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Biomedical subjects

D Glogar

Publications and source records attributed to D Glogar.

At least 109 records · Page 6Linked to original sources
PubMed1981

Value of exercise testing for prediction of physical and psychosocial rehabilitation potential 3 months after acute myocardial infarction.

In 147 patients exercise tests were performed at the beginning and after 1 year of an ambulatory rehabilitation program. Measurements of both tests and the degree of functional improvement were correlated with patients' characteristics, the results of a psychological analysis using the Freiburger Personality Inventory and a patient's questionnaire for self-assessment. Among the major determinants for functional improvement were age, location of the infarct, rate of participation and greater initial functional impairment. High degree of psychosomatic impairment accompanied low levels of exercise capacity, the patients' self-assessment showed no correlation with exercise performance.

Adult↗
PubMed1981

[Computer-assisted long-term ECG analysis in patients with artificial trial pacemaker (AAI) (author's transl)].

Control of AAI-function is limited. To investigate the efficacy of AAI-stimulation, a computer-assisted analysis system for long-term ECG records was developed using "Multipass-Scanning I". 12 patients (5 females, 7 males, 33--78 years old with AAI) underwent Holter-monitoring for 24 hours continuously. THe ECGs of 5 among the collective with heart rate programmable AAI were recorded three times each with different AAI stimulation rates (50--80 b.p.m.). The number of AAI-induced heart beats in relation to the total number of QRS-complexes (AAI-QRS%) was 43 +/- 37% mean. AAI-QRS% during day showed a significantly lower distribution (35 +/- 38%, p less than 0.01) than during night (58 +/- 40%, p less than 0.001). Using an AAI-stimulation frequency of 50 b.p.m., only 9% of the heart beats were AAI-induced during day. Whereas AAI-QRS% increased to 72% during night in patients with AAI-stimulation frequency of 70 b.p.m. The interval between the PM-spike (S) and the following answer of the heart, i.e. SR-interval, demonstrated also a circadian behaviour: SR max occurred between 10 p.m. and 2 a.m. It was significantly prolonged to the SR min. (9--31%, m 20%, p less than 0.0001), which occurred between 9 a.m. and 4 p.m. So the presented computer-assisted long-term ECG analysis system for AAI-pacemakers is able to evaluate the efficacy of AAI with regard to different AAI-stimulation rates. The quantity of AAI-induced heart beats is dependent on patient's heart rate, its circadian behaviour and the stimulation rate of the AAI. The SR-interval also demonstrated a significantly circadian pattern, which can be related to the vagus-influenced PQ- and also AH-interval.

Adult↗
PubMed1981

[Therapy of ventricular tachyarrhythmias refractory to lidocaine with propafenone (author's transl)].

Lidocaine is most widely used for suppression of recurrent ventricular tachyarrhythmias by IV application. Advantages are good control and low incidence of signs of cardiac toxicity. Most important disadvantage is lack of possibility to continue therapy by oral administration. A serious problem is a high rate of non-responders, between 15 and 50% according to the literature. In our patients, rate of non-responders is about 25%. In these patients, other antiarrhythmic agents can be used, but therapeutic success is even more uncertain because of a higher rate of non-responders and adverse reactions in most instances. We administered Propafenone as drug of second choice in 30 patients with ventricular tachyarrhythmias refractory to Lidocaine. Initial bolus injection of 1-2 mg/kg body weight followed by drip infusion (0,2-0,5 mg/kg body weight/hr) or oral administration in those patients who responded to the initial bolus injection (83%). This regimen allowed sufficient control of the tachyarrhythmia in all patients of the responder group. Serious adverse reactions of cardiac origin were fall of blood pressure and exorbitant widening of QRS-complexes in three patients. A demonstration of a patient dying from pump failure with extremely widened QRS-complexes is given. Therefore we ask for caution regarding administration of Propafenone in patients with serious diffuse myocardial damage. Propafenone therefore seems to be well suited for therapy of ventricular tachyarrhythmias refractory to Lidocaine because of its low rate of non-responders and the possibility to continue treatment of oral administration of the drug.

Administration, Oral↗
PubMed1980

[Calcium induced necroses of cardiac muscle causing death in acute hyperparathyroidism (author's transl)].

Typical symptoms of acute myocardial infarction led to admission of a 66-year-old female. Creatine kinase (CK) was 720 U/l on admission and together with CK-MB of 108 U/l fitted the clinical picture. The ECG showed complete left bundle branch block. The patient died a few hours later in cardiac failure. Massive hypercalcaemia of 6.2 mmol/l and hyperphosphataemia of 1.6 mmol/l suggested acute primary hyperparathyroidism already clinically which later could be verified by a parathormone level of more than 100 000 ng/l ("C-terminal assay"). At necropsy chief cell adenoma of the epithelial bodies was found, typical changes of primary hyperparathyroidism in the skeleton and kidneys, and disseminated calcifications and fresh necroses of cardiac muscle. The coronaries were normal. This is the first clinical report of fatal acute primary hyperparathyroidism due to hypercalcaemia-induced myocardial necroses.

Acute Disease↗
PubMed1979

[Documentation of arrhythmias - the value of long-term ECG monitoring].

Computer-supported long-term ECG-analysis, must be considered as complementary to other methods of documentation concerning arrhythmias. With the introduction of computers in the last several years, exact quantification and qualification of arrhythmias, over long monitoring periods, has become possible. With this method diverse forms of documentation and data presentation enhance its value of information and increase plausibility. Major indications for long-term ECG-monitoring of ambulatory patients are detection of occult arrhythmias, evaluation of subjective symptoms such as dizziness or syncope, recognition of pacemaker dysfunctions, selection of patients with coronary heart disease at high risk and evaluation as well as control of the efficacy of antiarrhythmic therapy.

Arrhythmias, Cardiac↗
PubMed1979

[Non arrhythmogenic sudden death as complication of coronary heart disease].

In a cohort of 417 patients admitted consecutively to the Coronary Care Unit for acute myocardial ischemia (unstable angina pectoris in 121, acute myocardial infarction in 296 patients) 21 cases of non arrhythmogenic sudden death occurred within 24 hours after admission. 16 of these patients suffered from acute myocardial infarction and 5 from unstable angina pectoris. Cause of death was cardiac rupture in 12 and pump failure in 4 patients with acute myocardial infarction, whereas all patients with unstable angina pectoris died from pump failure. Patients with cardiac rupture within 24 hours after admission, had significantly higher systolic and diastolic blood pressure in comparison with the other groups and with patients dying from cardiac rupture on the third day, or later. All patients dying from pump failure with unstable angina pectoris and one of the patients dying from pump failure with acute myocardial infarction had beta blocker therapy. Beta blockers were given to 68 of the patients with unstable angina pectoris. Acute pump failure occurred in this group only. The risk of pump failure with beta receptor blocking drugs is indicated by angina decubitus, marked dyspnea during anginal attacks (even in patients free of signs of cardial insufficiency outside their attacks) and a lack of responsiveness to beta blocking therapy. In these patients rapid coronary angiography and bypass surgery seems to be the prefered method of management. Beta blockers should not be given to these patients or discontinued in cases which lack responsiveness.

Adrenergic beta-Antagonists↗
PubMed1979

[Rehabilitation potential after myocardial infarction].

For determination of the individual rehabilitation potential in patients after myocardial infarction, factors were extracted which are of importance for exercise capacity and its influence upon rehabilitation measures. Further results of exercise tests were correlated with psychological tests (Freiburg-personality-inventory) and the results of a patients' questionnaire for individual self-assessment, with concerning restitution by means of rehabilitation measures. 147 patients were admitted to a controlled rehabilitation program 10 weeks after myocardial infarction or later. Mean increase of exercise capacity after one year of rehabilitation was 21.6% of the initial test. Significantly greater increases of exercise capacity were achieved in patients with regular attendance particularly in younger patients in comparison with older patients. As evidenced by ergometric test data initially low maximal heart rate, low increase of heart rate, low exercise capacity and low double product were correlated with greater increase of exercise capacity. Patients with anterior-wall myocardial infarction tended to increased exercise capacity more. A relation between "psychosomatic disturbance" at onset of rehabilitation and a greater increase of exercise capacity could be determined as a trend. Connections between psychosocial factors and determinants of exercise capacity in influencing the rehabilitation potential are discussed.

Adult↗
PubMed1978

[Clinical efficacy of perhexiline maleate in stable angina pectoris (author's transl)].

The antianginal effect of perhexiline was evaluated in a placebo-controlled double-blind study of 20 patients with stable angina pectoris. Only patients with documented myocardial infarction of more than 6 months' standing and with ST-segment depression on exercise were admitted to the study. Objective parameters of bicycle stress tests at a submaximum level of 50 watts and a maximum exercise level were evaluated. Subjective data such as nitroglycerin consumption and incidence of anginal attacks per week were obtained from the patients' self-maintained records. No negative chronotropic effect of perhexiline was found at rest. At a submaximum exercise level with unchanged double-product, a significantly lower heart rate (p less than 0.05) and a significant reduction in ST-segment depression were observed in comparison with the placebo. At maximum exercise level an increase in exercise tolerance of 8.1% and in aerobic capacity of 8.3% resulted in a significant increase in the double-product (p less than 0.01), with a shift in the blood pressure/heart rate ratio. Discontinuation of exercise occurred at the same heart rate, but at a markedly higher level of exercise attainment. Heart rate on exercise proved to be the most valuable parameter in this study for the evaluation of the aerobic capacity of the individual patient. Nitroglycerin consumption and frequency of anginal attacks per week were reduced, but were not of statistical significance. Side-effects occurred in 6 patients, but these did not require termination or reduction of medication. The selective effect on heart rate during exercise opens a new field of application for perhexiline in comparison with beta-blocking agents.

Adult↗
PubMed1978

[Haemodynamic response to antihypertensive treatment with atenolol in patients with hypertension (author's transl].

The antihypertensive effect of atenolol, a cardioselective beta-blocker, was examined in 8 patients with essential hypertension. The most important haemodynamic changes observed were a significant reduction in heart rate (reduction in maximum heart rate at the end of symptom-limited exercise by 23% p less than 0.01) and a moderate fall in systolic blood pressure (reduction at submaximum level of exercise by 22%, p less than 0.01). The antihypertensive effect was attributable in half the patients to a drop in peripheral vascular resistance and in the other half evenly to a predominant reduction in cardiac output or to a reduction in both parameters. In view of the compensatory rise in stroke volume a significant reduction in cardiac output was not found. Symptom-limited exercise tolerance was increased in all patients. These results lead to the conclusion that the antihypertensive action of the cardioselective beta-blocker, atenolol is based on a lowering of the increased peripheral vascular resistance and a reduction in cardiac output; the latter mechanism is predominantly found in patients with hyperkinetic features.

Adolescent↗
PubMed1978

[Circadian variations in the frequency of arrhythmia and quantitative analysis of rhythm disturbances].

In 29 patients with long term ECG monitoring the circadian rhythm of extrasystoles was investigated. A decrease of maximal frequency of extrasystoles was calculated for each hour and an increase of the minima during night was detected. In 77% of the patients also for 6 hour-segments a circadian rhythm could be calculated. The effect of the antiarrhythmic treatment on the frequency of extrasystoles was different depending on the frequency of the sinus rhythm.

Anti-Arrhythmia Agents↗