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Biomedical subjects

H Roskamm

Publications and source records attributed to H Roskamm.

At least 19 recordsLinked to original sources
PubMed1992

[Results of heart valve replacement. Prognosis--occupational and general disability--occupational rehabilitation].

The success of valve surgery has led to a marked improvement in prognosis, quality of life and exercise tolerance in patients with symptomatic valvular heart disease. The degree of subjective and objective improvement depends on multiple preoperative factors like NYHA status, left ventricular function, valve lesion and type of valve replaced as well as peri- and postoperative factors like the occurrence of a perioperative myocardial infarction, the degree of intraoperative myocardial damage, the type of valve replaced and the speed and degree of postoperative regression of left ventricular hypertrophy and dilatation. The postoperative exercise tolerance is a major determinant for postoperative vocational rehabilitation. Therefore the individual functional assessment of patients postoperatively is of major importance.

Aortic Valve↗
PubMed1992

[Extrasystole following heart transplantation].

A 43 year old man developed extensive supraventricular and ventricular extrasystoles (over 500 supraventricular extrasystoles per hour, VES class II) within 3 months after orthotopic heart transplantation because of dilatative cardiomyopathy. At the same time severe graft rejection (class III according to Billingham) was documented. After treatment of the rejection the following three controls by 24 hours Holter EKG showed only slight supraventricular extrasystoles of less than 10 per hour and in three consecutive myocardial biopsies no rejection process requiring additional treatment was found. In individual cases severe ventricular arrhythmia registered by the family doctor may be a first hint for early rejection. Since intervals for inpatient controls have been extended observation of extrasystoles may be helpful for initiation of a next inpatient control. Incidence of extrasystoles after heart transplantation in the cyclosporine-era is discussed.

Adult↗
PubMed1992

Exercise tolerance and working capacity after valve replacement.

Between 1978 and 1987, 1270 patients who survived single aortic or mitral valve replacement at the Rehabilitation Center in Bad Krozingen, Germany, underwent a comprehensive rehabilitation program. The preoperative diagnosis was isolated aortic stenosis in 425, isolated aortic regurgitation in 159, mixed aortic lesion in 211, isolated mitral stenosis in 208, isolated mitral insufficiency in 137 and mixed mitral lesion in 130 cases. Follow up examinations were carried out one and six months after surgery, and at yearly intervals thereafter. Exercise testing was performed with an electrically braked bicycle ergometer in the supine position, and the load was increased by 25 or 50 watts every two minutes until fatigue, severe angina, more than 0.3 mV ST-segment depression, or 80% of the age predicted maximum heart rate was achieved. Patients after aortic valve replacement had a better exercise performance one month after operation than did those after mitral valve replacement. Those with mitral stenosis showed more severe impairment of exercise tolerance than did the mitral insufficiency group. There was a steady increase in exercise tolerance between one and six months postoperatively, both in patients with aortic and those with mitral valve replacement, but the difference in performance between the two groups was still present (72% versus 57% of normal). The results of univariate and multivariate analyses showed that the preoperative employment status was the most important factor for postoperative return to work, followed by gender (male > female), exercise tolerance and valualar lesion (aortic > mitral).(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve↗
PubMed1992

[Interval resistance exercise in comparison with bicycle ergometry stress. Studies with resistance endurance training in coronary patients].

UNLABELLED: In the rehabilitation of coronary patients there is an increased interest in using complementary resistance exercise training. Therefore, we studied nine patients (males; age: 51 +/- 7 years) with chronic stable coronary heart disease during extensive resistance exercise (ex RE) (legpress, abduction, adduction) (60-s work: 60-s rest; contraction intensity: 65% of 1 RM) and during intensive resistance exercise (int. RE) (legpress) (30-s work: 45-s rest) with 85% of 1 RM. Non-invasive continuously measured blood pressure, heart rate, norepinephrine, epinephrine, lactic acid, and glucose were compared with values from maximal bicycle ergometry (3-min steps, each 25 w; max. performance: mean 156 w; range 125-200 w). RESULTS: 1) Comparing ex RE and int RE with bicycle ergometry there were no differences in blood pressure (systolic: 206 and 204 vs. 210 mm Hg; ns; diastolic: 98 and 104 vs. 92 mm Hg; ns). Heart rates (104 and 103 vs. 125/min; p < .01), norepinephrine (3.8 and 3.3 vs. 8.8 nmol/l; p < .01) and epinephrine (0.7 and 0.6 vs. 1.4 nmol/l; p < .01) were considerably lower. 2) The most significant increase and decrease of blood pressure and heart rate occurred within 15-30 s after the beginning and end, respectively, of isometric exercise. CONCLUSIONS: 1) ex RE is suitable for patients with stable CHD and cardiac exercise tolerances of 1.5-2 W/kg = 125-150 watts. 2) Blood pressure monitoring by the cuff method (RR) immediately after RE did not reflect blood pressure during RE. 3) Controlling RE by the training heart rate prescribed for endurance exercise is not possible.

Adult↗
PubMed1992

Ambulatory electrocardiography evaluation of the post-coronary artery bypass graft and post-percutaneous transluminal coronary angioplasty patient. Diagnostic and prognostic value.

Investigations carried out in recent years have shown that patients with coronary heart disease display partial to considerable extent transient ST-segment changes that can be determined with ambulatory ECG. An interesting question is how often transient ST-segment changes are present in patients in whom the indication for an aortocoronary bypass operation or percutaneous transluminal coronary angioplasty (PTCA) has already been determined. In the patients who are waiting for a bypass operation or PTCA, the proof of myocardial ischemia has been determined, and which subgroups of patients display ST changes in the ambulatory ECG must be tested. It is interesting to ask what happens to such transient ischemic episodes as a result of surgical or catheter intervention, how often such episodes are present even after these interventions, and whether the latter has a clinical significance in view of the success of the intervention (graft patency in coronary artery bypass graft patients or reocclusion in PTCA patients). Furthermore, it is to be tested whether transient ST-segment changes take on a prognostic significance in the long-term follow-up after bypass operation or PTCA.

Angioplasty, Balloon, Coronary↗
PubMed1991

Prognostic importance of collateral flow and residual coronary stenosis of the myocardial infarct artery after anterior wall Q-wave acute myocardial infarction.

Residual high-grade coronary stenosis and collateral flow are frequent findings in the chronic phase after a Q-wave acute myocardial infarction (AMI). The prognostic importance of a residual stenosis of the infarct artery and of collateral flow to the infarct area was analyzed in a group of 102 young patients (mean age 35 years, range 22 to 39) who had survived an anterior wall Q-wave AMI. Patients whose only significant lesion (greater than 50% luminal diameter reduction) was in the proximal portion of the left anterior descending artery were enrolled in the study. A 50 to 74% diameter stenosis was present in 33 of 102 patients (32%), 43 (42%) had a 75 to 99% stenosis and 26% had a total occlusion of the infarct vessel. Collateral vessels, which were evaluated by a scoring system, were present in 52 of 102 patients (51%). Four percent had only faint (score 1), 17 of 102 patients (17%) had moderate and 32 patients (31%) had good collateral flow (score greater than 4). The 8-year cumulative mortality was 15.2%--an eightfold increase compared with the age-matched general population. No patient with less than 75% stenosis died during follow-up, whereas the cumulative 8-year mortality was 23 and 17% in patients with a 75 to 99% stenosis or total occlusion, respectively (p less than 0.01). Patients with at least moderate collateral flow had a mortality rate of 21%, versus 8% for patients without or with faint collateral flow (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Differences in the antiischaemic effects of molsidomine and isosorbide dinitrate (ISDN) during acute and short-term administration in stable angina pectoris.

The acute and short-term effects of treatment with 10 consecutive doses of isosorbide dinitrate 40 mg t.i.d. and molsidomine 8 mg t.i.d. in slow release formulations were investigated in 10 patients with angiographically documented coronary artery disease and stable angina pectoris according to a randomized, double-blind, double-dummy, cross-over study design using conventional symptom-limited exercise testing. Acute exercise testing 3 h following the first dose of ISDN and molsidomine showed a significant reduction of maximal ST segment depression and of the area above the ST segments. Time to occurrence of 0.1 mV ST segment depression, exercise duration, time to onset of angina and exercise tolerance increased significantly. On the fourth treatment day with ISDN and molsidomine an attenuation of these antiischaemic effects was seen. The mean effects on ST segment depression, area above ST segments, time to occurrence of 0.1 mV ST segment depression, exercise duration, time to onset of angina and exercise tolerance were reduced by 40%, 44%, 47%, 58%, 54% and 65%, respectively, in patients administered ISDN and by 33%, 48%, 58%, 59%, 45% and 60% in those given molsidomine. Thus, following sustained short-term therapy the antiischaemic effects of both drugs seem to be attenuated. In this report no marked differences were found between ISDN and molsidomine.

Angina Pectoris↗
PubMed1991

Experimental pain thresholds and plasma beta-endorphin levels during exercise.

Experimental pain thresholds (electrical intracutaneous finger and dental pulp stimulation) and plasma hormone levels (beta-endorphin, cortisol, and catecholamines) were measured in ten healthy sportive men before, during, and after progressively more strenuous physical exercise. In a double-blind study conducted on two different days, 20 mg of the opioid-antagonist naloxone or placebo was administered prior to exercise. A significant pain threshold elevation was found during exercise for finger (ANOVA, P less than 0.004) and dental pulp stimulation (P less than 0.01). Pain threshold elevation was most pronounced during maximal exertion, at which time the subjects reported the greatest subjective fatigue. Thresholds remained elevated 10-15 min after the end of exercise, and, 60 min after exercise, thresholds returned to baseline values. The subjective magnitude estimation of suprathreshold stimuli was significantly reduced (P less than 0.0001) 5-10 min after exercise. Plasma beta-endorphin, cortisol, and catecholamines increased significantly (P less than 0.0005, all values) during exercise. Plasma beta-endorphin levels did not correlate significantly with pain thresholds (r = -0.37, NS). Naloxone failed to affect pain thresholds, although beta-endorphin and cortisol increased significantly more (P less than 0.02) during exercise after naloxone. It is concluded that short-term, exhaustive physical exercise can evoke a transient elevation in pain thresholds. This exercise-induced elevation in pain threshold does not, however, appear to be directly related to plasma endorphin levels.

Adult↗
PubMed1989

[Prevention of cigarette smoking in school. A prospective controlled study].

752 schoolchildren, mean age 12.7 years, were asked by multiple-choice questionnaire about their smoking experience. After this, eight educational lessons were given in seven of the schools ("intervention schools") to reinforce non-smoking. In six control schools no activities were performed. After 2.3 years, 579 schoolchildren (301 males and 278 females, mean age 15.0 years) again filled in a similar questionnaire. In the control schools 12.4% of children had begun to smoke, (greater than 1 cigarette per month), but only 7.4% in the intervention group (P less than 0.06). Daily cigarette smoking had been taken up by 8.4% in the control schools, but by only 4% in the intervention schools (P less than 0.04). 9.9% of children in the control schools and 3.8% in the intervention schools had smoked during the 24 hours before the questionnaire was filled in (P less than 0.004). The data indicate that an eight-hour course of instruction with reinforcement of non-smoking can lastingly influence smoking behaviour of juveniles.

Adolescent↗
PubMed1989

Acute and long-term hemodynamic effects of pimobendan (UD-CG 115 BS) in comparison with captopril.

The acute and long-term hemodynamic efficacy of the positive inotropic and vasodilatory drug pimobendan (5 mg b.i.d.) was compared with that of the angiotensin converting enzyme (ACE) inhibitor captopril (25 mg t.i.d.) in a double-blind, randomized study in 20 patients suffering from chronic congestive heart failure (NYHA functional classes II-III). The hemodynamics at rest and under comparable exercise conditions were always obtained on the first and 14th treatment day before and 2 h following drug administration. Under resting conditions, pimobendan reduced the end-diastolic pulmonary arterial pressure measured 2 h after drug administration by 33% (p less than 0.05) and increased the cardiac output by 16% (p less than 0.05). These effects were maintained after a treatment period of 14 days. Following administration of captopril, no significant hemodynamic changes at rest were noted 2 h after the first dose on day 1 and the last dose on day 14. There was, however, a tendency to continuous decline of the end-diastolic pulmonary arterial pressure over the study period. Under comparable work load (median of 25 W), both substances decreased the end-diastolic pulmonary arterial pressure 2 h following the first dose (pimobendan, -38%, p less than 0.01; captopril, -9%, p less than 0.05). The difference in the magnitude of effect between both treatment groups was statistically significant (p less than 0.01). Following a treatment period of 14 days, the end-diastolic pulmonary arterial pressure before drug administration was significantly reduced (-24%, p less than 0.05) only in the pimobendan group, whereas the reduction in the captopril group (-11%) could not be statistically verified.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Silent myocardial ischemia.

Myocardial ischemia can manifest itself as strictly silent or a combination of symptomatic and silent episodes. We have demonstrated that most asymptomatic patients have a higher threshold for pain than did symptomatic patients. Low sensitivity to pain in patients with silent ischemia may be related to both a neural pain inhibitory system and the release of endogenous opiates, the endorphins. beta-Endorphin release occurs during and after exercise; patients with asymptomatic ischemia had higher plasma beta-endorphin levels than did patients with symptomatic ischemia, especially during exercise. With naloxone treatment, the pain threshold of patients with silent myocardial ischemia (SMI) can be reduced to the same values as those of symptomatic patients. This supports the possibility of a role for endorphins in SMI. Patients who experience both asymptomatic and symptomatic ischemic episodes do so because their pain threshold and endorphin regulatory system varies throughout the day and because severity and duration of ischemic episodes are different. Although there is controversy over the appropriate therapy for SMI, it is more likely that this should simply be treated in the same way as painful ischemia.

Biomechanical Phenomena↗
PubMed1989

[Silent myocardial ischemia].

As an introduction the main aspects concerning clinical picture, subgroups, pathophysiology, frequency, prevalence and incidence, diagnosis, prognosis and therapy of silent ischemia are summarized: 1) CLINICAL PICTURE: Transient silent ischemia (SMI), silent infarction, relationship to sudden cardiac death, ischemic "cardiomyopathy". 2) Subgroups of SMI: SMI patients (always symptomatic patients without myocardial infarction, after infarction, after stable or unstable angina pectoris, after coronary angioplasty, and after bypass surgery). SMI episodes in otherwise symptomatic patients with coronary heart disease (without myocardial infarction, after infarction, with stable or unstable angina, after coronary angioplasty and after bypass surgery). 3) PATHOPHYSIOLOGY: SMI patients: generally reduced sensitivity to pain. SMI episodes: differences in severity and duration of ischemia. 4) Frequency: Approximately one-third of all provoked ischemic episodes are silent (independent of the mode of provocation and the ischemia indicators used), two-thirds of all spontaneous ischemic episodes are silent. 5) Prevalence and incidence: 2-5% of all healthy males aged 40-59, and 20-30% of all postinfarction patients are SMI-patients; 60-90% of all symptomatic patients with coronary heart disease have additional SMI-episodes. 6) DIAGNOSIS: screening by means of exercise ECG in patients at high risk for coronary heart disease, and in patients working in specific professions (like busdrivers, pilots, etc.). Systematic screening in postinfarction patients, in patients after unstable angina, after coronary angioplasty or bypass surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1988

ST segment monitoring before, three weeks and six months after aortocoronary bypass surgery.

ST segment monitoring by Holter ECG was conducted in 80 consecutive patients 2-4 weeks before aortocoronary bypass surgery and three weeks and six months after surgery. Preoperatively, all patients were under maximal medical therapy. In 31 out of 80 patients medical therapy could be stopped and thus 24-h ST monitoring could also be conducted without medication. Preoperative and early postoperative (three weeks) examinations were performed under hospital conditions. At 6 months after surgery the patients were monitored at home during their everyday activities. Twenty-eight per cent of patients waiting for aortocoronary bypass surgery under full medication showed transient ischaemic episodes in 24-h Holter ECG. Seventy-eight per cent of these episodes were asymptomatic. Without medication, 55% of patients had transient ischaemia. The exercise ECG data partly predicted the Holter ECG data. Patients with ST segment depression greater than 0.1 mV during exercise ECG had on Holter monitoring more and longer lasting ischaemic episodes than those with ST segment depression less than or equal to 0.1 mV. In patients with asymptomatic ST segment depression during exercise ECG the relation of silent episodes to symptomatic episodes on Holter monitoring was 5.3:1 while in patients with symptomatic ST segment depression during exercise ECG this relation was 2.3:1. Three weeks after operation the informative value of the Holter ECG was very restricted due to changes in the resting ECG caused by the operation and because patients do not exert themselves much at this time. Six months after surgery, Holter ECG is more informative, especially when conducted at home.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Artery Bypass↗