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Biomedical subjects

H Emanuelsson

Publications and source records attributed to H Emanuelsson.

At least 91 records · Page 5Linked to original sources
PubMed1992

Prognosis in diabetics with chest pain or other symptoms suggestive of acute myocardial infarction.

We evaluated the prognosis of 599 diabetics who came to the emergency department with chest pain or other symptoms suggestive of acute myocardial infarction (AMI). They made up 8% of the patients with such symptoms (n = 7,157). Diabetics had a 1-year mortality rate of 25% as compared with 10% for nondiabetics (p less than 0.001). The difference remained significant regardless of whether there was a strong or a vague initial suspicion of AMI. On admission, independent risk factors for death were age, acute congestive heart failure and initial degree of suspicion of AMI. We conclude that among diabetics who appear in the emergency department with chest pain or other symptoms suggestive of AMI, 25% are dead within 1 year. The prognosis is directly related to the initial suspicion of AMI.

Aged↗
PubMed1992

Autoradiographic localization in polychaete embryos of tritiated mesulergine, a selective antagonist of serotonin receptors that inhibits early polychaete development.

Developing embryos of the polychaete Ophryotrochal labronica were exposed to tritiated mesulergine, a selective antagonist of the serotonin receptors 5-HT1c and 5-HT2, that also has significant affinity to dopamine D-2 sites, and the labeling was analyzed by autoradiography. Already at the earliest developmental stages (1-4 cells), numerous silver grains visualizing 3H-mesulergine binding sites and possibly also serotonin receptors were recorded over the cytoplasm, mostly in association with decomposing yolk granules, but few grains were detected over the nuclear region. In advanced pregastrular embryos (3 days) the number of silver grains was greatly increased over nuclei, cell borders and non-yolk cytoplasmic elements, notably in the animal half of the embryos. For newly gastrulated embryos (4 days), more than 90% of the grains appeared over non-yolk cellular structures. Abundant access to serotonin receptors is probably a fundamental condition not only for gastrulation but also for the high mitotic activity of the cleavage period. An indication hereof is the observation that exposure of cleaving polychaete eggs/embryos to unlabeled mesulergine inhibited cytokinesis and chromosome movements, whereas spindle formation and chromosome duplication were unaffected.

Animals↗
PubMed1991

Initial experiences with a miniaturized pressure transducer during coronary angioplasty.

A newly constructed pressure sensor with a diameter of 0.45 mm was evaluated in 15 patients undergoing balloon coronary angioplasty (PTCA). The sensor and an optic fiber were mounted on a 0.018" guide wire, which was used in the balloon catheter. Pressure gradients were recorded before and after PTCA, respectively. The pressure tracings were of satisfactory quality in all cases. The mean systolic and diastolic gradients before PTCA were 32 +/- 20mm Hg and 44 +/- 26mm Hg, respectively. Pressure gradients were also obtained with the balloon placed in the lesion in order to simulate the conventional way of pressure measurement through the balloon catheter. In this setting, the systolic and diastolic gradients were 77 +/- 32mm Hg and 59 +/- 25mm Hg, respectively. Following balloon dilatation, the systolic pressure gradient decreased to 14 +/- 12mm Hg, and the diastolic gradient to 13 +/- 11mm Hg. In conclusion, this new pressure sensor delivers recordings of good quality and may be especially of interest during angioplasty due to its small diameter.

Adult↗
PubMed1991

Evaluation of the antianginal effect of nifedipine: influence of formulation dependent pharmacokinetics.

Nifedipine capsules t.d.s. and an extended release formulation of nifedipine, nifedipine-ER tablets, given once daily in corresponding daily doses, have been compared with placebo in a double-blind, three-way cross-over study in 24 patients with stable angina pectoris. The objective was to study the influence on the antianginal effect of the different pharmacokinetics of several preparations of nifedipine. All patients received concomitant treatment with beta-adrenoceptor blockers. Antianginal efficacy was assessed by a dynamic exercise test at the end of the dosage intervals, i.e. 8 and 24 h after nifedipine capsules and nifedipine-ER, respectively, as well as 6 h after dosing. Six h after dosing the time of onset of chest pain and total exercise time were longer and total work was significantly higher during both nifedipine-ER (plasma concentration 260 nmol/l) and placebo treatment than after nifedipine capsules (plasma concentration 78 nmol/l). Time to 1 mm ST depression was longer during nifedipine-ER than during nifedipine capsule treatment. No significant difference was seen between nifedipine-ER and placebo. At the end of the dosage interval (24 and 8 h after nifedipine-ER and nifedipine capsules, respectively), no significant difference was found between nifedipine-ER (plasma concentration 75 nmol/l) and the other two treatments. However, placebo was superior to nifedipine capsules (plasma concentration 58 nmol/l) both in the time to onset of chest pain and total exercise time. The lack of effect at the end of the dosage interval was probably due to the subtherapeutic plasma nifedipine level.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

One-year mortality rate after discharge from hospital in relation to whether or not a confirmed myocardial infarction was developed.

Consecutive patients admitted to our hospital with suspected acute myocardial infarction during 21 months were prospectively evaluated. One-year mortality after discharge from hospital was related to whether or not an infarction developed (infarct versus non-infarct patients). Of patients discharged alive after developing an infarct, there was a mortality of 17% (n = 777) versus 12% (n = 1830) (P less than 0.001) for all patients not developing infarction. In a high risk group (any of the following: age greater than or equal to 75 years, previous history of myocardial infarction, diabetes mellitus or congestive heart failure) patients developing infarction had a mortality of 24% (n = 457) versus 17% (n = 1221) for those who did not (P less than 0.001). In a low risk group (none of the high risk criteria), the corresponding mortality was 8% (n = 316) for patients suffering infarction and 3% (n = 603) for those not having infarction (P less than 0.001). The difference in mortality between patients with and without infarction was most marked in women (21% vs 11%; P less than 0.01) and in hypertensives (25% vs 12%; P less than 0.001), but less marked in men (16% vs 13%; NS) and in patients without hypertension (13% vs 12%; NS). Among patients not suffering infarction, mortality was particularly high in those with previous congestive heart failure (23%) and diabetes mellitus (21%).

Age Factors↗
PubMed1991

Serum lipids and lipoproteins in relation to restenosis after coronary angioplasty.

Restenosis after coronary angioplasty (PTCA) is a major problem, limiting the long-term efficacy of the procedure. Lipoprotein levels are associated with the development of atherosclerosis and may also be associated with restenosis. In this study the serum levels of cholesterol (CH), triglycerides (TG), high density lipoprotein (HDL) and low density lipoprotein (LDL) were analysed in 157 patients undergoing 161 PTCA procedures. Follow-up coronary angiograms were performed after 6.0 +/- 4.3 months. The restenosis rate was 33%. Treatment with aspirin and a residual stenosis of 25-49% immediately after successful PTCA were the only variables associated with restenosis (P less than 0.05), otherwise the clinical and angiographic characteristics were similar with and without restenosis. There was no relationship between restenosis and the levels of CH, TG, HDL or LDL (P greater than 0.05). In univariate and multivariate analysis of males (n = 121) and females (n = 40) separately, restenosis was associated with low HDL in men and high HDL in women (P less than 0.05), but not with CH, TG or LDL (P greater than 0.05). We conclude that the serum levels of CH, TG and LDL do not seem to be related to restenosis after PTCA. It is suggested that low HDL in males and high HDL in females is related to restenosis.

Adult↗
PubMed1991

Adenosine infusion to patients with ischaemic heart disease may provoke left ventricular dysfunction detected by echocardiography.

Infusion of the endogenous vasodilator adenosine to patients with ischaemic heart disease (IHD) frequently provokes myocardial ischaemia, possibly caused by a coronary steal. The aim of this study was to detect the occurrence and incidence of disturbances in left ventricular (LV) wall motion and Doppler indices of altered LV function during infusion of adenosine. Thirty-seven patients (six female) aged 37-74 years with IHD, verified by coronary angiography, were given up to 200 micrograms kg-1 min-1 (mean 155 +/- 5) adenosine i.v. for 18 +/- 1 min. LV wall motion was monitored by two-dimensional echocardiography (2D-echo). Doppler spectral signal was obtained from the mitral blood flow. All but six of the patients experienced angina pectoris of habitual character in connection with the adenosine infusion. Heart rate increased by 22 +/- 1 beats min-1, systolic blood pressure was unchanged, but diastolic blood pressure decreased slightly. 2D-echo revealed severe regional LV wall motion disturbances already in the basal state in 17 patients. During infusion of adenosine, these abnormalities were aggravated and disturbances also occurred in another 15 patients. Thus, adenosine increased the sensitivity for IHD in this selected material from 49 to 89%. In all, the mean index of wall motion abnormalities increased from 5.1 +/- 1.1 to 10.1 +/- 1.4 (P less than 0.001). The diastolic LV filling characteristics, as evaluated by the Doppler A/E ratios, were of limited value for determination of IHD grade. It is concluded that infusion of adenosine to patients with IHD frequently elicits myocardial ischaemia with disturbances in LV function, and offers an alternative to exercise for stress echocardiography.

Adenosine↗
PubMed1991

Higher recurrence rate after coronary angioplasty in unstable angina pectoris.

PURPOSE: Recurrent stenosis after percutaneous transluminal coronary angioplasty (PTCA) is a significant problem, requiring repeat dilation in about one-third of all treated patients. Various clinical and procedure-related predictors have been proposed. Between 1983 and 1987, 257 patients underwent 322 procedures, where 380 stenoses were attempted. Indications were: stable angina pectoris 73%, unstable angina pectoris 22%, other indication 5%. The primary success rate was defined as a less than 50% remaining postprocedure stenosis. FINDINGS: Repeat angiograms were done for 88% of the initially successful cases, either six months after PTCA or if there was a clinical recurrence. Restenosis was defined as a recurrence of a more than 50% diameter stenosis. The restenosis rate was 33% and was significantly higher (p less than 0.05) for unstable (46%) than for stable angina pectoris (29%). There was a nonsignificant tendency to a higher restenosis rate in the left anterior descending artery than in the other coronary vessels. IMPLICATIONS: The increased restenosis rate seen after PTCA for unstable angina pectoris could be caused by a higher activity in systems affecting the proliferative processes in the smooth muscle cells of the arterial wall, which is thought to form the pathophysiologic basis for restenosis after PTCA.

Adult↗
PubMed1991

Transient myocardial ischemia during Holter registration before and after coronary angioplasty.

PURPOSE: Revascularizing procedures like percutaneous transluminal coronary angioplasty (PTCA) aim at reducing the incidence and severity of myocardial ischemia. To evaluate this, continuous Holter ST analysis is a possible method. DESIGN: 41 patients (35 men, 6 women) with stable angina pectoris had continuous twenty-four-hour two-channel Holter registration (V5/aVF-analogous leads) recorded before and after PTCA. Transient myocardial ischemia (TM) was defined as 0.1 mV ST depression or more 80 msec after the J point for one minute or more. FINDINGS: PTCA was successful for 37 patients (90%). Eleven of these had a total of 53 episodes of TM, 36 (68%) before and 17 (32%) after PTCA (p less than 0.05). Fifteen episodes (28%) were symptomatic, and 38 (72%) were asymptomatic. Six patients had TM after successful PTCA, 5 of whom had one-vessel disease and a clinically uncomplicated course. One patient had multivessel disease, with only one vessel dilated. Follow-up angiograms for 9 of the 11 patients with TM revealed 5 restenoses. There was no significant correlation between TM after PTCA and subsequent restenosis (p greater than 0.05). IMPLICATIONS: TM is common in patients with stable angina pectoris. The incidence significantly decreases after successful PTCA, but TM is seen also with a clinically uncomplicated course. In multivessel disease this is consistent with incomplete revascularization, whereas in single-vessel disease the most likely cause is intermittent spasm or thrombosis. TM after successful PTCA does not seem to be a predictor of restenosis.

Angina Pectoris↗
PubMed1991

Changes in arterial levels and myocardial metabolism of catecholamines during pacing-induced angina pectoris.

In order to elucidate the effects of atrial pacing on cardiac catecholamine metabolism, 11 patients were studied during cardiac catheterization. Blood samples were drawn from a peripheral artery and the coronary sinus for estimation of catecholamine concentrations. Heart rate was increased by 10 beats/min each minute, and all patients experienced chest pain at maximal pacing rate. Coronary sinus blood flow rose from 122 +/- 19 at rest to 208 +/- 25 ml/min at final pacing rate, and myocardial lactate extraction ratio decreased. There was no significant change in arterial epinephrine levels, whereas the extraction ratio decreased (p less than 0.05). The norepinephrine arterial levels increased at the final pacing rate (p less than 0.01). The calculated myocardial release increased as well, but not to a statistically significant degree. The exact mechanisms of the rise in sympathetic activity and arterial norepinephrine levels cannot be ascertained with the present study design. Myocardial ischemia with subsequent chest pain seems to be a probably cause for the increased sympathetic outflow.

Aged↗
PubMed1991

Effects on chest pain of early thrombolytic treatment in suspected acute myocardial infarction: results from the TEAHAT Study.

In a randomized, double-blind study, in which recombinant tissue plasminogen activator (rt-PA) administered at an early stage was compared with placebo in patients with suspected acute myocardial infarction (AMI), the effects on pain were studied in 312 patients. Inclusion criteria were as follows: (a) chest pain of duration less than 2 h and 45 min; and (b) age less than 75 years. Chest pain was estimated subjectively by the patients, using a 10-point numerical rating scale, at hourly intervals for the first 24 h, and by the requirement for narcotic analgesics. Compared with placebo, rt-PA treatment resulted in a 43% reduction in mean total pain score (P less than 0.0001), a 26% reduction in pain duration (P less than 0.01), and a 33% reduction in morphine requirement (P = 0.01). Fifty-seven per cent of all patients developed a confirmed AMI. In these subjects rt-PA reduced the pain score by 46% (P less than 0.001). Among patients without confirmed AMI, a 37% reduction in pain score was observed (P = 0.05). The effect on pain was most marked in patients with ST-elevation on the initial ECG. We conclude that early treatment with rt-PA in suspected AMI reduces chest pain considerably. The effect is most marked in patients with ST-elevation on the initial ECG.

Aged↗
PubMed1990

Role of beta-adrenergic blockers after percutaneous transluminal coronary angioplasty.

Restenosis after percutaneous transluminal coronary angioplasty (PTCA) cannot currently be prevented. Different medical regimens have been largely unsuccessful. Experimental studies suggest roles for beta-adrenergic blockers and calcium antagonists. Controlled clinical studies have failed to show any decrease in restenosis rate for calcium antagonists. Corresponding studies for beta blockers are lacking. This study evaluates 541 consecutive PTCA procedures, 455 (86%) in patients treated with beta blockers after PTCA (76% metoprolol, 14% atenolol, 4% sotalol, 6% others) and 86 (14%) in patients without beta blockers. Angiographic success was achieved in 483 of 620 lesions (78%), and was not significantly different with or without beta blockers (79 vs 73%, p greater than 0.05). The procedure success rate and the complication rates (myocardial infarction, emergency coronary artery bypass grafting, death) did not differ with or without beta blockers (p greater than 0.05). Follow-up angiograms for 426 of the 483 successfully dilated lesions (88%) revealed that a total of 155 stenoses had recurred (36%). The restenosis rate was not significantly different with (368) or without (58) beta blockers (36 vs 38%, p greater than 0.05). For beta blockers with calcium antagonists (84% nifedipine, 13% diltiazem, 2% verapamil, 1% others), the restenosis rate was 97 of 250 (39%) vs 36 of 118 (31%) (p greater than 0.05). This retrospective study indicates that treatment with beta-adrenergic blockers after PTCA, alone or in combination with calcium antagonists, does not influence either the success rate or the restenosis rate and can be continued if indicated from an antiischemic viewpoint.

Adrenergic beta-Antagonists↗
PubMed1990

Buccal nitroglycerin decreases ischemic pain during coronary angioplasty: a double-blind, randomized, placebo-controlled study.

Nitroglycerin (NTG) has the potential to reduce myocardial ischemia during percutaneous transluminal coronary angioplasty (PTCA). Buccal administration of NTG offers practical advantages compared to intravenous or intracoronary administration. In a double-blind, randomized, placebo-controlled study, 100 patients were given 5 mg of buccal NTG or placebo during PTCA. A scoring system for ischemic pain during balloon inflation was defined as pain intensity (0 to 5) multiplied by duration of pain after balloon deflation (1 = 0 to 30 seconds, 2 = 30 to 60 seconds, 3 = 60 to 120 seconds, 4 = greater than 120 seconds but subsiding, and 5 = until next inflation). Fourteen patients were excluded: 12 for vagal reaction (eight NTG and four placebo; p greater than 0.05) requiring atropine, making buccal absorption unreliable, and two for inability to dilate. Eighteen patients (nine NTG and nine placebo) had no pain during balloon inflation. Sixty-eight patients (32 NTG and 36 placebo) had ischemic pain with a pain score (mean +/- SD) of 4.8 +/- 3.8 for the NTG group versus 7.1 +/- 4.8 for the placebo group (p = 0.03). We conclude that buccal NTG significantly decreases myocardial ischemia during PTCA.

Administration, Buccal↗
PubMed1990

The prognosis of patients suspected of having acute myocardial infarction subsequent to its exclusion as the diagnosis.

This review of the literature concerns the prognosis of patients suspected of having myocardial infarction subsequent to its exclusion as the diagnosis. Several investigations show a surprisingly bad prognosis for patients in this category, almost comparable to that of patients with a confirmed infarction. When the results of the different studies are pooled, however, there is a significant difference between those patients with true infarction, and those in whom infarction was excluded, in terms of overall mortality (12% and 7%; P less than 0.0001) and the development of subsequent non-fatal infarction (11% and 6%; P less than 0.05) when the results are analysed for a period of follow-up of one year. The difference was significant even when both fatal and non-fatal infarctions were taken into account over the one-year period of follow-up (13% and 8%; P less than 0.0001). The analysis shows that electrocardiographic ST-T changes are a risk factor for coronary events, but the results are conflicting for other possible risk factors. The selection of patients varies between the different studies, which probably contributes to the different results reported. Prospective studies with well defined groups of patients large enough to permit analysis of subgroupings will be needed to resolve the outstanding questions.

Diagnostic Errors↗
PubMed1990

Effects of thoracic epidural anesthesia on coronary arteries and arterioles in patients with coronary artery disease.

The effect of cardiac sympathetic blockade by high thoracic epidural anesthesia (TEA) (T1-T6, bupivacaine) on the luminal diameter of normal and diseased portions of epicardial coronary arteries was determined by quantitative coronary angiography in patients (n = 27) with severe coronary artery disease (CAD). In a separate group of patients (n = 9) with severe CAD, the effects of TEA on coronary arterioles (resistance vessels) were studied, by measuring total and regional myocardial blood flow and metabolism with the retrograde coronary sinus thermodilution technique. At the stenotic segments, TEA induced an increase in luminal diameter from 1.34 +/- 0.11 to 1.56 +/- 0.13 mm (P less than 0.002), but did not change the diameter of the nonstenotic segments (3.07 +/- 0.13 to 2.99 +/- 0.13 mm). In the second group of patients, TEA induced no changes in coronary perfusion pressure, total or regional myocardial blood flow, coronary venous oxygen content, coronary blood flow distribution, regional myocardial oxygen consumption, or lactate extraction or uptake. Two patients had chest pain in the control situation and had regional myocardial lactate production that was attenuated by TEA. We conclude that TEA may increase the diameter of stenotic epicardial coronary artery segments in patients with CAD without causing a dilation of coronary arterioles. These effects may be beneficial when high TEA is used to treat severe ischemic chest pain in patients at rest.

Aged↗
PubMed1990

Eligibility for intravenous thrombolysis in suspected acute myocardial infarction.

Based on the registration of all the 7,157 patients admitted during a 21-month period to the emergency ward of a single hospital in an urban area with chest pain or other symptoms suggestive of acute myocardial infarction, we studied eligibility for intravenous thrombolysis in suspected acute myocardial infarction. We have limited the present analysis to those 1,715 patients with a strong suspicion of myocardial infarction, and for these patients, we have calculated the percentages eligible for thrombolysis when various electrocardiographic and delay time criteria are applied, but we have not considered contraindications to thrombolysis. We have also calculated the proportions of all infarctions in this group that would thereby receive the treatment, and the proportions of patients treated that would develop a confirmed infarction. Using the criteria ST elevation on the initial electrocardiogram and arrival in hospital within 6 hours from onset of symptoms, 18% of patients would have been given early intravenous thrombolysis, 37% of confirmed infarctions would have been treated, and 91% of all treated patients would have developed a confirmed infarction; with a delay time criterion of 12 hours, these percentages would have been 20%, 41%, and 91%, respectively; with a criterion of 24 hours, they would have been 22%, 45%, and 90%, respectively. By not considering the initial electrocardiogram and applying only the criterion of delay time, these percentages would have been 70%, 72%, and 45%, respectively, for a delay time of 6 hours; 83%, 84%, and 45%, respectively, for a delay time of 12 hours; and 91%, 92%, and 44%, respectively, for a delay time of 24 hours.(ABSTRACT TRUNCATED AT 250 WORDS)

Electrocardiography↗
PubMed1990

Thoracic epidural anesthesia improves global and regional left ventricular function during stress-induced myocardial ischemia in patients with coronary artery disease.

The aim of the present investigation was to study the effects of high thoracic epidural anesthesia (TEA), including the cardiac sympathetic segments, on ischemic ST-segment changes and left ventricular global and regional wall motion abnormalities. Ten patients with a two- or three-vessel coronary artery disease, all treated with the beta-adrenergic blocker metoprolol because of severe stable angina pectoris, performed two identical exercise stress tests, the first without TEA (control exercise) and the second with TEA (TEA exercise). Before each stress test, intravenous metoprolol was given to achieve maximal or near maximal beta-adrenoceptor blockade. Systolic and diastolic arterial pressures (radial artery cannula), heart rate, and rate-pressure product, as well as global and regional ejection fractions, using equilibrium radionuclide angiography in the left anterior oblique projection, were measured at rest and during maximal exercise. ST-segment analysis (V3 or V5) was performed, and the regional wall motion score was calculated at control exercise and TEA exercise. Intravenous metoprolol or intravenous metoprolol plus TEA at rest did not cause any significant changes of any of the variables. During TEA exercise, systolic arterial pressure, diastolic arterial pressure, and rate-pressure product, but not heart rate, were significantly lower compared to control exercise. The global and anterolateral ejection fractions were significantly higher (52.8% versus 46.5% and 53.2% versus 46.0%, respectively, P less than 0.05), and the regional wall motion score was significantly lower (8.8 versus 11.8, P less than 0.01) during TEA exercise than during control exercise. ST-segment depression was significantly lower during TEA exercise (-1.03 versus -1.84 mV, P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗