduction of the contractility in nearly uninfluenced left-ventricular filling pressure. In comparison to a conventionally treated control group (n = 11) the decrease of the heart rate as well as of the contractility was somewhat more distinct. The changes found are to be explained in the sense of a heart exoneration. In one patient possibly by talinolol a deterioration of the pumping function developed 56 hours after the acute event. In another patient a depressive effect on the sinus node is not to be excluded. Ventricular fibrillation and disturbances of the atrioventricular conduction did not appear in contrast to the control group. The influence on supraventricular and ventricular cardiac dysrhythmias was distinctly favourable in other 9 patients with acute myocardial infarction despite clinical signs of cardiac decompensation. Only in one patient a further deterioration of the pumping function developed despite control of the disturbance of rhythm. According to the experimental and up to now existing clinical experiences beta-receptor blockers are indicated above all in the early phase of the acute myocardial infarction, if shock, acute heart insufficiency and bradycardiac disturbances of the heart rhythm are not existing. Here paticularly at the beginning of the therapy is a proved change in the first 2-4(-8) hours to prevent the expansion of the infarct size or the onset of large infarctions.

Since 1972 6 patients (4 males and 2 females) at the age from 18 to 44 years with myocardial infarctions could be observed whose coronary system in the subsequent coronarographic examinations proved to be unconspicuous. The diagnosis of the infarction was anamnestically, laboratory-chemically, electrocardiographically and partly scintigraphically ascertained. Issuing from features of infarction and pseudoinfarction, respectively, in the ECG other differential-diagnostically important cardiac and extracardiac causes could be excluded. In comparison to patients with coronary sclerosis typical symptomatology could not be delimited. Peculiarities of the clinical picture are the juvenile age, the in most cases short or lacking angina pectoris anamnesis, the frequent lack of factors of risk and the inclination to disturbances of rhythm. Up to now a satisfying etiologic clarification could not be rendered. The relevance of the different possibilities of the disturbed equilibrium between O2-offer and -need concerning the clinical course of our patients is discussed. Here on the side of the O2-offer the spasm of the big and small vessel and the disease of the small vessels are regarded as decisive factors of the development of the infarction, where as the coronary embolism with subsequent lysis is less to be taken into consideration. Other pathogenetic mechanisms, such as the pathologic Hb-O2-dissociation and the metabolic changes influencing the O2-need must be included into the causal chain of this presumably polyetiologic process. Prognostic and therapeutic aspects which closely correlate with the etiologic explanation are discussed.

As a result of an adjustment of the experiences which were made in four clinics with the electrotherapy of life-threatening disturbances of rhythm in acute myocardial infarction recommendations for the use of this therapy are given. The value of the various methods of electrotherapy compared with medicamentous treatment are elaborated.

The authors indicate the possibility of an "Isolated Ultrafiltration" in cardiologic patients only with the transportable blood conducting part of the artificial kidney. The loss of oedema fluid by ultrafiltration of the blood is about 500 ml/h using a twin coil dialysator "Keradenta", or, resp., more than 1,200 ml/h using a Hollow Fibre Artificial Kidney "Dow Cordis" Mod. 5 or two HFAKs Mod. 4 in parallel. The method should be practised only in such cardiologic patients, in whom a drug-resistent hyperhydration including hypervolaemia is not a sign of a sure terminal state.

It is reported of acute beta-blocker intoxications in 34 patients (16 with talinolol, 18 with propranolol ingestion). The mean ingestion dose was for talinolol 2.5 g, for propranolol 1.55 g, the mean time of latency up to the appearance of intoxication symptoms 116 min after intake of talinolol, 79 min after intake of propranolol. The picture of intoxication was characterized in the two substances by the antiadrenergic effects, there was no more a cardioselectivity in the high ingestion doses. In talinolol were in the first place dysrhythmias, hypotension and vomiting and nausea, respectively, in propranolol central-nervous symptoms and hypotension. Substance-specific intoxication symptoms are also possible. In mixed intoxications alcohol accelerated the beginning of the effect, sedatives prolonged the latency. Threatening of life is to be expected in ingestion doses over 2 g. In 6 patients the course was lethal after extreme doses of talinolol - according to the present experiences due to the too late beginning of therapy and/or insufficient intensity of therapy. Distinct intoxication symptoms need extremely high applications of antidotes of beta-stimulants, in their inffectiveness glucagon. Furthermore, treatment with cardiac pacemakers and 24-hour control in an intensive care unit proved necessary.

It is reported on two rare complications occurring in the pulmonary catheterisation with long-term control of the pressure of the pulmonary artery. In case 1 in confluenting bronchopneumonias the formation of an abscess in the region of the point of the catheter developed, in which case by the infusion therapy with very peripheral position of the catheter local lesions are very probable. In case 2 the catheter via an atrial septum defect passed into a pulmonary vein in PCA-position. A haemorrhagic infarction of the lung developed. In the two cases after removal of the catheter and adequate therapy the pulmonary complications healed.

The frequency of the electric heart death in the early phase of the acute myocardial infarction demands a prophylactic use of antiarrhythmic remedies. In a guarded ward for coronary diseases since 1972 all patients with a fresh myocardial infarction or suspicion of infarction were treated with a continuous intravenous lidocain drip in a dosage of 100 mg/per hour for 48 hours. In 266 patients in a certain examination period ventricular fibrillation was observed only once and ventricular tachycardias twice. In accordance with literary data the prophylatic medication of lidocain gives an effective defence against threatening disturbances of the ventricular rhythm. The indications for a passagere electrostimulation in bradycardiac disturbances of rhythm associated with acute myocardial infarction are demonstrated.

It is reported on the use of an intraarterial infusion therapy by means of indwelling catheter in arterial obstructive disease. The catheters were shoved forward towards the opposite side in Seldinger's techinque under X-ray control antegrade and retrograde through the bifurcation of the aorta. The infusions were performed during several hours with above all metabolically effective substances in combination with various antibiotics. The simultaneous use of aimed surgical measures is to be aspired too. In 6 out of 8 cases a healing of the necroses could be achieved.