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Biomedical subjects

C M Jespersen

Publications and source records attributed to C M Jespersen.

At least 37 records · Page 2Linked to original sources
PubMed1992

The significance of myocardial ischaemia and verapamil treatment on the prevalence of supraventricular tachyarrhythmias in patients recovering from acute myocardial infarction. Danish Study Group on Verapamil in Myocardial Infarction.

Twenty-four hour Holter monitoring and symptom-limited exercise testing were carried out prior to discharge in 157 patients recovering from acute myocardial infarction. Supraventricular arrhythmias (SVT) during Holter monitoring were recorded in 15%, and ST segment depression during exercise in 27%. No association between exercise-provoked ischaemia and SVT was found in the late hospital phase of myocardial infarction. After the tests, patients were double-blindly randomized to treatment with verapamil 120 mg t.i.d. or placebo. One month after randomization 24 h Holter monitoring was repeated in 125 patients (verapamil = 63, placebo = 62). At one month a significantly increased incidence of SVT was found in the placebo group (25%) compared to the verapamil-treated patients (9%) (P = 0.04). The increased prevalence in the placebo group was mainly due to an increased incidence of SVT in patients with exercise-induced ischaemia (P = 0.03). This increment was blurred in the verapamil group. In conclusion, the prevalence of SVT increases during the first month after myocardial infarction. The increase is most pronounced in patients with residual myocardial ischaemia and seemed to be prevented by treatment with verapamil.

Double-Blind Method↗
PubMed1992

Detection of myocardial ischaemia by transthoracic leads in ambulatory electrocardiographic monitoring.

OBJECTIVE: To determine the best sites for ambulatory monitoring leads to detect myocardial ischaemia. PATIENTS: 50 consecutive patients recovering from myocardial infarction. Six patients were excluded because of unsatisfactory recordings or baseline electrocardiographic abnormalities that influenced the diagnostic accuracy of ST segment depression. In 38 patients important ST segment changes were seen before the study recordings. MAIN OUTCOME MEASURE: Reproducibility of detecting the electrocardiographic ST segment changes with 12 bipolar leads alone or in combination. RESULTS: The highest reproducibility rate was found in infarcts involving both the anterior and inferior left ventricular walls (80%). The reproducibility decreased as the extent of ventricular wall involvement decreased and was lowest in inferior infarcts (31%) (p < 0.001). For large infarcts the detection rate was almost equal for the 12 study leads, whereas disparity between leads increased as the infarct size decreased. The highest overall reproducibility was found in a transthoracic lead (V2, V9R) (76%). This lead was significantly better (p = 0.03) than lead CM5 (50%). When the transthoracic lead was combined with an inferior lead, the reproducibility increased (82%) and was significantly better than the combination of CM5 and an inferior lead (58%) (p = 0.02). CONCLUSIONS: Extensive ischaemic electrocardiographic changes are better detected than smaller ones and anterior infarcts better than inferior. A transthoracic lead (V2, V9R) was significantly better than CM5 both alone and when CM5 and the transthoracic lead were combined with an inferior lead.

Electrocardiography, Ambulatory↗
PubMed1991

The effect of verapamil on major events in patients with exercise-induced ischemia recovering from acute myocardial infarction: a review. The Danish Study Group on Verapamil in Myocardial Infarction.

The effect of verapamil on death and reinfarction in patients with and without exercise-induced myocardial ischemia after acute myocardial infarction was studied in a double-blind, placebo-controlled multicenter study. Two hundred ninety-eight patients were included. A symptom-limited exercise test was carried out 9 days after the myocardial infarction but before randomization. Forty-four patients with and 111 without exercise-induced ischemia were randomly assigned to verapamil and 39 and 104, respectively, to placebo treatment. The patients were observed for 18 months. The overall 18-month event rate was 12.1%. The lowest event rate was seen in patients with myocardial ischemia and verapamil treatment (9.1%), and the highest in patients with myocardial ischemia receiving a placebo (15.4%), while rates of patients without ischemia were sandwiched in between (12.5 and 12.6%). The differences were not statistically significant.

Blood Pressure↗
PubMed1990

[Isoptin Retard. Pharmacokinetics and pharmacodynamics in patients with angina pectoris].

Sustained-release Verapamil is suitable for treatment of angina pectoris. The initial dose should be 240 mg administered at bedtime. If the desired effect is not obtained, the dosage may be increased first to 360 mg at bedtime and then to 240 mg morning and evening. In patients already receiving treatment with standard Verapamil, this may be replaced by Sustained-release Verapamil mg for mg. In long-term treatment the half life is increased and reduction of the dosage should, therefore, be attempted.

Angina Pectoris↗
PubMed1990

Dose-dependent effects of verapamil and nifedipine on in vivo platelet function in normal volunteers.

The effects of 1 week of treatment with low and moderate doses of verapamil or nifedipine upon platelet function has been studied in 12 healthy volunteers. The ex vivo platelet aggregation threshold for ADP or adrenaline was not altered by verapamil or nifedipine. The plasma concentrations of beta-thromboglobulin and platelet factor 4 were significantly reduced by low but not by moderate doses of verapamil and nifedipine. Low doses of verapamil and nifedipine inhibit in vivo platelet activity in healthy volunteers.

Adenosine Diphosphate↗
PubMed1990

Assessment of blindness in the Danish Verapamil Infarction Trial II (DAVIT II). Danish Study Group on Verapamil in Myocardial Infarction.

In a double-blind, randomized, placebo-controlled study comparing verapamil and placebo in late secondary intervention after acute myocardial infarction, the physicians were asked to try to identify the treatment in 100 consecutive patients. The assessment of the presumed treatment was based upon the presence of effects and side effects. It was only possible correctly to group 36% (95%: 26.7-46.2) of the patients. 35 patients were grouped as indeterminable. In 65 a treatment was proposed, correctly in 55%, and thus ideal blindedness had been achieved.

Adolescent↗
PubMed1989

Circadian variation in the pharmacokinetics of verapamil.

Circadian variation in the metabolism of verapamil was investigated in 10 patients with stable angina pectoris during treatment with sustained-release verapamil 360 mg at 08.00 h or 22.0 h. No major difference in exercise parameters was found. During the evening dosage schedule a significantly greater bioavailability (AUC) and a prolonged time to peak concentration was found. During the night (24.00 h-06.00 h) the half-life of verapamil was significantly longer than during the day (16.00 h-22.00 h). These differences in pharmacokinetics may be due to reduced hepatic blood flow at night or to circadian variation in hepatic microsomal metabolism.

Angina Pectoris↗
PubMed1989

Sustained-release and instant-release verapamil in treatment of angina pectoris.

The efficacy of a sustained-release preparation of verapamil (verapamil-SR) has been compared with that of a conventional instant-release formulation (verapamil-IR) in 10 patients with stable angina pectoris treated for 3 weeks with both preparations. The diurnal serum concentrations of verapamil and norverapamil did not differ significantly during treatment with verapamil-IR 120 mg t.i.d. and verapamil-SR 360 mg once daily, but verapamil-SR 240 mg produced significantly lower serum concentrations. The differences did not affect the exercise capacity or the occurrence of ST-segment depression during maximal exercise. Verapamil-SR was well tolerated. A multiple instant-release dosage regime can now be replaced by once daily administration of the sustained-release preparation.

Angina Pectoris↗
PubMed1989

Focal intracerebral oedema in hypertensive encephalopathy visualized by computerized tomographic scan.

A previously healthy man was admitted due to a severe rise in the arterial blood pressure. The patient was found confused and drowsy, but the neurological investigation was otherwise normal. A computerized tomographic scan of cerebrum showed widespread areas of diminished density in the brain. After normalization of the arterial blood pressure, a new computerized tomographic scan did not show any pathological enhancement. The total regression of signs and symptoms after the normalization of the blood pressure support the assumption that a severe increase in blood pressure leads to formation of focal cerebral oedema.

Brain Diseases↗
PubMed1988

Value of a bipolar modified inferior lead in detection of inferior myocardial ischaemia.

Only bipolar leads are normally available for ambulatory monitoring. Bipolar precordial leads are reliable for detecting left coronary artery insufficiency, but may not detect changes caused by right coronary artery insufficiency. The magnitude and polarity of ST segment changes in a bipolar modified inferior lead and in CM5 were compared with those in standard electrocardiographic leads in 10 consecutive patients with acute myocardial infarction (eight inferior and two anteroseptal). The polarity of the ST segment in the modified orthogonal y lead was the same as that in aVF in all eight patients with inferior myocardial infarction and in six the size of the ST segment shift was identical in the two leads as well. In two patients the ST segment shift was larger in the modified orthogonal y lead than in aVF. In one of the two patients with anteroseptal myocardial infarction the polarity of the ST segment shift was the same in the modified orthogonal y lead and aVF. In the other patient it was slightly different. The CM5 lead did not reliably detect inferior myocardial ischaemia. A modified orthogonal y lead is suitable for the detection of inferior myocardial ischaemia.

Ambulatory Care↗
PubMed1987

Mitral annulus calcification and embolism.

Of 388 patients consecutively referred to echocardiography, 49 were suspected of having a cardiac source of systemic arterial embolism (SE). Mitral annulus calcification (MAC) was revealed in 27% of the patients with SE and in 8% of the remaining patients (p less than 0.05). The group of patients with SE were slightly older (median age 67 years) and included more female patients (47%) compared to the group without SE (62 years, p less than 0.05; 40% female patients, p greater than 0.05). However, the small differences in age and sex distribution did not explain satisfactorily the considerably increased prevalence of MAC in the group of patients with SE. Our preliminary data indicated that thromboembolism caused by left atrial dilatation and atrial fibrillation might be the most important cause of the condition in patients with MAC and SE. However, the significance of the possible mechanisms of embolism in patients with MAC and the incidence of the complication should be further clarified before therapy and prophylaxis can be suggested.

Adult↗
PubMed1986

Changes in blood pressure, heart rate and thyroid hormones after sudden withdrawal of pindolol and atenolol in hypertensive patients.

In a double-blind study 19 patients with mild and uncomplicated arterial hypertension were randomized to treatment with either pindolol 10 mg or atenolol 100 mg once daily for 4 weeks. After abrupt withdrawal a minor overshoot of free-T3 was seen in both groups. This was, however, statistically significant in the pindolol group only. The only overall haemodynamic changes which was observed after the withdrawal was an overshoot in heart rate in the standing position in the atenolol group. Great inter-individual differences in the haemodynamic parameters were found, however, and changes suggestive for withdrawal syndrome were found in 14 patients (pindolol = 7). The time for this overshoot varied considerably from 48-132 h post-drug in both groups. No correlation between the alterations in free-T3 and the cardiovascular parameters was found.

Adult↗