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Biomedical subjects

K Swedberg

Publications and source records attributed to K Swedberg.

At least 163 records · Page 9Linked to original sources
PubMed1988

Tolerability of enalapril in congestive heart failure.

In a double-blind, randomized trial, 253 patients with heart failure (New York Heart Association functional class IV) received either enalapril (n = 127) or placebo (n = 126) in addition to their conventional therapeutic regimens (digitalis, diuretics and vasodilators other than angiotensin-converting enzyme inhibitors). Enalapril was administered in a dose of 2.5 to 40 mg/day. The placebo group was administered placebo tablets in addition to their conventional therapeutic regimen. The study was discontinued prematurely for ethical reasons because of the highly significant (p = 0.003) difference in mortality between the enalapril (n = 50) and placebo groups (n = 68). The important reduction was observed among patients dying from progressive heart failure. Follow-up ranged from 1 day to 20 months (average 188 days). The reduction in mortality was associated with general improvements in symptoms and signs of left and right ventricular heart failure, reduction of heart size, improvements in New York Heart Association classification, reduction of concurrent cardiovascular medication, and reduction in the number of hospital admissions and duration of hospitalization. The overall rate of withdrawal from the study was low and was comparable in the 2 treatment groups (16%). Induced hypotension was an intentional part of the treatment, and symptomatic hypotension was observed in 17% of treated patients vs 0% of the placebo group. Hypotension was the reason for withdrawal in 7 patients. After the initial dose of enalapril was reduced to 2.5 mg in high-risk patients, hypotension was the reason for withdrawal in only 3% of all patients. Hyperkalemia was observed exclusively among patients concurrently using potassium-sparing agents.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Trials as Topic↗
PubMed1988

Effects on mortality during five years after early intervention with metoprolol in suspected acute myocardial infarction.

This study reports the mortality over a 5-year-period determined a double-blind trial, which evaluated the effect of early intervention with metoprolol in suspected acute myocardial infarction. In all, there were 1,395 randomized patients, 698 and 697 of whom were allocated to metoprolol 200 mg daily and placebo treatments, respectively, for the first 3 months. Thereafter, the two groups were treated in a similar fashion implying beta-blockade to a majority. Within the first 3 months, mortality in the metoprolol group was 5.7% versus 8.9% of the placebo group (p = 0.02). This difference persisted after 2 years (metoprolol 13.2%; placebo 17.2%; p = 0.04). Over a 5-year-period, 24.2% of the patients who originally were allocated to metoprolol had died as compared to 25.7% of those originally allocated to placebo (p greater than 0.2). Among patients in whom treatment started early (less than or equal to 8 hours after onset of pain = the median delay time), enzyme activities in the metoprolol group was lower (p = 0.03) than in the placebo group. Mortality during the first 2 years among these patients treated early was lower in the metoprolol (11.8%) than in the placebo group (17.3%; p = 0.04). Corresponding figures after 5 years were 22.0% and 25.3%, respectively (p greater than 0.2). Among patients in whom treatment started later than 8 hours onset of pain, there was neither any difference in enzyme activity nor in mortality after 2 and 5 years. It can be concluded that early treatment with metoprolol in suspected acute myocardial infarction reduced mortality during the first 3 months compared with placebo. The difference persisted after 2 years. However, 5 years after randomization, no significant difference in mortality was observed between the two treatment groups.

Adult↗
PubMed1988

QRS amplitudes, QTc intervals and ECG abnormalities in pheochromocytoma patients before, during and after treatment.

QRS amplitudes (S1 + R5), Minnesota Code ECG abnormalities and QTc intervals were analyzed in ECGs from 31 pheochromocytoma patients on admission to hospital, after 17 +/- 7.2 (SD) days of preoperative phenoxybenzamine therapy in a dosage of 148 +/- 45.0 (SD) mg/day and after a mean postoperative follow-up of 6 years. QRS voltage decreased significantly from 3.37 +/- 1.48 on admission, to 2.26 +/- 0.69 mV at postoperative follow-up (p less than 0.001). The prevalence of total Minnesota Code changes increased or was unchanged on the different occasions. Severe to moderate changes, however, became less prevalent, while mild changes increased. The QTc interval was 0.44 +/- 0.04 s on admission and 0.41 +/- 0.02 s at follow-up (p less than 0.01). No significant differences were observed during treatment with phenoxybenzamine. Pathological ECGs are common findings in patients with pheochromocytoma and significant improvements occur after surgery. Significant effects of phenoxybenzamine therapy were only found in patients with sustained hypertension.

Electrocardiography↗
PubMed1987

Central haemodynamic and antiplatelet effects of iloprost--a new prostacyclin analogue--in acute myocardial infarction in man.

In 14 patients with acute myocardial infarction, a 24-hour Iloprost infusion was started with a mean delay of 309 +/- 22 minutes from onset of symptoms. Patients were haemodynamically monitored with a pulmonary artery catheter and an arterial cannula. The dose of Iloprost was 1-4 ng kg-1 min-1 and titrated according to blood pressure and systemic vascular resistance. When 2.0-4.0 ng kg-1 min-1 of Iloprost were infused, 5 out of 10 patients required dose reduction due to hypotension, nausea or both. However, in all patients the infusion period was completed as planned. Acute reductions of systolic blood pressure and vascular resistance were seen, whereas stroke volume increased and heart rate remained unchanged. The infusion of Iloprost caused profound inhibition of ADP-induced platelet aggregation but no significant changes in plasma values for platelet-specific proteins or thromboxane B2 were recorded. It is concluded that it was possible to safely administer Iloprost over 24 hours in the early phase of acute myocardial infarction and profound anti-aggregatory effects were observed. These findings should be evaluated in a controlled study.

Adult↗
PubMed1987

Use of nitrates in acute and chronic congestive heart failure.

The literature available on the use of nitrates (glyceryl trinitrate, isosorbide dinitrate and isosorbide 5-mononitrate) as various formulations (oral, buccal, sublingual, transdermal and intravenous) in the treatment of acute and chronic congestive heart failure is reviewed. There are adequate data on the acute haemodynamic effects of these preparations, but little information is available on the long term use of nitrates in chronic congestive heart failure. The exception is isosorbide dinitrate, which, in combination with hydralazine, has been shown to reduce mortality.

Acute Disease↗
PubMed1987

Haemodynamic effects of felodipine in congestive heart failure.

The acute and long term central haemodynamic effects of felodipine were studied in 9 patients with severe congestive heart failure (NYHA III-IV). A felodipine dose of 5 to 15 mg tid was individually titrated during a 24 to 48 hour catheterisation period. One patient received 5mg tid, 5 patients 10mg tid and 3 patients 15 mg tid. At rest the individual maximal dose was associated with a significant fall in systolic and diastolic blood pressure, pulmonary artery diastolic pressure, heart rate and systemic vascular resistance, while stroke volume was significantly increased. During upright submaximal (30-50 watts) bicycle exercise, the changes were principally the same with the addition of a significant increase of cardiac index. Six patients were re-evaluated after 30 days of continuous treatment. Their resting haemodynamics had returned to the control level but during exercise the significant changes in cardiac index, stroke volume and vascular resistance persisted. The results indicated a beneficial effect of felodipine in the treatment of heart failure, but further studies are needed.

Adult↗
PubMed1986

Acute hemodynamic and metabolic effects of ICI 118,587 (Corwin), a selective partial beta 1 agonist, in patients with dilated cardiomyopathy.

The effects of acute intravenous administration of ICI 118,587 (Corwin), a partial beta 1 agonist, were studied in nine patients with dilated cardiomyopathy and symptomatic congestive heart failure. Hemodynamic and metabolic parameters were measured using Swan-Ganz, arterial, and coronary sinus catheters. Repeated doses of Corwin produced no significant change in left ventricular performance, while a trend towards decreased blood pressure and stroke work was seen. No change occurred in coronary sinus blood flow, transmyocardial lactate extraction, or catecholamine release. One patient had significant depression of left ventricular function with hypotension. Thus, acute infusion of Corwin produced no beneficial inotropic responses, but rather produced features suggestive of further myocardial depression.

Adrenergic beta-Agonists↗
PubMed1986

The influence of early intervention in acute myocardial infarction on long-term mortality and morbidity as assessed in the Göteborg metoprolol trial.

The mortality and morbidity were assessed during a 2-year follow-up in an acute intervention trial in suspected acute myocardial infarction with metoprolol (a selective beta 1-blocker). On admission to the trial, the 1395 participating patients were randomly allocated to metoprolol or placebo for 3 months. Thereafter, if there was no contraindication, patients with infarction and/or angina pectoris were continued on metoprolol for 2 years. A lower mortality was observed after 3 months in patients randomised to metoprolol. The difference remained after 2 years. The difference in 2-year mortality rate was restricted to patients randomised early after onset of pain. Late infarction was observed more often in the placebo group during the first 3 months. When the two groups thereafter were treated similarly, the difference successively declined and did not remain after 2 years. A similar incidence of angina pectoris was observed in the two groups at each check up. During the early recovery period, more patients in the metoprolol group returned to work. No such difference was observed later on.

Adult↗
PubMed1986

Natural evolution of left ventricular haemodynamics following uncomplicated acute myocardial infarction.

In an attempt to investigate the changes in left ventricular haemodynamics following uncomplicated myocardial infarction 95 patients with definite electrocardiographic signs of infarction, without clinical signs of cardiac failure, were monitored with a Swan Ganz catheter for the first 24 hours after admission to hospital. The median delay from onset of symptoms was 6.8 hours. Mean heart rate increased (83-86 beats/min; P less than 0.05) while stroke volume index fell (38.4-36.6 ml/m2; P less than 0.05); cardiac index therefore remained unchanged during the observation period. As a result of a fall in arterial pressure both systemic vascular resistance and left ventricular stroke work index fell significantly (P less than 0.01). Pulmonary wedge pressure also fell (13.6-10.5 mm Hg; P less than 0.001), but this fall was confined to patients whose initial reading was above the median of 13 mm Hg. Pulmonary wedge pressure fell both among the 41 patients who required some medical therapy (15.6-10.8 mm Hg; P less than 0.001) and the 54 who received no medication throughout the 24 hours (12.0-9.8 mm Hg; P less than 0.05). The 39 patients with anterior wall infarction had higher baseline pulmonary wedge pressure and systemic vascular resistance than the 42 with inferior wall infarction. Later the stroke volume and stroke work index were persistently lower reflecting the greater degree of impairment of left ventricular function in anterior wall infarction. In conclusion, following an uncomplicated myocardial infarction, cardiac index was maintained, despite a fall in stroke volume, by an increase in heart rate. Pulmonary wedge pressure showed both a spontaneous fall and a fall in those patients given additional medical therapy during the study period.

Aged↗
PubMed1986

Central haemodynamic effects of metoprolol early in acute myocardial infarction. A placebo controlled randomized study of patients with low heart rate.

The central haemodynamic effects of metoprolol in patients with acute myocardial infarction and with heart rate less than or equal to 65 beats min-1 have been investigated in a randomized double-blind trial. The aim was to study the tolerance in this selected patient group and to assess possible differences in haemodynamic response amongst patients with initially higher heart rates. Exclusion criteria were: treatment with beta blockers; heart rate greater than 65 beats min-1; systolic blood pressure less than 110 mmHg; and physical signs of serious heart failure. Following pulmonary artery catheterization, 22 patients were randomized to metoprolol 15 mg i.v. + 50 mg q.i.d. orally (N = 12) or placebo (N = 10). Central pressures and cardiac output were recorded before and during the 24 hours after drug administration. There was a significant fall in heart rate, cardiac index, rate pressure product and stroke work index of 10-20% in the metoprolol, compared with the placebo group. The differences were most pronounced immediately after the metoprolol injection. The pulmonary artery capillary wedge pressure was not significantly changed. The overall haemodynamic response to metoprolol was similar to that reported in patients with acute myocardial infarction and heart rate above 65 beats min-1. Tolerance was good.

Aged↗
PubMed1986

Central haemodynamics in acute myocardial infarction in relation to mortality and peak enzyme activity.

The relation of central haemodynamic changes to subsequent mortality and peak enzyme activity was investigated in 190 patients with acute myocardial infarction. The mean delay time from onset of symptoms to the haemodynamic study was 7.2 hours. Major exclusion criteria were heart rate less than 65 beats min-1, systolic blood pressure less than 105 mmHg and lung rales to a distance of greater than 10 cm above the lung bases. Nine patients (4.7%) died within 15 days and 16 patients (8.4%) within 90 days after the infarction. Compared to survivors, non-survivors were characterized by baseline depression of cardiac index, stroke volume index and left ventricular stroke work index, while pulmonary capillary wedge pressure and peripheral resistance were increased. However, a wide overlap between survivors and non-survivors makes the predictive value low in the individual patient. Peak serum aspartate aminotransferase (S-ASAT) activity was weakly related to baseline pulmonary capillary wedge pressure (r = 0.28; P less than 0.001) and stroke volume index (r = -0.22; P less than 0.01). The correlation to pulmonary capillary wedge pressure was only found in anterior (r = 0.34) infarcts. Peak serum lactate dehydrogenase (LD1) was not correlated with baseline haemodynamics.

Aged↗
PubMed1986

Increased plasma levels of atrial natriuretic peptide in patients with congestive heart failure.

Atrial natriuretic peptide (ANP) is a recently discovered hormone, originating from atrial myocardium. The peptide (or family of peptides) induces potent diuretic/natriuretic, vasorelaxing and aldosterone inhibitory effects. We have investigated plasma concentrations of immunoreactive ANP in 10 patients with congestive heart failure (CHF). Mean plasma ANP concentrations were more than three times higher in CHF patients than in a matched control group. High plasma ANP concentrations in pathophysiological conditions with a high preload combined with salt and water retention is consistent with a physiological role of this hormone to correct hypervolemia by causing natriuresis and diuresis. It is concluded that ANP homeostasis is altered in patients with CHF and that this hormone may be of importance in the pathophysiology of CHF.

Atrial Natriuretic Factor↗
PubMed1986

Effects of ACE-inhibition on regional circulation in congestive heart failure.

During development of heart failure there are marked changes in the peripheral circulation. The renal and splanchnic circulations are reduced early. The cerebral circulation is maintained by autoregulation. Skeletal muscle blood flow is reduced in relation to the decrease of cardiac output. There are also important metabolic changes in these muscles with reduced mechanical efficiency. Treatment with arterial vasodilators increase cardiac output. However, most of this increase is usually shunted, probably in the splanchnic circulation. If any, only small increases in muscle blood flow have been reported. ACE-inhibition has been shown to have beneficial acute effects on the renal, cerebral and skeletal muscle blood flow with improved flow in these areas. This treatment seems to be the most beneficial vasodilatory alternative available so far.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1986

Development of tolerance to nitrate therapy in chronic congestive heart failure.

In several studies the nitrate effects on central hemodynamics during less than 24 hours have been evaluated in heart failure. Higher doses than in angina have been used. A pronounced response is seen acutely. An attenuation has been reported after 12-24 hours. A relation to continuous (intravenous, transdermal) administration of nitroglycerin has been proposed, but it is not clear. During chronic treatment with ISDN a tolerance is not obvious within 12 weeks. The heart failure patient has a different neurohumoral situation compared to angina patients. This could be one reason for differences in tolerance development during nitrate therapy.

Chronic Disease↗