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Biomedical subjects

M Kaltenbach

Publications and source records attributed to M Kaltenbach.

At least 343 records · Page 19Linked to original sources
PubMed1980

[Incidence and quality of collaterals in coronary heart disease estimation of size and function in the angiogram by a score-system (author's transl)].

345 angiograms obtained from consecutively catheterized patients with ischemic heart disease (112 without infarction, 215 with infarction, 18 with possible small infarction) were studied for the presence and quality of collateral coronary vessels. Patients were classified according to one- two-, or three-vessel disease as well as the percentage of coronary occlusion. Collateral quality was quantified using a point system (collateral score) which included four individual criteria: 1) degree of opacification, 2) quality of retrograde filling, 3) extent of collateralization, and 4) flow rate. Good reproducibility was obtained using this approach. The development of 10 various collateral types is dependent upon the stenosed coronary artery. Collaterals are only demonstrable when vessels narrowing exceeds 60 percent. With more severe degrees of stenosis both collateral incidence (%) and score are increased. The individual range of collateral development for any given degree of stenosis varies widely. The coronary score appears to represent a useful, semiquantitative means of assessing the functional significance of collateral vessels in man.

Collateral Circulation↗
PubMed1980

[Mechanical dilatation of coronary artery obstructions (transluminal angioplasty) (author's transl)].

29 procedures of transluminal angioplasty were performed in 25 patients with 26 coronary artery stenoses. Of 18 stenoses passed with the dilatation catheter 14 could be successfully dilated (dilatation of stenoses of greater than or equal to 30%). Localization of stenoses was: left main (3), left anterior descendens (10), left circumflex (2), right coronary artery (10), and aortocoronary bypass (1). Long-term follow up over 2 to 19 months (mean 7 months) showed favourable results in 11 patients, while in 3 restenosis occurred.

Adult↗
PubMed1980

[Transluminal angioplasty: control of efficiency by nuclear medical methods after non-operative dilatation of critical coronary artery stenoses (author's transl)].

Preliminary results are reported using 201Tl-myocardial scintigraphy (MSC) with quantitated analysis of redistribution kinetics immediately after ergometry (climbing step test) two to four hours later respectively and (Dual-ROI-) Equilibrium-Radionuclide-Ventriculography (ERNVG) with 99mTc-in vivo-labeled erythrocytes during bicycle exercise prior to and after nonoperative transluminal angioplasty (TAP) in nine patients with critical coronary artery stenosis. ERNVG showed a good reproducibility (r = 0,972, n:20 double check) of LVEF. Successful TAP was associated with 1. increase of LVEF from 41,8 (before) to 49,8% (after TAP), 2. increase of mean normalized systolic ejection rate (MNSER = LVEF/ET) from 1,30 (before TAP) to 1,66 (after TAP), 3. increase of maximal volume change during systole (dV/dtmax/EDV) from 2,12 (before TAP) to 3,03 s-1 (after TAP). Parameters of 201Tl-redistribution kinetics (in MSC) were normalized. Ischemic reaction index increased from 62,9 +/- 5,5 (before) to 79,1 +/- 6,9% (after TAP). The degree of 201Tl-redistribution was normalized from 10,3 +/- 7,4 (before TAP) to 2,1 +/- 1,9 (after TAP, between three and four hours after exercise) as a sign of disappearance of exercise-inducible regional myocardia ischemia after successful TAP. These preliminary results underline the effectiveness of non-operative TAP in selected cases of critical coronary artery stenosis.

Cardiac Output↗
PubMed1979

[Effect of prazosin in therapy-resistant chronic cardiac failure (author's transl)].

In addition to standard treatment with digitalis and diuretics prazosin (20 mg/d) and placebo were given to 14 patients with chronic therapy-resistant cardiac failure mainly of stage III for periods of 6 weeks each. Cardiac frequency, blood pressure, cardiac volume, pulmonary artery pressures and cardiac minute volume were assessed at rest and during physical exercise. Body weight, congestive changes in the chest radiograph, oedema and complaints were evaluated. During the acute trial using 2 mg of prazosin a significant increase of cardiac minute volume was demonstrable at rest and during exercise (2 P less than 0.05). After administration for 6 weeks cardiac minute volume increased from 3.2 to 4.0 l/min at rest and from 6.9 to 8.0 l/min during exercise (2P less than 0.005; n=12). There was a noticeable decrease of cardiac size from 1440 to 1306 ml/1.73 m2 (2 P less than 0.02). Haemodynamic improvement paralleled the decrease of complaints which was equivalent to an improvement of half to one stage of the New York Heart Association. In severe cardiac failure prazosin has thus an additional therapeutic effect beyond digitalis and diuretics.

Adult↗
PubMed1979

[Frequency of life-threatening complications associated with exercise testing (author's transl)].

Most of the statistics on complications of ergometric exercise tests come from the United States and are largely related to treadmill ergometry. A questionnaire was sent in the summer of 1978 to 198 investigative units in the German-speaking regions. The results of 1065 923 person-tests were made available. Exercise testing of 353 638 sports-persons revealed no serious complications. On the other hand, testing of 712 285 patients, predominantly with coronary heart disease, lead to 17 deaths and a total of 96 life-threatening complications. The result of this survey indicates that one must expect one such complication for every 7500 ergometry tests. The danger of pulmonary oedema on exercise in recumbency is about five times higher than that on sitting or standing. The most frequent complication was ventricular fibrillation. A defibrillator should therefore always be immediately available during exercise tests.

Coronary Disease↗
PubMed1979

[IX. Randomized study of the effect of nitroglycerin on CK and CK-MB infarct size. Preliminary report (author's transl)].

In 38 patients with acute myocardial infarction the effect of nitroglycerin on infarct size was studied. Patients were randomized into two groups. 16 patients received continuous nitroglycerin infusions of 0.6 to 6.0 mg/h (mean 2.3 mg/h) over a 48 h period, 22 patients received no specific therapy and served as control. Nitroglycerin was given in the mean 12 +/- 5 (+/- 1 SD) hours following onset of chest pain and 8 +/- 5 after the increase of CK values. Infarct size was determined according to the time activity curve of creatine kinase (CK) and of its myocardial isoenzyme (CK-MB). In all but one patient hemodynamic parameters (left ventricular filling pressure, blood pressure, cardiac index) were measured. The mean infarct size was 51 +/- 30 CK-g-equiv. in control patients, and 48 +/- 33 g in nitroglycerin treated patients. Infarct size as calculated from CK-MB values was 60 +/- 36 g (n=16) in control, and 52 +/- 41 g (n=11) in treated patients. At left ventricular filling pressure values (LVFP) below 20mm Hg infarct size amounted to 43 +/- 30 g (n=12) in control, and to 41 +/- 32 g (n=11) in the nitroglycerin group. At LVFP values above 20 mmHg infarct size was 61 +/- 29 g (n=10) in control as opposed to 64 +/- 32 g (n=5) in treated patients. There was no difference between infarct size as predicted during the first 7 h and the observed infarct size. - Despite the known beneficial effect of nitroglycerin on hemodynamics and on myocardial ischemia, infarct size seems not to be greatly reduced, however, intervention occurred fairly late (12 h). In early intervention beneficfial effects seem likely.

Adult↗
PubMed1979

[Comparison of bicycle ergometry and step-ladder exercise (author's transl)].

Repeat exercises (three hours apart) on a bicycle ergometer and a vertical step-ladder were performed in a randomised series on 79 subjects: 13 doctors, 44 patients and 22 sportsmen. Duration of exercise was on average 250% longer in the three groups on the step-ladder than the bicycle. Correspondingly, exercise-pulse sums, recovery-pulse sums and exercise indices were two-and-a-half to three times higher than on bicycle ergometry. As a sign of comparability of the exercise by the two methods there was, on average, no significant difference with regard to the final heart rate, although duration of exercise was longer on the step-ladder. 67% of subjects discontinued the exercise because of peripheral muscle fatigue on the bicycle ergometer, compared with only 8% on the step-ladder. During bicycle ergometry lactate concentration rose by 6.7 mmol/l compared with only 0.78 mmol/l during step-ladder exercise. These results indicate that the value of bicycle ergometry exercise is limited by muscle fatigue in the legs: step-ladder exercise can be extended much longer. The practical significance is that patients with coronary heart disease especially have symptoms and/or ECG changes of ischaemia only at higher levels of physical exercise.

Adolescent↗
PubMed1979

Treatment of hypertrophic obstructive cardiomyopathy with verapamil.

Twenty-two patients with hypertrophic obstructive cardiomyopathy were treated with the calcium inhibitor, verapamil, which was administered in a mean oral dose of 480 mg per day. After an average of 15 months of treatment (4 to 24 months), the QRS amplitude in the electrocardiogram was significantly reduced from 4.2 to 3.8 mV. Heart volume calculated from chest x-ray films in the supine position decreased significantly from 858 to 766 ml per 1.73 m2. In 10 patients, follow-up heart catheterisation showed a decrease in left ventricular muscle mass in 7 patients and a slight increase in 3 patients. Coronary artery diameter decreased in 7 patients, increased in 1, and was unchanged in 2. The reduction in coronary artery diameter is considered to be a consequence of a reduced heart muscle mass. From all available clinical data it is concluded that verapamil treatment is superior to beta-blocker therapy.

Adult↗
PubMed1979

[Diameter of coronary arteries before and after bypass grafting (author's transl)].

Patients with patent coronary bypass grafts showed the followings: 1. a decrease in prestenotic coronary diameter due to a reduction in flow. 2. An increase of the poststenotic segment of the bypassed vessel due to an increase in flow via the venous graft. 3. An increase of the bypassed stenosis, mainly due to a general decrease of vessel diameter proximal to the stenosis. 4. No change in diameter in non bypassed arteries. The postoperative changes in diameter were not dependent on the time elapsed since surgery and were independent from the severity of coronary sclerosis and the number of risk factors. A correlation was found between the amount of the diameter changes and the amount of reduction in exercise induced ST-segment depression. The decrease in coronary diameter proximal to the stenosis is not due to progression of coronary sclerosis but to a functional change. A narrow poststenotic vessel does not constitute a contraindication for bypass grafting because its true diameter is flow dependent and cannot be judged with certainty from the preoperative angiogram.

Coronary Angiography↗