The aim of the present study was to examine the nailfold capillary morphology and dynamics in treated chronic heart failure (CHF) in relation to parameters of left ventricular structure and function. Twenty patients with CHF class II according to the New York Heart Association underwent a capillaroscopic examination at the finger nailfold using a computerized videophotometric system (Capiflow) at rest and after 1 min arterial occlusion. Study parameters ere number, length and diameter of the capillaries as well as capillary blood velocity (CBV). Further experiments included echocardiography and determination of left ventricular ejection fraction by Tc scintigraphy. Nailfold capillaries in established CHF are enlarged and the CBV is dramatically decreased. The reactive hyperemic response to 1 min arterial occlusion is attenuated. CBV correlates positively with left ventricular ejection fraction (r = 0.61, p = 0.01) and inversely with left ventricular end-diastolic (r = -0.56, p = 0.04) and end-systolic (r = -0.69, p = 0.01) diameters. The time-to-peak flow after 1 min arterial occlusion is positively related (r = 0.68, p < 0.05) to the duration of CHF. Our data indicate that finger microcirculation in CHF deteriorates as a function of the severity and duration of heart failure.

Aged↗

PubMedDate not supplied

Circulatory changes in muscle and skin arteries in primary hypertension.

This review deals with circulatory adjustments occurring in the limb arteries of hypertensive patients. Measurements of regional blood flow are mandatory, because conclusions drawn from calculated total peripheral resistance often are not applicable to local vascular beds. Limb arteries, which can be followed by easy and noninvasive methods, often are the first choice for study of regional circulation. In this discussion, a few historic studies are cited first; next, the data available on skeletal muscle (forearm and calf) and skin (finger) circulation are reviewed, to show that flow through both muscle and skin is increased in mild and moderate hypertension, while there is a trend to lower values in more severe hypertension. Our own data are derived from 51 untreated patients showing mild to moderate hypertension, matched to 23 normotensive subjects. Flow is measured simultaneously with an ECG-triggered venous occlusion plethysmograph at calf and finger. At rest, calf and finger blood flows are significantly higher and calculated resistance is lower in hypertensive subjects; during reactive hyperemia, blood flow remains higher in hypertensive subjects but calculated resistance increases up to values that are higher, compared to normotensive control subjects; these data are compatible with structural changes in the vascular wall.

Arm↗

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Medical treatment of peripheral artery occlusive disease (PAOD).

The goal of this review is to focus attention of the physicians to the point that peripheral artery occlusive disease (PAOD) is not only a local problem impairing walking distance, but also a manifestation of atherosclerosis. As a consequence, one should realise that in PAOD patients, atherosclerotic narrowing is likely to be present in other territories such as the coronary and cerebral arteries; mortality and morbidity in PAOD will largely depend on impairment of the circulation in these areas more than on the local ischaemia in the limbs. Also, control of risk factors will be a major issue. The most important steps in the local medical treatment of PAOD are training and nicotine stop. All efforts should be given to help patients in their compliance to these non-pharmacological means. Vasoactive drugs have been shown to cause significantly positive effects on walking distance and for naftidrofuryl on quality of life; such effects should be seen as an addition to training and nicotine stop. The approach to PAOD has come in a completely new light in medicine since it is has been recognised as a major marker of coronary or cerebral atherosclerosis.

Arterial Occlusive Diseases↗

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[Intermittent claudication of the legs: what can be obtained without pharmacologic agents].

Intermittent claudication of the lower limbs is treated routinely by either drugs, percutaneous transluminal angioplasty, surgery or a combination of these. Each of these therapeutic approaches carries a certain risk; side effects can develop. Moreover, often there is a lack of well controlled studies to evaluate the objective basis of the results. Therefore, in the present paper, evolution of walking distance in patients presenting with intermittent claudication was followed during non-pharmacological treatment mainly consisting of daily muscle training and avoiding to use nicotine.

Chronic Disease↗

PubMedDate not supplied

Ketanserin in intermittent claudication. A double-blind placebo-controlled study.

Twenty patients with intermittent claudication and having an ankle/arm blood pressure ratio less than or equal to 0.75 were randomized to receive ketanserin 40 mg b.i.d. or placebo for three months under double-blind conditions following a six-week run-in period. A placebo was administered for an additional six weeks at the end of the double-blind phase. Results indicated that ketanserin significantly increased (p less than 0.04) the pain-free walking distance by 36% versus a non-significant 10% rise with placebo. During the run-out period, this parameter remained significantly increased (p less than 0.04) with ketanserin. Changes in the total walking distance during the double-blind period were 15% and 11% for ketanserin and placebo, respectively, with a significant (p less than 0.05) increase to 30% occurring in the ketanserin group during the run-out phase. There was a decrease in the ankle/arm blood pressure ratio in the worst leg in both groups. The rise of systemic blood pressure after exercise was attenuated with ketanserin. Side-effects were reported in only one patient in the placebo group. These data indicate that ketanserin may be of value in patients suffering from intermittent claudication. Other studies are, however, warranted to determine whether this beneficial effect is general or restricted to a subgroup of patients.

Aged↗

PubMedDate not supplied

Localisation and risk factors of peripheral arterial occlusive disease in the female.

Peripheral arterial occlusive disease has been described frequently as a disease affecting predominantly men. There is only a few information available concerning peripheral vascular disease in the female. Therefore, the aim of the present study was to examine risk factors in relation to localisation and symptoms of peripheral arterial occlusive disease in female patients. A retrospective study has been performed in 48 female patients (52-82 years with a mean age 69.5 years). Finally 45 patients were witheld because they had all a doppler examination and an oscillography of the lower limbs. The majority of the patients, namely 22 patients (49%) had combined ileofemoral and distal lesions. There were 15 patients (33%) who had isolated distal lesions, while only 8 patients (18%) had isolated ileofemoral vascular lesions. With respect to the symptoms the population could be divided in three groups: 16 patients (36%) were asymptomatic, 19 patients (42%) had intermittent claudication and 10 patients (22%) had rest pain and necrosis. Smoking was not the predominant risk factor in this group. Diabetes mellitus seemed to enhance distal vascular lesions, while arterial hypertension, obesity and lipids were predictive risk factors in peripheral vascular disease in the female. A high incidence of cardiovascular disease (31 patients, 69%) and cerebrovascular disease (13 patients, 29%) was concomitant.

Aged↗

PubMedDate not supplied

Cutaneous periarteritis nodosa. A case report.

We studied a patient with severe ulcerations on the lower limbs due to cutaneous periarteritis nodosa. Chronic relapsing course during more than 12 years with no systemic involvement was documented.

Adult↗

PubMedDate not supplied

Diagnostic performance of the bidirectional Doppler velocity curve recorded at the ankle.

The diagnostic value of different parameters derived from the Doppler velocity curve recorded at the ankle was analysed in a population of 432 subjects. To document the presence or absence of obliterative arterial diseases in the lower limbs, systolic blood pressure measurements were made and oscillography before and after exercise was recorded. A descending slope below 20.5 mm as recorded during 0.40 sec, appears as a sensitive indicator of occlusive arterial diseases of the lower extremities: 84% of the limbs were correctly classified showing with a high sensitivity of 91.8% but a lower specificity of 76%. By considering a combination of two parameters (descending slope and crest-time), the overall performance increases up to 88% and specificity becomes satisfactory (85%), while sensitivity is kept at 90%. Quantitative analysis of the Doppler velocity curve recorded at the ankle is feasible and is most helpful in discriminating normal and abnormal limbs both in daily clinical practice and in large scale studies.

Adolescent↗

PubMedDate not supplied

Peripheral vascular effects of calcium entry blockers in normal volunteers.

The peripheral vascular effects of calcium entry blockers have been scarcely investigated. Therefore we examined the effects of different doses of tiapamil and nifedipine in two groups of volunteers. The measurements were done by plethysmography. At a lower dose there is a significant increase in venous capacity. At a higher dosage there is an increase of the arterial flow, eliciting a reflex sympathetic stimulation with heart rate increase and venoconstriction. Therefore calcium entry blockers can be considered as arterial and venodilators.

Adult↗

PubMedDate not supplied

Comparison between ankle and toe index in patients with peripheral arterial disease.

In contrast to the systolic blood pressure at the posterior tibial artery, the evaluation of pressure at the digital artery of the foot before and after exercise in patients with peripheral arterial disease is not well known. Twenty three patients with peripheral vascular disease were examined. The systolic pressure was measured by means of an ultrasound velocity detector at the brachial and posterior tibial artery. Digital artery pressure was determined with photoplethysmography. Pressures were measured before and within 5 and 10 minutes after a treadmill test. Ankle and toe index was calculated. At rest the toe index is lower than the ankle index and after a treadmill test the decrease in toe index occurs in parallel to the ankle index.

Ankle↗

PubMedDate not supplied

Value of venous occlusion plethysmography to study venoactive medication in men.

Venous occlusion plethysmography is a useful tool to investigate the effect of a vaso-active medication on the venous circulation in man. However, room temperature can be very critical when small changes have to be detected. Therefore several authors induce a preconstriction of the veins for example with norepinephrine. When the conditions of the experiment are carefully controlled and a very sensitive plethysmograph is used, a significant effect on forearm veins can be shown even after small doses of nitrates and a high room temperature; matching with placebo is critically needed. It is likely that by lowering room temperature the response would be exaggerated. Taking these restrictions in mind, venous occlusion plethysmography can be a very valuable, non-invasive tool to study the effect of vaso-active treatment on the veins in men.

Heart Failure↗

PubMedDate not supplied

Critical evaluation of venous occlusion plethysmography in the diagnosis of occlusive arterial diseases in the lower limbs.

In this paper, the value of venous occlusion plethysmography in the differentiation between normal and abnormal is discussed. Data are obtained with an ECG triggered plethysmograph allowing an automatic and also a fast recording of the different parameters of the reactive hyperemia. A group of 74 proven "normal" limbs and of 93 proven "abnormal" limbs was studied. No difference in resting blood flow was seen; however, several parameters derived from reactive hyperemia were significantly different; curves obtained after arrest of the circulation during 3 minutes yielded the best results. Discriminant analysis showed that peak blood flow was the best individual performing parameter; using four variables of the reactive hyperemia curve, an overall performance of 84.9% was obtained with specificity of 93% and sensitivity of 76%. The place of plethysmography in the definition of vascular changes is discussed.

Arterial Occlusive Diseases↗

PubMedDate not supplied

Sympathetic nervous control of muscle and skin circulation.

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Animals↗

PubMedDate not supplied

[Contribution of noninvasive vascular exploration methods to the diagnosis of intermittent claudication].

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Humans↗