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Biomedical subjects

T Lundman

Publications and source records attributed to T Lundman.

At least 37 records · Page 2Linked to original sources
PubMed1979

Early mobilization and discharge of patients with acute myocardial infarction. A prospective study using risk indicators and early exercise tests.

Consecutive patients (n=184) surviving 48 hours in a coronary care unit were divided into one rapidly (RM) (n=55, 30%) and one conventionally mobilized (CM) group (n=129, 70%). The selection of RM patients was based on the absence of five early risk indicators (RI), reflecting electrical and mechanical heart dysfunction. During after-care, five late RIs were evaluated, including a submaximal bicycle exercise test to 50 W, which excluded nine (16%) additional patients from the RM group. After excluding four patients for non-cardiac reasons, the remaining 42 RM patients were rapidly mobilized and discharged after a mean of nine days, in contrast to a mean of 19 days in the CM group, comprising 121 patients. No RM patient dies in hospital and only one patient died during a six-month follow-up, compared to 17 (p less than 0.01) and 28 (p less than 0.01) patients respectively, in the CM group. Both reinfarction and mortality increased with the number of positive RIs. The early exercise test excluded four patients from the RM group. Altogether 22 of 45 patients showed some abnormality during exercise. Half of these 22 patients were readmitted due to cardiac complications during the follow-up period. These findings indicate that it is possible to identify a group of patients with AMI suitable for early discharge, and that an early exercise test in selected good risk patients is safe and identifies a group prone to complications during the early follow-up period.

Aged↗
PubMed1979

Dobutamine in left heart failure after acute myocardial infarction.

Dobutamine, a new positive inotropic drug, was given as i.v. infusion at a rate of 2.5--7.5 micrograms/kg/min to nine male patients with a moderately severe left heart failure. The patients were treated in our CCU for acute myocardial infarction (AMI) and had PEP/LVET above 0.40 on routine registrations of systolic time intervals, PEP (preejection phase), PEPI (PEP corrected for heart rate), LVET (left ventricular ejection time) and LVETI (LVET corrected for heart rate). Dobutamine increased contractility, measured as shortening of PEP and PEPI, and also increased ejection fraction, measured as PEP/LVET. Concomitantly, heart rate increased significantly but no changes were noted in systolic or diastolic BPs. The positive inotropic effect of dobutamine was thus accompanied by a positive chronotropic effect, which limits the usefulness of the drug in patients with recent AMI.

Acute Disease↗
PubMed1978

The relationship between QT interval and ventricular arrhythmias in acute myocardial infarction.

Out of a total of 947 patients admitted to the CCU at Serafimerlasarettet during 2 years, all those with AMI and vintricular fibrillation (VF) or ventricular tachycardia (VT) during the CCU stay were selected. The QT interval could be measured in 15 patients with VF and 12 with VT before the event. The QT interval was also measured in two control groups; one consisted of 27 consecutively admitted patients with AMI without ventricular arrhythmias (VA), the other of 27 non-AMI patients treated in the CCU. Most patients in the group with VA showed pathologically prolonged QT intervals and there were statistically significant differences between this group and the control groups regarding corrected mean QT intervals. If these findings are confirmed, QT measurements might be of value in the prediction of malignant VA in AMI.

Acute Disease↗
PubMed1978

Prognostic implications of ventricular arrhythmias registered before discharge and one year after acute myocardial infarction.

The prognostic weight of ventricular ectopic beats (VEBs) was evaluated in 160 patients discharged after a CCU-treated acute myocardial infarction (AMI) and followed for two years. VEBs were registered prior to discharge by 6 hours of telemetry (3 hours during daytime including exercise and 3 hours at night) and again one year after the AMI. During the first year of follow-up, 11 patients died suddenly and 20 suffered reinfarction. Sixteen (55%) of these had shown severe VEBs, i.e. multiform, paired, R-on-T, or ventricular tachycardia, as compared to 42 (29%) of the remainder. During the second year of follow-up, eight patients suffered reinfarction and five died suddenly. The occurrence of severe VEBs prior to discharge was not of prognostic value for the second year per se but continued to carry prognostic weight for the first plus the second year. One year after the AMI the VEB incidence in 122 survivors without reinfarction increased insignificantly from 71 to 78%. VEB severity increased in 43% and decreased in 27% and the shift towards severe forms is significant. Severe VEBs one year after the AMI carry a prognostic weight for the second follow-up year, as 18% of patients with severe VEBs reinfarcted or died suddenly against 5% of those with nor or uniform VEBs only. Patients who had severe VEBs both prior to discharge and one year later did especially badly.

Acute Disease↗
PubMed1977

A survey for circulating immune complexes in patients with acute myocardial infarction. Use of a C1q-binding assay with soluble protein A as indicator.

A new assay for the detection of circulating C1q-binding immune complexes (IC) is described. The assay makes use of solid-phase C1q and iodinated soluble protein A, extracted from the cell wall of Staphylococcus aureus. In a model system the assay could detect heat-aggregated IgG down to a concentration of about 50 ng/ml. This method and three other assays, previously described, were used to survey the appearance of IC activity in sera from hospitalized patients with acute myocardial infarction. Depending on the assay system used, from 56% to 66% of the patients investigated were found to develop circulating IC. The earliest appearance of circulating IC was noted 5 days after infarction. The highest incidence of positive reactions and the strongest reactions occurred 2 to 3 weeks after hospitalization; thereafter the IC positiveness tapered off, and all patients were negative 6 weeks after infarction.

Acute Disease↗
PubMed1976

Death-discordant twins--a new method to evaluate genetic factors in chronic diseases.

One of the most important lines of research on unselected large scale twin registries are mortality followups. Death-specific concordance rates have been calculated using different measures of concordance. These estimates are of great importance but they only reflect an "all or-none" classification of the genetic effect. It is suggested that mortality studies could be extended to, and include studies on, death-discordant twins. Such studies combine the advantages from mortality follow-ups on total twin populations with the detailed clinical investigation on subsamples. By examining the surviving cotwins with respect to various traits and supposed risk factors, an opportunity has been provided to study the genetic determination on the development of disease. This approach has been used in a study of ischaemic heart disease (IHD) and its risk factors in a representative subsample from the Swedish Twin Registry.

Coronary Disease↗
PubMed1976

A validation of cause-of-death certification in 1,156 deaths.

Swedish twins have been followed for mortality since 1961, when the Swedish Twin Registry was formed. During the years 1961-73 there were 1290 deaths among twins born in 1901-25. In 1156 cases the cause of death could be established from collected records and classified according to the 1965 revision of ICD. Using the review of records as the standard, rates of detection and confirmation relating to the death certificate diagnoses were calculated. It is concluded that Swedish death certificate data are fairly valid for use in epidemiological studies and mortality statistics with regard to most cancer forms, cerebrovascular disease, ischemic heart disease, bronchitis, asthma and emphysema, accidents and suicides, but not for diabetes mellitus, alcoholism, mental diseases, rheumatic heart diseases and other heart diseases. However, in selected clinical-epidemiological studies it is often necessary to collect all available documents prior to judging the cause of death.

Aged↗
PubMed1976

Mortality pattern among initial survivors of acute myocardial infarction using a life-table technique.

The 5-year pattern of mortality among 475 immediate survivors of acute myocardial infarction (AMI) (mean age 65 years on entry) is described by a life-table technique. The risk of death was highest during the early part of the follow-up. After 3-4 years, the prognostic influence of the AMI seemed to be overshadowed by the age effect. Special attention was paid to the incidence of sudden death, a fictive elimination of which was shown to reduce the risk of death by 9-22% during the different years of the investigation period. The absolute number of sudden deaths was highest during the early part of the follow-up period but the relative importance of this mode of death was approximately the same during the entire 5-year period after the AMI.

Acute Disease↗
PubMed1975

Initial serum potassium level in relation to early complications and prognosis in patients with acute myocardial infarction.

During two years 450 patients with AMI have been treated in the CCU at Serafimerlasarettet. Serum potassium level was determined in 444 patients on admission. Hyperkalaemia was a rare finding associated with a bad state on admission and a poor prognosis. Hypokalaemia was recorded in 15% of the patients and was associated with previous diuretic treatment, supraventricular bradycardia as well as atrial flutter and fibrillation during the first 24 hours in the CCU. Ventricular ectopic beats and venticular tachycardia were also seen more frequently in hypokalaemic than in other patients.

Acute Disease↗