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Biomedical subjects

M Kaltenbach

Publications and source records attributed to M Kaltenbach.

At least 145 records · Page 8Linked to original sources
PubMed1989

[The anti-ischemic effect of isosorbide dinitrate alone and in combination with gallopamil and propranolol].

In 18 patients (17 male and 1 female, 40 to 63 years old) with coronary heart disease, a randomized double-blind study was carried out to investigate in comparison to placebo, the antiischemic effects of 5, 10 and 20 mg isosorbide dinitrate (ISDN) alone and in combination with gallopamil (G: 25 and 50 mg) or 80 mg propranolol (P: 80 mg) on the ischemic ST-segment-depression in standardized exercise ECGs. ST-depression following administration of ISDN alone was reduced significantly and dose-dependently: following 5 mg from 1.32 +/- 1.14 to 1.0 +/- 0.85 mm (-25.2%; p less than 0.05), 10 mg from 1.17 +/- 0.85 to 0.91 +/- 0.69 mm (-21.7% n.s.) and 20 mg from 1.19 +/- 0.5 to 0.52 +/- 0.57 mm (-53.6%; p less than 0.001). In combination with gallopamil (G: 25 and 50 mg) or propranolol (P) reduction of ST-depression was more pronounced: by 5 mg ISDN with 25 mg G from 1.32 +/- 1.14 to 0.7 +/- 0.71 mm (-46.4%; p less than 0.05), with 50 mg G from 1.32 +/- 1.14 to 0.8 +/- 0.83 mm (-38.8%; p less than 0.01), with 80 mg P from 1.32 +/- 1.14 to 0.28 +/- 0.35 mm (-79.5% p less than 0.01), by 10 mg ISDN combined with 25 mg G from 1.17 +/- 0.85 to 0.69 +/- 0.6 mm (-40.7%; p less than 0.05), with 50 mg G from 1.17 +/- 0.85 to 0.66 +/- 0.62 mm (-43.5%; p less than 0.05), with 80 mg P from 1.17 +/- 0.85 to 0.64 +/- 0.78 mm (-46.4%; p less than 0.01), and by 20 mg ISDN with 25 mg G from 1.19 +/- 0.5 to 0.42 +/- 0.43 mm (-62.6%; p less than 0.001), with 50 mg G from 1.19 +/- 0.5 to 0.39 +/- 0.45 mm (-65.2%; p less than 0.001) and with 80 mg P from 1.19 +/- 0.5 to 0.05 +/- 0.16 mm (-95.8%; p less than 0.001).

Adult↗
PubMed1989

[Can the progression of coronary heart disease be modified by calcium antagonists?].

Experimental atherosclerosis in animals preferentially induced by cholesterol-rich food can be successfully suppressed by calcium channel blocking agents such as verapamil, nifedipin, nicardipin, and diltiazem. The question whether calcium channel blockers can favorably influence atherosclerosis in humans remains a matter of debate. A few observational investigations in the past showed positive results of calcium channel blocker therapy in patients with angiographically proven coronary artery disease (CAD). At present three prospective randomized clinical trials are under way (INTACT-study, FIPS-study, study from the Montreal Heart Institute). Target variable is the severity of coronary atherosclerosis assessed by angiography both at entry into the study and after 2-3 years of treatment. 445 patients after coronary bypass surgery were included in the FIPS study (Frankfurt Isoptin Progression Study) and were randomly allocated to either verapamil 120 mg t.i.d. or placebo treatment. Extent of coronary atherosclerosis, assessed by repeat angiography 1 and 3 years after randomization, is expressed by scores with separate evaluation of non-bypassed vessels, segments distal to the peripheral bypass insertion, bypassed segments and grafts. The 1-year follow-up was completed for 162 patients (Group A = 80 patients; group B = 82 patients). There was a homogeneous distribution in both groups for all clinical variables, graft patency rates (76%/75%), and the incidence of clinical events (myocardial infarct, need for cardiac surgery or PTCA, cardiac death: 5%). The overall progression of atherosclerosis in the first year after bypass surgery was small. Thus, the question of whether calcium channel blockers can retard progression of coronary atherosclerosis cannot be answered before completion of the aforementioned trials.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

[The spectrum of side effects of gallopamil in comparison with other calcium antagonists].

Severe adverse effects associated with the use of calcium channel blockers do not occur very often. Sometimes nifedipin produces hypotension, tachycardia, and headache, whereas verapamil, gallopamil, and dilitiazem show more negative chronotropic effects such as bradycardia or sinuatrial and atrioventricular nodal conduction disturbances. Gastrointestinal side effects are constipation after verapamil and stomach problems after gallopamil.

Arrhythmias, Cardiac↗
PubMed1989

[Dose-response relation of gallopamil in comparison with nifedipine, diltiazem and tiapamil in patients with coronary heart disease].

For effective treatment of coronary heart disease with calcium antagonists, knowledge of both the dose-response relationship of a remedy and equipotent dosage for comparison of different drugs is necessary. We performed controlled studies to evaluate the influence of single oral doses of calcium antagonists on ischemic ST-depression (calculated as the mean of all exercise and recovery minutes = mean ST-depression) in exercise ECGs of patients with proven CHD and stable angina pectoris. Ergometries were carried out under constant conditions, particularly with individually constant work load and duration. All calcium antagonists reduced ischemic ST-depression during ergometry dose-dependent when compared to placebo. Diltiazem: 90 mg: 6% (n.s.), 120 mg: 19% (n.s.) und 180 mg: 26% (p less than 0.025); gallopamil: 25 mg: 19% (n.s.), 50 mg: 34% (p less than 0.01) und 100 mg: 57% (p less than 0.0025); nifedipine-Cps.: 5 mg: 17%, 10 mg: 33% und 20 mg: 42%; nifedipine-Tbl.: 20 mg: 8% (p less than 0.05), 40 mg: 23% (p less than 0.057 und 60 mg: 31% (p less than 0.05); tiapamil: 300 mg: 30% (p less than 0.05) und 600 mg: 60% (p less than 0.01). As the result of our findings, comparable antiischemic effects can be expected with 120 mg diltiazem, 50 mg gallopamil, 20 mg nifedipin as capsule or 60 mg nifedipin as tablet and 600 mg tiapamil.

Adult↗
PubMed1988

[Coronary revascularization with the internal thoracic artery. Angiographic controls in 86 patients].

Among a cohort of 454 consecutive patients who had undergone coronary revascularization with the internal mammary artery (from November 1984 to October 1987), postoperative angiography was performed in 86 (18.9%) (77 males and 9 females, aged 33-74 years; median age 56 years). The interval between operation and angiography ranged from one week to 26 months (median 47 weeks). The mean patency rate for the internal mammary artery grafts was 83.7% (72 of 86 grafts), the patency rate having increased from 71% in 1984/85 to 92% in 1987. In the same cohort the patency rate of venous grafts was 64.5% (78 of 121 aortocoronary venous grafts). Many asymptomatic patients refused follow-up angiography; the patency rate is therefore likely to have been higher for the entire cohort. The high patency rate and good long-term results for internal mammary artery grafts support the view that this type of graft is preferable to others for coronary revascularization.

Adult↗
PubMed1988

[Opening of chronic coronary artery occlusions with a recanalization catheter].

Percutaneous transluminal angioplasty for recanalization was attempted for 44 chronic coronary arterial occlusions in 41 patients (two occluded vessels in three patients). In 11 instances the occlusion could be passed with a guide-wire. In the other 33 this was not possible. In 25 of them a 3, 4 or 5 F recanalization catheter, its end tapered to 2 or 3 F, was used. In this way re-opening was possible in 17 cases (68%). The catheter made it possible to splint or stiffen the guidewire to keep it straight, superselectively inject contrast medium, measure the pressure distal to the occlusion, and gradually bougie-like enlarge the resulting subtotal stenosis. A total of 28 of 44 coronary occlusions were re-opened (64%). All these patients were functionally improved. At subsequent angiography (a mean of 3.6 months later) 22 of 25 vessels had remained open, but ten had narrowed and three had become re-occluded.

Adult↗
PubMed1988

[Transfemoral closure of the duct of Botallo. Acute and long-term results].

A persistent ductus arteriosus was occluded with an Ivalon plug via a catheter delivery system, introduced through the femoral artery, in 38 patients, aged 11-72 years (mean 39). The mean diameter of the ductus was 4.5 +/- 1.2 (2-9) mm, mean pulmonary artery pressure 30/12 (15/5-70/27) mm Hg. In two patients the plug became dislocated after two and seven weeks, respectively, without serious consequences. In all others the occlusion was successful and permanent. There were only a few complications and none was serious. During a follow-up period of up to four years there were no instances of recanalization or further plug dislocation.

Adolescent↗
PubMed1988

[Long-term results of transluminal valvuloplasty in calcified aortic valve stenosis].

Transluminal valvuloplasty (TVP) was attempted in 11 patients, aged 38-82 years, with calcified aortic valve stenosis (AS). The transvalvular systolic pressure gradient was reduced from a mean of 91 +/- 28 to 44 +/-30 mm Hg. Two patients had needed an emergency with decompensated AS in cardiogenic shock, died during the operation, another died of the consequences of an endocarditis. One patient had an inadequate TVP: a renewed TVP was subsequently performed at another hospital, followed by an operation for severe aortic regurgitation produced by the second TVP. In four patients left-heart catheterization 3-12 months post-dilation demonstrated considerable restenosis. One patient was significantly improved clinically (but no angiography had as yet been performed) four months after the TVP. Doppler echocardiography in this patient, too, demonstrated renewed increase in transvalvular pressure gradient. The results demonstrate that, because of the high rate of recurrence, TVP is at present only rarely indicated for calcified AS.

Adult↗
PubMed1988

[Reopening of long-segment occluded aortocoronary venous bypasses. Short- and long-term results].

Recanalization of an occluded aortocoronary vein bypass was achieved in six out of seven patients (aged 57 +/- 4 years) 3-40 months after operation and 2-16 weeks after occlusion. The recanalization was done with a specially modified catheter introduced into the stump of the occluded vessel: urokinase was infused followed by balloon dilatation. Subsequent treatment included administration of nitrates, calcium antagonists, aspirin and heparin for at least three months. Repeat coronary angiography after 3-6 months (mean 4.3 +/- 1.0 months) demonstrated vessel patency in four of the six bypasses. One of them, severely stenosed, was again successfully dilated. It is concluded that bypass recanalization can be attempted if the occlusion occurred only a few weeks previously, angiography demonstrates a bypass stump and the state of the peripheral coronary artery makes good outflow likely.

Angioplasty, Balloon↗
PubMed1988

[Anti-ischemia effect of continuous 24-hour infusion of glyceryl trinitrate in patients with stable angina pectoris].

In a placebo-controlled, double-blind trial with intraindividual changes in a randomized sequence, 12 patients received either glyceryl trinitrate (Perlinganit), 3 mg/h, or a placebo (physiological saline) via a perfusion system continuously for 24 hours. All had been shown to have angiographically demonstrated coronary heart disease, stable angina and exercise-inducible ischaemia reaction in the electrocardiogram (ST-segment depression). The ischaemia reaction in the exercise ECG (sum of ST-segment depressions) 90 min after onset of the infusion was improved by a mean of 45% during glyceryl trinitrate compared with the placebo response (P less than 0.001). At the end of the 24-hour period of infusion, however, no significant anti-ischaemic effect was any longer demonstrable (diminution of the ischaemia reaction by 15%). The glyceryl trinitrate-induced effect, after 90 min infusion, on arterial systolic pressure (-14%; P less than 0.01) and heart rate (+17%; P less than 0.001) during standing, was also no longer demonstrable after the 24-hour infusion. Thus the haemodynamic and antiischaemic effects of glyceryl trinitrate in the described dosage were largely absent after continuous 24-hour intravenous infusion. The causes of this rapid loss of effect are most likely to be sought in counter regulatory events, e.g. activation of neurohumoral mechanisms.

Adult↗
PubMed1988

[Angiotensin-converting enzyme inhibitors in angina pectoris].

In ten patients with angiographically demonstrated coronary heart disease exercise electrocardiograms were recorded before as well as two and four hours after administration of 5 or 10 mg Quinapril, an angiotensin converting enzyme inhibitor (ACEI). This reduced the sum of ST-segment depressions from 16.3 to 11.6 mV (P less than 0.001). While the heart rate remained unchanged, blood pressure fell from 147/91 to 119/79 mm Hg and the angina-free exercise time was clearly prolonged. Altogether there was a reduction of the ischaemia reaction by 35%. This perhaps speaks for an anti-anginal effect of ACEI, which could be of importance in the management of both hypertension and heart failure. In addition, the ACE inhibitors might be used as anti-angina drugs.

Adult↗
PubMed1988

[Digitalis therapy in chronic heart failure. Digitoxin in patients in sinus rhythm pretreated with diuretics].

Eight patients in sinus rhythm with chronic heart failure were studied. After individually adjusted six-week treatment with diuretics (hydrochlorothiazide-triamtere and/or frusemide) all patients were clearly improved symptomatically. Subsequently they additionally received digitoxin for six weeks, 0.07-0.1 mg daily. Before and at the end of the digitoxin period cardiac volume was determined radiologically, echocardiography was performed and haemodynamic parameters determined at rest and on exercise via indwelling catheters. During digitoxin administration there was a slight increase in cardiac output from 4.63 +/- 0.82 to 5.05 +/- 0.98 l/min (P less than 0.1) at rest and from 7.22 +/- 1.94 to 7.79 +/- 2.59 l/min at rest. The mean values of all other haemodynamic parameters remained unchanged. These results suggest that in patients with chronic heart failure and sinus rhythm any clinical or haemodynamic improvement achieved will not be significantly bettered by digitoxin.

Adult↗
PubMed1988

Coronary hemodynamics during left and right coronary arteriography with an ionic and nonionic contrast medium.

The direct effects of ionic amidotrizoate (iodine content 370 mg/ml, osmolality 2.1 osmol/kg) and nonionic iopamidol (iodine content 370/ml, osmolality 0.8 osmol/kg) on the coronary circulation were intraindividually compared in 10 patients suffering from coronary heart disease. In accordance with a double-blind, crossover protocol, both contrast media were injected into the left and right coronary arteries (8 ml and 5 ml per injection, respectively). Injections of both dyes into the left coronary artery caused a similar decrease in heart rate. The prolongation in the QT interval was significantly greater after amidotrizoate (p less than 0.05). Systolic (p less than 0.01) and diastolic (p less than 0.05) aortic pressures decreased to a greater extent following amidotrizoate injection. Each contrast agent produced a similar increase in coronary sinus flow, but iopamidol resulted in a smaller decrease in coronary vascular resistance (p less than 0.05). After right coronary artery injections, both contrast media caused bradycardia and prolongation of the QT interval, a decrease in systolic and diastolic aortic pressure, a rise in coronary sinus flow, and a lowering of coronary vascular resistance. Though most changes were more pronounced following amidotrizoate injection, the differences in the ionic and the nonionic agent were not statistically significant. Thus, after selective coronary arteriography, both contrast media caused a transient drop in coronary vascular resistance and a rise in coronary sinus flow despite a decrease in aortic pressure. The effects of amidotrizoate were more marked, which might be attributed to the higher osmolality of this ionic contrast medium. Coronary hemodynamics, however, usually returned to baseline values within 1 minute.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography↗
PubMed1988

Ultrastructural localization of calcium in the myocardium of cardiomyopathic syrian hamsters.

Cardiomyopathy of the Syrian hamster is characterized by myocardial calcium overload and focal myocardial necrosis. The cause of the myocardial calcium overload is not yet fully understood. In this study, the ultrastructural localization of calcium was determined in normal hamster hearts and in non-necrotic and necrotic myocardium of cardiomyopathic hamsters (strain BIO 82.62). In many cells from the non-necrotic myocardium of the cardiomyopathic hamsters the calcium deposits, visible as 20 nm particles, were confined to the inner leaflet of the plasma membrane, the T-tubules and the intercalated disks. This corresponds to the calcium distribution found in normal hamsters and other mammalian species. A number of morphologically normal cells, however, displayed an increased amount of calcium precipitate in the mitochondria as well as at the sarcolemma indicating that, in the cardiomyopathic hamster, focal calcium overload is detectable cytochemically in cells which otherwise do not show gross abnormalities. In cells showing morphological signs of myolytic degeneration a marked redistribution of calcium precipitate took place. Sarcolemma became devoid of calcium deposits whereas an enormous amount of clustered precipitate occurred in largely swollen mitochondria. These data are in support of a relationship between impaired ion homeostasis and degeneration events in cardiomyopathy. Furthermore, there appears to be a clear parallelism in calcium redistribution between hypoxic and cardiomyopathic myocardium.

Animals↗