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Biomedical subjects

D Brandt

Publications and source records attributed to D Brandt.

At least 55 records · Page 3Linked to original sources
PubMed1983

[Calcium antagonists in the treatment of chronic arterial hypertension and hypertensive crisis].

Elevated peripheral vascular resistance is usually significant in patients with arterial hypertension. Peripheral vasodilation is caused by calcium antagonists and thus elevated blood pressure can be lowered effectively. Primarily verapamil (i.v.) and nifedipine (sublingual) have been proved to be effective in hypertensive crises. A similar effect of lowering the blood pressure is caused in chronic arterial hypertension by the calcium antagonists verapamil, diltiazem and nifedipine, which seems to correspond to the effect of beta-blockers. Side effects are rare and in most cases innocuous and passing.

Acute Disease↗
PubMed1983

Effect of calcium antagonists on cardiac performance in patients with dilatative cardiomyopathy evaluated by noninvasive methods.

We present 14 patients with dilatative cardiomyopathy, proven by hemodynamic and angiographic assessment who received in a single-blind, randomized study, equipotent doses of the three calcium blockers: verapamil (0.1 mg/kg i.v., followed by an infusion of 0.01 mg/kg/min), nifedipin (20 mg sublingually), or diltiazem (0.2 mg/kg i.v., followed by infusion of 0.02 mg/kg/min). Before and after treatment in 8 patients systolic time intervals were recorded with an AVL-Myocard-Check (Q-S2, pre-ejection period, left ventricular ejection time, and pre-ejection period/left ventricular ejection time) and end-systolic and end-diastolic diameter, fractional shortening, and circumferential fiber shortening velocity were measured by M-mode echocardiography. In another 6 patients radionuclide ventriculography was performed before and after each treatment (ejection fraction, cardiac index). PEP/LVET increased slightly after verapamil (+ 15%) and decreased after nifedipin (-5%) and diltiazem (-3%), the changes being not significant. Fractional shortening and circumferential fiber shortening velocity however, decreased after verapamil (-5%, resp. -15%) and increased after nifedipin (+ 14%, resp. + 25%) and after diltiazem (+ 23%, resp. + 16%). In the radionuclide studies ejection fraction increased after verapamil (+ 9%), nifedipin (+ 14%), and diltiazem (+ 13%), while cardiac index remained unchanged with verapamil and nifedipin and increased with diltiazem (+ 14%). In conclusion there are no significant changes in myocardial performance with the calcium blockers verapamil, nifedipin, and diltiazem. However, under verapamil there is a tendency to deterioration of myocardial performance, while it was slightly improved after nifedipin and diltiazem. Calcium antagonists may be used safely, therefore, also in patients with impaired myocardial performance.

Adult↗
PubMed1983

[Effect of sulmazol on left ventricular function in congestive cardiomyopathy].

In 11 patients with congestive cardiomyopathy (NYHA class III and IV, mean cardiothoracic ratio 0.59) the effect of a new positive inotropic agent, 2[(2-methoxy-4-methylsulfinyl)phenyl ))-1H-imidazo[4,5-b]pyridine (AR-L 115 BS, sulmazol, Vardax), on haemodynamics was studied. Simultaneously plasma levels of the drug were measured. All patients were pretreated with digitalis and diuretics. The following results were obtained: Heart rate increased only slightly, by 8% (n.s.), maximal left ventricular pressure rise by 37% (p less than 0.01), left ventricular enddiastolic pressure decreased by 42% (p less than 0.01), mean pulmonary artery pressure by 23% (p less than 0.01) and pulmonary vascular resistance by 22% (p less than 0.05). Left ventricular enddiastolic volume was reduced by 20% and left ventricular systolic volume by 31% (p less than 0.01). Ejection fraction increased by 36% (p less than 0.05), cardiac index, stroke index, stroke work index and systolic aortic pressure as well as systemic vascular resistance remained unchanged. In conclusion, sulmazol is an effective inotropic agent with vasodilating properties (especially on the venous capacity system). The lacking increase of cardiac output despite the augmentation of ejection fraction must be due to the prominent reduction of preload, decrease of left ventricular volume and heart size. Sulmazol therefore should not increase oxygen consumption of the heart and should be especially advantageous in patients with predominant backward failure.

Adult↗
PubMed1983

Role of calcium antagonists in the treatment of essential hypertension.

The calcium antagonists, diltiazem and nifedipine, are effective in mild-to-moderate chronic essential hypertension. The overall responder rate is 80%. Diastolic blood pressure is lowered by 10-15% at rest and during exercise. Systolic blood pressure is reduced only at rest. Heart rate may be unchanged by nifedipine and lowered by diltiazem. Both drugs lead to a decrease of peripheral resistance by 15-20% at rest and 30% during work. As a consequence of afterload reduction, cardiac output, stroke index, and stroke work index increased by 17, 21, and 7% with nifedipine and 34, 26, and 20% with diltiazem. During exercise, these changes are even more pronounced. However, pulmonary artery pressure and pulmonary vascular resistance are reduced only by nifedipine, not by diltiazem. Presumably due to this combined preload and afterload reduction, nifedipine therapy is associated with a reflex activation of the sympathetic nervous system in all cases, with an increase in norepinephrine plasma concentration and, sometimes, tachycardia. Diltiazem, however, has the advantage of being a potent blood pressure-lowering agent, with afterload reduction and increased stroke index, with less pronounced catecholamine increase, and without tachycardia. Side effects with this drug are rare, and long-term therapy is well tolerated.

Adult↗
PubMed1982

[Double-blind, placebo-controlled trial of propranolol vs celiprolol in stable effort angina: antianginal efficacy and side effects ].

A new cardioselective betablocker, celiprolol (C) in a dosage of 100 mg t.i.d. and propranolol (P) 40 mg t.i.d. were compared in 21 patients with angiographically documented obstructive coronary artery disease (stenosis of 75% or more in at least one vessel) and stable angina in a double-blind, placebo-controlled trial. C led to a significant reduction of anginal attacks and of nitroglycerin consumption (P less than 0.01), to a reduction of diastolic blood pressure (P less than 0.01) and heart rate (P less than 0.001) during rest and exercise. Under P, however, the number of anginal attacks and used nitroglycerin tablets was only slightly decreased, diastolic blood pressure remained constant and only heart rate was reduced significantly during rest and exercise (P less than 0.001). Total work performed was higher on drug treatment than on placebo (placebo: 238 +/- 21, celiprolol: 285 +/- 25, propranolol: 308 +/- 34 Watt/min). The difference against placebo is significant (p less than 0.01) with both drugs, but there is no difference between C and P. C led to a slight but constant decrease of triglycerides. Side effects were minor with both drugs.

Adrenergic beta-Antagonists↗
PubMed1982

Comparison of various WISC-R summary scores for a psychiatric sample.

Compared two sets of summary scores for the Wechsler Intelligence Scale for Children-Revised (WISC-R). The traditional scores used to summarize information about WISC-R performance (i.e., Verbal IQ (VIQ), Performance IQ (PIQ) and discrepancy between VIQ and PIQ) were compared to scores based on the three factors identified by Kaufman (1975) (i.e., Verbal Comprehension (VC), Perceptual Organization (PO) and Freedom from Distractibility (FD). Ss were 260 psychiatric outpatients who were administered the WISC-R during a 4-year period. The independent variables were sex and DSM II diagnosis. There were significant main effects for diagnosis for the VC and FD scales. There was a significant interaction for VIQ and nonsignificant results for the VIQ-PIQ discrepancy score. The groups did not differ in perceptual organization skills as assessed by PO and PIQ. Delinquents performed particularly poorly on the VC scale; hyperactive children had the highest VC score and relatively low scores on the FD factor; learning disabled children had low VC and FD scores. These findings suggest that the scores based on Kaufman's factors provided important clinical summary information that was not available from the traditional scores.

Adjustment Disorders↗
PubMed1982

[Treatment of stable exercise angina with calcium blockers-a double-blind, placebo-controlled comparison of diltiazem and nifedipine].

In a placebo-controlled, randomized double-blind study, 43 out-patients with stable angina pectoris were treated for 2 months with a calcium-antagonist. 9 patients received a constant dose of 60 mg diltiazem t.i.d.; 12 patients underwent a dose increase to 90 mg t.i.d. after 4 weeks of treatment because of insufficient therapy response. In 5 patients 10 mg nifedipine t.i.d. was sufficient, 17 patients received 20 mg t.i.d. during the second part of the study. The patients were examined and subjected to symptom-limited ergometric tests at 2-week intervals. Under both medications, the frequency of anginal attacks decreased significantly; this was accompanied by a concomitant decrease of nitroglycerin consumption. During the tests, the time to occurrence of anginal complaints and thereby work capacity increased. ST-depression and ST-index were diminished. Heart rate, blood pressure and pressure-rate product did not change at rest or under exercise. There was no statistically significant difference between the two calcium-antagonists. Patients who showed satisfactory results under one of the two medications participated in an open, uncontrolled long-term trial and were treated with 60 mg or 90 mg diltiazem t.i.d. over a one-year period. There were no clinically remarkable events on changing from nifedipine to diltiazem. The monthly controls and the quarterly ergometric tests showed an unchanged efficacy of diltiazem. During the double-blind short-term treatment, the frequency of side effects was slightly lower under diltiazem than under nifedipine. Long-term treatment especially confirms the good tolerance of diltiazem.

Angina Pectoris↗
PubMed1981

Substrate cardioplegia during hypothermic arrest in the alloxan diabetic dog.

In an experimental study, 26 mongrel dogs were treated with alloxan (50 mg per kilogram) to induce fasting hyperglycemia and diabetes. The animals were randomly subdivided into two groups, one of which received 100 mg of propranolol in divided doses for two weeks. The animals underwent sternotomy and were placed on total cardiopulmonary bypass. After aortic cross-clamping, each animal received 10 ml per kilogram of cardioplegic solution. Two different solutions were used, a standard hyperkalemic solution and a high-energy glucose-insulin-potassium (GIK) substrate. Baseline studies were made on the four groups of diabetic animals. Animals given potassium cardioplegia but no propranolol showed statistically significant decreases in cardiac index, heart rate, mean arterial pressure, and minute left ventricular stroke work index after bypass. In contrast, animals given GIK cardioplegia but no propranolol showed no changes in any of these measurements. Animals administered propranolol and potassium cardioplegia experienced decrease in mean arterial pressure from 77.5 +/- 14.1 mm Hg before bypass to 57.5 +/- 17.8 mm Hg after bypass. A similar reduction occurred in animals given propranolol and GIK cardioplegia. However, in this group, the cardiac index increased from 1.78 +/- 0.38 L/min/m2 before bypass to 2.96 +/- 0.73 L/min/m2 after bypass (p less than .006). Similarly, the minute left ventricular stroke work index increased after bypass in these animals. This study demonstrates the protective effect against myocardial ischemia of the addition of substrate to the cardioplegic solution in diabetic animals subjected to aortic cross-clamping during cardiopulmonary bypass, one group receiving propranolol and one group not receiving it.

Alloxan↗
PubMed1981

[Intravenous fibrinolytic treatment in chronic ischemic heart disease (author's transl)].

In 13 male patients (mean age 49.1 years) with chronic ischemic coronary heart disease (7 transmural and 2 intramural myocardial infarctions), angina pectoris and signs of ischemia during exercise an intravenous streptokinase therapy was performed. The treatment was installed 18.9 months after infarction or after onset of angina pectoris. Before and after intravenous streptokinase therapy the following parameters were measured: history, heart volume, exercise-ECG, Swan-Ganz pulmonary artery measurements during exercise, aortic and left ventricular pressures, coronary angiography, left ventricular angiography. 1. Angina pectoris disappeared in 1 and became better in 4 patients. In none of the patients angina pectoris became worse. 2. The parameters for ischemia were not changed overall by the therapy. But in single patients signs of exercise-induced ischemia were influenced. 3. Mean values of left ventricular function (EF, LVEDP) were not changed. 4. Angiographic changes were discrete. 5. Complications of therapy and worsening of subjective parameters did not occur. 6. The angina pectoris behaviour in 5 patients (became better) is explained by changes of blood properties. The not-appearance of coronary artery occlusions is explained by the inhibition of platelet aggregation. 7. It is suggested that the effect of intravenous streptokinase therapy should be examined in patients with short-lasting angina pectoris and subgroups, such as initial angina pectoris.

Adult↗
PubMed1981

[Experiences with transluminal angioplasty in critical coronary artery stenosis (author's transl)].

In this study the first results of percutaneous transluminal angioplasty (TAP) at the university hospital of Graz, Department of internal Medicine, are presented. Out of 19 attempts in 18 patients (one with two vessel-disease) 15 were angiographically successful (79%). In three cases the stenosis could not be passed, in one patient with previous non transmural anterior infarction the vessel was nearly occluded after the procedure. Serum CK-levels of this patient increased up to the fourfold on the following day; however, no clinical or electrocardiographic features or reinfarction occurred. In the majority of patients the dilatation of the obstruction was accompanied by a diminuation of the gradient across the stenosis and followed by a significant clinical improvement, increase in exercise tolerance (64% of cases) and the degree of 201Tl-redistribution as a sign of disappearance of exercise-induced myocardial ischemia was normalized in 6 of 8 patients (75%). No serious complications were noted in this group of patients.

Adult↗
PubMed1980

[Effect of nitroglycerine on haemodynamics and on catecholamine metabolism in patients with congestive left heart failure (author's transl)].

In 17 patients with severe chronic left heart failure 0.8 resp. 1.6 mg of nitroglycerine led to a marked decrease of LVEDP or PADP and a shift of left ventricular function to the left, indicating reduced preload. Cardiac output and exercise performance, were not improved. However, during exercise, nitroglycerine diminishes myocardial noradrenalin release, due to reduced sympathetic stimulation of the heart. This may be of importance in patients with chronic heart failure due to coronary artery disease, since reduction of sympathetic stimulation means a reduction of myocardial oxygen consumption.

Catecholamines↗
PubMed1980

[Social fate (return to work) after coronary heart surgery and/or aneurysmectomy (author's transl)].

The "return to work"-rate of 4 groups of patients with myocardial infarction (MI) is evaluated (all coronary angiography): Group 1: 314 patients after aorto-coronary bypass operation: mean age 50.5 years. Time after infarction 28 months, after surgery 18 months. The social fate of 52% were not yet decided. 20% got pension, 25% returned to work. Group 2: 86 patients after conservative treatment of myocardial infarction: mean age 42 years. Time after MI 18 months. The social fate of 21% was not yet decided, 41% got pension, 36% returned to work. Patients with one-vessel disease returned to work in 52%, with two-vessel disease in 20% and with three-vessel disease in 12.5%. Group 3: 24 patients after aneurysmectomy: mean age 47 years. Time after infarction 28 months, time after operation 11 months. Social fate of 8 out of 24 patients was not yet decided, 7 out of 24 got pension, 5 out of 24 returned to work. Group 4: 27 patients with conservatively treated left ventricular aneurysm: mean age 43 years. Time after infarction 42 months. The social fate of 2 out of 27 patients was not yet decided, 14 out of 27 got pension, and 8 out of 27 returned to work. Exercise-tolerance is no good indicator for the work status 18 months after myocardial infarction, 18 months after aorto-coronary bypass, 18 months after aneurysmectomy and 42 months after conservative treatment of left ventricular aneurysm. Selection of patients (all were examined by coronary angiography because of limitation by angina pectoris in daily life activities) may be partly responsible for the poor long-term work status. But more important seems to be the "tied social network". Decision for "return to work" or "pension" should be made 6 months after MI or after operation.

Activities of Daily Living↗
PubMed1979

[Progress in the therapy of acute and chronic cardiac insufficiency by means of systemic vasodilators. Studies with prazosin and nitroglycerin].

In acute and chronic left heart failure peripheral resistance is elevated due to increased sympathetic tone. This should compensate the decrease in stroke volume. In the diseased left ventricle however the augmentation of afterload leads to further reduction of stroke volume and to increase of heart size and myocardial oxygen consumption. This vitious cycle may be interrupted by vasodilators. Drugs like nitroglycerin, mainly acting on the venous system, reduce preload and thereby relieve symptoms of pulmonary congestion (backward failure). Phentholamin on the other hand primarily reduces afterload by an action on the resistance vessels and thereby increases cardiac output (forward failure). Nitroprusside has effects on both, the capacity and resistance vessels. So nigroglycerin is the remedy of choice in acute pulmonary edema. Nitroprusside in leftf heart failure in acute myocardial infarction and Phentolamin in acute left ventricular failure due to critical rise in blood pressure. For long term treatment of chronic left heart failure (coronary heart disease, cardiomyopathy, rheumatic heart disease) hydralazin or prazosin may be used as well as long acting nitrates.

Blood Pressure↗