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H Lydtin

Publications and source records attributed to H Lydtin.

At least 19 recordsLinked to original sources
PubMed1998

[Myocardial involvement in carrier states for Duchenne muscular dystrophy. A rare cause of supraventricular arrhythmia].

HISTORY AND CLINICAL FINDINGS: Two women, both aged 54 years, were admitted because of supraventricular arrhythmias of recent onset. Patient 2 was also in heart failure. Male family members of both patients were known to have Duchenne's muscular dystrophy, of which one had died. INVESTIGATIONS: The electrocardiogram of patient 1 demonstrated atrial fibrillation. Patient 2 had a raised serum creatine kinase concentration and increased pulmonary marking in the chest radiogram. Patient 1 had normal findings on left heart catheterization, but immunohistochemical analysis of a myocardial biopsy revealed dystrophin mosaic with 20% dystrophin-negative fibres. Patient 2 had a reduced ejection fraction and 80% dystrophin-negative fibres. DIAGNOSIS, TREATMENT AND COURSE: Myocardial involvement in the carrier state for Duchenne's muscular dystrophy having been demonstrated in both women, patient 1 received antihypertensive treatment while patient 2, who was in cardiac failure, was given diuretics, ACE-inhibitor and beta-receptor blockers. CONCLUSION: Cardiomyopathy in carriers of Duchenne's muscular dystrophy is a rare cause of supraventricular arrhythmias. The cause can be confirmed by immunochemical analysis of an endomyocardial biopsy.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1996

Felodipine or hydrochlorothiazide/triamterene for treatment of hypertension in the elderly: effects on blood pressure, hypertensive heart disease, metabolic and hormonal parameters.

The aim of the study was to compare the antihypertensive efficacy of either felodipine or the diuretic combination hydrochlorothiazide/triamterene in a group (n = 65) of elderly (> or = 70 years) hypertensives (office blood pressure > or = 160/95 mmHg) with special regard to ambulatory blood pressure monitoring, hypertensive heart disease and metabolic parameters. This was a randomized, double-blind study with a treatment period of 6 months. Reduction of office and 24-hr ambulatory blood pressure was comparable with both treatment regimens; after 6 months. 18 of 29 patients in the felodipine group (62%) and 20 of 27 patients in the diuretic group (74%; p = 0.4) were controlled. While episodes of ischemic type ST-segment depression were significantly reduced in the felodipine group (from 49 to 9 episodes), there was no significant change in the diuretic group (from 24 to 21 episodes). Both regimens decreased left ventricular wall thickness, but the decline in left ventricular muscle mass index was significant only for felodipine. Felodipine did not induce any change in metabolic or hormonal parameters; the diuretic combination significantly increased serum creatinine, uric acid, plasma renin activity, and plasma prorenin. Thus, the antihypertensive efficacy of felodipine and the diuretic combination was comparable in elderly hypertensives; only felodipine, however, improved parameters of hypertensive heart disease and showed a neutral metabolic and hormonal profile.

Aged↗
PubMed1996

[Diagnostic error of thrombosis of the inferior vena cava with contrast-CT in tricuspid valve insufficiency].

Sonographic evidence of a cystic adrenal tumour was found in a 73-year-old female patient with a 6-month history of chest pain and dyspnoea. A computed tomogram of the abdomen revealed, in addition to the 5-cm lesion, a contrast medium-free area in the vena cava inferior, leading to an initial diagnosis of recurrent pulmonary emboli due to a thrombosis of the vena cava inferior. Further diagnostic procedures excluded emboli and indicated a dilating cardiomyopathy with mitral and tricuspid regurgitation. The contrast medium-free area in the vena cava inferior was caused by the influx and regurgitation of contrast medium-free blood from the renal and hepatic veins in addition to blood from the right atrium due to the tricuspid valve regurgitation. A thrombosis was excluded by means of a color-duplex investigation. The patient declined any further diagnostic procedures concerning the lesion.

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PubMed1995

[Gastrointestinal amyloidosis in IgG-chi-light chain plasmacytoma. Diagnostic problems despite advanced changes].

A 50-year-old man with an IgG-chi light chain multiple myeloma stage IIIA, developed--in a phase of low disease activity, after 18 months of an uncomplicated course--marked malabsorption syndrome with 20 kg weight loss, diarrhoea and meteorism. Although the H2-breath test indicated intestinal bacterial colonisation, neither antibacterial treatment with trimethoprim/sulphamethoxazole and metronidazole nor prokinetic treatment with cisapride (30 mg daily) and erythromycin (1 g twice daily) improved the symptoms. Suspected amyloidosis was not demonstrable at first, despite repeated step biopsies of stomach, duodenum and rectum. Amyloidosis of the entire gastrointestinal tract was proven only by repeated biopsies deep into the submucosa. Despite treatment of the underlying disease with melphalan and prednisone (Alexanian's scheme) the amyloidosis advanced further to involve liver, spleen, lung, kidneys and heart. The patient died, 2 years after diagnosis of the multiple myeloma, from recurrent pulmonary emboli due to atrial fibrillation.

Amyloidosis↗
PubMed1994

Antihypertensive treatment with felodipine but not with a diuretic reduces episodes of myocardial ischaemia in elderly patients with hypertension.

Episodes of transient myocardial ischaemia can frequently be observed in hypertensive patients. To assess the effects of antihypertensive treatment with the calcium antagonist felodipine or the diuretic combination hydrochlorothiazidel triamterene on episodes of ischaemic-type ST-segment depression (ST-D), simultaneous ambulatory electrocardiographic and blood pressure (BP) monitoring was performed in 42 elderly hypertensives without manifest coronary artery disease. All patients (mean age 79 +/- 6 years, office BP > or = 160/95 mmHg) were evaluated off any antihypertensive or anti-ischaemic therapy and after 3 months treatment with either felodipine or the diuretic (randomized, double-blind study) for episodes of significant ST-D (> or = 0.1 mV, duration > or = 1 min, interval > or = 1 min). The reduction in office BP and daytime ambulatory BP was similar for both agents, as was a significant reduction in the heart rate x systolic BP product (DP) over 24 h (felodipine: 12,441 +/- 2076 vs 11,643 +/- 1953 mmHg.min-1; P = 0.048; diuretic: 12,366 +/- 2782 vs 11,062 +/- 2012 mmHg.min-1; P = 0.003). While felodipine significantly decreased the total number of ST-D (from 40 to six episodes; P = 0.03), the total number of ST-D remained unchanged with the diuretic (non-significant increase from 31 to 45 episodes; P = 0.24). The same trend was observed for the number of patients with ST-D.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Prevalence, awareness, treatment and control of hypertension in a population over the age of 65 years: results from the Starnberg Study on Epidemiology of Parkinsonism and Hypertension in the Elderly (STEPHY).

OBJECTIVE: To assess the prevalence of hypertension and isolated systolic hypertension and the level of awareness, treatment and control of hypertension, in a population aged over 65 years. DESIGN: Cross-sectional survey of the total population aged > or = 65 years of two Bavarian villages with a representative age distribution. PATIENTS: From a total of 1190 inhabitants aged > or = 65 years, 982 (394 male, 588 female) participated (response rate 82.5%). METHODS: All of the participants were visited at home by physician observers. After a standardized questionnaire, blood pressure was measured three times on one occasion with the subject in the sitting position, using a standard mercury sphygmomanometer. 'Actual' hypertension was defined as systolic blood pressure (SBP) > or = 160 or diastolic blood pressure (DBP) > or = 95 mmHg, or both, or current use of antihypertensive drugs given for the indication hypertension in patients with blood pressure < 160/95 mmHg. Isolated systolic hypertension was defined as SBP > or = 160 and DBP < 90 mmHg. All 'actual' hypertensives were further classified as 'unaware' of hypertension, 'aware' (but not treated), 'treated' (current use of antihypertensive drugs for the indication hypertension and blood pressure > or = 160/95 mmHg) or 'controlled' (treated and blood pressure < 160/95 mmHg). RESULTS: Mean +/- SD blood pressure was 154.5 +/- 24.4/84.9 +/- 11.6 mmHg (when 52 institutionalized participants were excluded, 155.6 +/- 24.4/85.3 +/- 11.6 mmHg). The SBP was significantly higher in females than in males and increased up to the age group 80-84 years both in males and in females. The DBP decreased with age. The prevalence of 'actual' hypertension was 53% and increased up to the age group 75-79 years in males and 80-84 years in females. The prevalence of isolated systolic hypertension was 17% (with patients currently using antihypertensive drugs excluded). Of the patients with 'actual' hypertension, 34% were 'unaware' of the diagnosis, 12% 'aware', 32% 'treated' and 22% 'controlled'. CONCLUSIONS: In central Europe hypertension, with a prevalence of > 50%, remains the most common cardiovascular risk factor in the elderly. Although most elderly hypertensives are currently treated with antihypertensive agents, less than one-quarter are controlled, and more than one-third are still unaware of the diagnosis. These levels of awareness and control call for better strategies in the diagnosis and treatment of hypertension in the elderly.

Age Factors↗
PubMed1994

[Cardiovascular risk factors in patients over 65-years of age in Germany. Results of the STEPHY Study (Starnberg Trial on Epidemiology of Parkinsonism and Hypertension in the Elderly)].

The aim of the study was to assess the current cardiovascular risk factor profile including data on treatment of a representative population over the age of 65 in Germany. From a total of 1190 inhabitants > or = 65 years living in two Bavarian villages near Munich, 982 could be visited at home ("door-to-door" survey), where a questionnaire and the measurement section were performed (response rate 82.5%). Blood pressure was measured three times in the sitting position with a standard sphygmomanometer, ("actual") hypertension was defined as systolic blood pressure > or = 160 mm Hg and/or diastolic blood pressure > or = 95 mm Hg or effective antihypertensive treatment. Obesity was defined as body mass index > or = 27.8 kg/m2 for men or > or = 27.3 kg/m2 for women, hypercholesterolemia as total cholesterol > or = 250 mg/dl (6.5 mmol/l), diabetes as fasting serum glucose > 120 mg/dl, glucosuria or treatment with insulin or oral antidiabetics. With a prevalence of 53% hypertension was the leading risk factor, followed by obesity with 35% and hypercholesterolemia with 21%; smoking and diabetes were observed in < 10%. Hypertension and obesity tended to be more prevalent in women, diabetes in men; hypercholesterolemia was significantly more prevalent in women. While the prevalence of hypertension increased up to the age groups "75-79 years" in men and "80-84 years" in women, there was a constant decrease with age for obesity, hypercholesterolemia and smoking. Three-quarters of the participants showed a minimum of one cardiovascular risk factor, the risk factor combination "hypertension/hypercholesterolemia/smoking" was observed however only in 1%.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1993

Usefulness of simultaneous ambulatory electrocardiographic and blood pressure monitoring in detecting myocardial ischemia in patients > 70 years of age with systemic hypertension.

Ischemic-type ST-segment depression is frequently observed in younger hypertensive patients. To assess the frequency of ST-segment depression in elderly hypertensive patients and to determine the influence of heart rate (HR) and blood pressure (BP) on the episodes of transient myocardial ischemia, ambulatory electrocardiographic and BP monitoring was simultaneously performed in 41 untreated hypertensive patients > 70 years of age (mean age 79 +/- 6 years; office BP > or = 160/95 mm Hg). A total of 66 episodes of significant ST-segment depression (> or = 0.1 mV, duration > or = 1 minute, interval > or = 1 minute) could be demonstrated in 15 patients (37%); 26 patients (63%) had no ST-segment changes. The 2 groups did not differ in age, gender, office or ambulatory BP, diurnal BP profile, concomitant diseases, ventricular arrhythmias, or in left ventricular (LV) mass or function. In 11 patients with ST-segment depression (73%), an increase in HR of > 15% preceded the episodes of ST-segment depression; 2 of these patients (13%) had an additional increase in BP of > 20/10 mm Hg. The extent of ST-segment depression was correlated significantly to BP, HR and HR x systolic BP product during the ischemic events, to office BP, and to LV mass. In conclusion, transient myocardial ischemia is a frequent phenomenon in elderly hypertensive patients with and without LV hypertrophy. Whereas most episodes of ischemia are preceded by an increase in HR, the extent of ST-segment depression is dependent on HR, BP and LV mass.

Age Factors↗
PubMed1993

"White coat" hypertension and alerting reaction in elderly and very elderly hypertensive patients.

"White coat" hypertension can be demonstrated in 20-25% of younger patients with mild-to-moderate hypertension. In a population of 50 untreated hypertensive patients > or = 70 years (mean age 79 +/- 6 years, office blood pressure > or = 160 mmHg systolic and > or = 95 mmHg diastolic) ambulatory blood pressure monitoring, ECG and echocardiography were performed to assess the frequency of "white coat" hypertension and the alerting reaction ("white coat" effect). "White coat" hypertension was diagnosed, if mean daytime ambulatory blood pressure was < or = 146/87 mmHg (taken as upper "normal" limit), "definite" hypertension, if > 146/87 mmHg. Nine patients (18%) were classified as "white coat", 28(56%) as "definite" hypertensives, 13(26%) as an "intermediate" group. There were no differences in gender, weight, concomitant diseases, pre-study treatment, and systolic or diastolic left ventricular function between the groups. Patients with "white coat" hypertension showed lower office blood pressure (178 +/- 13/98 +/- 3 vs 201 +/- 19/104 +/- 7 mmHg; p < 0.004), lower left ventricular mass index (131 +/- 9 vs 139 +/- 26 g/m2, p < 0.5), no left ventricular hypertrophy (ECG-criteria; p < 0.05), a more pronounced alerting reaction (39 +/- 13/22 +/- 5 vs 27 +/- 17/8 +/- 9; p < 0.01) and no correlation between office blood pressure and left ventricular mass compared to the "definite" hypertension group. The total group showed an average alerting reaction of 30 +/- 19/12 +/- 8 mmHg. It is concluded that "white coat" hypertension and an alerting reaction can be demonstrated in untreated elderly and very elderly hypertensive patients. Patients with "white coat" hypertension are characterized by a milder degree of hypertension, less cardiac target organ damage and a more pronounced alerting reaction. The prognostic significance of "white coat" hypertension in the elderly needs to be reevaluated in a larger population.

Aged↗
PubMed1992

Three cases of malignant neoplasm, pneumonitis, and pancytopenia during treatment with low-dose methotrexate.

A 77-year-old man with chronic obstructive pulmonary disease was treated with low-dose methotrexate (7.5-15 mg per week). After 15 months a diagnosis of urothelial carcinoma of the bladder was made; after a further 6 months pneumonitis and pancytopenia developed. The patient died due to massive pulmonary hemorrhage. A malignant teratoma was diagnosed in a 65-year-old asthmatic man 16 months after initiation of methotrexate therapy (15 mg per week). The patient died 4 months later due to fulminant progression of the neoplasm. A third malignant neoplasm (dermal squamous cell carcinoma) was seen in a 64-year-old woman with rheumatoid arthritis after 13 months treatment with 7.5 mg methotrexate per week. These three cases, while obviously not proving a causal relationship between long-term treatment with low-dose methotrexate and development of malignant neoplasm, do call for stringent treatment criteria, close surveillance, and prospective studies.

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