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Biomedical subjects

C Wilhelmsson

Publications and source records attributed to C Wilhelmsson.

At least 55 records · Page 3Linked to original sources
PubMed1984

Intravenous and oral administration of molsidomine, a pharmacodynamic and pharmacokinetic study.

In 12 healthy male volunteers, molsidomine 1, 2 and 4 mg i.v. increased resting heart rate and decreased systolic blood pressure, the latter still being affected after 8 hours. After single oral doses of 1 and 2 mg, systolic pressure tended to be reduced for 90 minutes and exercise heart rate tended to be increased. After oral treatment with 2 mg molsidomine three times daily for 1 week, the pharmacokinetic parameters and the effects on heart rate and blood pressure after the final dose were not different from those after the first dose. The terminal half-life was independent of dose and route of administration. Clearance and distribution volume were not dose-dependent. The bioavailability of a 2 mg oral dose of molsidomine was 44%. Inter-individual variation in heart rate, blood pressure and pharmacokinetics was observed.

Administration, Oral↗
PubMed1984

Psychosocial outcome one year after a first myocardial infarction.

Psychosocial outcome in terms of mental state, health preoccupation, leisure activity, avoidance behaviour, sexual activity and attitude towards life and the future one year after a myocardial infarction (MI) was studied in 177 consecutive male, able-bodied patients below 61 yr of age with a first MI. Questionnaires and a brief interview covered the psychological and social data while the somatic variables were recorded in a standardized medical examination. Emotional distress, self-reported symptoms, avoidance behaviour, overprotection, pessimism and a diminished sexual activity were frequent, indicating a poor adaptation. These disturbances were apparent two months after the MI and remained stable. Psychological factors were stronger determinants of maladjustment than smoking, angina pectoris and recorded somatic illness. Neither severity of the infarction nor social and demographic factors determined maladjustment. Intervention must take place early and be directed to psychological factors as well as to the cardiac condition.

Adaptation, Psychological↗
PubMed1984

Prognostic importance of cholesterol levels after myocardial infarction.

The aim of this study was to analyze the relationship between serum cholesterol level and all causes mortality in men who sustained a first myocardial infarction. The cholesterol distribution 3 months after the infarction was established. Ten annual cohorts (n = 1,204) were followed for a maximum period of 11 years. Secondary risk factors were comparable among the groups of the serum cholesterol distribution quintiles according to a multiple logistic prognostic function based on left heart failure, atrial fibrillation, breathlessness on infarction, maximum S-ASAT, relative heart size, and a history of hypertension. When all ages were analyzed together, the total mortality was higher in the upper cholesterol quintiles (P = 0.02). This association was confirmed when analyzed with Coxian adjustments for age, change in smoking habits after infarction, and the previously mentioned prognostic function. When broken down by age (less than or equal to 49, 50-59, greater than or equal to 60) and period of follow-up (3-24 and 25-84 months), the association between mortality and cholesterol quintiles was confined to patients under 50 years during the late follow-up period (P = 0.01), whereas there was no association for the other age groups.

Adult↗
PubMed1984

Myocardial infarction among women in Göteborg, Sweden: a community study of mortality and incidence, 1968-1977.

Studies were made of all female cases below 65 years of age with acute myocardial infarction in Göteborg. Incidence and mortality rates were calculated. During the 10-year period 1968-1977, 1048 women were registered. More than half of the 491 fatal cases occurred outside hospital. In general, the incidence of myocardial infarction was unchanged during the study period except for women 50-54 years of age. In this group the incidence increased. There were no time trends as to case fatality and the proportion of the total mortality due to infarction.

Adult↗
PubMed1984

Sex differences in preinfarction characteristics and longterm survival among patients with myocardial infarction.

The prevalence of primary risk factors, previous medical history, and physical activity were assessed among 262 women and 1259 men who suffered a first nonfatal myocardial infarction between 1968 and 1977 in Göteborg, Sweden. The probability of suffering a myocardial infarction based on the conventional factors cholesterol level, systolic blood pressure and smoking habits was estimated in both sexes by means of a multiple risk function. Comparisons between sexes were made with age alone and age and estimated primary risk as confounders. Survival rate and reinfarction rate were calculated for a 5-year period of follow-up. Women with infarctions had higher serum cholesterol levels (p less than 0.001) and higher blood pressure values (p less than 0.001) but were less often smokers than men (p less than 0.001). The female patients also reported chest pain and dyspnea on exertion, and low physical activity both at work and during leisure time significantly more often than men; these differences remained after controlling for estimated primary risk. An overrepresentation of hypertension and diabetes prior to myocardial infarction was found among women below 45 years of age compared with men. A high frequency of women in this age group was also on sick leave or disability pension at onset of myocardial infarction, suggesting that mainly women with several risk factors including socioeconomic factors suffer an infarction at this age. No similar and consistent differences were found between women and men of older ages. The cumulative 5-year survival rate was 80% in women and 81% in men. Below age 45 the survival rate was lower among women than men (p less than 0.01). No sex difference was found in the recurrence rate of nonfatal reinfarctions. This indicates that once women have suffered a myocardial infarction they are exposed to at least as high a risk as men.

Adult↗
PubMed1984

Sex differences in cardioangiographic findings after myocardial infarction.

The cardioangiographic findings in 50 women 40-54 years of age were compared with those of a series of 69 men with infarction recruited from the same catchment area and investigated according to the same principles. Women less often had left ventricular abnormalities than men; this difference was mainly confined to patients with non-Q wave infarctions. There was no difference in the prevalence of left ventricular abnormalities among women and men with Q wave infarctions. No major sex difference was found in the prevalence of coronary abnormalities. Collaterals were less common in women than in men.

Adult↗
PubMed1984

Declining trend in mortality after myocardial infarction.

All patients under 60 years of age who were discharged from hospital after a first myocardial infarction between 1968 and 1977 in Göteborg were followed for a minimum of 24 months. The patients were unselected, and treatment was standardised. The patients were divided into five two yearly cohorts, and the prognostic comparability and mortality of these cohorts were assessed. There was a reduction in the two year mortality rate after discharge during the 10 year period. Small baseline differences between the cohorts were controlled by multivariate methods, and a subsequent analysis showed that there was a declining trend in mortality between 1968 and 1977. A higher tendency among smokers to give up smoking and a lower prevalence of angina pectoris could explain only part of the reduction in mortality. A small number of patients underwent a coronary bypass operation; the slight increase in the number of operations during the period cannot, however, account for the reduced mortality. Most of the patients in the later cohorts were treated with beta blockers, and this is the most likely explanation for the majority of the decline in mortality.

Adult↗
PubMed1984

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↗
PubMed1984

Computer aided exercise electrocardiographic testing and coronary arteriography in patients with angina pectoris and with myocardial infarction.

A set of electrocardiographic criteria for the diagnosis of coronary artery disease was evaluated in two different groups of patients examined by computer aided 12 lead exercise electrocardiographic stress testing and coronary arteriography. One group consisted of patients with severe angina pectoris and the other of patients who had suffered a myocardial infarction three years before the study. Angiographically determined categories of patients could be identified with satisfactory precision by the electrocardiographic criteria under test in the patients with angina pectoris but not in those with infarction. A new method of classifying patients on the basis of data from coronary arteriography improved the correlation with ST segment analysis compared with conventional classification.

Adult↗
PubMed1984

Emotional reaction, health preoccupation and sexual activity two months after a myocardial infarction.

Emotional reaction, health preoccupation and sexual adjustment two months after a first myocardial infarction (MI) were studied in relation to social, psychological and somatic factors prior to, during and after the MI in 201 consecutive male patients. Psychological and social data were covered by means of questionnaires and a brief interview and somatic data by a standardized medical examination. New concepts were introduced after factor analysis. The degree of preoccupation varied very much and was considered as a reaction to the diagnosis of MI. Seventy-nine percent of the patients complained about fatigue and 65% felt anxious and depressed. Fatigue and nervousness were regarded by the patients as more disabling than cardiac symptoms. Emotional distress was related to a previous history of emotional complaints and to psychological factors and self-reported coronary symptoms but was unrelated to severity of the infarction, medically rated cardiac symptoms, demographic and social data. Sexual maladjustment, mainly due to fear, was frequent and associated with both emotional and somatic variables. Emotional disturbance after MI is considerable and further measures ought to be taken in order to prevent future disability.

Adult↗
PubMed1984

Sick-role and attitude towards disease and working life two months after a myocardial infarction.

Sick-role and attitude towards disease and work two months after a first myocardial infarction (MI) were studied in relation to social, psychological and somatic factors prior to, during and after the MI in 201 consecutive male patients. Questionnaires and a brief interview covered psychological and social data. Somatic data were registered in a standardized medical examination. New concepts were introduced after factor analysis of the psychological variables. Two out of three patients displayed avoidance behaviour. Seventy per cent had restricted their everyday activities. The leisure time was dominated by passivity. Over-protection was frequent. Sick-role behaviour was significantly related to emotional upset, preoccupation with the health and self-reported coronary symptoms while the shortage of relationships to somatic and cardiac factors was notable. The patients attributed the onset of MI to work-related factors. Work dissatisfaction was an aspect of a general negative attitude towards life and was more frequent among patients with emotional symptoms. The psychological care ought to be improved in order to prevent long-term disability.

Activities of Daily Living↗
PubMed1983

Beta blockers in ischemic heart disease.

Many trials have reported that beta blockers increase survival after myocardial infarction; these trials are reviewed. The timolol trial was randomized and showed that mortality was reduced for all patients randomized to beta blockers. Similar findings have been found in both the metoprolol trial in Göteburg and the Beta-Blocker Heart Attack Trial in the U.S. Chronic beta-blockade therapy appears to reduce mortality in patients who survive acute myocardial infarction. The mechanism is as yet unknown.

Adrenergic beta-Antagonists↗
PubMed1983

Effect of metoprolol on indirect signs of the size and severity of acute myocardial infarction.

In a double-blind randomized trial, 1,395 patients with suspected acute myocardial infarction (MI) were investigated to evaluate the possibility of limiting indirect signs of the size and severity of acute MI with the beta 1-selective adrenoceptor antagonist metoprolol. Metoprolol (15 mg) was given intravenously and followed by oral administration for 3 months (200 mg daily). Placebo was given in the same way. The size of the MI was estimated by heat-stable lactate dehydrogenase (LD[EC 1.1.1.27]) analyses and precordial electrocardiographic mapping. Lower maximal enzyme activities compared with placebo were seen in the metoprolol group (11.1 +/- 0.5 mukat X liter-1) when the patient was treated within 12 hours of the onset of pain (13.3 +/- 0.6 mukat X liter-1; n = 936; p = 0.009). When treatment was started later than 12 hours, no difference was found between the 2 groups. Enzyme analyses were performed in all but 20 patients (n = 1,375). Precordial mapping with 24 chest electrodes was performed in patients with anterior wall MI. The final total R-wave amplitude was higher and the final total Q-wave amplitude lower in the metoprolol group than in the placebo group. Patients treated with metoprolol less than or equal to 12 hours also showed a decreased need for furosemide, a shortened hospital stay, and a significantly reduced 1-year mortality compared with the placebo group, whereas no difference was observed among patients treated later on. After 3 months, however, there was a similar reduction in mortality among patients in whom therapy was started less than or equal to 12 hours and greater than 12 hours after the onset of pain. The results support the hypothesis that intravenous metoprolol followed by oral treatment early in the course of suspected myocardial infarction can limit infarct size and improve long-term prognosis.

Aged↗
PubMed1983

A double-blind trial of metoprolol in acute myocardial infarction. Effects on ventricular tachyarrhythmias.

During a double-blind trial in which patients with suspected myocardial infarction received metoprolol or placebo, we analyzed the occurrence of ventricular tachyarrhythmias. Metoprolol (15 mg intravenously) was given as soon as possible after admission, and thereafter 200 mg was given daily for three months. Antiarrhythmic drugs were given only for ventricular fibrillation and sustained ventricular tachycardia (greater than 60 beats per second). Definite acute myocardial infarction developed in 809 of the 1395 participants, and probable infarction in 162. Metoprolol did not influence the occurrence of premature ventricular contractions or short bursts of ventricular tachycardia. However, there were 17 cases of ventricular fibrillation in the placebo group (697 patients) and only 6 in the metoprolol group (698 patients, P less than 0.05). During the hospital stay significantly fewer patients receiving metoprolol (16) than placebo (38) (P less than 0.01) required lidocaine. In a separate analysis of 145 patients, metoprolol did not influence the occurrence of premature ventricular contractions or short bursts of ventricular tachycardia during the first 24 hours of treatment. Despite a lack of effect on less serious ventricular tachyarrhythmias, metoprolol had a prophylactic effect against ventricular fibrillation in acute myocardial infarction.

Double-Blind Method↗
PubMed1983

Pharmacodynamic and pharmacokinetic study of oral and intravenous penbutolol.

The present study was done to establish the dose-response relationships for effects on heart rate and systolic and diastolic blood pressure, tolerance and plasma disappearance kinetics after large intravenous and oral doses of penbutolol. Twelve healthy volunteers were randomly allocated to receive penbutolol (n = 8) or placebo (n = 4) in this single blind, placebo-controlled investigation. The degree of beta-blockade was measured by standarized exercise tests at work loads selected to produce a heart rate of 150/min without treatment. Penbutolol was given as single i.v. doses of 3, 6 and 12 mg and as 40, 80 and 120 mg once daily for one week, measurements being made 2 and 24 h after the last dose. Penbutolol i.v. did not influence the resting heart rate but it did reduce resting systolic blood pressure in a non-dose dependent manner. Exercise heart rate and systolic pressure were lowered by all the intravenous doses. All oral doses of penbutolol lowered exercise heart rate and systolic blood pressure to the same extent. The reductions in exercise tachycardia was still present after 24 h. After i.v. administration t1/2 was approximately 1.2 h and the volume of distribution was 32-421. All doses were well tolerated.

Administration, Oral↗
PubMed1983

Characteristics of males with myocardial infarction below age 40.

All cases of initial myocardial infarctions (MI) diagnosed among men below age 40 in Göteborg during 1970-1977 have been studied. The cases have been compared with a random sample from the general population in Göteborg with respect to socio-economic factors and conventional risk factors. The MI-cases showed a special socio-economic pattern prior to the infarction and were more often single and of foreign origin, had more previous sickness benefit days and were more often registered for alcohol abuse than contemporaries in the general population. Moreover, the surviving MI-cases were found to be heavily burdened with the conventional risk factors smoking, cholesterolemia and high blood pressure.

Adult↗
PubMed1983

Bias due to non-participation and heterogenous sub-groups in population surveys.

A random sample of men in the age-group 30-39 years from the general population in Göteborg, Sweden, has been investigated with respect to socioeconomic factors and risk factors for coronary artery disease. The total sample could well be characterized with socioeconomic variables obtained from public registers. All the individuals of the sample were invited to an examination which 68% attended (participants). It was found that those not attending the examination (non-participants) greatly differed from the participants. The non-participants were more often unmarried, and had lower annual incomes and more sickness benefit days. There were more foreigners and more individuals registered for intemperance among the non-participants than the participants. Among the participants the foreigners reported lower physical activity and had higher serum cholesterol than the participating Swedes and individuals registered for intemperance stated a higher tobacco consumption and had higher systolic and diastolic blood pressures than those not registered. This highlights that consideration of factors discriminating participants and non-participants is important for proper estimation of population parameters. The same is true for comparisons between cases and controls recruited from cross-sectional population surveys.

Adult↗