[Heart infarction before the age of 40].
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Biomedical subjects
Publications and source records attributed to A Vedin.
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Six healthy volunteers took part in a randomized, single-blind, crossover study to quantitate the intrinsic sympathomimetic activity (ISA) of penbutolol in comparison with one drug possessing ISA (alprenolol) and with the standard non-ISA drug (propranolol). Single intravenous and one week oral administrations were studied. Complete parasympathetic and sympathetic isolation of the heart was obtained by administration of atropine 0.04 mg/kg body weight i.v. and propranolol 0.4 mg/kg i.v., or corresponding equipotent doses of alprenolol 0.4 mg/kg i.v. and penbutolol i.v. 0.08 mg/kg. In the chronic, oral study propranolol 160 mg b.i.d. was given, or corresponding equipotent doses of alprenolol (400 mg b.i.d.) or penbutolol (40 mg b.i.d.). The test procedure included measurement of heart rate and blood pressure in the supine, sitting and standing positions, and during isometric and dynamic exercise. ISA was calculated by comparison of the change in of heart rate with that produced by propranolol. The ISA of alprenolol was 22--26% and of penbutolol 12--18% of maximal sympathetic activity. Isometric and dynamic exercise gave comparable ISA values.
The influence of intravenous labetalol and propranolol on the blood pressure response to isometric and dynamic exercise was examined in a double blind study in eight, young, normotensive volunteers. Effects were recorded after propranolol 7.5, 15 and 30 mg i. v., and after labetalol 30, 60 and 120 mg i. v. In control experiments saline was administered. Mean blood pressure rose with successive handgrip tests following saline and propranolol, but not after labetalol, and the difference was significant. The total dose of each drug produced the same reduction in heart rate during sub-maximal bicycle exercise. The exercise-induced systolic blood pressure response did not differ between the drugs.
Blood pressure (BP) was measured before and after acute myocardial infarction (MI) in 21 men aged 49--60 years from a random population sample. Men on drugs affecting BP before MI or during follow-up were excluded. Pre- and postinfarction cholesterol levels were analyzed in 49 men not on hyperlipidemic treatment recruited from the same population sample. The mean fall in systolic BP (SBP) was 14 mmHg both five weeks and one year after the acute event, but 10 mmHg after two years. The mean fall in diastolic BP (DBP) was 10 mmHg five weeks after the MI and remained at this level for two years. The decreases in SBP and DBP were significant. There was a positive correlation between the maximum rise in SGOT during the acute phase of MI and the decrease in DBP between preinfarction readings and readings five weeks after the MI. Serum cholesterol was unchanged three months, and one and two years after the MI as compared to the preinfarction level.
Studies were made on the effects of long-term beta-blockade on the QT interval in patients discharged alive from hospital after myocardial infarction. The patients (n = 230) in this study constituted all those who participated in the alprenolol study on postmyocardial patients in Göteborg, Sweden. The study was double-blind (alprenolol 200 mg b.i.d. or placebo) and randomised. The patients were divided into 4 risk groups (1-4) with different predicted mortality. The electrocardiograms before and after 8 weeks of treatment were analysed with respect to heart rate and QT time. There was a decrease in heart rate of about 10% in the alprenolol treated patients. The QT time was not significantly influenced by alprenolol. The rate corrected QT time (QTc) decreased in the subgroup of the most severely diseased patients (subgroup 4) treated with alprenolol.
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Studies were made in Göteborg over a period of 6 years of all cases of acute myocardial infarction diagnosed among men below the age of 40. Thirty-six cases were registered and 8 of these died outside hospital. Three patients died early during the hospital stay. The remaining 25 patients were compared with a random sample from the general population in Göteborg with respect to conventional risk factors. Smoking, and high plasma cholesterol values were dominating findings among the patients, whereas there was no significant differences in blood pressure levels. Coronary angiography was performed in 18 patients of whom 2 showed normal coronary arteries and left ventricular angiograms. These 2 patients were the only ones free from risk factors. Of the remaining 16 patients, 10 had only one vessel affected.
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The present study concerns the development and validation of a logistic multivariate prognostic function in patients followed for two years after myocardial infarction. The patients studied constituted at least 90% of all cases in a total community--the City of Göteborg, Sweden. Using a multivariate logistic function with 7 variables, based on 30 cardiovascular deaths during two years after discharge from hospital among 292 men with first infarction, breathlessness at onset of symptoms of infarction, SGOT quartile, left heart failure, relative heart size, atrial fibrillation, a history of hypertension, and AV block recorded during the hospital phase were the most important variables. The first five of these variables made significant contributions (p less than 0.01) to the predictive power. The predictive capacity was confirmed in an independent series of 195 men with first infarction, among whom 17 cardiovascular deaths occurred. Around 60% of the total cardiovascular mortality was concentrated in the highest risk quintile. Deaths from non-cardiovascular causes were predicted less efficiently. Non-fatal recurrences could not be predicted by the present model. Thus, the function can predict the excess risk of mortality but not the excess risk of reinfarction during two years among men after an initial myocardial infarction.
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The efficacy and toleration of a new beta1-selective beta-blocker, H 87/07, was compared with placebo in 33 patients with angina pectoris. The efficacy was evaluated using subjective assessments of attack rate and nitroglycerin consumption as well as objective assessments of exercise tolerance on a bicycle ergometer. H 87/07 significantly reduced the attack rate and the nitroglycerin consumption compared with placebo. The mean reduction amounted to 13 and 36% respectively. No significant differences were found between H 87/07 and placebo with regard to exercise tolerance. Due to high intrinsic stimulating activity (I.S.A.) H 87/07 altered the heart rate and blood pressure only slightly at rest but during exercise significant reductions were seen. Except for one patient who had cardiac decompensation on H 87/07 no side-effects of clinical importance were seen. No significant changes were seen with regard to the laboratory tests performed.
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A predicted probability of suffering myocardial infarction based on a multiple risk function involving serum cholesterol, systolic blood pressure, and tobacco consumption, was allocated retrospectively to 270 men who survived a primary myocardial infarction. The infarction patients were representative of all surviving, diagnosed cases of primary infarction in men in certain age groups in Göteborg, Sweden, during the years 1968-70. The patients were divided into three groups-low, moderate, and high risk. A large number of patients had suffered infarction despite relatively low risk, but the patients showed a tendency toward higher risk in comparison with the risk distribution in a representative population sample. In order to study whether other variables, not included in the risk function, could "explain" the infarction in patients with relatiely low risk, the different risk groups were compared. A high degree of mental stress, diabetes mellitus, and dyspnea on exertion, and possibly also raised triglycerides, contributed to "explain" the infarctions in the low-risk group. Low physical activity during leisure time was probably also of importance.
A series of 299 men, aged 27-67, who had survived their first myocardial infarction (MI), have been compared with representative population samples with respect to tobacco consumption, alcoholic intemperance, physical activity during work and leisure time, occurrence of hypertension, and cholesterol and triglyceride levels in serum. The infarction patients comprised 90% of all surviving, diagnosed cases of primary MI in men aged 67 years or below during 1968-70 in Göteborg, Sweden. The comparison between infarction patients and general population samples revealed that the patients smoked more, and were less physically active during leisure time but not during work. They had more often a positive history of hypertension and treatment for high BP and their serum cholesterol and serum triglyceride values were higher. For all these variables the difference decreased with increasing age and was generally not statistically significant above the age of 60 years. Alcoholic intemperance was more common among infarction patients who died outside hospital, but there was no difference in this respect between surviving patients and the general population.