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Biomedical subjects

A Hjalmarson

Publications and source records attributed to A Hjalmarson.

At least 253 records · Page 14Linked to original sources

Time lapse from estimated onset of acute myocardial infarction to peak serum enzyme activity.

In 581 patients with acute myocardial infarction (MI), the time lapse from estimated onset of infarction to estimated peak serum (S) enzyme activity was evaluated. Heat-stable lactate dehydrogenase (LD; E.C. 1.1.1.27) was analyzed every 12 h for 48-108 h after arrival in hospital (n = 581) and creatine kinase (CK; E.C. 2.7.3.2.; n = 224), and creatine kinase subunit B (CK-B; n = 211) were analyzed every 6 h for 48 h. Peak S-LD was observed between 14 and 110 h after estimated onset of MI (mean 46.6 +/- 0.6 h), peak S-CK was observed between 8 and 58 h (mean 25.0 +/- 0.6 h), and peak S-CK-B was also observed between 8 and 58 h (mean 22.8 +/- 0.7 h) after onset. In 86% of patients, peak LD was reached within 60 h after onset of MI, in 78%, peak CK was reached within 30 h, and in 82%, peak CK-B was observed within 30 h after onset of MI. A weak correlation was found between duration of pain and time lapse to S peak enzyme activity (r = 0.25 -0.27; p less than 0.001), while there was no correlation between S peak activity and time lapse from onset of MI to S peak activity. It is concluded, that although in the majority of patients with MI, peak serum-enzyme activity is reached within a predictable amount of time after estimated onset of MI there is wide variation, difficult to establish from the clinical course, among individual patients.

Adult↗

Relationship between infarct size and incidence of severe ventricular arrhythmias in a double-blind trial with metoprolol in acute myocardial infarction.

In 585 patients having an acute myocardial infarction for the first time the relationship was investigated between estimated infarct size and the incidence of ventricular fibrillation and treated ventricular tachycardia during hospitalization. The size of the infarct was estimated from analyses of heat stable lactate dehydrogenase (LD) (EC 1.1.1.27.) in serum collected every 12 hr for 48-108 hr. All patients participated in a double-blind comparison of the beta 1-selective blocker metoprolol with placebo in suspected acute myocardial infarction. A correlation was observed between the enzymatically estimated infarct size and the incidence of ventricular fibrillation and treated ventricular tachycardia in patients on placebo (P less than 0.001), while this could not be demonstrated in patients on the beta-blocker (P greater than 0.2). In placebo treated patients there was a correlation between the maximum heat stable LD activity and early ventricular fibrillation (P = 0.034), late ventricular fibrillation (P less than 0.001), primary ventricular fibrillation (P = 0.002) as well as secondary ventricular fibrillation (P = 0.034). It is concluded that there seems to be a relatively strong correlation between the final size of the infarction and the occurrence of severe ventricular arrhythmias. Treatment with beta-blockade appeared to disturb this correlation.

Adult↗

Relationship between electrocardiographically and enzymatically estimated size in anterior myocardial infarction.

In 179 patients with anterior myocardial infarction the electrocardiographically estimated infarct size was related to serum enzyme activity. A precordial map containing 24 precordial positions and the peak activity of heat stable dehydrogenase (LD; EC 1.1.1.27) were used. A positive correlation was found between the area at risk (initial sum of ST-elevation) and the peak LD activity (r = 0.48 - 0.55; p less than 0.001). When the final Q-and R-wave amplitude were related to peak enzyme activity a better correlation was observed (r = 0.56 - 0.68; p less than 0.001). The sum of R-waves (sigma R) and the sum of Q-waves (sigma Q) in the 24 precordial leads were related to sigma R and sigma Q in five precordial standard leads. A good correlation was found between the two ECG methods (r = 0.75 - 0.83; p less than 0.001), indicating that an increased number of precordial leads gives information regarding the extent of infarction similar to that obtained with the routinely used standard leads. It is concluded that in the individual patient, serum enzyme activity and the final Q-and R-wave changes can give different information about infarct size. If, however, these two independent methods are used in a large number of patients in intervention studies they will probably give similar information about relative influence of the intervention on the mean infarct size.

Adult↗

The relationship between electrocardiographic changes and early mortality rate in acute myocardial infarction.

In 587 patients with acute myocardial infarction (AMI) and no previous MI, electrocardiographically estimated infarct size was related to three-month mortality. Mortality was found to be higher in patients with transmural MI (Q or R-wave changes in standard ECG) than in patients with subendocardial infarction (ST-T wave changes in standard ECG). In patients with anterior MI, precordial mapping with 24 chest electrodes was analyzed four days after arrival in hospital (n = 197). Neither the sum of R-waves, the sum of Q-waves, nor the number of Q-waves correlated significantly with early mortality, although there was a trend towards higher mortality among patients with more pronounced ECG changes. Finally, in patients with inferior AMI (n = 230), neither the sum of R-waves nor the sum of Q-waves in leads II, III and aVF on the fourth day influenced three-month mortality. However, when subtracting the sum of Q-waves from the sum of R-waves, there was a significant correlation between the estimated infarct size and the early mortality.

Acute Disease↗

Comparison of atrial pacing and the cold pressor test in patients with angina pectoris.

A haemodynamic and myocardial metabolic study was performed to compare effects of maximal atrial pacing and the cold pressor test (CPT) in patients with angina pectoris. Twelve patients (group I) had angiographically severe coronary artery disease, while 16 patients (group II) had normal coronary angiograms. At maximal pacing, angina developed in all patients in group I, and myocardial lactate production was found in eight of 12 patients. In group II, 12 out of 16 patients experienced chest pain, but only two patients had myocardial lactate production. Neither angina nor myocardial lactate production was present in any patient in either group during CPT. Coronary sinus flow increased and coronary vascular resistance decreased significantly in both groups at maximal pacing (P less than 0.001). At CPT, coronary flow decreased (P less than 0.05) and coronary resistance increased (P less than 0.001) in group I, while individual response was more variable in group II. In conclusion, maximal pacing was a more effective method of provocation of angina pectoris than CPT. The reactions of coronary sinus flow and coronary vascular resistance were different in group I than in group II. However, because of the variability of response in patients with normal coronary arteries, CPT cannot be used to distinguish patients with coronary artery disease from patients with no such disease.

Adult↗

Electrocardiographic changes and their relation to serum enzyme activity after heart surgery.

In 80 patients who underwent heart surgery the incidence of electrocardiographic (ECG) changes after the operation was analysed. A precordial grid containing 24 leads and leads II, III and aVF was used. Electrocardiographic measurements were taken the day before the operation and again 5 days after the operation. New Q-waves were observed in 2 patients (2.5%) in the 24 precordial leads, in 2 patients in leads II, III and aVF, and in one patient in both precordial leads and leads II, III and aVF. New T-wave inversions were observed in 20 patients (25%) in the 24 precordial leads, in 5 patients (6%) in leads II, III and aVF, and in 3 patients in both precordial leads and leads II, III and aVF. A similar serum enzyme activity was observed both in patients developing Q-waves as well as T-wave inversions compared with cases in whom ECG changes did not appear.

Adult↗

Effects of felodipine on systemic and coronary haemodynamics in patients with angina pectoris.

In order to study the systemic and coronary haemodynamic effects of felodipine, a new dihydropyridine derivative, 10 patients with coronary artery disease were studied during cardiac catheterization. Measurements were performed at rest and during pacing-induced angina pectoris. At rest, the heart rate rose from 70 +/- 20 to 78 +/- 20 (P less than 0.05), the systemic arterial pressure decreased by about 20% (P less than 0.01) and the cardiac index rose from 2.9 +/- 1.2 to 4.0 +/- 1.0 (P less than 0.05). The coronary sinus flow (CSF) increased about 50% (P less than 0.01). During pacing to the same heart rate as in the control measurements, felodipine induced similar changes in systemic haemodynamic values as in the resting position. Myocardial lactate extraction and ST segment depression were not significantly altered. After felodipine, the pacing rate could be further increased in 7 patients as compared with the control value. Both systemic and coronary effects were then very similar compared with those during the lower pacing rate. In conclusion, felodipine is a very potent systemic and coronary vasodilator with potential value in the treatment of hypertension and cardiac failure. The drug may also be of value in the treatment of ischaemic heart disease, but further studies with titration of optimal doses are needed in that respect.

Adult↗

Relationship between enzymatically estimated infarct size and short- and long-term survival after acute myocardial infarction.

In 585 patients with acute myocardial infarction (AMI) and no previous MI the maximal activity of serum heat-stable lactate dehydrogenase (LD) (EC 1.1.1.27) activity was related to 1-year and 2-year mortality rates. All patients participated in a double-blind trial with metoprolol during the first three months after an AMI. Thereafter both groups were treated in a similar way. A strong relationship was found between LD maximum activity and the in-hospital prognosis (p less than 0.001), the 1-year survival rate (p less than 0.001) and the 2-year survival rate (p less than 0.001). When the patients who were alive after primary hospitalization were analyzed as a separate group, the relationship between LD maximum activity and 1-year and 2-year survival rates remained (p less than 0.001). In a subsample of 171 patients the maximal activity of creatine kinase (CK) (EC 2.7.3.2) and CK subunit B did not correlate either with in-hospital, 1-year or 2-year survival rates. We conclude that, when a sufficiently large number of patients are investigated, there is a strong relationship between serum enzyme maximum activity and short- and long-term survival.

Adult↗

Relationship between the enzymatically estimated infarct size and clinical findings in acute myocardial infarction.

In 580 patients with a definite myocardial infarction (MI) and no previous MI, the enzymatically estimated infarct size was related to the clinical course including various complications. In all patients, heat-stable lactate dehydrogenase activity (EC 1.1.1.27, LD) was analyzed every 12 hours for 48-108 hours and in a subgroup (n = 170) creatine kinase activity (EC 2.7.3.2, CK) and creatinine kinase subunit B (CK B) were analyzed every 6 hours for 48 hours. The highest recorded enzyme activity was used as a rough estimate of infarct size. A positive correlation was found between serum enzyme activity and most of the clinical variables studied, such as incidence of congestive heart failure, treatment with furosemide, incidence of hypotension, cardiogenic shock, pericarditis, post myocardial infarction syndrome, AV block III, and the duration of hospitalization. We conclude that the enzymatically estimated infarct size determined by heat-stable LD, CK and CK B closely reflects the severity of the infarction.

Adrenergic beta-Antagonists↗

Effects of acute ketotic and non-ketotic diabetes on the myocardial muscarinic receptors.

Myocardial membranes from rats rendered diabetic with streptozotocin were used to determine muscarinic receptors with 3H-quinuclidinyl benzilate. In the acute state of diabetes, four days after induction, the density of receptors were equal in controls, insulin (glucosuria) and non insulin-treated (glucosuria and ketonuria) diabetic animals. In myocardial membranes from diabetic rats agonist binding to the muscarinic receptor was shifted to higher affinity than in controls. Computer modeling revealed that guanine nucleotides transformed agonist binding from two sites to a site of low affinity in controls. In membranes from insulin-treated diabetic animals the shift to lower affinity occurred but two receptor sites remained. In non insulin-treated membranes the nucleotides failed to exert any effect. Inhibition of adenylate cyclase by the muscarinic agonist oxotremorine was amplified in diabetic membranes. This indicates that the function of the inhibitory nucleotide binding protein (NI), as reflected by agonist binding to the receptor and adenylate cyclase inhibition, is sensitive to the hormonal status.

Adenylyl Cyclase Inhibitors↗

Effect of metoprolol on chest pain in acute myocardial infarction.

A total of 1395 patients aged 40 to 74 years were included in a double blind trial with the beta 1 selective blocker metoprolol in suspected acute myocardial infarction. Metoprolol was given intravenously (15 mg) as soon as possible after admission to hospital followed by 200 mg daily for three months. A placebo was given in the same manner. The severity of chest pain in the acute phase was calculated by recording the number of injections of analgesics given and the time from the start of blind treatment to the time when the last analgesic was given (duration of pain). The patients receiving metoprolol were given a lower mean number of injections of analgesics during the first four days and after randomisation than those receiving a placebo. The estimated duration of pain was shorter in the metoprolol group than in the placebo group. These effects were related to the initial heart rate, the initial systolic blood pressure, and the final site of the infarct as determined electrocardiographically. Thus metoprolol given in the acute phase of suspected or definite myocardial infarction appears to reduce the severity of chest pain.

Adult↗

Development of congestive heart failure after treatment with metoprolol in acute myocardial infarction.

In a double blind study of metoprolol in the treatment of suspected acute myocardial infarction 698 patients (study group) received metoprolol and 697 a placebo (control group). Metoprolol was given in an intravenous dose of 15 mg as soon as possible after admission to hospital followed by 50 g by mouth four times a day for two days and thereafter 100 mg twice a day for three months. A placebo was similarly given. Congestive heart failure occurred in a similar percentage of patients in both the study (27%) and the control groups (30%). Its severity was estimated by calculating the total dose of frusemide given during the first four days in hospital. Less frusemide was given to patients treated with metoprolol compared with those given a placebo in the total series. An appreciably lower total dose of frusemide was given to patients included in the trial less than or equal to 12 hours after the onset of pain and treated with metoprolol compared with a placebo, while no difference was seen among patients treated later. The initial heart rate, systolic blood pressure, and infarct site affected the results.

Adult↗

The use of the EEG for assessment of vigilance changes caused by beta-blockers.

The aim of this study was to investigate the changes of vigilance caused by beta-blockers. A recently developed method to measure the vigilance fluctuations, based on the EEG spectra, was employed together with self-rating. Repeated vigilance measurements were made in 20 healthy volunteers before and after administration of placebo, propranolol and metoprolol in random sequence. Both EEG analysis and self-rating confirmed that the vigilance level was significantly decreased after administration of beta-blockers compared to placebo. No significant difference between propranolol and metoprolol could be found. The results suggest that the decrease in systolic blood pressure after beta-blockade may be responsible for the drug-induced drowsiness. However, some of the observations made in the study can be interpreted as indirect proof that central mechanisms are also involved, and that both propranolol and metoprolol have sedative properties comparable to those observed with conventional psychotropic drugs.

Adult↗

Enzymatically and electrocardiographically estimated infarct size in relation to pain in acute myocardial infarction.

In 563 patients with acute myocardial infarction and no previous myocardial infarction, the estimated infarct size was related to the estimated duration of pain and the amount of analgesics given. The size of infarction estimated from analyses of heat-stable lactate dehydrogenase (EC 1.1.1.27) at 12-hour intervals for 48-108 h and from Q- and R-wave changes in the ECG correlated positively, although weakly with duration of the pain and the amount of analgesics given. These data support the hypothesis that larger infarcts, as a group, evolve over a longer time period than smaller infarcts and that the duration of pain in many patients might be an indicator of the infarct size. In the individual patient, however, one cannot predict the size of the infarction from the severity of pain.

Adult↗

Spectral scan of Orion A and IRC+10216 from 72 to 91 GHz.

The spectra of the Orion KL molecular cloud and the envelope of the carbon star IRC+10216 have been surveyed at 1 MHz resolution over the interval 72.2-91.1 GHz to a sensitivity (in terms of main beam brightness temperature) usually better than 0.1 K. Some complementary data have been obtained at selected higher and lower frequencies. Detected lines are reported in Table 1. Approximately 170 lines from 24 known interstellar molecules were detected in Orion (Table 2); the corresponding numbers for IRC+10216 are 45 and 12, respectively (Table 3). Some 15 recombination lines of hydrogen (alpha, beta, gamma, delta) and helium (alpha) are also identified in Orion (Table 2). More than 100 of the Orion lines can be attributed to astronomically new transitions, the vast majority of which belong to only five species: SO2 (in total 17 lines), CH3CH2CN (19), CH3OH (16), (CH3)2O (21) and CH3OOCH (32). The rare occurrence of unidentified lines (5 definite lines in each object) is significant, possibly indicating that, in the case of Orion, the dominant chemical constituents are recognized. For IRC+10216 our results are less conclusive in this respect, partly due to the less effective excitation conditions in the envelope. We report (or confirm) the existence in these sources of several molecules which previously had only been found elsewhere: methylformate (CH3OOCH), isocyanic acid (HNCO), cyanodiacetylene (HC5N), vinyl cyanide (CH2CHCN), ketene (H2CCO) and probably the formyl radical (HCO) in Orion; and in IRC+10216 the first species containing the methyl group, methyl cyanide (CH3CN). The first astronomical detections of the isotopically rare species 34SO2 (Orion), and 29SiS and, tentatively, Si34S (IRC+10216) are also reported, as well as a number of newly identified high energy methanol lines. Multi-transition analysis of several molecular species is presented and gives information on physical conditions and chemical abundances in the Orion KL region (Tables 5 and 6). Gaussian decomposition of 0.25 MHz resolution profiles into "ridge", "hot core" and "plateau" emissions is used in an attempt to individually characterize these subregions. Striking chemical differences among the subregions emerge: (i) The estimated abundance ratios [SO, SO2, SiO]/[CO] are enhanced by a factor approximately > 100 in the plateau relative to the ridge, [HCN, HDO]/[CO] by a factor approximately > 10, while [HCO+, OCS, HNC, HC3N]/[CO] seem to be less enhanced in the plateau (by a factor approximately >10). (ii) The ratio of chemically saturated to unsaturated species differs markedly between the hot core and the ridge cloud (specifically HC3N vs. CH3CH2CN, and CH2CHCN) with the latter region more closely resembling both the cloud TMC-1 and IRC+10216. The chemical selectivity in the ridge cloud is very pronounced, with CH3OH as abundant as H2CO while (CH3)2O and CH3OOCH are an order of magnitude less abundant. We have neither detected CH3CH2OH and CH3COOH (acetic acid)--isomers of the two latter species, respectively--nor HCOOH, CH3CHO, or CH2CHCHO. H2C2O (ketene) is two orders of magnitude less abundant than H2CO. From the isotopic species of CH3OH, OCS, and HC3N we find 12C/13C approximately 40, in agreement with independent estimates by others and a factor of two lower than the solar system isotope ratio. The observed intensities of the hydrogen recombination lines are consistent with optically thin LTE emission, indicating that our He alpha/H alpha intensity ratio is relatively model independent and thus is an accurate measure of the helium abundance. We estimate a helium abundance by mass of 28 +/- 2%. The excitation conditions and relative abundances in the IRC+10216 envelope are reviewed. It is emphasized that the low detection rate of molecular lines in this object does not necessarily imply a poorer chemistry compared with that in interstellar clouds, but is partly a reflection of low abundances and unsatisfied excitation requirements. However, the CH3CN data indicate less favorable conditions for species containing methyl groups in this environment relative to interstellar clouds. The chemistry appears to be dominated by linear, especially unsaturated carbon-chain, molecules (Table 9). Rotational temperatures for HC3N and HC5N are estimated to be on the order of 15 K. Guided by the selective chemistry in IRC+10216 we tentatively assign two close doublets at 76.2 and 98.0 GHz to the radical C3H. In addition to Orion KL and IRC+10216 a few other sources have been observed, however in a less systematic way. We present selected data for W 51 M. The W 51 M methanol data, including newly identified high energy lines, indicate a rotational temperature of about 100 K.

Astronomy↗

Correlation between electrocardiographically and enzymatically estimated infarct size and its relation to clinical course in inferior myocardial infarction.

In 194 patients with inferior wall acute myocardial infarction (MI) defined from ECG, the initial ST elevation and final Q- and R-wave changes in leads II, III and aVF were related to peak serum enzyme (heat stable lactate dehydrogenase) activity. Positive correlations were observed between initial ST elevation and peak LD (r = 0.54; p less than 0.001) and between peak LD and the final Q- and R-wave changes (r = 0.45; p less than 0.001). Peak LD activity was strongly related to the incidence and severity of congestive heart failure, and to mortality after 90 days and 2 years. A similar relationship could not be demonstrated between ECG findings and clinical outcome.

Adult↗