[Ventricular aneurysm and coronary heart disease. Pathophysiology, differential therapy, and postoperative haemodynamics (author's transl)].
In the course of coronary heart disease an aneurysmal dilatation of the left ventricle may occur. This may be an additional risk for the patient by changed haemodynamics. Depending on the extent of the aneurysm and the contractile potency of the remaining myocard the cardiac compensation may be sufficient. A reduction of the pump efficiency is not necessarily the consequence. In case there is an increasing cardiac insufficiency by means of a pathologic ventricular filling pressure pulse, the best therapy is digitalis in combination with a reduction of volume by sodium-selective diuretics. Under same haemodynamic conditions the treatment of angina pectoris consists of long acting nitrites in combination with a betablocking agent having some intrinsic activity. Special care for the choic of medicaments has to be taken in relation to the sufficiency of the remaining myocard, if an antiarrhythmic therapy is necessary. If there is no stabilisation of the haemodynamic parameters by conservative therapy, the left ventricular function is meliorated by surgical aneurysmectomy. The data demonstrate, that under resting condition a normalisation and under exercise condition at least a melioration of pulse pressure and circulation is achieved after resection of the aneurysma. A small but measurable decrease in cardiac output under exercise condition is the consequence of a persisting cardiodepressive effect due to the operation.
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000188:drug therapy; D003327:Coronary Disease / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D004071:Digitalis Glycosides / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006322:Heart Aneurysm / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D006352:Heart Ventricles; D006439:Hemodynamics; D006801:Humans; D008134:Long-Term Care; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D009573:Nitrites / Q000627:therapeutic use; D011182:Postoperative Care
D000319:Adrenergic beta-Antagonists; D004071:Digitalis Glycosides; D009573:Nitrites
Ventrikuläre Aneurysmen bei koronarer Herzkrankheit. Pathophysiologie, Differentialtherapie, postoperative Hämodynamik