[Upright T-wave in V1 as predictor of significant coronary artery disease]. / Die positive T-Welle in V1 als Hinweis auf eine signifikante KHK.

HISTORY AND CLINICAL FINDINGS: The 56-year-old man came to our emergency department because of heartburn, chest tightness and sweating. Cardiovascular risk factors were obesity and hypertension. Clinical examination revealed no significant abnormalities. EXAMINATIONS: Laboratory results showed no pathologies except a slightly elevated creatinine (1,19 ng/dl). Troponin I ultra sensitive was negative (< 0,006 ng/ml), CK and CK-MB not elevated. The 12-channel-ECG revealed sinus rhythm with a heart rate of 68/min, a non-significant ST-elevation in V2 as well as elevated T-waves in V1 and V2. The T-wave in V1 was positive (> 0,15 mV) and bigger than the T-wave in V6. TREATMENT AND COURSE: The patient was monitored at our intermediate-care ward. The troponin level was checked again after about four hours and showed a troponin of 1,519 ng/ml (norm: 0,02 - 0,06 ng/ml). NSTEMI was diagnosed and coronary angiography was performed next morning, demonstrating coronary three vessel disease with 95 % occlusion of the left anterior descending (LAD). CONCLUSION: An upright T-wave in V1 can be an indicator for coronary artery disease (CAD). A bigger T-wave in V1 than in V6 can indicate CAD  with LAD  involvement. Therefore, in patients with thoracic pain and a positive T-wave in V1 cardiac ischemia should be considered.

Concentration of cyclic AMP in rat liver as a function of the insulin/glucagon ratio in blood under standardized physiological conditions.

The concentration of insulin and glucagon in peripheral blood and the concentration of cAMP in liver was followed in rats throughout a 48 hour starvation period and up to 6 hours afer refeeding glucose or casein. By so changing the insulin/glucagon molar ratio from minimum to maximum values, simultaneous inverse changes in the concentration of hepatic cAMP could be induced. The study, thus, suggests that during a starvation-refeeding cycle the level of cAMP in the liver is regulated predominantly by the insulin/glucagon ratio in the blood. Possible criticisms of this conclusion are discussed.