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Biomedical subjects

R Nordlander

Publications and source records attributed to R Nordlander.

At least 109 records · Page 6Linked to original sources
PubMed1981

Estimation of infarct size by creatine kinase. A comparison between maximal value, planimetry and computer calculation.

Serum samples for creatine kinase (CK) activity were obtained serially during 48 h in patients with acute myocardial infarction (AMI) diagnosed according to conventional criteria. Infarct size was estimated as peak enzyme value (CKmax), area under the enzyme curve measured planimetrically (AUC) and was also calculated according to Sobel et al. (IS) by a computer. In 16 patients with enzyme curves judged to fit the computer method, there was a good correlation between AUC and IS (r = 0.97), between AUC and CKmax (r = 0.99) and accordingly also between IS and CKmax (r = 0.96). The results from 34 consecutive patients with AMI were plotted in the graphs obtained from the 16 patients with "ideal" enzyme curves. 15% fell outside +/- 2 SD when AUC was correlated to IS, 3% when AUC was correlated to CKmax and 12% when IS was correlated to CKmax. There was no difference between enzyme curves falling outside or within +/- 2 SD. The explanation for the high correlation between these three methods may be that all these ways of estimating the high concentration between these three methods may be that all these ways of estimating infarct size are imprecise and only give a rough estimation of the size of the infarction.

Computers↗
PubMed1980

Comparative bioavailability of disopyramide after multiple dosing with standard capsules and controlled-release tablets.

Plasma concentrations and bioavailability of disopyramide following repeated administration of standard capsules and controlled-release tablets have been compared. Ten patients were randomized into two groups; Group I received disopyramide capsules 150 mg every 6 h for five days. Group II received the same preparations in the reverse order. There was a more rapid rise in disopyramide concentration after the capsules: the maximum of 10.7 +/- 0.6 mumol/l (mean +/- SEM) was reached within 1.8 +/- 0.4 h as compared to 10.6 +/- 0.4 mumol/l within 4.0 +/- 0.3 h after the controlled-release tablets. No significant difference in the fluctuations in individual plasma concentrations during each dose interval at steady state were observed after ordinary capsules compared to controlled-release tablets. The extent of bioavailability was the same. Eight patients reported some side-effects during the capsule period and nine during the controlled-release tablet period.

Aged↗
PubMed1980

Hemodynamic and antiarrhythmic effects of tocainide in patients with acute myocardial infarction.

In order to evaluate the hemodynamic and antiarrhythmic efficacy of tocainide, studies were performed in patients suffering acute myocardial infarction. Intravenous tocainide was administered over a 15-minute period in order to determine its acute effects and subsequently, in a randomized double-blind study with placebo control, to determine its effects over a 24-hour period in acute myocardial infarction. Tocainide resulted in a significant decrease of frequent and complex ventricular arrhythmias acutely and had only minimal effects of hemodynamics in most patients. In the long-term studies, tocainide produced no adverse hemodynamic effects when compared with placebos.

Anilides↗
PubMed1980

Thallium-201 scintigraphy after acute myocardial infarction.

Fifty-five patients with acute myocardial infarction were examined with thallium-201 scintigraphy before discharge from hospital. Fifty-one showed significant scintigraphic defects. The number of abnormal Q waves in a 12-lead ECG but not the maximal ASAT value for each patient were correlated to the total estimated image defect. Mortality during the follow-up period of 14-28 months was not related to the estimated total image defect, but the two early deaths occurred among patients with the most dilated left ventricles.

Adult↗
PubMed1980

Treatment of dilutional hyponatremia in congestive heart failure.

Water restriction is a slow and difficult way to treat dilutional hyponatremia during diuretic therapy of congestive heart failure. An i.v. infusion of 400-1 400 mmol hypertonic saline combined with repeated i.v. injections of loop diuretics was used instead in 9 cases (6 patients). In 4 cases with dominating left heart failure the serum sodium concentration increased and the heart failure was not aggravated as judged from pulmonary rales and body weight. Two of the five cases with dominating right heart failure responded in the same favourable way, but body weight increased 1-2 kg and hyponatremia reappeared in three. The only difference observed between responders and non-responders was that the responders were free from leg edema. This treatment of dilutional hyponatremia seems worth further cautious use in situations in which water restriction is troublesome, but it should probably be reserved for patients without severe right heart failure.

Adult↗
PubMed1980

Hemodynamic effects of combined treatment with lignocaine, procainamide and practolol in acute myocardial infarction.

In the treatment of refractory ventricular tachyarrhythmias antiarrhythmic drugs must sometimes be combined. An electrophysiologically appropriate combination is lignocaine and procainamide and, when needed, a beta-blocking agent. The hemodynamic effects of this treatment were studied in 6 patients in the acute phase of myocardial infarction. After a control period, an infusion of lignocaine was started and 1 h later procainamide/placebo was added in a double-blind system and finally also practolol/placebo. The drugs were given intravenously in ordinary doses. Hemodynamics were studied by bedside catheterization. During triple treatment heart rate and aortic pressures fell significantly whereas right atrial mean pressure increased compared to the control period. Stroke volume, cardiac output and pulmonary artery pressures were unchanged. Most of the changes appeared when practolol was added. Following the procainamide injection a transient fall in aortic pressures was noted. Lignocaine gave no hemodynamic effects. The number of ventricular premature beats was reduced in all patients and no patient had ventricular tachycardia during treatment. In these patients it was possible to combine lignocaine, procainamide and practolol in the acute phase of myocardial infarction. However, 3 patients developed hypotension, 1 sinus bradycardia and 1 had a short run of nodal tachycardia. It is concluded that this kind of combined treatment, because of its potential risks, should be restricted to critical clinical situations and then it ought to be hemodynamically controlled.

Adult↗
PubMed1979

Peripheral hemodynamics in assisted circulation with intra-aortic balloon pumping in patients with cardiogenic shock.

Seven patients treated for cardiogenic shock were studied with and without intra-aortic balloon pumping (IABP). Calf and forearm blood flows were determined with a Dohn plethysmograph and arterial pressures were registered intra-arterially and in the great toe and thumb with the cuff method. During IABP, an augmented flow was registered in the arms and legs and accurate arterial BPs could also be determined from the extremities. The findings demonstrate a beneficial effect of IABP on peripheral flow, expecially in patients who could be weaned off the pump.

Aged↗
PubMed1979

Mortality, arrhythmias and pump failure in acute myocardial infarction in relation to estimated infarct size.

Serial estimations of total serum creatine kinase (S-CK) were made in 194 consecutive patients with acute myocardial infarction (AMI). By itself, the maximum CK value could not separate patients in terms of high and low mortality but when the maximum CK value was related to age for patients with and without a history of previous AMI, two subgroups became apparent, one with 46% mortality (high-risk group) and another with 6% (low-risk group) during the hospital stay plus the next 90 days. In 114 of the patients, infarct size could be calculated. A good correlation was found between maximum CK and calculated infarct size (r = 0.93). Calculated infarct size alone could not distinguish between high and low mortality but when it was related to age for patients with and without a history of previous AMI, two subgroups emerged, one with 43% mortality and another with 3% during the hospital stay plus the next 90 days. The incidence of ventricular tachycardia during the stay in the Coronary Care Unit did not differ between the two risk groups separated either by maximum CK value or calculated infarct size. However, the incidence of shock and severe left heart failure during the acute phase was higher in the high-risk groups.

Acute Disease↗
PubMed1979

Intraaortic balloon pumping in the treatment of cardiogenic shock complicating acute myocardial infarction.

A 5.1% incidence of cardiogenic shock was found in consecutive series of 680 patients with acute myocardial infarction (AMI) during a five-year period. The hospital mortality was 94%. Shock was treated according to a stepwise policy including assisted circulation with intraaortic balloon pumping (IABP). During the five-year period, only five patients, 14% of the shock patients, had shock for more than three hours (the minimal time for attempting medical therapy and preparing for assisted circulation), were below 75 years of age and without terminal diseases. Together with ten AMI patients in shock referred from or treated in other hospitals, altogether 15 patients were given IABP during 1--318 hours (mean 58). Shock was reversed in 12 (80%) of these patients and five (33%) could be weaned off IABP and discharged from the CCU. However, only two patients (13%) were long-term survivors.

Acute Disease↗
PubMed1979

Quinidine dosage, with special reference to an oral loading dose schedule.

1 Plasma concentrations of quinidine were analyzed in 52 cardiac patients after different oral loading doses and during different maintenance dosage intervals using both conventional and sustained release preparations of quinidine. 2 The majority of patients reached therapeutic plasma concentrations in the order of 2--4 microgram/ml within 3 h after the loading dose of 600--800 mg of rapidly absorbed ordinary quinidine sulphate tablets and institution of maintenance therapy with sustained release tablets 1 h after the loading dose. 3 The dosage interval of 12 h during maintenance therapy with sustained release tablets gave as acceptable plasma drug fluctuations as an 8 h interval. 4 A large individual variation in plasma concentrations was noticed. Thus monitoring of therapy by plasma concentration analyses is desirable.

Aged↗
PubMed1979

Patients treated in a coronary care unit without acute myocardial infarction: identification of high risk subgroup for subsequent myocardial infarction and/or cardiovascular death.

Consecutive patients admitted to a coronary care unit (CCU) during one year were studied. The diagnosis of acute myocardial infarction was not substantiated by our criteria in 206 of the patients discharged from the CCU. Of these, 193 were retrospectively followed up during one year. Seventeen of the patients (9%) died from cardiovascular causes during the 1-year period. Another 14 patients (7%) had a subsequent non-fatal acute myocardial infarction during the same period. The majority of the patients had coronary artery disease. Only 32 (17%) could be classified as non-coronary cases, and these had an excellent prognosis without any subsequent acute myocardial infarctions or deaths. The occurrence of transient ST-T shifts in serial electrocardiograms obtained during the first 3 days in hospital selected a subgroup of patients who had a high risk for subsequent non-fatal acute myocardial infarction and/or cardiovascular death. This high risk subgroup provides a basis for more aggressive diagnostic and therapeutic intervention.

Acute Disease↗
PubMed1979

Application of diagnostic criteria in the diagnosis of myocardial infarction.

A random sample of all patients with a registered diagnosis of acute myocardial infarction (AMI) was selected from the hospitalisation register of Stockholm County in 1973. The sample consisted of 269 patients. The medical records of these patients were scrutinized concerning the fulfilment of criteria of a diagnosis of AMI. The criteria of AMI chosen were those established in a Sweden cooperative study (6). 33 patients did not fulfil the diagnosis of AMI, corresponding to an estimated proportion of 10%. In 4% this was due to more technical reasons such as the use of incorrect code numbers, and in 6% the diagnosis had been made without the criteria being fulfilled.

Acute Disease↗
PubMed1979

A high risk subgroup of patients with unstable angina pectoris treated medically or surgically.

Among patients consecutively admitted to a coronary care unit (CCU) without a subsequent diagnosis of acute myocardial infarction (AMI), a subgroup fo unstable angina was selected, defined as continued episodes of angina at rest during a 48-hour period, despite medical treatment in the CCU. During a four-year period, 15 patients fulfilled these criteria. Eight patients were medically treated, seven of whom developed an AMI with three subsequent deaths. Six of the infarcts occurred within eight days of admission. In six patients, fulfilling the criteria, surgical treatment was performed. Angiography and surgery in this group were associated with low incidences of myocardial infarction, late infarction and death. In one patient, surgery was declined due to unfavourable anatomical conditions. This patient subsequently developed an AMI and died. It is concluded that the combination of recent onset of angina and continued episodes of angina at rest, despite medical treatment, selects a high risk subgroup of unstable angina. Acute coronary angiography and surgery ought to be considered in this subgroup.

Aged↗
PubMed1979

Coronary artery spasm--a case with fatal outcome.

The case of a 45-year-old man with nocturnal angina and angiographically verified spontaneous spasm of the left anterior descending and left circumflex coronary arteries is described. The patient died suddenly one month after investigation, despite treatment with a beta-blocker and nitroglycerin. Other forms of pharmacological treatment should be tried in such patients.

Angina Pectoris↗