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Biomedical subjects

O Bertel

Publications and source records attributed to O Bertel.

At least 91 records · Page 5Linked to original sources
PubMed1989

[Current pharmacotherapy of heart insufficiency in old age].

Signs of cardiovascular diseases have been found in more than 50% of elderly people over 65 years in industrialized countries. Congestive heart failure is an especially disabling consequence in up to 49% of the age-class 75 to 80 years. Treatment of these patients follows the same guidelines as in younger patients with congestive heart failure; however, treatment results are poor in many instances, and undesirable side effects are frequent. For an adequate management of congestive heart failure in the elderly, one should consider specific age-related changes of the heart muscle cell, of the myocardial structure, of the vessel wall as well as functional changes of cardiovascular regulation, e.g. blunted reflexes and disturbed feed-back loops of hormonal regulation. Moreover, pharmacokinetic and pharmacodynamic properties of medicaments differ in elderly people, which should be considered for an age-adapted specific management of congestive heart failure in this patient-group.

Aged↗
PubMed1988

[Nitrate tolerance].

Nitrate tolerance is defined as an attenuation or even loss of hemodynamic and anti-ischemic effects during continuous nitrate medication. The blunted response may be due to the development of pseudotolerance and true pharmacologic tolerance. Pseudotolerance is the result of volume and salt retention, as well as the stimulation of counter-regulatory mechanisms which may alter the baseline hemodynamics of a patient during nitrate therapy. Far less important are changes in nitrate pharmacokinetics. True pharmacological tolerance may also be of practical importance. Diminished uptake of nitrates into the vascular smooth muscle cell, a decrease in intracellular SH groups, inhibition of the guanylate-cyclase, and stimulation of a specific phosphodiesterase may result in a decrease of cyclic GMP formation and hence to a decrease in nitrate induced vasodilatation. Tolerance development may be prevented by intermittent nitrate administration providing intervals with low plasma and tissue nitrate levels. In consequence, nitrates should be used predominantly for treatment of ischemic episodes, but 24-hour anti-ischemic action for the prevention of ischemia can be better achieved by treatment with a beta-blocker and/or a calcium antagonist. Nitrates should be added in times of maximum susceptibility to ischemia, while allowing nitrate levels to fall at other times.

Coronary Disease↗
PubMed1988

[Fibrinolysis in acute myocardial infarct. Treatment rate, assessment and follow-up treatment in the Zürich hospitals].

We report the results of i.v. fibrinolysis in patients with acute myocardial infarction treated in four major hospitals in Zürich. Between 1986 and 1988 only 96 (9%) of 1069 patients admitted to intensive care units with acute myocardial infarction received thrombolytic therapy (less than 3 hours after onset of symptoms), 7% (50/703) during the first treatment period (streptokinase for 14 months), 13% (46/306) during the second treatment period (rt-PA for 8 months). The hospital mortality was 4% and severe complications of fibrinolytic therapy occurred in 4%. Coronary angiography was performed in 60% of patients in 1986/87 and in 87% in 1987/88. Despite this significant increase in invasive diagnostic procedures the percentage of patients after thrombolysis qualifying for invasive therapy remained unchanged at 53%. The indications for PTCA or bypass surgery were postinfarct angina in 41%, silent ischemia in 5%, left main coronary artery stenosis or multivessel disease with reduced left ventricular ejection fraction in 16%, and residual high grade stenosis with preserved contractility of the infarct-related myocardium in 38%. The mean in-hospital stay was 16 days, with significant variation from 13 to 22 days between the different hospitals (p less than 0.05). In the follow-up of 65 men aged below 65 years, 75% of the patients undergoing invasive therapy and 65% of those treated medically had returned to work 6 months after myocardial infarction. Due to the limited possibility of detecting viable myocardium by non-invasive methods, and the high rate of invasive therapy necessary in our patients, further management after thrombolysis should generally include large scale coronary angiography.(ABSTRACT TRUNCATED AT 250 WORDS)

Anticoagulants↗
PubMed1988

[Mortality in 709 patients with acute myocardial infarct treated in the intensive care unit].

To control the quality of our care and to define the potential for lifesaving early intervention in patients with acute myocardial infarction, we analyzed the course of 709 patients (66.4 +/- 10.8 yrs) admitted to the coronary care unit for acute myocardial infarction over a period of 36 months. 77 patients (70.2 +/- 9.3 yrs) died in the coronary care unit, and thus early mortality was 10.9%. Only 8% died from disturbances of cardiac rhythm and 19% from rupture of a ventricle. 73% died in cardiogenic shock, of whom 21 were below 70 years old and represent a potential group for early intervention. In 13 patients of this subgroup possibilities of better management in the pre-hospital phase were found retrospectively. In 5/77 patients the optimal treatment was not achieved during clinical course. Cardiogenic shock is the major cause of death in the early phase of acute myocardial infarction. A further substantial reduction of mortality will be achieved only by reaching more risk patients in the pre-infarction phase and by shortening the pre-hospital phase.

Acute Disease↗
PubMed1988

Additional molsidomine in refractory unstable angina pectoris.

In a prospective single-blind study we examined the effects of additional molsidomine in 20 patients (63 +/- 10 years; 15 males, 5 females) with unstable resting angina (greater than or equal to 3 attacks/24 hours) refractory to triple therapy (nitrates, calcium antagonists, and beta blockers) combined with heparin or aspirin. All but one patient had coronary artery disease documented by coronarography (n = 17) or by recent myocardial infarction (n = 3). Two patients had angiographically documented severe coronary spasms. Patients entered the study if coronary bypass surgery or PTCA could not be performed within 3 days after angiography (n = 9) or was not feasible due to anatomical or technical reasons (n = 6), concomitant malignant disease (n = 2), or age greater than 75 years (n = 3). All patients received molsidomine orally 12 to 24 mg/day. In 15 of the 20 patients molsidomine was given i.v. initially, starting with 20 mg i.v., followed by infusion of 1 to 4 mg/hour. Heart rate and blood pressure did not change significantly, and eight patients had a slight decrease of systolic and diastolic blood pressure. Severe adverse effects did not occur, and moderate headaches were reported by five patients. In 13 patients, unstable angina could be stabilized, and they remained free of resting angina; five had a marked reduction of the frequency of anginal attacks. In two patients, molsidomine was without demonstrable beneficial effects.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

Antihypertensive monotherapy with nitrendipine in general practice.

Efficacy and feasibility of antihypertensive monotherapy with the calcium antagonist nitrendipine were investigated in a 6-week open trial in 768 patients with mild to moderate essential hypertension from 191 practicing internists and general practitioners. Previous antihypertensive therapy (n = 501) was withheld for 1 week and therapy then started with nitrendipine 20 mg q.d. If diastolic blood pressure before tablet intake in the morning stayed above 90 mm Hg or fell less than 10 mm Hg, the dose could be doubled to the maximum dose of 20 mg b.i.d. Alternatively, if blood pressure control was good, the dose could be halved to 10 mg q.d. One hundred thirty-four patients discontinued therapy prematurely because of unwanted effects mostly characteristic with dihydropyridines (headaches, flushes, and ankle edema) and mostly within the first 3 weeks. In 72% of the remaining 634 patients, the goal blood pressure was achieved by nitrendipine monotherapy (10 mg q.d. in 8%, 20 mg q.d. in 87%, and 20 mg b.i.d. in 5%) and diastolic blood pressure was between 90 and 95 mm Hg in another 3%. Reductions of blood pressure did not result in changes of heart rate or weight. Nitrendipine was effective in patients of all age groups but patients older than 65 years showed a significantly greater fall of systolic and mean arterial pressure than middle aged or young patients. Nitrendipine's efficacy under conditions of general practice and the high proportion of patients responding to once daily administration appear well suited for first-line therapy of uncomplicated hypertension. The incidence of side effects might have been smaller if therapy had started with a smaller dose.

Aged↗
PubMed1987

Effects of antihypertensive treatment on cerebral perfusion.

Antihypertensive treatment reduces the risk of ischemic strokes and cerebral hemorrhage as complications of excessive or long-standing hypertension. However, neurologic dysfunction and brain damage may also accompany short-term, and under certain conditions, even long-term antihypertensive treatment. Therefore, treatment should be instituted restrictively and cautiously. Special regard should be given to the action of antihypertensive drugs on cerebral perfusion in patients with an increased risk for the development of treatment-induced cerebral ischemic complications, such as patients with hypertensive encephalopathy or autonomic dysfunction, and elderly patients with suspected sclerotic stenosis of cerebral or neck arteries. The structural and functional lesions of cerebral vessels observed in acute and chronic hypertension are reviewed, as are the effects of antihypertensive drugs on cerebral blood flow. Calcium channel blockers and angiotensin-converting enzyme inhibitors may have advantages as first-line drugs in the treatment of patients with an elevated risk of cerebral hypoperfusion, because of the selective action of these agents on vasoconstricted vessels and their differential effects in varying regional vascular beds. The excellent efficacy of these drugs in the short- and long-term treatment of hypertension may lead to changes in the traditional management of hypertensive emergencies as well as in management strategies for other patients at risk for treatment-induced complications.

Adrenergic beta-Antagonists↗
PubMed1987

Cerebral blood flow and calcium antagonists in hypertension.

Antihypertensive treatment reduces the risk of ischaemic strokes and cerebral haemorrhage as complications of excessive or long-standing hypertension. However, neurological dysfunction and brain damage may also accompany acute and, under certain conditions, even chronic antihypertensive treatment. Treatment should therefore be instituted restrictively and cautiously, with special regard to the action of antihypertensive drugs on cerebral perfusion in patients with an increased risk for treatment-induced cerebral ischaemic complications, e.g. patients with hypertensive encephalopathy, patients with autonomic dysfunction or elderly patients with suspected sclerotic stenosis of cerebral or neck arteries. The present study is a review of the structural and functional lesions of cerebral vessels observed in acute and chronic hypertension, together with the effects of antihypertensive drugs on cerebral blood flow. Calcium channel blockers such as nifedipine, nitrendipine and verapamil may have advantages as first-line drugs in the treatment of patients with an elevated risk for cerebral hypoperfusion, because of their selective action on vasoconstricted vessels and their differential effects in different regional vascular beds. The particular efficacy of calcium antagonists in acute antihypertensive treatment, with a significant increase in cerebral blood flow in the case of nifedipine, and also in chronic antihypertensive therapy without decreasing cerebral blood flow, may change the traditional management of hypertensive emergencies, as well as of other patients at risk of treatment-induced complications.

Aged↗
PubMed1987

Individualized care in patients with chronic congestive heart failure.

Based on our experience with the prospective follow-up study in a group of patients (n = 21) with congestive heart failure (CHF) (NYHA III n = 10, NYHA IV n = 11) and left ventricular ejection fraction below 30%, who were referred to our ordinary care unit by their family physicians after an initial work-up, we investigated the impact of a special treatment program in 25 patients with similar CHF despite therapy (60 +/- 4 years, NYHA III n = 11, NYHA IV n = 14, LVEF less than 30%, 17 +/- 3%). The program focused on three issues: (1) individualized medical therapy of CHF, (2) antiarrhythmic treatment and close follow-up visits, and (3) continuous education of patients and physicians in order to improve treatment compliance and the early management of complications. Medical treatment was based on diuretic and vasodilator therapy in all the patients, while positive inotropic substances including digoxin were given selectively. Vasodilator treatment was started with prazosin in 22 patients and with ACE inhibitors in three patients with low serum sodium. Fifty-five percent of the patients on prazosin had to be changed over to ACE inhibitors. Amiodarone was used as first line drug to treat symptomatic ventricular tachycardia in two patients and two survivors of ventricular fibrillation.(ABSTRACT TRUNCATED AT 250 WORDS)

Anticoagulants↗
PubMed1987

Hypertensive emergencies.

Hypertensive emergencies are defined as conditions where a seriously elevated blood pressure imposes a substantial threat to a patient's life or vital organ functions. Since acute blood pressure reduction by lowering cardiac output and/or vascular resistance itself has the potential for serious and even life-threatening complications, treatment should be given restrictively based on pathophysiological considerations concerning altered patterns of blood pressure and blood flow regulation in these patients. Ischemic treatment related complications can be avoided by a rational choice of first-line drugs. These include beta-blockers for patients with a compromised myocardial oxygen supply as in acute myocardial infarction and unstable angina as well as for patients with dissecting aneurysms and patients with pronounced catecholamine release. In other types of hypertensive emergencies, calcium antagonists have emerged as the treatment of choice with excellent efficacy and a favorable risk-benefit ratio. Sodium nitroprusside is rarely necessary in treatment failures after calcium channel blockade.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1987

Antihypertensive efficacy of ketanserin alone or in combination with a beta-blocker or a diuretic: the Swiss Ketanserin Study.

In the Swiss Ketanserin Study the antihypertensive efficacy and tolerability of ketanserin (given in 20 or 40 mg doses twice daily) was investigated, after a placebo run-in phase, as monotherapy (n = 68) as well as in combination with either atenolol (100 mg/day) (n = 30) or the potassium-sparing diuretic hydrochlorothiazide (50 mg/day) and amiloride (5 mg/day) (n = 26) in 124 patients with essential hypertension, aged 41 to 82 years. With the addition of ketanserin, diastolic blood pressure fell by 8 +/- 8, 8 +/- 8, and 7 +/- 9 (+/- SD) mm Hg, respectively (p less than 0.05 for all) in the three treatment groups; heart rate remained unchanged or fell slightly. Ketanserin had no effect on body weight, or biochemical variables, including total serum cholesterol and triglycerides, with the exception of a minor increase in apolipoprotein B. Using a patient self-assessment questionnaire (30 items), the addition of ketanserin was associated with a reduction of most of the symptoms encountered in the placebo phase, including sleep disturbances, general feeling of weakness, headaches, nervousness, and fatigue, but there was a tendency toward increases in stuffy nose and dry mouth. In patients older than 60 years, the antihypertensive efficacy of ketanserin was greater, with 59% achieving a diastolic pressure less than or equal to 95 mm Hg versus 45% in the younger patients. This age trend also emerged when ketanserin was combined with either atenolol or the diuretic.

Adrenergic beta-Antagonists↗
PubMed1986

Acute and chronic sympathetic reflex activation and antihypertensive response to nifedipine.

The importance of counterregulatory mechanisms triggered by arterial vasodilation for the antihypertensive response to the calcium entry blocking agent nifedipine was investigated in 13 men with mild to moderate essential hypertension. Blood pressure and systemic vascular resistance were significantly reduced 30 minutes after sublingual administration of 10 mg of nifedipine while heart rate, cardiac index and plasma norepinephrine concentrations increased (all p less than 0.01). Also, changes in mean blood pressure correlated inversely with arterial baroreflex sensitivity (r = -0.74, p less than 0.01), suggesting that arterial baroreflex mechanisms by means of sympathetic activation tend to limit the acute antihypertensive response. Blood pressure, but not systemic vascular resistance, decreased further (p less than 0.01) after 6 weeks of therapy with nifedipine 20 mg three times daily, while average heart rate, cardiac index and plasma norepinephrine concentrations had returned toward pretreatment values. Thus, a reduction of acutely increased sympathetic activity toward pretreatment values during long-term nifedipine therapy was associated with further decreases in blood pressure. The importance of sympathetic activity was also stressed by the finding of an inverse relation between chronic changes in heart rate and blood pressure (percent of control, r = -0.76, p less than 0.01). Blood volume did not change during long-term nifedipine therapy. The results suggest that the degree of sympathetic reflex activation in part determines the antihypertensive response to nifedipine monotherapy.

Adult↗
PubMed1985

Calcium release from intact calmodulin and calmodulin fragment 78-148 measured by stopped-flow fluorescence with 2-p-toluidinylnaphthalene sulfonate. Effect of calmodulin fragments on cardiac sarcoplasmic reticulum.

Calcium release from high and low-affinity calcium-binding sites of intact bovine brain calmodulin (CaM) and from the tryptic fragment 78-148, purified by high-pressure liquid chromatography, containing only the high-affinity calcium-binding sites, was determined by fluorescence stopped-flow with 2-p-toluidinylnaphthalene sulfonate (TNS). The tryptic fragments 1-77 and 78-148 each contain a calcium-dependent TNS-binding site, as shown by the calcium-dependent increase in TNS fluorescence. The rate of the monophasic fluorescence decrease in endogenous tyrosine on calcium dissociation from intact calcium-saturated calmodulin (kobs 10.8 s-1 and 3.2 s-1 at 25 degrees C and 10 degrees C respectively) as well as the rate of equivalent slow phase of the biphasic decrease in TNS fluorescence (kobsslow 10.6 s-1 and 3.0 s-1 at 25 degrees C and 10 degrees C respectively) and the rate of the solely monophasic decrease in TNS fluorescence, obtained with fragment 78-148 (kobs 10.7 s-1 and 3.5 s-1 at 25 degrees C and 10 degrees C respectively), were identical, indicating that the rate of the conformational change associated with calcium release from the high-affinity calcium-binding sites on the C-terminal half of calmodulin is not influenced by the N-terminal half of the molecule. The fast phase of the biphasic decrease of TNS fluorescence, observed by the N-terminal half of the molecule. The fast phase of the biphasic decrease of TNS fluorescence, observed with intact calmodulin only (kobsfast 280 s-1 at 10 degrees C) but not with fragment 78-148, is most probably due to the conformational change associated with calcium release from low-affinity sites on the N-terminal half. The calmodulin fragments 1-77 and 78-148 neither activated calcium/calmodulin-dependent protein kinase of cardiac sarcoplasmic reticulum nor inhibited calmodulin-dependent activation at a concentration approximately 1000-fold greater (5 microM) than that of the calmodulin required for half-maximum activation (5.9 nM at 0.8 mM Ca2+ and 5 mM Mg2+) of calmodulin-dependent phosphoester formation.

Animals↗
PubMed1985

[Variable assessment of intensive medical care by patients with acute myocardial infarct and by the nursing staff].

We investigated the assessment for intensive care in 63 consecutive patients (aged below 75 years) hospitalized in the intensive care unit (ICU) because of an acute myocardial infarction. A questionnaire was answered by the patients immediately after leaving the ICU and by 25 nurses who were asked to complete the test from the patients' point of view. Three patients and 5 nurses refused to answer. The two groups differed in the assessment of many items concerning intensive care. Hospitalization and transfer to the ICU, the first emergency measures and continuous monitoring were regarded as reassuring by the patients but not by the nurses. Further differences concerned invasive therapeutic or diagnostic measures, the effect of analgesic drugs, the ward round and transfer out of the unit. Factors experienced as especially unpleasant by patients were uncertainty about the danger they were in, venous catheterization and bowel movements in bed. From the assessment of the ICU by the patients, conclusions can be drawn with a view to improving patient care.

Adult↗
PubMed1985

[Does closely monitored control and therapy adjustment improve the prognosis in patients with severe heart insufficiency?].

The one year mortality of patients with severe congestive heart failure ranges between 30 and 70%. The effect was investigated of a stepped care program, including weekly monitoring and frequent adjustment of medical treatment, on the prognosis of 18 consecutive outpatients with severe congestive heart failure (NYHA class III and IV, 60 +/- 3.5 years). The diagnosis of congestive heart failure was proven by an invasively measured cardiac index below 2.5 l/min/m2 or by a left ventricular ejection fraction below 30%. Plasma adrenaline and noradrenaline values and plasma renin activity were substantially increased in all patients compared with 20 normals. 11 of the heart failure patients had coronary heart disease, 10 with a large left ventricular aneurysm, 6 patients had congestive cardiomyopathy and one patient had valvular heart disease with aortic insufficiency. In 9 patients ventricular tachycardias were registered, four had recurrent syncopes, and in 7 other patients atrial fibrillation, atrial flutter and paroxysmal supraventricular tachycardias were found. Medical treatment in all patients included pre- and afterload reduction by vasodilators. 11 patients received digoxin and 8 antiarrhythmic drugs. After a mean follow-up of 25 +/- 3.3 months, the one-year mortality was 7% and the two year mortality 15%. The favorable prognosis in patients in this special care program shows the favorable effects of individualized therapy, of frequent patient monitoring and the influence of strict compliance on survival and symptoms in patients with chronic congestive heart failure.

Adult↗