[Cerebral embolism as the first manifestation of left ventricular metastatic bronchial carcinoma]

Commonly the diagnosis of cardiac metastases in extracardiac cancer is difficult because of predominant symptoms of the underlying disease. In the reported case, a cerebral embolization was the first manifestation of a bronchogenic carcinoma with left ventricular metastasis. A 58-year-old male patient was admitted to the hospital with symptoms of an incomplete left-sided hemiparesis that occurred without prodromi. Other clinical abnormalities were not found. The two-dimensional echocardiogram showed a small space-occupying lesion in the left ventricle. Clinical symptoms completely disappeared within 3 days of heparin therapy. In order to prevent repeated embolization (after angiographic exclusion of coronary stenoses), the tumor was excised by cardiac surgery. In the histologic examination, malignant tumor cells were found. As primary origin, a small peripheral bronchogenic carcinoma with (clinically silent) additional metastases to the left adrenal gland and the right pelvic bone was found. The patient died 7 months later because of progressive metastatic cancer disease. Thus (on one hand) the reported case underlines the value of echocardiographic examination in suspected heart manifestation of cancer disease. On the other hand, in patients with heart tumors prior to curative therapy, additional diagnostic procedures (such as CT or MRI) should be performed in order to detect extracardiac tumor manifestations.

[Phonographic diagnostic aid in heart defects using neural networks]

New approaches to pattern recognition and modeling using neural networks also provide powerful tools for the analysis of heart sounds in the diagnosis of heart failure. This paper describes how a neutral network can be used to estimate the duration of systolic and diastolic heart phases as well as to suggest a suitable diagnosis. A neural network-based auscultation system is capable of documenting and analysing a heart sound signal by applying methods similar to those used by physicians in the subjective interpretation of stethoscopic signals.

[Prevention of effort-induced ventricular arrhythmia using verapamil]

In this study prophylactic antiarrhythmic effects of verapamil on exercise-induced ventricular arrhythmias were evaluated in a total of 22 patients. All patients displayed frequent and/or complex ventricular arrhythmias during repeated exercise tests under control conditions. After two control exercise tests, all patients were treated with 120 mg verapamil given every 8 h orally for 4 days. On the 3rd and 4th day of treatment the exercise tests were repeated. The results were that verapamil caused a significant reduction in the incidence and severity of exercise-induced ventricular arrhythmias in 13 out of 22 patients. In patients with concomitant significant ST-segment depression, a prophylactic action could be demonstrated in nine out of ten cases. The antiarrhythmic effect was independent of changes in heart rate. In patients with myocardial ischaemia, a reduction in myocardial oxygen consumption and direct electrophysiological effects (suppression of the "slow response" and/or an increase in the resting potential of the "depressed fast response") can be discussed as mechanisms of action. Also, a suppression of "triggered activity" or a direct inhibition of adrenergic effects must be considered. According to our results and the literature, calcium antagonists (verapamil type) proved to be suitable drugs for the treatment of exercise-induced ventricular arrhythmias, particularly in patients with concomitant myocardial ischaemia.

Antiarrhythmic effects of stirocainide in acute myocardial infarction

Ventricular arrhythmias, especially ventricular fibrillation, are assumed to be a main cause of sudden death during the first 24 h of acute myocardial infarction. Effective prophylaxis and acute suppression of these life-threatening rhythm disturbances are a major therapeutic problem. The present study was undertaken to investigate the efficacy of the new antiarrhythmic compound stirocainide (2-(1-benzylidene)cycloheptenimino-oxyethyl-diisopropylamine -2-butenedionate, Th 494) in suppressing "2nd phase arrhythmias" arising from large anteroseptal myocardial infarctions using a standardized experimental canine preparation. Our results demonstrate that "2nd phase arrhythmias"--i.e. frequent ventricular ectopics, tachycardias, salvos, and R-on-T phenomena--are reduced by 80-90% (sometimes even completely abolished) by stirocainide (dose: 4 mg/kg within 3 min, followed by 300 micrograms/kg X min over a 20-min period). The administration of the drug at the dose used does not produce severe cardiodepression, but intraventricular conduction time is significantly prolonged. Thus, Th 494 is a highly effective antiarrhythmic agent in acute myocardial infarction, and further experimental and clinical investigations on its antiarrhythmic and antifibrillatory properties may lead to beneficial therapeutic results.

[Effects of sulfinpyrazone on early ventricular fibrillation and 2d-phase arrhythmias in acute myocardial infarction (author's transl)]

Clinical and experimental studies indicate that ventricular arrhythmias, mainly ventricular fibrillation, are responsible for sudden cardiac death. A recent double-blind multicenter trial ("Anturane Reinfarction Trial") showed that the incidence of sudden cardiac death was reduced in Sulfinpyrazone-treated patients after acute myocardial infarction compared with the placebo group, although the rate of reinfarctions was not diminished. We investigated the efficacy of Sulfinpyrazone on the reduction and prevention of ventricular arrhythmias and primary ventricular fibrillation, utilizing a standardized experimental canine preparation. At normal therapeutic and at high cumulative doses of the drug, a reduction in ventricular arrhythmias within the first 24 hours after coronary occlusion could not be observed. Sulfinpyrazone failed also to alter the ventricular vulnerability to fibrillation in the very early myocardial infarction period. Furthermore, haemodynamics, contractility and oxygen consumption of the heart were not changed. These experimental findings show that the reduction in sudden cardiac deaths in Sulfinpyrazone-treated patients cannot be attributed to antiarrhythmic effects of the drug. Further research is needed to delineate the mechanism of action of Sulfinpyrazone as reported by the Anturane Reinfarction Trial Research Group.