A 67-year-old woman without history of heart disease was admitted with chest oppression. Her electrocardiogram (ECG) at the time of admission showed ST segment elevation in leads V2–V6. Cardiac ultrasound revealed severe hypokinesis in mid to apical portion of anterior wall. Emergent coronary angiography showed normal coronary arteries. Left ventriculography (LVG) revealed akinesis of mid portion of anterior and inferior wall with hyperkinesis of apex and basal portion of anterior and inferior wall. Cardiac ultrasound examination 3 months later revealed improvement in LV contraction without mid-ventricular akisesia. The LVG performed 6 months later showed no focal asynergy. In I-123-beta-metyl-iodophenyl pentadecanoic acid myocardial scintigraphy the discrepancy of uptake between apical and anterior and inferior wall of mid region (more uptake in apex) was reduced. Using I-123-meta-iodobenzyl-guanidine myocardial scintigraphy in acute phase, decreased uptake in the mid portion of anterior and inferior to lateral wall was seen in early and delayed images and that persisted through 6 months. As these findings resembled those of Takotsubo cardiomyopathy other than affected region, it is possible to say that basically they belong to same entity of disease but they are different in their phenotype.

The ability of body surface potential mapping to localize coronary arterial narrowings during exercise stress testing was investigated. An array of 48 chest wall electrodes, simultaneously recorded, was used. Digital filtering and signal processing, data reduction techniques and discriminant analysis were applied to process the information. Forty patients whose coronary angiograms showed a single significant narrowing of either the left anterior descending or right coronary artery were selected for further study. On the basis of body surface potential mapping, the site of coronary arterial narrowing was correctly classified in 88% of the patients.

The main indication for PTCA is based on clinical symptoms. Therefore relief or improvement of angina and reduction of antianginal therapy are most important, although, subjective criteria of successful PTCA (short term and long term). As restenosis occurs in 20 to 33% (mostly within the first weeks) there is a need for an objective non-invasive indicator. A new positive stress test is highly specific but a negative test does not exclude recurrence, as its sensitivity is only 50 to 70% and depends on the degree and location of stenosis. An increase of sensitivity can be reached by a withdrawal of antianginal therapy, if tolerated. The knowledge of a pathological stress test before PTCA makes it much easier to judge new symptoms. Therefore it is generally accepted to do a stress test in all patients before and after PTCA and to compare both with the angiographical results. Scintigraphical methods have been reported to be more sensitive. Regional perfusion disturbances assessed by thallium-201 exercise scintigraphy and no increase of left ventricular ejection fraction during exercise, measured by a gated blood pool technique with technetium-99m, indicate restenosis. Both are not available in most hospitals and expensive. As the insufflation of the balloon produces complete coronary artery occlusion and regional well defined ischemia, we developed a mapping system with 63 x-ray transparent electrodes to detect the precordial region of ischemia according to the occluded vessel. These data provide important information of precordial regions with ischemic ECG changes and hopefully improve the sensitivity of ECG exercise tests. In conclusion, the use of clinical symptoms in conjunction with ECG and myocardial scintigram acquired during exercise provide a lot of information but can not substitute angiogram, if there is any suspicion of restenosis.

Anhand zahlreicher kontrollierter Studien konnte bewiesen werden, daß die Intracoronare Thrombolysetherapie beim akuten Myokardinfarkt in der Lage ist.dle Infarktgröße zu begrenzen und die Langzeitprognose zu verbessern. Der hohe apparative und personelle Aufwand der Intracoronaren Throntolyse sowie die Entwicklung neuer.ralt geringeren Nebenwirkungen verbundener Throrabolytika führ t jedoch in zunehmenden HaSe zur systetnischen Thrombolysetherapie des akuten Herzinfarktes. Während bei der intracoronaren Lyse eine Kontrolle des Therapieerfolgs unmittelbar angiographisch erfolgt.wird man bei der systemischen Behandlung zuna'chst auf nicht1nvasive.Methoden zurückgreifen wollen.Zur sicheren Beurteilung der ReperfusIonsrate bietet sich das Elektrokardiogramm mit 63 Brustwandableitungen an ("prücordiales mapplng"). In der vorliegenden Arbeit wurde bei Patienten mit akutem transmuralem HyokardInfarkt der Zusammenhang .zwischen dem Reperfusionsgrad und dem zeitlichen Verhalten der ST-Hebung im Elektrokardiogramm untersucht und wurden EKG-Kriterien einer erfolgreichen Thrombolysetherapie aufgestellt. Tabelle 1: Einschlußkriterie mit intracoronare für die Behandlung des akute« Streptokinase

The diagnostic facilities of electrocardiography have been improved in recent years by the application of computer systems. Compared to conventional ECG recording, advantages result from the increased number of electrodes possible (precordial mapping ECG) and facilities to record continuously during a long period of up to several days.