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Biomedical subjects

M Kaltenbach

Publications and source records attributed to M Kaltenbach.

At least 91 records · Page 5Linked to original sources
PubMed1991

Nitrate therapy in heart failure.

Nitrates are drugs of first choice in patients with acute heart failure. Acute pulmonary edema can be successfully treated with single or repeated doses of sublingual nitroglycerin. In cases of prolonged acute heart failure, e.g. in the setting of acute myocardial infarction, nitroglycerin or isosorbide dinitrate can be given by the intravenous route for up to 24 h. Patients with acute myocardial infarction usually benefit from nitrate therapy if filling pressures are high and/or left ventricular function is compromised. Nitrate therapy can be considered safe if arterial blood pressure is maintained above 95 mm Hg. With these precautions nitrates can reduce infarct size and the incidence of complications as well as improve long-term prognosis. In the chronic treatment concern has risen with regard to possible nitrate tolerance. Thus, therapy schedules allowing for nitrate-poor phases are generally recommended. Therapy schedules with constant-rate delivery of drugs achieved with patches or intravenous administration of nitrates should be used with caution.

Administration, Cutaneous↗
PubMed1991

[Neither propranolol nor the vasodilating beta-blocker carvedilol have a direct effect on coronary resistance vessels].

Seventeen patients with coronary heart disease were included in a double-blind randomized study. They received either 5 mg of carvedilol or 6 mg of propranolol intravenously. Heart rate, aortic pressure, mean coronary sinus pressure and coronary flow (thermodilution) were measured, and coronary resistance and rate-pressure product were calculated before and 15 min after the infusion, which lasted 10 min. Carvedilol lowered significantly (p less than 0.05) heart rate (mean 76 to 69/min), aortic pressure (mean 153/80 to 135/72 mm Hg), rate-pressure product (mean 117 to 93 mm Hg/min) and coronary flow (mean 114 to 94 ml/min). Coronary resistance and coronary flow related to rate-pressure product showed no significant change after carvedilol. Propranolol lowered heart rate (mean 76 to 64/min; p less than 0.05) and rate-pressure product (mean 109 to 96 mm Hg/min; ns). Aortic pressure, coronary flow, coronary resistance, and coronary flow related to rate-pressure product showed no significant change after propranolol. Thus, carvedilol lowered rate-pressure product more markedly than propranolol on account of its acute blood-pressure lowering effect. Neither drug seems to have a direct influence on coronary resistance vessels.

Adrenergic beta-Antagonists↗
PubMed1991

[Effect of bypass operation and balloon angioplasty on heart function at rest].

Improvement of exercise left-ventricular ejection fraction after successful aortocoronary bypass operation and transluminal coronary angioplasty has been demonstrated. The purpose of this study was to investigate in which patients improvement of left-ventricular function at rest can be observed. Radionuclide ventriculography and exercise stress test was carried out in 34 patients before and after successful aortocoronary bypass operation (Group 1), and in 69 patients before and after successful transluminal coronary angioplasty (Group 2). After bypass surgery, mean ejection fraction at rest increased from 42 +/- 11 to 49 +/- 13% (p less than 0.001). Marked improvement (greater than or equal to 5%) was observed in 19 patients (56%) in whom severe myocardial ischemia could be documented during exercise ECG (Group 1.1: Increase of ejection fraction from 40 +/- 14 to 54 +/- 12%, p less than 0.001; ischemia score during exercise test 8.8 +/- 10). In the remaining 15 patients no significant improvement occurred (Group 1.2: 43 +/- 16 vs. 43 +/- 16%, p = n.s.; ischemia score during exercise test 3.2 +/- 2.4, p = 0.02 vs. Group 1.1). After angioplasty, resting left-ventricular ejection fraction increased, on average, from 50 +/- 11 to 52 +/- 12% (p less than 0.001). Comparable to the results observed in patients after surgery, improvement was most pronounced in patients with severe exercise-induced ST-depression (Group 2.1: Increase of ejection fraction from 49 +/- 10 to 58 +/- 10%, p less than 0.001; ischemia score during exercise 2.5 +/- 2.3).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

[Modification of coronary arteriosclerosis in man by calcium antagonists?].

Calcium channel blockers may retard development and progression of coronary arteriosclerosis in man because of protective effects on membranes, (especially the endothelium), relaxation of vessel walls, inhibition of various platelet functions, impairment of proliferation and migration of smooth muscle cells in the vessel wall, and an improvement of vascular cholesterol metabolism. In animal trials development of atheromas in large arteries induced by cholesterol-rich food and other stimuli of atherogenesis could be successfully retarded by a broad variety of calcium channel blockers. Some clinical observations in patients with coronary artery disease pointed at positive effects of calcium antagonists in coronary arteriosclerosis. To date, the results of three prospective placebo-controlled trials with calcium antagonists in coronary arteriosclerosis are available. In all trials progression of atherosclerosis was assessed by serial angiograms: 1) INTACT (nifedipine: 20 mg four times daily; observation period: 3 years, two coronary angiograms); 2) Study of the Montreal Heart Institute (nicardipine: 30 mg three times daily; observation period: 2 years, two coronary angiograms); 3) FIPS (Frankfurt Isoptin Progression Study) (verapamil: 120 mg three times daily; observation period: 3 years, three coronary angiograms). Target variables in these studies were progression or regression of preexisting lesions, development of new lesions and the incidence of vessel occlusions. The INTACT and the Nicardipine studies preferably included patients in early stages of coronary artery disease. The patients of FIPS who were entered into the study immediately after coronary bypass surgery suffered from severe, advanced coronary artery disease. In the latter study progression of coronary artery disease was assessed separately in different vascular regions (bypassed and non-bypassed segments) and in the bypass grafts.(ABSTRACT TRUNCATED AT 250 WORDS)

Calcium Channel Blockers↗
PubMed1991

[Long-term results after coronary dilatation].

The angiographic long-term success of percutaneous transluminal coronary angioplasty (PTCA) is 80% for all patients with attempted PTCA, and 90% for all patients with acutely successful intervention. This long-term success rate results from todays acute success rate of more than 90%, even though an increasing number of more and more complex stenoses have been dilated during recent years, from a rate of restenosis of 20-30% and a success-rate exceeding 90% in patients who undergo redilatation due to a restenosis. The long-term clinical course of successfully dilated patients is considerably influenced by the progression of the underlying coronary heart disease, with a development of new hemodynamically significant stenoses in some 5% of the patients per year. A large percentage of these patients undergo successful redilatation so that aortocoronary bypass surgery can again be avoided in the majority of these cases. In a minority--mostly patients with multivessel disease - aortocoronary bypass surgery can at least be postponed. Successful PTCA results in a long-term improvement of cardiac symptoms and vocational status, perhaps even in a reduction of the incidence of myocardial infarction of cardiac death. Results on latter, derived from retrospective studies, have to be confirmed by prospective trials.

Angioplasty, Balloon, Coronary↗
PubMed1991

[Trans-femoral ductus Botalli occlusion in patients over 60 years of age].

A persistent ductus arteriosus was occluded with an ivalon-plug introduced through the femoral artery in 14 patients over 60 years old (61 to 70 years). Two patients had previous surgery. The maximum left-to-right shunt was 53%, the maximum pulmonary artery pressure 54/24 mm Hg. In all patients ductus occlusion was successful and permanent. Bleeding at the puncture site in two patients could be stopped by manual compression. During a follow-up period of up to 5 years there were no instances of recanalization.

Aged↗
PubMed1991

[Acute effect of enoximone and captopril in patients with heart failure].

UNLABELLED: The acute effects of enoximone (E) and captopril (C) were compared in a single-blind, randomized, cross-over trial in 10 patients (P) (nine with dilative cardiomyopathy, one with coronary heart disease) with heart failure (NYHA Class III: 6P and Class IV:4P). Cardiac index (Cl, 1/min.nm(-2), mean pulmonary artery pressure (PAM, mmHg), and pulmonary capillary wedge pressure (PC, mmHg) were measured at baseline and 15, 30, and 60 min after 0.1 mg/kg C and 0.75 mg/kg E, respectively, followed by measurements at 15, 30, 60, 180, and 300 min after 0.2 mg/kg C and 1,5 mg/kg E, respectively. RESULTS: Cl was unchanged 60 min after 0.1 mg/kg C, increased 60 min after 0.2 mg/kg C by 7.7% from 2.1 +/- 0.5 to 2.4 +/- 0.5 (p = 0,001), and was unchanged after 5 h. Cl increased 60 min after 0.75 mg/kg E by 32.5% from 2.1 +/- 0.5 to 2.9 +/- 0.4 (p = 0.001), 60 min after 1,5 mg/kg E by 59% to 3.3 +/- 0.6 (p = 0,001), and after 5 h by 19% to 2.5 +/- 0.4 (p = 0.01). PAM was unchanged 60 min after 0.1 mg/kg C, decreased 60 min after 0.2 mg/kg C by 10% from 35.7 +/- 11 to 31.7 +/- 10, and was unchanged after 5 h. PAM decreased 60 min after 0.75 mg/kg E by 13% from 35 +/- 9 to 31 +/- 10 (p = 0.01), 60 min after 1.5 mg/kg E by 19% from 35 +/- 9 to 27 +/- 9 (p = 0.001), and was unchanged after 5 h. PC decreased 60 min after 0.1 mg/kg C by 23% from 24 +/- 8 to 19 +/- 9 (p = 0.05) and was unchanged 60 min und 5 h after 0.2 mg/kg C. PC decreased 60 min after 0.75 mg/kg E by 35% from 25 +/- 6 to 17 +/- 8 (p = 0,01) and 60 min after 1.5 mg/kg E by 47% to 14 +/- 8 (p = 0,001) and was unchanged after 5 h. CONCLUSION: The clinical trial showed that in P with chronic heart failure (NYHA III and IV) the acute increase of Cl and decrease of PC is higher after E than after C. The improvement of hemodynamics lasts longer after i.v. E than i.v.C.

Adult↗
PubMed1991

[Course of dilatative hypertrophic cardiomyopathy].

Five patients with hypertrophic cardiomyopathy developed left-ventricular dilatation and congestive heart failure during an observation period of 16-29 years. In one patient cardiac transplantation had to be performed. The initial predominant symptoms of outflow-tract obstruction and diastolic dysfunction developed into progressive left-ventricular systolic failure. The question of whether this is a well-defined subgroup of patients with hypertrophic cardiomyopathy, or whether hypertrophic cardiomyopathy turns into a phase of left-ventricular dilatation and failure after some years remains to be elucidated by long-term studies.

Adult↗
PubMed1991

Dose-related antiarrhythmic effects of nicainoprol in patients with chronic ventricular arrhythmias--a double-blind, placebo-controlled, cross-over multicentre trial. Nicainoprol Study Group.

One hundred and three patients with a history of ventricular arrhythmia were screened by baseline 24-h Holter monitoring for a minimal mean number of 30 premature ventricular beats (PVB) per hour. One hundred and one patients were subsequently enrolled in a double-blind, cross-over trial, including four 4-day periods with administration of placebo (PL) or nicainoprol (N.) in doses of 200, 400, 600 mg three times daily in randomized order. Antiarrhythmic efficacy could be evaluated in 61 patients who met all requirements of the protocol, including a complete sequence of valid Holter recordings (greater than 18 h each). Total PVBs were significantly reduced by the 400-mg dose (65%) and the 600-mg dose (71%) as compared to baseline. Two hundred mg N. and PL led to a non-significant reduction of PVBs by 41% and 24%, respectively. An individual response, assumed where there was simultaneous reduction of total PVBs greater than 75%, of ventricular pairs greater than 90% and elimination of ventricular runs, was found in 6 (10%), 10 (16%), 21 (34%), and 22 (36%) patients with PL, 200 mg N., 400 mg N. and 600 mg N., respectively. Four hundred and 600 mg N, significantly prolonged the PR interval (0.17 s and 0.18 s; median values) as compared with baseline (0.16 s), while the QRS duration was significantly increased only by the 600-mg dose (from 0.10 to 0.11 s). Heart rate, mean blood pressure, QT and JTc intervals were not significantly influenced by any dose of N.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Analysis of 100 emergency aortocoronary bypass operations after percutaneous transluminal coronary angioplasty: which patients are at risk for large infarctions?

Severe vascular complications are an inherent risk of percutaneous transluminal coronary angioplasty (PTCA). Data from 100 emergency aortocoronary bypass operations required after 2850 interventions (3.5%) were retrospectively analysed in order to identify factors that determine postoperative infarct size. Large infarctions were assumed if the patient died of cardiogenic shock (n = 12), if postoperative angiography demonstrated a decrease in left ventricular ejection fraction of more than 20% of if R-waves in the ECG decreased by more than 40% and a QRS-score increased by more than 5. According to these definitions, 29 patients experienced large infarctions, while 71 experienced no or only small infarctions. The following factors differentiated the two groups: age (58 vs 53 years, P = 0.008), pre-PTCA exercise work load (88 vs 118 Watts, P = 0.0001), exercise ischaemia score (2.7 vs 1.9, P = 0.045), degree of pre-PTCA stenosis (83 vs 86%, P = 0.03), coronary multivessel versus single vessel disease (60 vs 38%, P = 0.02), collaterals to the target vessel (10 vs 34%, P = 0.05), total vascular occlusion during PTCA (76 vs 56%, P = 0.035), and long duration of ischaemia after onset of the complication (253 vs 179 min, P = 0.012). Data from patients with large postoperative infarctions who survived ranged between those with no or small infarctions and those who died of cardiogenic shock. Higher age (P = 0.04), reduced exercise tolerance (P = 0.0004), absence of collaterals (P = 0.04), and duration of ischaemia until reperfusion (P = 0.001) were independent predictors of large postoperative myocardial infarctions.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1991

[Main branch stenosis following aortic valve replacement].

Three patients developed left main stem stenosis within some months after aortic valve replacement. In all of them diagnosis was confirmed by angiography and bypass surgery was performed successfully. Left main stem stenosis is a rare complication of aortic valve replacement and is due to cannulation and perfusion of the coronary arteries. The mechanism is probably injury of the vessel wall due to the perfusion-catheter, followed by intimal hyperplasia. A similar mechanism is assumed for restenosis after transluminal coronary angioplasty.

Adult↗
PubMed1991

[Improved left ventricular function and perfusion at rest following transluminal coronary angioplasty].

The purpose of this study was to evaluate left ventricular function and perfusion at rest before and after percutaneous transluminal coronary angioplasty. In consecutive 69 patients in whom coronary stenoses were dilated, the radionuclide left ventricular ejection fraction at rest increased significantly. In 26 of these patients, the ejection fraction increased by at least 4%. In these patients, exercise-induced ischemic ST depression had been more pronounced than in the others. 36 other patients underwent 201TI myocardial scintigraphy before and after angioplasty. Twelve patients in whom pre-PTCA images had revealed regions with irreversible 201TI uptake defects, showed normal 201TI distribution patterns on post-PTCA scintigrams. Post-exercise 201TI uptake (representing myocardial perfusion and metabolic activity) during pre-PTCA exercise stress tests was significantly lower in these cases. It is concluded that PTCA can improve left ventricular function and perfusion at rest. This improvement is most obvious in patients with pronounced exercise-induced myocardial ischemia as diagnosed by typical ST segment depression and reduced thallium uptake.

Adult↗
PubMed1991

[Comparison of ischemic pain threshold and reactive hyperemia in autonomic diabetic neuropathy and silent myocardial ischemia].

31 patients with coronary artery disease (11 patients with diabetes mellitus and autonomic neuropathy. 10 patients with diabetes without neuropathy, and 10 patients with asymptomatic myocardial ischemia) participated in a study designed to investigate whether there is a difference in forearm skeletal muscle ischemia and pain threshold. The degree of ischemia was determined by plethysmographically measured reactive hyperemia. There was no difference in maximum reactive hyperemia after passive forearm ischemia of 5-min duration in the three groups. After symptom-limited ischemic work, there was significantly more reactive hyperemia in patients with silent myocardial ischemia as compared to diabetic patients. Exercise time was longer in patients with silent myocardial ischemia (153 +/- 51 s) than in patients with diabetic neuropathy (139 +/- 45 s) and diabetics without neuropathy (120 +/- 45 s). Pain as a cause of termination of symptom-limited ischemic forearm exercise occurred less frequently in patients with diabetic neuropathy (2/11) and patients with silent myocardial ischemia (3/10) as compared to patients with diabetes without neuropathy. Patients with silent myocardial ischemia had a higher ischemic tolerance in the ischemic working forearm than did diabetic patients with and without neuropathy. In patients with neuropathy, however, ischemic pain occurred less frequently at the same ischemic work level compared to diabetics without neuropathy. Therefore, diabetic neuropathy appears to facilitate the occurrence of silent myocardial ischemia. The data presented here suggest that there is a qualitative difference in ischemic tolerance between patients with silent myocardial ischemia and patients with diabetic neuropathy.

Angina Pectoris↗
PubMed1990

[Echocardiographic functional parameters of the left ventricle as a prognostic indicator in coronary heart disease].

The value of two-dimensional cross-sectional echocardiography for the estimation of the left ventricular function had been investigated in 241 consecutive patients with suspected coronary artery disease (CAD). The day before left heart catheterization the left ventricular volumes (EDV, ESV) as well as the global left ventricular ejection fraction (EF) were calculated from the RAO-equivalent in the 2D-echo and in addition the classification of the EF was visually performed from different cross-sections. The coronary angiography showed in 208/241 patients hemodynamically effective stenoses (lumen restriction greater than 50%). For 192/208 patients there were diagnostically usable 2D-echograms as well as clinical data over an observation period of 3 years and 7 months. The 2D-echo correspond quite well to the levocardiography for the calculation of the EDV with r = 0.75, with r = 0.85 for the ESV, and with r = 0.80 for the EF. The mere visual evaluation of the EF out of the 2D-echo agreed well in 84% of the cases to the quantitative determination. During the observation period 18/192 patients died; 17/18 of these patients of cardial causes. Out of the patients with normal EF in the 2D-echo only 3.5% died, with slightly reduced EF 10% died. With highly reduced EF mortality was with 40% significantly increased (p less than 0.001). Thus in patients with CAD unfavourable long-time prognosis may be quickly recognized by their markedly reduced left ventricular function in the 2D-echocardiogram, which shows favourable correspondence to invasive data.

Adult↗
PubMed1990

Concentrations of isosorbide dinitrate, isosorbide-2-mononitrate and isosorbide-5-mononitrate in human vascular and muscle tissue under steady-state conditions.

The concentrations of isosorbide dinitrate (ISDN), isosorbide-5-mononitrate (IS-5-MN) and isosorbide-2-mononitrate (IS-2-MN) were determined in plasma (PL), saphenous vein wall (SV) and pectoral muscle (PM) from 8 patients undergoing coronary bypass surgery. The patients were pretreated for 2 days with ISDN 240 mg per day (standard release formulation) in 4 doses of 40 mg and one dose of 80 mg. The plasma and tissue samples were obtained during the operation, 10-12 h after the last dose. Isosorbide-2-mononitrate and isosorbide-5-mononitrate were present in plasma and tissues in the same concentration ranges with molar concentration ratios of 0.88 (IS-2-MN: PM/PL), 0.85 (IS-5-MN: PM/PL), 0.99 (IS-2-MN: SV/PL) and 1.06 (IS-5-MN: SV/PL). Mean ISDN concentrations in tissue were considerably higher than in plasma; the molar concentration ratios were 4.9 (SM/PL) and 7.21 (SV/PL). The accumulation of ISDN in vessel walls may contribute to its greater vascular action compared to the mononitrates, but it may also facilitate the development of tolerance during long-term treatment.

Aged↗
PubMed1990

Influence of carvedilol and propranolol on coronary blood flow.

A total of 17 patients with angiographically proven coronary artery disease and at least one stenosis blocking greater than or equal to 70% of the left anterior descending or circumflex artery were included in a double-blind, randomized study. They received either 5 mg carvedilol or 6 mg propranolol intravenously. Heart rate, aortic pressure, mean coronary sinus pressure and coronary flow (thermodilution) were measured and coronary resistance and the rate-pressure product were calculated before and 25 min after injection. Carvedilol significantly (P less than 0.05) lowered the heart rate (mean, 76 to 69 beats/min), aortic pressure (mean, 153/80-135/72 mm Hg), rate-pressure product (mean, 117-93 mm Hg/min), and coronary flow (mean, 114-94 ml/min). Coronary resistance (mean, 0.97-1.07 mm Hg x min/ml) and coronary flow related to the rate-pressure product (mean, 1.0-1.02 ml/mm Hg) showed no significant change after carvedilol treatment. Propranolol lowered the heart rate (mean, 76-64/min; P less than 0.05) and rate-pressure product (mean, 109-96 mm Hg/min; not significant). Aortic pressure (mean, 145/72-147/74 mm Hg), coronary flow (mean 109-101 ml/min), coronary resistance (mean, 1.1-1.2 mm Hg x min/ml), and coronary flow related to the rate-pressure product (mean, 1.12-1.19 ml/mm Hg) showed no significant change after propranolol administration. Following single application, carvedilol lowered the rate-pressure product more markedly than did propranolol on account of its acute blood-pressure-lowering effect. No differences in the hemodynamic effects of carvedilol and propranolol were found. Neither drug seems to influence the adaption of coronary flow to myocardial oxygen demand.

Adrenergic beta-Antagonists↗
PubMed1990

Is technetium-99 m-pyrophosphate scintigraphy valuable in the diagnosis of cardiac amyloidosis?

Amyloidosis is a systemic disease frequently involving the myocardium and leading to functional disturbances of the heart. Amyloidosis can mimic other cardiac diseases. A conclusive clinical diagnosis of cardiac involvement can only be made by a combination of different diagnostic methods. In 7 patients with myocardial amyloidosis we used a combined first-pass and static scintigraphy with technetium-99 m-pyrophosphate. There was only insignificant myocardial uptake of the tracer. The first-pass studies however revealed reduced systolic function in 4/7 patients and impaired diastolic function in 6/7 patients. Therefore, although cardiac amyloid could not be demonstrated in the static scintigraphy due to amyloid fibril amount and composition, myocardial functional abnormalities were seen in the first-pass study.

Amyloidosis↗