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Biomedical subjects

W Baedeker

Publications and source records attributed to W Baedeker.

At least 37 records · Page 2Linked to original sources
PubMed1985

Long term efficacy of class I antiarrhythmic agents and amiodarone in patients with malignant ventricular arrhythmias.

The long term efficacy of class I antiarrhythmic drugs and of amiodarone was investigated in 34 patients with severe organic heart disease accompanied by frequent complex ventricular arrhythmias. All patients had undergone cardiac catheterisation which included coronary angiography, and each patient underwent a short and a long term study phase. During the short term study 6 class I antiarrhythmic agents were administered orally in a randomised, single-blind fashion. The drugs investigated were disopyramide, flecainide, mexiletine, prajmalium, propafenon and tocainide. The response was judged to be effective when there was a 90% reduction of couplets and a 100% reduction of salvos. For long term treatment the patient was given one of the agents found to be effective in the short term testing. Holter monitoring was performed after 1 week, and 1, 3 and 6 months. If the drug administered initially was later found to be ineffective, the patient was given another effective class I agent. If during the short term study or the follow-up phase there was no positive response to any class I agent, the patient was given amiodarone. In 78% of the patients, one or more of the class I agents administered short term was effective. The percentage of effectively treated patients after 1 week was 56%, and was 28, 14, and 9% after 1, 3, and 6 months' treatment, respectively. In amiodarone-treated patients there was an effective response rate of 40% after 10 days, 50% after 1 month and 70% after 3 and 6 months.

Amiodarone↗
PubMed1984

[Cardiac arrhythmias and their clinical significance in mitral valve prolapse].

Among 160 patients with mitral-valve prolapse but no other illness there were 118 with cardiac arrhythmias. 30 had frequent or multifocal ventricular premature systoles, 21 had coupled ventricular extrasystoles, and seven had ventricular tachycardia. In six patients the prematurity index was under 1. Supraventricular premature systoles were registered in 56 patients, with seven each having paroxysmal atrial tachycardia and paroxysmal atrial flutter or fibrillation. Ventricular arrhythmias were significantly more frequent in late-systolic prolapse and with positive auscultation findings (systolic click or systolic murmur). Long-term ECG monitoring was more valuable than an exercise ECG. About half the patients with frequent arrhythmias had palpitations and rapid heart action. Coupled ventricular premature systoles and ventricular tachycardias, as well as R-on-T were relatively rare; our findings thus tend to suggest a relatively favourable prognosis for these arrhythmias.

Adolescent↗
PubMed1984

[The effect of amiodarone on thyroid gland function].

Plasma concentrations of T4, FT4, T3, rT3 and TBG, as well as of TSH before and after stimulation with TRH were studied in 25 patients, who had been treated with amiodarone for up to nine years. At the beginning of therapy, all the parameters mentioned above were found to be in the normal range in all patients. After two months of therapy, T4 had increased from 100 nmol/l +/- 24 nmol/l to 155 nmol/l +/- 32 nmol/l (p less than 0.01), and FT4 from 22 pmol/l +/- 10.5 pmol/l to 32 pmol/l +/- 8 pmol/l (p less than 0.01). T3 had decreased to the lower normal range (n.s.). TBG showed no significant changes. The TRH-tests had been normal in the beginning, but they remained positive in only 20% of the cases. At the end of the study, rT3 exceeded the normal range in all 25 patients. Two patients developed definite hyperthyroidism with elevations of T3 up to 4.7 nmol/l and 7.5 nmol/l, respectively. In one of them, we decided to discontinue amiodarone. Testing of thyroid function under antithyroid drug therapy revealed a hyperfunctioning autonomous adenoma, which was successfully eliminated by radioactive iodine therapy. In the other patient, it was not possible to withdraw amiodarone, so we initiated long-term treatment with antithyroid drugs. Our data support the assumption that amiodarone causes an impairment of the peripheral conversion of T4 to T3. As a result, one finds elevated serum concentrations of T4, which, in combination with the mainly negative TRH-test, must not be interpreted as proof of a hyperthyroid metabolic state being present. Hyperthyroidism is confirmed only if serum concentrations of T3 are also elevated.

Adolescent↗
PubMed1981

[Supernormal myocardial excitability and conduction (author's transl)].

The phenomenon of supernormality of myocardial excitability and conduction has been recognized for many years but somewhat neglected in recent literature. Supernormal excitability can be demonstrated occasionally in patients with pacemakers and high myocardial thresholds at an interval of 400 to 520 ms after the R-wave. Supernormal excitability is a prerequisite for supernormal conduction which may be observed to follow conducted sinus beats as well as beats of ectopic origin. In the latter case, retrograde concealed conduction must be assumed to be operative. The basis for the detection of supernormality in only occasional, but not all, similarly predisposed patients remains unestablished. The differential diagnosis of supernormality may pose a difficult electrocardiographic problem, the analysis of which should include consideration of the following: simultaneous occurrence of both premature atrial and ventricular beats, AV-dissociation with capture beats, longitudinal dissociation giving rise to varying AV-intervals and bilateral bundle branch block.

Arrhythmias, Cardiac↗
PubMed1980

[Transient supernormality of AV-conduction (author's transl)].

A case is presented which is believed to demonstrate a transient supernormal phase of av-conduction in the presence of av-block complicating acute inferior wall myocardial infarction. During the initial period following the infarct there was a regular av-escape rhythm without av-conduction. Then on the 12th and 13th day supernormal av-conduction occurred. At the end of this period the supernormal phase became longer and more atrial impulses were conducted to the ventricles. Following the administration of atropine, there was a shortening of the supernormal phase to the previous values. The ECG taken one day later revealed normal av-conduction. It appears that supernormality occurred as a transient phenomenon during the phase of restitution of av-block, possibly by the ventricular complexes retrogradely invading the av-node.

Aged↗
PubMed1977

[Treatment of acute myocardial infarction with sodium nitroprusside (author's transl)].

In 12 patients with acute myocardial infarction, seven of whom had high and five low blood pressure measurements, sodium nitroprusside infusions were given to reduce the myocardial oxygen consumption. The dosage was between 20 and 300 mug/min. Sodium nitroprusside led to a considerable reduction of the systemic arterial pressure, while the left ventricular filling pressure was less influenced. In normotensive patients the filling pressure could often not be sufficiently lowered as a too severe reduction of arterial pressure occurred beforehand. In hypertensive patients the relationship between left ventricular filling pressure and arterial pressure was better: in all patients the arterial pressure could be lowered to normal values and the filling pressure also became normal in most cases. Angina pectoris improved markedly in all patients. These results show that sodium nitroprusside has a satisfactory effect on the haemodynamics in hypertensive infarct patients, whereas it is less suitable for the treatment of normo- or hypotensive patients.

Acute Disease↗
PubMed1977

[Nitroprusside-sodium and intravenous nitroglycerin in acute myocardial infarction (author's transl)].

Using Nitroglycerin (NTG) and Nitroprusside-Sodium (NPN) intravenously we tried to reduce the necrotic area following myocardial infarction by reducing the myocardial O2 consumption. In 12 patients with acute myocardial infarction the effect of NPN was compared to intravenous NTG. In all patients the blood pressure, the pulmonary artery pressure, the pulmonary capillary wedge pressure and the heart rate were continuously monitored; in few patients with cardiac output was measured using a thermodilution device. In some patients with normal blood pressure NPN lowered the blood pressure to such a degree that NPN had to be discontinued before and effect on the pulmonary capillary wedge pressure could be seen. Even in patients with normal blood pressure this effect was not seen with NTG. Intravenous NTG lowered the pulmonary capillary wedge pressure in most patients with only a moderate effect on the blood pressure. We conclude from our results that patients with acute myocardial infarction and normal blood pressure should receive NTG, if a lowering of the pulmonary capillary wedge pressure is desired. When NPN was used in this group of patients a considerable decline of the blood pressure was seen. We think that an elevated pulmonary capillary wedge pressure should be treated with NPN only in patients with an elevated blood pressure.

Acute Disease↗