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Biomedical subjects

M Niederberger

Publications and source records attributed to M Niederberger.

At least 55 records · Page 3Linked to original sources
PubMed1982

[Exercise tolerance for indicating of aortocoronary bypass surgery (author's transl)].

In order to evaluate effects of aortocoronary bypass grafting on exercise tolerance, we analyzed the data of 109 patients who performed exercise tests before and one month or one year after surgery. Subgroups of patients were formed on the basis of preoperative exercise tolerance. Previously severely impaired patients benefited from surgery by an improvement of exercise capacity, whether preoperative left ventricular enddiastolic pressure at rest exceeded 16 mm Hg and left ventricular ejection fraction was below 50% or not. On the other hand, exercise capacity of patients who were comparable in respect to the numbers of coronary lesions and bypass grafts but whose exercise tolerance was less impaired preoperatively did not improve after surgery. Because in such patients, independent of coronary anatomy, surgery has been reported to be ineffective for prolongation of life, indication for aortocoronary bypass grafting in the presence of "good" exercise capacity must be questioned for symptomatic as well as for prognostic reasons.

Aged↗
PubMed1982

[Principles of ergometry. - Part II: criteria for assessment of the exercise test. Criteria for interpretation (author's transl)].

Because exercise testing is of value not only for "qualitative" but even more for "quantitative" diagnostic purposes, the exercise ECG is often of minor importance in relation to the other exercise responses. 1. Exercise capacity. Maximal aerobic power or aerobic capacity as a measure of physical and cardiovascular performance can not be calculated from measurements during submaximal exercise (with the exception of young healthy persons), but correlates well with the maximal workload attained in a (symptom-limited) maximal test when sex, age and the state of health as well as of physical training are taken into account. Therefore, exercise capacity as measured in such a test is of diagnostic and prognostic significance. 2. Heart rate. Changes in heart rate at a given submaximal workload correlate well with qualitative changes of exercise capacity in the individual. The peak heart rate that is attained in a (symptom-limited) maximal exercise test (HR max) varies greatly interindividually. It declines with age and because heart rate is one of the major determinants of myocardial oxygen uptake it is a measure of "coronary reserve" in the patient with coronary heart disease. Limits for professional activities or other physical exercise may be expressed as a certain percentage of HR max (% HR max). 3. Blood pressure. An inadequate rise of systolic blood pressure or a fall despite increasing workloads indicate inadequacy of cardiac output. In coronary heart disease, it is often a sign of acute left ventricular dysfunction due to reversible ischemia and is of therapeutic and prognostic consequence. 4. ECG. Electrocardiographic changes should always be related to other exercise responses. Sensitivity and specificity of the ST-segment changes depend on sex, age, resting ECG, type of exercise, lead system and medical treatment. In coronary heart disease, "Bayes' theorem" should be regarded. The predictive value of a test result should be calculated, based on the prevalence and the pretest likelihood of the disease. Other than ST-segment changes are or relatively minor significance or need further evaluation.

Blood Pressure↗
PubMed1981

Value of exercise testing for prediction of physical and psychosocial rehabilitation potential 3 months after acute myocardial infarction.

In 147 patients exercise tests were performed at the beginning and after 1 year of an ambulatory rehabilitation program. Measurements of both tests and the degree of functional improvement were correlated with patients' characteristics, the results of a psychological analysis using the Freiburger Personality Inventory and a patient's questionnaire for self-assessment. Among the major determinants for functional improvement were age, location of the infarct, rate of participation and greater initial functional impairment. High degree of psychosomatic impairment accompanied low levels of exercise capacity, the patients' self-assessment showed no correlation with exercise performance.

Adult↗
PubMed1979

[A study of a swimming training programme in the rehabilitation of patients following myocardial infarction (author's transl)].

A special swimming programme was initiated during the course of rehabilitation of patients after myocardial infarction with additional disturbances of the musculoskeletal system. Allowance was made for aspects of individual training requirements. Patients were divided in two groups according initial values of physical working capacity: One group contained patients with less than 80% of the normal work capacity, the other those with borderline normal values. The first group showed an average increase of 35% in the initial values during a one-year period of swimming training once a week. The other group with practically normal initial values showed only a slight or negligible increase. Serum lipid levels were unchanged in both groups. No serious side effects were encountered in more than 3000 patients hours. However, no prediction of the risks of this type of training as compared to other forms of physical exercise in patients recovering from myocardial infarction can be made from this study.

Adult↗
PubMed1979

[Rehabilitation potential after myocardial infarction].

For determination of the individual rehabilitation potential in patients after myocardial infarction, factors were extracted which are of importance for exercise capacity and its influence upon rehabilitation measures. Further results of exercise tests were correlated with psychological tests (Freiburg-personality-inventory) and the results of a patients' questionnaire for individual self-assessment, with concerning restitution by means of rehabilitation measures. 147 patients were admitted to a controlled rehabilitation program 10 weeks after myocardial infarction or later. Mean increase of exercise capacity after one year of rehabilitation was 21.6% of the initial test. Significantly greater increases of exercise capacity were achieved in patients with regular attendance particularly in younger patients in comparison with older patients. As evidenced by ergometric test data initially low maximal heart rate, low increase of heart rate, low exercise capacity and low double product were correlated with greater increase of exercise capacity. Patients with anterior-wall myocardial infarction tended to increased exercise capacity more. A relation between "psychosomatic disturbance" at onset of rehabilitation and a greater increase of exercise capacity could be determined as a trend. Connections between psychosocial factors and determinants of exercise capacity in influencing the rehabilitation potential are discussed.

Adult↗
PubMed1978

[Clinical efficacy of perhexiline maleate in stable angina pectoris (author's transl)].

The antianginal effect of perhexiline was evaluated in a placebo-controlled double-blind study of 20 patients with stable angina pectoris. Only patients with documented myocardial infarction of more than 6 months' standing and with ST-segment depression on exercise were admitted to the study. Objective parameters of bicycle stress tests at a submaximum level of 50 watts and a maximum exercise level were evaluated. Subjective data such as nitroglycerin consumption and incidence of anginal attacks per week were obtained from the patients' self-maintained records. No negative chronotropic effect of perhexiline was found at rest. At a submaximum exercise level with unchanged double-product, a significantly lower heart rate (p less than 0.05) and a significant reduction in ST-segment depression were observed in comparison with the placebo. At maximum exercise level an increase in exercise tolerance of 8.1% and in aerobic capacity of 8.3% resulted in a significant increase in the double-product (p less than 0.01), with a shift in the blood pressure/heart rate ratio. Discontinuation of exercise occurred at the same heart rate, but at a markedly higher level of exercise attainment. Heart rate on exercise proved to be the most valuable parameter in this study for the evaluation of the aerobic capacity of the individual patient. Nitroglycerin consumption and frequency of anginal attacks per week were reduced, but were not of statistical significance. Side-effects occurred in 6 patients, but these did not require termination or reduction of medication. The selective effect on heart rate during exercise opens a new field of application for perhexiline in comparison with beta-blocking agents.

Adult↗
PubMed1978

[Haemodynamic response to antihypertensive treatment with atenolol in patients with hypertension (author's transl].

The antihypertensive effect of atenolol, a cardioselective beta-blocker, was examined in 8 patients with essential hypertension. The most important haemodynamic changes observed were a significant reduction in heart rate (reduction in maximum heart rate at the end of symptom-limited exercise by 23% p less than 0.01) and a moderate fall in systolic blood pressure (reduction at submaximum level of exercise by 22%, p less than 0.01). The antihypertensive effect was attributable in half the patients to a drop in peripheral vascular resistance and in the other half evenly to a predominant reduction in cardiac output or to a reduction in both parameters. In view of the compensatory rise in stroke volume a significant reduction in cardiac output was not found. Symptom-limited exercise tolerance was increased in all patients. These results lead to the conclusion that the antihypertensive action of the cardioselective beta-blocker, atenolol is based on a lowering of the increased peripheral vascular resistance and a reduction in cardiac output; the latter mechanism is predominantly found in patients with hyperkinetic features.

Adolescent↗
PubMed1978

[The value of submaximal ergometer tests for the determination of physical fitness].

Maximal work endurance of heart and circulation measured by submaximal work load on an ergometer can be estimated with reasonable accuracy by means of the physical working capacity 170 (PWC 170) only in healthy individuals aged 30 years or below. Limitation of exercise by pulmonary factors does not appear to bias the results essentially. In healthy people aged 40 or over, the risk of miscalculating maximal working ability based on PWC 170 increases considerably despite maintenance of high statistical correlation to maximal work load. In patients with coronary heart disease, there is no statistical correlation between PWC 170 and maximal work load; therefore, symptom-limited ergometry is required in these patients. For the assessment of quality in follow-up tests, the watt-pulse at submaximal work load appears to be the most adequate parameter. It is recommended that submaximal tests be also carried out in a rectangular-triangular manner, for the purpose of comparison with symptom-limited tests and for evaluation of changes in the dynamics of pulse and blood pressure regulation.

Adolescent↗
PubMed1977

[Maximum exercise testing during hypobaria and normoxia (author's transl)].

The effects of high altitude (3000 m, low-pressure chamber) on maximum exercise and maximum oxygen uptake were studied in four normal subjects. In order to separate the effects of hypobaria and of hypoxia, exercise testing was performed under normoxic, hypobaric conditions and compared with the results under normoxic, normobaric conditions. There was no significant difference in performance, nor in the effects of exercise on the measured cardiovascular parameters.

Adult↗
PubMed1977

[A comparative study of patients following myocardial infarction assessed by the freiburger personality inventory (author's transl)].

The relationship between coronary disease and psychological factors is generally accepted. Numerous psychiatric studies have shown that there are typical basic personality features which predispose to heart disease. A personality inventory - the Freiburger Persönlichkeitsinventar (FPI) - was applied to a group of patients attending the Cardiology Clinic of the University of Vienna for a follow-up control examination after a heart attack. The results were compared with those of a control group (taken from the control population of the FPI). With respect to one personality dimension of the FPI, the so-called,,Nervositätsskala" (nervousness scale), significant differences were observed between the two groups. This scale includes so-called ,,psychosomatic" distrubances and disorders. According to these results,patients with coronary disease were more likely to experience such ,,psychosomatic distrubances" (as far as could be measured by this dimension of the FPI) than members of the control group. A comparison of patients graded according to the physical stamina level showed that those with a greatly-reduced work capacity as a consequence of myocardial infarction had a significantly higher score than patients whose work capacity was impaired to a lesser extent. This study introduces a new aspect in the relationship between coronary disease and personality dimensions.

Austria↗
PubMed1977

A global display of the heart vector (spherocardiogram). Applicability of vector-and polarcardiographic infarct criteria.

The spatial loop of the heart vector can be projected on the Aitoff projection of the globe. The complete information that is contained in the orthogonal leads in displayed on a single graph when the vector magnitudes are indicated by the diameter of circles drawn around the vector projection in short time intervals (spherocardiogram). Diagnostic vector- and polarcardiographic criteria were applied to the spherocardiograms of 68 survivors of inferior myocardial infarction and 30 healthy men. Sensitivity increased from 65% (standard 12-lead ECG) to 87% (VCG criteria) (P less than 0.001) to 94% (VCG and PCG criteria combined), with no false-positive diagnoses. The spherocardiogram can be obtained by use of an "intelligent plotter." In contrast to the vectorcardiogram (VCG) and the polarcardiogram (PCG), it permits the direct visual study of the spatial direction and the spatial magnitude of the heart vector and of their sequential changes during the heart cycle.

Adult↗
PubMed1977

[Exercise therapy in coronary disease. An overall practical model for long-term rehabilitation].

This report concerns a model for multifactorial rehabilitation after myocardial infarction (MI), with minimum requirements of personnel, space and equipment. Groups of patients are treated twice weekly, in a gymnasium of a school. Survivors of MI increased their exercise capacity from 77% to 93% of sex- and age adjusted normal within 3 to 6 months of therapy (mean values, P less than 0.001). A similar improvement was observed regardless of whether exercise training was started soon (less than 6 months) or late (greater than 12 months) after MI, indicating that exercise capacity increased with training, but was not dependent on time alone. The majority of 87 patients who answered a questionnaire, indicated that in their opinion a strictly organized program requiring a regular attendance was important for the rehabilitation and 89% thought that their participation had resulted in physical and psychological benefits. Two groups of survivors of MI were compared by use of the "Freiburger personality inventory" (FPI). Patients who were more physically impaired, showed a greater degree of a sort of psychosomatic disorder as indicated by the ratings of scale 1 of the FPI. The described program has proved successful, as it resulted in an increase of exercise capacity. This may have a favorable influence on a sort of psychosomatic disorder encountered in patients with healed MI. Beneficial physical and psychological effects were reported by the participants.

Evaluation Studies as Topic↗
PubMed1977

[Rehabilitation after myocardial infarct. Assessment of result and possibilities for the prognosis of success].

Data of 253 patients with acute myocardial infarction (data collected from primary hospital, from the rehabilitation center-- R.C.-- and from a questionnaire dealing with the individual problems of the rehabilitation period; response rate 77%) were correlated in order to derive criteria for the estimation of the success of rehabilitation. It could be shown that the increase in physical performance and the clinical judgement in the R.C. are well paralleled by the further course of the rehabilitation period (return to work etc.). On the other hand it seemed difficult to predict rehabilitative results from the hospital data alone. It was only shown that the severity of the disease had a major influence upon rate of and interval, before return to work.

Acute Disease↗
PubMed1976

[A new antihypertensive imidazoline derivative (St 600, Fluoronidine): I. Haemodynamic investigations at rest and during exercise (author's transl)].

Treatment of 12 hypertensive patients with a new imidazoline derivative, St 600 (1.5 to 12.0 mg daily over at least 7 days) resulted in a significant lowering of the blood pressure, mostly to normal values, parallelled by a reduced heart heart rate. A significant decrease in arterial resistance was observed at rest and during exercise in 6 of the patients, whereas a slight increase or no change was recorded in the remaining 6 patients. The changes in resistance in the pulmonary circulation were analogous to those in the systematic circulation for the 2 groups, respectively. The latter half of the patients displayed a decrease in stroke volume, cardiac index and oxygen consumption. No negative inotropic effect was observed.

Adult↗