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Biomedical subjects

H Schmutzler

Publications and source records attributed to H Schmutzler.

At least 37 records · Page 2Linked to original sources
PubMed1985

Hemodynamic effects of molsidomine, isosorbide dinitrate, and nifedipine at rest and during exercise.

In the first study the hemodynamic effects of standard doses of molsidomine (2 mg intravenously), isosorbide dinitrate (ISDN) (5 mg sublingually), and nifedipine (20 mg sublingually) were assessed at rest and under exercise conditions in a group of 30 patients with coronary heart disease. With the patients at rest both molsidomine and ISDN were associated with prompt reductions in left ventricular end-diastolic pressure and mean pulmonary artery pressure, whereas nifedipine was associated with slight reductions in left ventricular end-diastolic pressure and mean pulmonary artery pressure that did not attain statistical significance. Nifedipine and ISDN caused a decrease in mean aortic blood pressure, which resulted in a reactive increase in heart rate that was only significant with nifedipine. After administration of molsidomine, there was no significant change in mean aortic pressure at rest. There were reductions in stroke volume index and cardiac index after administration of molsidomine and ISDN. Nifedipine, however, was associated with significant increases in stroke volume index and cardiac index. None of the three test substances caused changes of contractility parameters. Under exercise conditions reductions in left ventricular end-diastolic pressure, mean pulmonary pressure, and mean aortic pressure were documented following administration of molsidomine, ISDN, and nifedipine. There were no major changes in maximum heart rate or stroke volume index during exercise with any of the three drugs. However, nifedipine was associated with a significant increase in cardiac index, whereas molsidomine and ISDN produced no major changes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Detection of regional hypertrophy in hypertrophic cardiomyopathy with ECG triggered nuclear magnetic resonance tomography--comparison with hypertensive patients and persons with healthy hearts].

Gated magnetic resonance tomography (MRT) was conducted in 40 patients (13 normal volunteers, 9 hypertensives and 18 patients with hypertrophic cardiomyopathy) using a 0.35 Tesla superconducting magnet. Multisectional spin echo imaging (35/400 msec) was obtained in coronal, transversal and sagittal planes. Myocardial wall thickness was measured in different segments and the three groups were compared to each other. 15/18 patients with hypertrophic cardiomyopathy (HCM) had asymmetrical regional thickening involving the septum and the anterior wall, in 8/15 the lateral wall was also hypertrophic. The distribution pattern in 3/15 patients with HCM was symmetric. Involvement of the right ventricle was found in 14/18 patients with HCM. There were significant differences (p less than 0.001) in wall thickness for the septal segment in all three groups and for the ratio septal to posterior wall between the HCM and the hypertensives and the normal volunteers. We conclude that MRT can differentiate HCM from hypertensives and normals, and is superior to echocardiographic imaging in the evaluation of the distribution of left ventricular hypertrophy in hypertrophic cardiomyopathy.

Adult↗
PubMed1985

[Follow-up of late potentials and complex tachycardiac arrhythmias following myocardial infarct over a 2-year period].

50 patients (mean age 53.8 +/- 9.2 years) were studied at 1.5 to 2 months (U1), 12 months (U2) and 24 months (U3) after acute myocardial infarction. Late potentials were registered at the body surface using the signal-averaging technique and a digital Butterworth filter with high pass cut-off frequencies DC, 25, 50, 100 Hz and a low pass cut-off frequency 300 Hz, 18 db/octave, and a 24-hour ECG was recorded. All patients underwent coronary angiography at U1. Late potentials were found at least once during the observation period in 56% of patients, and 18% of patients demonstrated late potentials at all three examinations but up to 38% at one of the three examinations. Complex tachyarrhythmias (Lown class IV) were found at least once in 48% of patients and at all three examinations in 18% but up to 38% at one of the three examinations. Only four patients demonstrated late potentials and complex tachyarrhythmias at all three examination dates. In contrast, 36% of patients showed neither late potentials nor complex tachyarrhythmias at all three examinations. When late potentials and complex arrhythmias were present simultaneously, the former were most often detected at the cut-off frequencies DC, 25 to 300 Hz (p less than 0.05). The median of the duration of late potentials was significantly longer at U1 and U2 when complex arrhythmias were also present. There was a significant relation between late potentials and complex arrhythmias at U1 and U2 (p less than 0.01 and p less than 0.025) and between the latter and disorders of regional wall motion at all examination dates (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Influence of propranolol, metoprolol, and pindolol on mucociliary clearance in patients with coronary heart disease.

The effects of the beta-adrenoceptor-blocking drugs propranolol, metoprolol, pindolol, and placebo, on mucociliary clearance were studied in three groups of 6 subjects with coronary heart disease and normal lung function. Clearance rates of inhaled 99mTc-labeled human serum albumin minimicrospheres were determined over the apical right region of the lung with a gamma camera. A 3-day medication of propranolol 40 mg b.i.d., when compared with placebo, led to a significant decrease (p less than or equal to 0.05) in mucociliary clearance. Metoprolol 50 mg b.i.d. or pindolol 5 mg b.i.d. did not show any influence on mucociliary clearance. Implications for the use of different types of beta-adrenoceptor-blocking drugs in the treatment of coronary heart disease are discussed.

Adult↗
PubMed1984

Comparison of the acute hemodynamic effects of nifedipine with nitrendipine and a study of the electrophysiological effects of nitrendipine in man.

Calcium antagonists are known to have an inhibitory effect on the contractile status of the smooth muscle of the arterioles, the muscle fibers of the heart, and the cardiac conduction system, especially the atrioventricular node. The vasodilatation that is produced may be observed in the coronary arteries but predominates in the peripheral resistance vessels. Nifedipine and its 1,4-dihydropyridine derivative, nitrendipine, are not only useful in coronary artery disease but also have potential as antihypertensive agents. The acute hemodynamic effects of both nifedipine and nitrendipine, administered in a 1.0 mg intravenous dose, were studied. The compounds were randomly allocated to six patients, where each served as his own control. In addition, the effect of 1 mg of nitrendipine intravenously on the electrophysiological impulse formation and conduction was investigated in a second group of six patients. There were substantial differences in the intensity and duration of the hemodynamic effects of both drugs. The total peripheral resistance (TPR) fell after nifedipine from 1,730 +/- 240 to 1,280 +/- 120 and after nitrendipine from 1,960 +/- 420 to 1,200 +/- 150 dynes-s-cm-5. There was a concurrent significant reduction in the systolic aortic and left ventricular pressure after nifedipine and nitrendipine from 152 +/- 8 to 128 +/- 13 and 161 +/- 19 to 122 +/- 18 mm Hg, respectively. Heart rate increased due to baroreceptor stimulation by 21% with nifedipine and by 32% with nitrendipine. From the results of the electrophysiological study, nitrendipine did not have any significant effect on the sinus or atrioventricular node function. The substance may be safely used in patients with conduction disturbances.

Angina Pectoris↗
PubMed1984

The influence of propranolol, metoprolol, and mepindolol on mucociliary clearance in coronary heart disease patients without pulmonary disease.

The effect of a beta-receptor blockade on the mucociliary clearance was studied in 24 patients without pulmonary disease but with coronary heart disease. No deterioration of mucociliary clearance was recorded under medication with 2 X 50 mg metoprolol or 2 X 2.5 mg mepindolol per day. In contrast, mucociliary clearance deteriorated significantly under medication with 2 X 40 mg propranolol.

Cilia↗
PubMed1983

A comparison of conventional contrast ventriculography and digital subtraction ventriculography.

We studied 46 patients with a history of transmural myocardial infarction or angiographic evidence of coronary artery stenosis with both conventional contrast ventriculography and digital subtraction ventriculography from May to September 1982. Urografin 76, 30 ml, was administered at a flow rate of 18 ml/s, by means of a catheter in the superior vena cava during digital subtraction ventriculography (DSV). Results of the latter were compared with conventional contrast ventriculograms. The correlation coefficient was r =0.938 (p less than 0.001) for determination of ejection fraction with both methods. The data in individual cases suggest that DSV is more sensitive than conventional contrast ventriculography in determination of severely reduced ejection fractions. The methods are practically identical in qualitative evaluation of disorders of regional wall motion in the anterolateral region, while DSV is more sensitive than conventional ventriculography in evaluating the apical region. Sensitivity was 85.7% when the two methods were compared in evaluation of the inferior region of the left ventricle. Both methods are identical in demonstration of severely deformed ventricles. Digital subtraction ventriculography may replace conventional contrast ventriculography in some of the situations discussed above.

Adult↗
PubMed1983

[Diagnosis of intracardial and paracardial space-occupying masses: comparison between two-dimensional echocardiography and computed tomography].

The validity of two-dimensional echocardiography (2-D echo) and computed tomography (CT) in the detection of intra- and paracardial tumors and thrombi was compared in 32 patients: 7 endocardial myxomas, 1 left ventricular fibroma, 2 paracardial cysts, 1 paracardial tumor, and 21 thrombi. In 16 cases intraoperative findings served as a control. The 2-D echo is easier to handle and free of radiation of contrast media. CT can visualize cardiac tumors independently of their location, whereas 2-D echo sometimes insufficiently images paracardial and right ventricular structures. It must be considered an advantage that 2-D echo detects mobile tumors such as those attached to valves, which the CT will not show. The tissue involved is more likely to be characterized by CT, although results are unreliable. However, in all cases tumors could be differentiated from thrombi by means of additional diagnostic criteria, such as the pattern of wall motion or valve motion. 2-D echo and CT therefore appear to be complementary methods rather than competitive ones. Invasive diagnostic procedures are required only to answer particular questions, e.g., concerning the coronary arteries.

Cysts↗
PubMed1983

[Relation between late potentials, ventricular arrhythmias, left ventricular dysfunction and occlusion time following intracoronary thrombolysis].

25 patients who had undergone intracoronary thrombolysis (ICT) during acute myocardial infarction were studied an average of 9.8 months after the event in order to test the effect of the procedure on the incidence of complex ventricular tachyarrhythmias, late potentials determined by the signal-averaging technique, ejection fraction, and left ventricular asynergy. The relationships between these findings were tested. ICT was successful in 17 patients. There was a statistically significant relationship (p less than 0.05) between demonstrable akinesia and dyskinesia, late potentials, and complex ventricular tachyarrhythmias. Akinesia and dyskinesia and complex tachyarrhythmias were found more often in the 8 patients in whom ICT was unsuccessful than in the remaining 17 subjects (p less than 0.05). In the latter group no relationship was found between duration of occlusion and the incidence of asynergy, complex tachyarrhythmias, and late potentials; occlusion time was more than 200 min in 7 patients and less than 200 min in 10 patients. It is desirable to hold occlusion time below 200 min if there is no collateral circulation to the jeopardized myocardium.

Arrhythmias, Cardiac↗
PubMed1982

[Recanalization by intracoronary infusion of streptokinase in acute myocardial infarction. Hospital course in 204 patients (author's transl)].

A multicenter study evaluated the early management and subsequent hospital course of 204 patients with acute myocardial infarction who were receiving intracoronary infusions of streptokinase (STK). The in-hospital mortality in 37 patients with thrombotic occlusion of the infarct-related vessel, in whom recanalization could not be achieved, was 24%. However, the cardiac mortality in 129 patients who were successfully treated by percutaneous transluminal coronary recanalization (PTCR) was only 5.4%. Cardiac deaths (5 patients) and nonfatal reinfarctions (20 patients) occurred in the early period in the cardiac care unit (CCU) in 21% of the latter group and, despite anticoagulation measures, could not be consistently prevented. Hemorrhagic complications, necessitating blood transfusion, occurred in 15 (7.4%) of the total 204 patients in the group, usually in the acute CCU stage, and were positively related to decline of fibrinogen serum concentrations below 100 mg/dl and to use of the Judkins technique. The later course of most of the patients on the general ward was uneventful until hospital discharge. Thus there were only 2 more cardiac deaths, and of 64 successfully treated STK-PTCR patients who left the CCU without clinical indications of reinfarction and agreed to repeat coronary angiography before hospital discharge, the infarct-related vessel was patent in 59 patients and reoccluded in only 5 (7.8%).

Aged↗
PubMed1982

[Long-term observation in patients with mitral and aortic valve disease under conservative management].

127 patients with diagnosis of acquired mitral and aortic valve disease confirmed by cardiac catheterization were followed for 5-17 years (mean 10 years) under conservative management. At the end of the study, 80 patients were still alive, and 68 of them were examined again. 23 patients died, and no information was available on 24. Analysis of the natural course of the disease showed that results obtained with different classification systems (NYHA, clinical findings, hemodynamic data) were not comparable. However, the majority of mitral and combined mitral-aortic lesions remained stable over the years, independent on the initial classification of the lesion. Aortic valve disease became hemodynamically worse in the absence of subjective and clinical change.

Adolescent↗
PubMed1981

Evaluation of the effectiveness of intracoronary streptokinase infusion in acute myocardial infarction: postprocedure management and hospital course in 204 patients.

A multicenter study evaluated the early management and subsequent hospital course of 204 patients with acute myocardial infarction who were receiving intracoronary infusions of streptokinase (STK). The in-hospital mortality in 37 patients with thrombotic occlusion of the infarct-related vessel, in whom recanalization could not be achieved, was 24%. However the cardiac mortality in 129 patients who were successfully treated by percutaneous transluminal coronary recanalization (PTCR) was only 5.4%. Cardiac deaths (five patients) and nonfatal reinfarctions (20 patients) occurred in the early period in the cardiac care unit (CCU) in 21% of the latter group and, despite anticoagulation measures, could not be consistently prevented. Hemorrhagic complications, necessitating blood transfusion, occurred in 15 (7.4%) of the total 204 patients in the group, usually in the acute CCU stage, and were positively related to decline of fibrinogen serum concentrations below 100 mg/dl and to use of the Judkins technique. The later course of most of the patients on the general ward was uneventful until hospital discharge. Thus there were only two more cardiac deaths, and of 64 successfully treated STK-PTCR patients who left the CCU without clinical indications of reinfarction and agreed to repeat coronary angiography before hospital discharge, the infarct-related vessel was patient in 59 patients and reoccluded in only five (7.8%).

Angiography↗
PubMed1981

[Cardiac valve replacement in the aged (author's transl)].

Prosthetic valve replacement was performed in 113 patients above the age of 60 with advanced valvular heart disease, whose prognosis without surgical correction was extremely poor. Although there was high risk of early mortality in isolated aortic valve disease (20%), in isolated mitral valve disease (28%) and in multiple valve disease (50%), improvement for the survivors was evident. Late mortality was rather low. Individual risk can be estimated by considering the patient's age, type and stage of valvular disease as well as the clinical condition and hemodynamic parameters.

Aged↗
PubMed1980

[Long-term results after cardiac valve replacement (author's transl)].

The value of prosthetic valve replacement is determined not only by the improvement in life expectancy but also by the quality of life. This statement resulted from an analysis of 168 patients undergoing isolated aortic -- or mitral -- valve replacement between 1970 and 1976. Besides numerous complications -- probably often avoidable such as side effects of incorrect anticoagulation -- long term results of 125 surviving patients were satisfactory over a period of 3-9 years after surgery. Though complete restitution was rare, subjective and objective improvement -- different and dependent on type and degree of valve disease -- was persisting and the effect on social and professional incorporation surprisingly positive.

Adolescent↗
PubMed1978

[Atrial septal defect in the aged (author's transl)].

The natural history of congenital heart disease in older patients will become increasingly difficult to delineate, since many of uncomplicated defects were repaired early in life. Therefore the frequency of clinical and hemodynamic progress in non-operated patients with atrial septal defects seems to be of great interest. We are able to compare 27 patients aged more than 60 years with a group between 40 and 59 years. In 80 out of 103 patients totally, the clinical findings could be completed with catheterization data. The progress of deterioration with age in spite of intensive medical care could be demonstrated by mostly statistical significant signs of greater right-ventricular overload in the Ecg, cardiac arrhythmias--usually atrial fibrillation--changes in the X-ray findings and increasing pulmonary hypertension.

Adult↗