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Biomedical subjects

K Lindvall

Publications and source records attributed to K Lindvall.

At least 55 records · Page 3Linked to original sources
PubMed1990

Comparison of CNS-related subjective symptoms in hypertensive patients treated with either a new controlled release (CR/ZOK) formulation of metoprolol or atenolol.

The present study evaluated and compared subjective symptoms in hypertensive patients (N = 83) at therapeutically comparable dosages of a new controlled release (CR/ZOK) formulation of metoprolol (100 mg od) and atenolol (50 mg od). The trial was a 4-week randomized double-blind study preceded by a placebo run-in period. Blood pressure (BP) was recorded 24 hours after intake of last dose. In subpopulations, 24-hour ambulatory BP was recorded and exercise tests performed. Subjective symptoms were evaluated with a previously documented questionnaire (MSE-profile) which has been shown to be sensitive in detecting CNS-related symptoms caused by beta blockers. The MSE-profile includes three dimensions: Contentment, Vitality and Sleep. The results showed that there were no significant differences between the groups in BP reduction either at 24 hours or over the entire 24-hour dose interval. Furthermore, the degree of beta 1-blockade (reduction in exercise-induced tachycardia) 24 hours after last dose did not differ between the groups. There were no significant differences regarding subjective symptoms (Contentment, Vitality, Sleep) between the two treatment groups. An a posteriori power analysis showed that the power to detect a true difference was of an acceptable magnitude. In conclusion, there was no difference in CNS-related symptoms between metoprolol and atenolol at therapeutically comparable dosages indicating that the degree of lipophilicity may be of minor importance for the occurrence of such symptoms.

Adolescent↗
PubMed1990

Lack of transmission of HIV to sexual and non-sexual contacts to HIV seropositive haemophiliacs following preventive information.

In order to evaluate the risk of HIV transmission to sexual and non-sexual contacts to seropositive haemophiliacs, HIV antibodies, p24 antigen, immunoglobulin levels and lymphocyte subsets were analyzed in a cohort of Swedish haemophiliac families to 19 patients who seroconverted in 1980-82. As controls served contacts to 26 seronegative haemophiliacs. A total of 77 contacts were investigated. Except for 3 sexual partners who had seroconverted before 1985 no signs of HIV infection were detected. It was concluded that no HIV transmission occurred to household contacts of seropositive haemophiliacs and that transmission to heterosexual partners not appeared since 1985 when the patients and their families were informed about the risk of infection.

Adolescent↗
PubMed1989

Regression of left ventricular hypertrophy on long-term treatment with captopril of severe hypertensives refractory to standard triple treatment.

Ten patients (mean age 53 years; range 37-65 years) with hypertension refractory to standard triple treatment were selected for measurement of blood pressure and echocardiographic evaluation of the left ventricular dimensions before and after 3, 6 and 12 months of captopril therapy. In each patient the dose of captopril was titrated to a maximum of 150 mg t.d.s. (range 25 to 150 mg t.d.s.) with a therapeutic goal of less than or equal to 90 mm Hg diastolic blood pressure. Most patients had added diuretic therapy. Four patients were unable to complete the study, two because of insufficient response to captopril therapy, and two because of side-effects (skin rash and cough). A significant fall in blood pressure was seen after three months of treatment and a reduced blood pressure was still maintained after 12 months. Over the same period, the average number of drugs was reduced from 3.6 to 2.1 per patient. A gradual reduction of septal and posterior wall thickness were noted, from 12.8 and 11.5 mm to 10.0 and 8.5 mm, respectively, after 12 months. Calculated left ventricular muscle mass was insignificantly reduced from 281 to 243 g after 12 months. The present study suggests that in hypertension resistant to conventional multiple therapy, captopril can reduce the blood pressure, and, in the long run it can also induce reversal of left ventricular wall thickening without causing deterioration of left ventricular function.

Adult↗
PubMed1989

Beta-adrenergic receptor responsiveness to isoprenaline in humans: concentration-effect, as compared with dose-effect evaluation and influence of autonomic reflexes.

1. Different techniques of assessing beta-adrenoceptor sensitivity in vivo, by use of i.v. infusions or bolus injections of isoprenaline (ISO), were compared in healthy volunteers. The importance of autonomic reflexes for responses to ISO was evaluated by studying the influence of 'autonomic blockade' by atropine and clonidine, which antagonize muscarinic effects and reduce sympathetic activity, respectively. Estimates of in vivo responsiveness to ISO were compared with parameters reflecting beta 2-adrenoceptor function in vitro in lymphocytes. 2. Heart rate responses to infused ISO were not significantly altered by 'autonomic blockade' when evaluated from concentration-effect curves. When related to the infused dose of ISO, however, sensitivity was artefactually increased (P less than 0.05), as the plasma concentrations of ISO were 40% higher after atropine and clonidine. Heart rate responses to bolus injections of ISO were attenuated (P less than 0.05) by 'autonomic blockade', suggesting that facilitatory reflexes contribute to these non-steady state responses. Intersubject variations in heart rate responsiveness to ISO were greater than the intrasubject variability caused by counterregulatory reflexes. 3. 'Autonomic blockade' lowered venous plasma noradrenaline at rest. The noradrenaline response to ISO infusion was attenuated and the diastolic blood pressure response enhanced, indicating that a counterregulatory vasoconstrictor reflex normally is activated by ISO-induced vasodilatation. The plasma cyclic AMP response to ISO, on the other hand, was unaffected by atropine and clonidine and reflects beta 2-adrenoceptor responsiveness in vivo. 4. In vitro data for beta-adrenoceptor binding sites (Bmax;[125I]-IHYP binding) and cyclic AMP responses to ISO in lymphocytes correlated with DBP and noradrenaline responses to infused ISO. No correlations were found between in vitro data and heart rate, plasma cyclic AMP or plasma glycerol responses to infused ISO in vivo. 5. During prolonged ISO infusions (in six other healthy subjects) physiological responses reached greater than 90% of their steady state level after 8 min, but no definite steady state level could be defined for the plasma concentration of ISO during 40 min of infusion. 6. The ISO infusion test showed a good reproducibility, especially when repeated on the same day. Evaluation of plasma concentration-effect relationships increase the precision of the ISO infusion test as confounding inter- and intra-individual variations in ISO concentrations (as caused by e.g. autonomic blockade) will be taken into account.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1988

Efficacy and tolerability of transdermal nitroglycerin in heart failure. A noninvasive placebo controlled double-blind cross over study.

The efficacy of transdermal nitroglycerin was investigated in 18 patients with moderate to severe congestive heart failure in a placebo-controlled, double-blind, crossover study. Treatment periods were of four weeks, following a one week dose titration period during which the maximum tolerated dose within the range of 5-15 mg was estimated. Therapeutic effects were evaluated by clinical examination (NYHA class), treadmill exercise, echocardiography and patient subjective scaling of general well being, cardiac symptoms and dyspnoea. Both patient and investigator analogue scaling of general well being showed improved scores indicating an improvement throughout the study. This tendency was even more marked when comparing inclusion values with those after each treatment period (P less than 0.05). However, when comparing values before with those after each treatment period, only the investigator scaling of heart failure level proved significantly higher after the placebo period (P less than 0.05). No other findings of significance were observed. We conclude that transdermal nitroglycerin given in the present doses over four weeks fails to improve the clinical situation in patients with moderate to severe congestive heart failure.

Administration, Cutaneous↗
PubMed1988

Cardiac function and cardiovascular hormone balance during hemodialysis with special reference to atrial natriuretic peptide.

Echocardiographically determined left ventricular function and cardiovascular hormone balance were assessed before and after hemodialysis in 10 patients who had been on hemodialysis for 4 months to 15 years. Plasma levels of atrial natriuretic peptide (ANP), antidiuretic hormone (ADH), renin activity and aldosterone were determined. All patients had vector- and echocardiographic evidences of slight to moderate left ventricular hypertrophy. The body weight decreased 2.0 kg (3.3 +/- 0.5%) with dialysis. Nine out of ten patients showed a slightly reduced ejection fraction that normalized after dialysis (p less than 0.05). Left atrial and ventricular systolic dimensions were around the upper reference limit before dialysis with a decrease after dialysis (p less than 0.05 and p less than 0.02, respectively). The levels of ANP decreased with dialysis from 2-17 times to 1 to 15 times the upper reference value in nine out of the ten patients. In the whole group the decrease was 117 +/- 35% (p less than 0.005). A significant regression was obtained between percentage decrease of body weight and percentage change of ANP (r = 0.67; p less than 0.05). The plasma concentration of ADH did not change following dialysis but the mean value was significantly higher than the mean value of the reference group of the laboratory (p less than 0.05 before and p less than 0.005 after dialysis). Renin activity and aldosterone levels were low and did not change during dialysis. In conclusion, the slight left ventricular hypertrophy may partly be a response to volume overload with hyperdynamic circulation and partly to metabolically depressed myocardial function.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Left ventricular function following withdrawal of chronic metoprolol treatment in patients with ischaemic heart disease. A double blind study.

The effect on left ventricular function of a gradual withdrawal of chronic metoprolol treatment in postinfarction patients was studied. All patients were in a randomized double-blind postinfarction study with metoprolol (M 100-200 mg daily; N = 14) or placebo (P; N = 18). After three years treatment the study medication was gradually withdrawn during one week. M-mode echocardiography, guided by concomitant cross-sectional recordings, were performed before, one and 12 weeks after the withdrawal. Treatment (i.e. M or P) had to be reinstituted in eight patients (5 M; 3P) because of the development of disabling symptoms during the follow-up. Heart rate was lower in patients treated with M (57 +/- 4) than with P (69 +/- 10) (p less than 0.01). One week after withdrawal of M, heart rate had increased to 77 +/- 13 (p less than 0.001), while patients on P showed no significant change. In order to minimize the influence of heart rate on the evaluation of time intervals in the cardiac cycle, heart rate dependent correction factors were used. One week after M withdrawal there was a prolongation of the pre-ejection period (PEP) from 120 +/- 15 ms to 133 +/- 16 ms (p less than 0.01), mainly due to a prolongation of the interval for early isovolumetric contraction (Q Mc) from 87 +/- 10 ms to 101 +/- 11 ms (N = 11; p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1986

Adrenaline responsiveness in borderline hypertension.

The effects of circulating adrenaline on cardiovascular function were studied in 14 subjects with borderline hypertension (BHT) and in 14 matched normotensive controls. Adrenaline was infused in stepwise increasing doses (0.1, 0.2, 0.4, and 0.8 nM/kg/min, i.v.). Noninvasive measurements of cardiac function (M-mode echocardiography) and blood pressure and blood sampling for determinations of venous plasma noradrenaline, adrenaline, cyclic AMP, and potassium were performed. Systolic and diastolic blood pressure responses to adrenaline were similar in both groups. Cardiac output was increased in BHT at rest but the signs of an increased myocardial contractility disappeared during adrenaline infusion. The BHT group displayed elevated heart rates and systemic vascular resistances over the full range of adrenaline concentrations studied but the responsiveness was similar in both groups. The beta 2-adrenoceptor-mediated increases in plasma cyclic AMP and decreases in plasma potassium were similar in the BHT and control groups. The results suggest an increased arousal in BHT at rest. Furthermore, beta 2-adrenoceptor sensitivity appears to be unaltered in BHT.

Adult↗
PubMed1986

Effects on angina pectoris and exercise tests of a 2% nitroglycerin gel adhesive in patients on chronic beta-blockade. A placebo-controlled study.

Twenty patients on chronic beta-blockade for angina pectoris were included in a double-blind randomized cross-over placebo-controlled study on a 2% nitroglycerin gel administered transdermally by an adhesive. Topinitro. The dose, 2.5-10 mg/day, was individually titrated and each treatment period was 28 days. The effect was evaluated by exercise tests and diary cards for anginal attacks and nitroglycerin tablets consumed. Results. In the 17 patients who completed the trial, active treatment did not influence systolic and diastolic blood pressure or resting and maximal heart rate. Maximal performance increased insignificantly from 92 +/- 23 to 96 +/- 20 W. The level at which 1 mm of ST depression appeared increased from 62 +/- 26 to 73 +/- 28 W (p less than 0.05). The number of attacks decreased significantly, from 92 +/- 30 to 14 +/- 28/4 weeks. The reduction in the number of sublingual nitroglycerin tablets consumed was insignificant. Conclusion. Nitroglycerin adhesive, in individual dosages, may improve signs and symptoms of ischemia.

Administration, Topical↗
PubMed1986

Evaluation of effects of nitroglycerin therapy by echocardiography.

Echocardiography (Echo) is a convenient method in diagnosing and in quantification of cardiac abnormalities, although dependent on registration quality. M-mode and two-dimensional Echo give adequate information regarding heart dimensions and cavity volume but only indirect information of pressures. M-mode Echo gives an ideal opportunity to study left ventricular wall motion as an expression of systolic and diastolic function. Both inter and intra patient comparisons will be possible to perform. Improved wall function after intake of nitroglycerin and other nitrate preparations, has been reported in Echo studies both in resting state and in induced acute myocardial ischemia during exercise in man or in acute coronary occlusion in dogs.

Cardiovascular Diseases↗
PubMed1985

Echocardiographic findings in a patient with left ventricular pseudoaneurysm.

A 57-year-old woman, treated for a large anterior transmural myocardial infarction, was readmitted after 8 weeks because of progressive cardiac failure. Chest X-ray showed cardiomegaly with an atypical cardiac silhouette. Two-dimensional echocardiography disclosed a large left ventricular pseudoaneurysm. The patient underwent resection of the false aneurysm with repair of the left ventricular wall and recovered gradually. Different methods for diagnosing pseudoaneurysm are discussed.

Echocardiography↗
PubMed1985

High-dose prenalterol in beta-blockade intoxication.

This study presents a case of beta-blocker intoxication due to massive overdose of metoprolol (7.5 g). Prenalterol in a dose of 420 mg was given as antidote, in combination with epinephrine in intermittent doses. Resuscitation was performed during 4 hours because of mechanical asystole. The patient regained health in 24 hours after further repeated doses of 30 mg prenalterol. Prenalterol is valuable in the management of toxic doses of beta-blocking drugs, and a titration to extremely high doses of prenalterol might be necessary.

Adult↗
PubMed1984

Comparative study of echo- and angiocardiographically determined regional left ventricular wall motion in recent myocardial infarction.

We have studied regional left ventricular (LV) wall motion with M-mode, cross-sectional (2D) echocardiography and LV angiography in 50 patients with a recent myocardial infarction. Regional LV wall motion was evaluated according to a 9-segment model. 2D echocardiography permitted information from all, M-mode echocardiography from 8 and angiocardiography from 6 segments. Wall motion was visually classified according to a 5-grade scale. Systolic mean wall velocity (V mean) and its deviation from normal values was calculated from M-mode registrations. 2D echo- and angiocardiography were evaluated in 35 patients and M-mode echo- and angiocardiography in 37. Total agreement in segmental wall motion was seen in 61% when comparing 2D echo- with angiocardiography, and a further 35% showed 1-grade and 4% a 2-grade difference. Corresponding values for comparisons between M-mode echo- and angiocardiography were 59%, 32% and 9%, respectively. Discrepant wall motion grading from the 2D echo- and angiocardiography comparison was seen in 94 of 243 (38%) segments. Approximately one quarter of the discrepancies were either due to minor differences in evaluation or due to wall motion scoring. Discrepancies were seen in 83 of 202 (41%) segments when M-mode echo- and angiocardiography were compared. In 42 (21%) these were attributed to obvious M-mode errors and in 8 (4%) to left ventricular angiography. In 20 further segments, nonidentical subsegmental evaluations were the probable cause of discrepancies, and in 8 (10%) ischaemia during the angiocardiography. Five segmental discrepancies remained unexplained.

Adult↗
PubMed1984

Electrocardiographic changes after myocardial infarction as indicators of deranged regional left ventricular wall motion. A serial M mode echocardiographic mapping study.

Electrocardiographic and echocardiographic findings were compared in 44 patients with a first transmural infarction. Each patient was investigated on days 1, 2, 10, and 360. The electrocardiogram was classified according to QRS and ST segment changes. Local left ventricular function was determined from mean systolic wall velocity measurements by an M mode echocardiographic mapping technique in 10 of 16 segments suitable also for electrocardiographic evaluation. Mean systolic wall velocity was corrected for differences in anterior and inferior wall motion. Wall motion was normal in segments without QRS or ST changes throughout the study. All segments with QRS or ST changes showed significantly lower corrected systolic wall velocity values during the acute stage. Segments with ST depression, alone or in combination with a minor Q wave, had corrected mean systolic wall velocity values similar to those of normal segments after one year. Segments with major Q waves and all segments with ST elevation showed reduced corrected mean systolic wall velocity values throughout the study. Segments with ST elevation, irrespective of Q waves, showed the most severely reduced wall motion with significantly lower corrected mean values than segments with minor or major Q waves without ST elevation on days 10 and 360. Thus when electrocardiograms are used for defining local left ventricular function, consideration must be given to the phase of illness, QRS morphology, and presence of ST segment elevation.

Adult↗