Search PubMed⌕ Search

Biomedical subjects

M Kaltenbach

Publications and source records attributed to M Kaltenbach.

At least 379 records · Page 21Linked to original sources
PubMed1977

Orally administered isosorbide dinitrate in patients with and without left ventricular failure due to acute myocardial infarction.

The oral effectiveness of 10 mg followed by 20 mg of isosorbide dinitrate in 21 patients with acute mycardial infarction was studied over a period of 13 hours. The patients were grouped according to initial left ventricular filling pressure: group I, pressure less than 20 mm Hg, and group II, pressure more than 20 mm Hg. Patients in group II had left ventricular failure. In both groups isosorbide dinitrate resulted in a significant decrease in pulmonary arterial pressure. The left ventricular filling pressure decreased in group I from 13.6 +/- 4.0 to 7.1 +/- 2.6 mm Hg (mean +/- 1 standard deviation) and in group II from 26.9 +/- 4.6 to 19.0 +/- 3.6 mm Hg (P less than 0.001). Cardiac output decreased in group I from 5.1 +/- 1.0 to 4.5 +/- 0.9 liters/min, whereas in group II it increased significantly from 3.5 +/- 0.8 to 4.1 to 0.9 liters/min (P less than 0.001). In both groups, peripheral arterial blood pressure decreased (P less than 0.60). Heart rate remained constant. Whether cardiac output increased or decreased was found to be dependent on the initial left ventricular filling pressure. In patients with an initially high value (above 20 mm Hg), the increase in cardiac output is probably due to the reduction of afterload. An additional factor may be the decrease in left ventricular filling pressure, which leads to an improved blood supply in the affected mural segments as a result of the decrease in the extravascular component of the coronary resistance. Significant changes in cardiac output and left ventricular filling pressure were achieved 3 to 5 hours after oral administration of isosorbide dinitrate. Clinical signs of failure were less pronounced. Isosorbide dinitrate is, therefore, a therapeutic agent in the treatment of left ventricular failure due to acute myocardial infarction.

Administration, Oral↗
PubMed1977

[Radiological heart volume determination--a new method carried out in the sitting position (author's transl)].

A method is described for the determination of cardiac volume with the subject in a sitting position. The results correspond with those of other accepted methods, but there are several significant advantages: 1. The position is easily maintained by the subject and the method is therefore acceptable for patients with cardiac disease. 2. The risks connected with a Valsalva effect are reduced. 3. There is no need to change the position of the x-ray tube during the examination. 4. Contrary to the traditional technique, the x-ray room does not require a very high ceiling. 5. Because of even blood distribution, the cardiac volume determinations also provide information regarding the lungs.

Adult↗
PubMed1977

[Left ventricular contraction reserve in coronary heart disease. Evaluation, quantification and prognostic value (author's transl)].

Regional and overall left ventricular contraction reserve was studied in 14 patients with coronary heart disease, in 5 healthy subjects and in 4 patients before and after aorto-coronary bypass surgery. Quantification of overall contraction was based on ventricular volumes and ejection fraction. Regional contraction reserve was calculated with the hemiaxis method and a ventricular score. Contraction reserve under nitroglycerin and in postextrasystolic beats was compared. For routine quantification of contraction reserve the ventricular score is recommended. For research purposes the hemiaxis method is to be preferred. Postextrasystolic beats are better suited for analysis of contraction reserve than are angiograms following administration of nitroglycerin. This is due to the minor expense of the procedure, furthermore, postextrasystolic beats allow better differentiation between contracting and non-contracting areas. Left ventricular contraction reserve is larger in patients with coronary heart disease, angina pectoris and ischemic reactions in the exercise ECG than in control patients. These findings are based on overall and on regional volume parameters. A quantitatively greater improvement in contraction could be provoked in the anterior wall than in the posterior wall. Regional contraction improved significantly in most cases either in the anterior wall or in the posterior wall; rarely it improved simultaneously in both left ventricular regions. In a few cases contraction deteriorated in one area with a simultaneous improvement in the opposite area. Overall and regional ventricular function, as assessed preoperatively by contraction reserve determinations could not be completely regained in normal beats after successful bypass surgery. Differences in the regional contraction reserve seemed to be mainly due to varying degrees of ischemia and scarring.

Angina Pectoris↗
PubMed1977

[Right and left ventricular volume parameters in cardiomyopathy (author's transl)].

In 41 patients with different types of cardiomyopathy (19 congestive = COCM, 6 hypertrophic obstructive = HOCM, and 16 hypertrophic non-obstructive = HCM) ventricular enddiastolic volume (EDV), endsystolic volume (ESV), and ejection fraction (EF) were determined angiographically and values of both ventricles were compared. In the mean, volume parameters increased significantly and EF of both ventricles decreased as compared to control values of patients with coronary heart disease without myocardial infarction. In COCM volume parameters reached pathologic values as in the total patient group whereas in HOCM and in HCM values did not differ significantly from control. Left ventricular function was reduced more often and, in the mean, more severely than right ventricular function. This became evident e.g. from the incidence of enddiastolic volume increase and the course of the regression line. A similar finding can be derived from the reversal of the normal relation of volume parameters of both ventricles. Only in rare cases right ventricular function was more severely impaired than left ventricular function. These findings indicate a simultaneous impairment of both ventricles in cardiomyopathy. The more pronounced left ventricular function disturbance may be attributed to the higher left ventricular work load. Thus, left ventricular biopsies might be of greater diagnostic significance than right ventricular biopsies.

Cardiac Catheterization↗
PubMed1977

[Contractile and relaxation reserve of the left ventricle. I. Normal left ventricle (author's transl)].

The validation of parameters of left ventricular contractility at rest is pure. Therefore, the contractile function of the left ventricle was measured during exercise. The reserve in contractility and relaxation was obtained in a group of 13 patients with normal left ventricle (ergometer). The maximal rate of left ventricular pressure rise (max dP/dt) increased from 1721 +-378 to 4954 +- 1246 mmHg/s and the peak measured velocity of contractile elements (dP/dt/P) from 38 +- 9 to 76 +- 11 s-1 at a mean load of 112 +- 43 (+-SD) watts. The parameter of the isovolumic relaxation phase, the maximal rate of left ventricular pressure fall (min dP/dt) increased from 1862 +- 343 to 3128 +- 445 mmHg/s. Left ventricular enddiastolic pressure was unchanged. All patients reached at least 3200 mmHg/s (max dP/dt) 60 s-1 (dP/dt/P) and 2400 mmHg/s (min dP/dt). The difference between rest- and exercise values was at least 1800 mmHg/s (max dP/dt), 22 s-1 (dP/dt/P) and 1000 mmHg/s (min dP/dt).

Adolescent↗
PubMed1977

[Contractile and relaxation reserve of the left ventricle. II. Patients with rheumatic valvular disease (author's transl)].

The function of the left ventricle is important for the success of surgery. To differentiate between normal and abnormal ventricular function, the contractile and relaxation reserve was measured. In 19 patients, 10 with mitral and 9 with aortic valve disease, max dP/dt and min dP/dt were measured at rest and during exercise (ergometer). Max dP/dt increased in 7 patients above 3200 mm Hg/s and dP/dt/P above 60 s-1 (normal contractile reserve). Only 3 of these patients reached a normal increment of relaxation velocity (min dP/dt above 2400 mm Hg/s). In 12 patients the contractile and relaxation reserve was decreased. All patients with mitral stenosis had abnormal relaxation reserve despite normal contractile function in 4 cases. Left ventricular enddiastolic pressure did not correlate well with myocardial dysfunction. Isovolumic contractility during exercise was decreased in patients with aortic valve disease. Enddiastolic pressure increased from 18 +- 8 to 22 +- 14 mm Hg during exercise.

Adolescent↗
PubMed1977

[Comparative blood flow measurements with arterio-venous oxygen difference and the 133-Xenon-technique in the region supplied by the left coronary artery (author's transl)].

In 17 mainly coronary patients increase in blood flow due to therapeutical vasodilation was measured in the region almost totally supplied by the left coronary artery by two different methods, the 133-Xenon washout technique and via arterio-venous oxygen difference (AVDO2). With both methods similar results were obtained (r=0.89). Mean maximal increase in flow 15 min. after 40 mg Carbochromen i.v. amounted to +22.4% with the 133-Xenontechnique, +21.5% with AVDO2. 5min. after 20 mg intracoronary dipyridamol mean flow increased by 47.8% (Xenon technique) and 47.1% (AVDO2) respectively. Decrease in coronary reserve is correlated more with the amount of damaged byocardium than with the degree of coronary obstruction. The limited reliablility of all measurements of total coronary blood flow in heart diseases with regional disturbances is specially indicated.

Adult↗
PubMed1977

[Clinical light and electron microscopic findings in patients with late and early congestive cardiomyopathies (author's transl)].

Right of left ventricular biopsies were performed in 50 patients with late and early forms of congestive cardiomyopathy. Clinical data as well as light and electron microscopic findings are described. Chronical myocarditis could be detected by histological examination in three patients. Hypertrophy and degenerative changes of the heart muscle cells and interstitial fibrosis were the major morphological finding in the other cases. There is a good correlation between the severity of clinical symptoms and the extent of light and electron microscopical changes. In some patients with mild clinical symptoms advanced ultrastructural alternations were found.

Biopsy↗
PubMed1976

[Accuracy of exercise tests in the recognition of coronary-artery stenosis. Comparison between post-exercise ECG and coronary arteriogram (author's transl)].

Post-exercise ECGs and coronary arteriograms were compared in 180 unselected patients. Coronary-artery stenosis had been diagnosed correctly by arteriography in 94% of cases. In 60% this was also possible from the resting ECG (signs of myocardial infarction), while in the remaining 34% only the exercise ECG was positive. Post-exercise ECG changes are thus an important and largely specific means of diagnosing coronary-artery stenosis.

Adult↗