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Biomedical subjects

M Kaltenbach

Publications and source records attributed to M Kaltenbach.

At least 289 records · Page 16Linked to original sources
PubMed1983

Quantitative evaluation of exercise T1-201 myocardial scintigraphy before and after transluminal coronary angioplasty. A preliminary report.

Quantitative evaluation of exercise T1-201 myocardial scintigraphy was carried out to determine the effect of transluminal coronary angioplasty (TCA) in 15 patients with critical coronary artery stenoses (greater than or equal to 70%). Thirteen lesions were successfully dilated (reduction in stenosis by more than 30%); two were unsuccessful. Calculated indices from T1-201 myocardial scintigraphy, using a semi-automatic computer image processing system, included washout factor (WF), vitality index (VI) and redistribution factor (RDF). No changes were noted in WF before and after dilatation. The VI increased in successfully dilated patients from 66.3 +/- 8.5% (mean +/- SD) to 77.8 +/- 10.9% (p less than 0.001) in the areas perfused by the vessels containing the lesions. The RDF decreased significantly after dilatation from 4.4 +/- 6.1% to 1.2 +/- 2.8% (p less than 0.05) 1 hour after exercise and from 10.4 +/- 7.5% to 4.1 +/- 4.2% (p less than 0.01) 3-4 hours after exercise. From these results, we conclude that the perfusion of ischemic areas distal to critical coronary artery stenoses improves following successful dilatation. T1-201 myocardial scintigraphy was shown to be very useful in the evaluation of TCA.

Adult↗
PubMed1983

[Anti-angina effectiveness of the calcium antagonist nifedipine in relation to coronary involvement].

36 patients with chronic stable or the variant form of angina pectoris were subdivided according to their coronary angiogram into 4 groups: Group A with a single highgrade stenosis in one coronary artery, Groups B, C and D with different patterns of occluded, but collateralized coronary arteries supplying noninfarcted myocardium. All patients underwent multiple exercise step tests before (K) and after randomly assigned crossover treatment with 20 mg nifedipine (N), 20 mg isosorbiddinitrate (I), the combination of both (I + N) and Placebo (P). Peak and mean ischemic ST-segment depression, the occurrence of angina pectoris and heart rate were evaluated. The mean ischemic ST-segment depression decreased significantly after N in group A by -28% (p less than 0.01), but was not significantly altered in the groups B, C and D (B: -12%, C: +7%, D: +2%). After I, mean ST-segment depression decreased significantly in all groups (A: -36%, p less than 0.001; B: -27%, p less than 0.001; C: -22%, p less than 0.01; D: -29%, p less than 0.05). The combination of I + N was not better than I alone. Peak ST-depression and angina pectoris paralleled the results of mean ST-depression. The resting heart rate increased significantly after N only in group A (+9%, p less than 0.01) and increased after I in the groups A, B and C (A: +11%, p less than 0.05; B: +12%, p less than 0.05; C: +12%, p less than 0.01). During exercise, heart rate was not significantly different in any group or after any type of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Active and passive coronary vasodilation after intracoronary and sublingual nitroglycerin.

Nitroglycerin is known to dilate epicardial coronary arteries. It is not known, however, to what extend pressure-dependent passive vasoconstrictive effects may counteract active vasodilation. Therefore, repeated coronary angiograms were performed in 100 patients under standardized conditions before (C) and after 0.16 mg nitroglycerin intracoronarily as well as after an additional 1.6 mg nitroglycerin sublingually. Coronary diameters were determined in stenotic and nonstenotic coronary artery branches. Aortic blood pressure and heart rate were monitored continuously. Aortic blood pressure decreased slightly after intracoronary injection from 146/70 mmHg (C) to 142/77 mmHg and decreased markedly after additional sublingual administration to 129/70 mmHg. Heart rate increased from 78 beats/min (C) to 79 beats/min after intracoronary injection and to 81 beats/min after sublingual administration. Diameters in nonobstructed coronary segments increased in proximal (+7%), medial (+10%), and distal (+12%) segments after intracoronary injection; after sublingual administration a more pronounced diameter increase was observed in all segments (proximal +12%, medial +13%, distal +14%). In obstructed coronary arteries, a stenotic dilation of more than 10% was found in 73% (58/80) after intracoronary injection, but only in 50% (40/80) of the patients after sublingual administration of nitroglycerin. The average diameter increase within coronary stenoses in all patients was 24% after intracoronary injection, but only 10% after additional sublingual administration. In conclusions dilation of epicardial coronary arteries occurs in nonstenotic and stenotic segments. In nonstenotic coronary arteries, there are additive vasodilative effects after intracoronary and sublingual nitroglycerin; in coronary stenoses, however, a maximal effect is achieved after intracoronary injection which is diminished after sublingual administration.

Adult↗
PubMed1983

Sustained antianginal efficacy of oral high-dose isosorbide dinitrate in patients with coronary heart disease.

Ten patients with angiographically proven coronary heart disease, stable exercise-induced angina pectoris, and reproducible ST-segment depression were treated with ISDN tablets in daily doses of 240 mg (6 X 40 mg) and placebo for 28 days each on the basis of a randomized double-blind protocol with intraindividual crossover. On the 1st, 7th and 28th days of each treatment cycle an exercise stress test was performed 1 h after the second dose of the day. ISDN treatment resulted in a sustained reduction of anginal attacks, with a weekly rate ranging from 1.4 to 3.9 (mean values) as compared to 10.5 to 11.7 attacks during placebo treatment (2 p less than 0.001). Exercise-induced ST-segment depression during ISDN-therapy (constant work-load) was found to be significantly improved as compared to placebo: day 1, ISDN: 5.3 +/- 1.5 mm vs. placebo: 12.1 +/- 2.2 mm (2p less than 0.01); day 7, ISDN: 7.6 +/- 2.0 mm vs. placebo: 10.8 +/- 2.1 mm (2p less than 0.05); day 28, ISDN: 5.7 +/- 1.2 mm vs. placebo: 11.2 +/- 2.1 mm (2p less than 0.01). Heart rate in the upright position (tilting table) was significantly different between ISDN and placebo on day 7: ISDN 92 +/- 3 bpm vs. placebo 85 +/- 4 bpm (2p less than 0.001), but not on day . 28.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1983

[Heart rate behavior and the ischemic ST-segment under carteolol hydrochloride. Dose-response relationship and duration of effect].

1. The dose-response relation and duration of action of the beta-blocking agent 5-(3-tert-butylamino-2-hydroxy-propoxy)-3,4-dihydro-2(1H)-quinolinone hydrochloride (carteolol hydrochloride, Endak, Endak mite) were investigated by means of exercise testing under randomized, double-blind conditions in two groups of healthy probands (n = 9 and n = 9, respectively). 2. The effect of 2 mg carteolol p.o. on changes in heart rate, ischemic ST-segment depression, and blood pressure was studied in 10 patients with coronary heart disease using an exercise test performed 2 h after ingestion of the drug. 3. In terms of exercise heart rate, a clear dose-response relation was demonstrated over the range of dosages (1 and 5 mg) employed. Exercise heart rate was reduced by 10% after a single dose of approximately 0.5 mg. The beta-blocking effect of 0.2 mg carteolol, however, remains unconfirmed. A dosage increase from 5 to 25 mg yields only a slight additional effect. The therapeutically attainable maximal reduction in the rise in exercise heart rate should be about 20%. 4. 24 h after a single dose of carteolol, 60-90% of the initial drug effect was still evident. 5. Resting and standing heart rate were not influenced significantly by 1, 2, 5 or 25 mg carteolol. The groups displayed a somewhat variable response. 6. 2 h after intake of 2 mg carteolol, mean ischemic ST-segment depression was reduced by somewhat more than 50%. Blood pressure at rest remained unchanged, whereas the rise in systolic blood pressure during exercise was lowered significantly. 7. In comparison with other beta-blocking agents, carteolol was effective at low dosage levels and retained considerable potency 24 h after ingestion. In many cases, once--daily administration should be adequate to yield a satisfactory clinical response.

Adult↗
PubMed1983

[Influence of cold-stimuli on hemodynamics and coronary diameters. Provocation of coronary artery spasm].

In 32 patients with coronary heart disease the influence of different cold-stimuli on hemodynamic parameters and coronary artery diameter was examined during left heart catheterization. The cold pressor test (CPT) and the cold air inhalation test (CAIT) were applied to 16 patients in random sequence. 16 patients served as control group. Systolic and diastolic blood pressure increased more under CPT (by 15 and 10 mm Hg respectively) than under CAIT (by 10 and 3 mm Hg). Heart rate and left ventricular enddiastolic pressure did not change. Proximal and distal coronary segment diameters showed a slight, not statistically significant increase under cold-stimuli. All 4 patients with a history of angina pectoris at rest developed coronary spasm, some with ischemic ECG changes; spasm and symptoms disappeared spontaneously when the cold-stimulus was withdrawn. Patients with a history of angina pectoris under cold conditions showed no pathological reactions. It is concluded that two different mechanisms may cause angina pectoris under cold-stimuli. First, the oxygen-consuming effect of an increase in blood pressure, and secondly, an immediate coronary vasospastic reaction. The combined use of CPT and CAIT seems to be an effective and safe means of identifying patients with a tendency to coronary artery spasms.

Adult↗
PubMed1982

[Catheter dilatation of coronary vessel stenosis (transluminal coronary angioplasty) Technic, risks, early and late results].

Between October 1977 and June 1982 a total of 300 transluminal angioplasty procedures were performed in Frankfurt. 75% were single vessel, 16% double vessel and 9% triple vessel disease. The approached stenosis was located in the LAD in 69%, the RCA in 20%, RCX in 4%, ACB in 4% and LM in 3%. Emergency surgery was carried out in 4.0%. One female patient died after surgery (0.3%). Two patients experienced a transmural myocardial infarction (0.7%). On average a widening of the approached stenosis from 80-40% was achieved. Success rate (less than or equal to 20% widening) rose from 59% in the first fifty patients to 76% in the last series. Good long-term results were achieved in 87% of the successful procedures.

Angioplasty, Balloon↗
PubMed1982

[Dose-effect relationship of isosorbide dinitrate in the treatment of angina pectoris (author's transl)].

Fifteen males with angiographic evidence of coronary heart disease and stable, exercise-induced angina pectoris were given placebo or isosorbide dinitrate (ISDN) in a dialy dose of 30 mg, 120 mg, 240 mg and 480 mg in a randomized single-blind trial. The daily doses were given as a single oral dose of 5 mg, 20 mg, 40 mg and 80 mg tablets. Each dose and placebo was given for seven days. On the seventh day an exercise ECG of standardized level and duration of exercise was recorded. The ischaemia response in the ECG revealed a dose-dependent reduction by 28% (5 mg ISDN), 43% (20 mg), 60% (40 mg) and 73% (80 mg). The number of anginal attacks similarly fell parallel to dose. Plasma level of ISDN and the mononitrates, measured one and four hours after drug intake, rose almost linearly in relation to dose. Oral ISDN thus has a dose-dependent effect on the frequency of angina and ischaemia parameters during ergometric exercise. The protracted anti-anginal effect of ISDN is largely due to its metabolites. At high doses there is presumably an added effect of the high blood level of the basic substance.U

Adult↗
PubMed1982

[Effect of molsidomine on hemodynamics and myocardial ischemia in patients with acute myocardial infarction (author's transl)].

The effect of molsidomine on hemodynamics and myocardial ischemia were studied in 48 patients with acute myocardial infarction. Between 8 and 12 mg of orally and intravenously administered molsidomine led to a significant reduction in left ventricular filling pressure. In response to 2 x 4 mg p.o., diastolic pulmonary arterial pressure fell from 12.1 to 8.8 mm Hg in patients with filling pressure below 20 mm Hg. Patients with left heart failure and left ventricular filling pressure above 20 mm Hg (Group 2) displayed a decline in filling pressure from 23.8 to 17.4 mm Hg following 12 mg i.v. In addition, right atrial pressure dropped significantly across the entire range of dosages. Although patients without left ventricular failure (Group I) showed a decline in cardiac output (5.7 to 4.7 l/min), this parameter remained unchanged in Group 2. Heart rate in Group 2 fell from 85 to 81 per min. Arterial blood pressure was reduced by a mean of only 10 mm Hg at high dosages and remained unchanged at lower dosages. No change was observed in peripheral resistance. The maximum effect was seen 30 min after oral administration. Three hours later, the effect was reduced by half. Only minimal activity could be observed after 8 h. The incidence of side effects was low, with transient headaches occurring in 8% of the patients. An intraindividual comparison with 1.6 mg of sublingually administered nitroglycerin demonstrated no significant difference in hemodynamic effectiveness (n = 11). Molsidomine, not unlike nitroglycerin, exerts a favorable effect on hemodynamics and myocardial ischemia. It acts primarily to reduce preload. The additional moderate effect on afterload with a slight decline in arterial pressure at high dosages may also be considered advantageous.

Administration, Oral↗
PubMed1982

The brachial artery method to transluminal coronary angioplasty.

The development of a brachial artery guiding catheter for (percutaneous) transluminal coronary angioplasty is described. Three-hundred angioplasty procedures were attempted with 196 (65%) via the branchial and 104 (35%) via the femoral artery. The coronary stenosis was crossed in 202 attempts (67%); in 138 via the brachial (70%) and 64 via the femoral artery (62%). A successful angioplasty occurred in 117 via the brachial (85%) and in 50 via the femoral artery (78%). Successful angioplasty of the left anterior descending artery was equally effective with either technique. Successful angioplasty of the right coronary artery was more difficult (P less than 0.05) using the femoral artery. An unsuccessful angioplasty with one technique was occasionally overcome by use of the other technique. No brachial artery complications were encountered. The brachial method to transluminal coronary angioplasty is an acceptable and complementary alternative to the femoral technique. Those laboratories contemplating percutaneous transluminal coronary angioplasty may desire to utilize both approaches.

Angina Pectoris↗