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Biomedical subjects

C Mannheimer

Publications and source records attributed to C Mannheimer.

At least 37 records · Page 2Linked to original sources
PubMed1998

Electrical stimulation versus coronary artery bypass surgery in severe angina pectoris: the ESBY study.

BACKGROUND: Spinal cord stimulation (SCS) has been shown to have antianginal and anti-ischemic effects in severe angina pectoris. The present study was performed to investigate whether SCS can be used as an alternative to coronary artery bypass grafting (CABG) in selected patient groups, ie, patients with no proven prognostic benefit from CABG and with an increased surgical risk. METHODS AND RESULTS: One hundred four patients were randomized (SCS, 53; CABG, 51). The patients were assessed with respect to symptoms, exercise capacity, ischemic ECG changes during exercise, rate-pressure product, mortality, and cardiovascular morbidity before and 6 months after the operation. Both groups had adequate symptom relief (P<.0001), and there was no difference between SCS and CABG. The CABG group had an increase in exercise capacity (P=.02), less ST-segment depression on maximum (P=.005) and comparable (P=.0009) workloads, and an increase in the rate-pressure product both at maximum (P=.0003) and comparable (P=.03) workloads compared with the SCS group. Eight deaths occurred during the follow-up period, 7 in the CABG group and 1 in the SCS group. On an intention-to-treat basis, the mortality rate was lower in the SCS group (P=.02). Cerebrovascular morbidity was also lower in the SCS group (P=.03). CONCLUSIONS: CABG and SCS appear to be equivalent methods in terms of symptom relief in this group of patients. Effects on ischemia, morbidity, and mortality should be considered in the choice of treatment method. Taking all factors into account, it seems reasonable to conclude that SCS may be a therapeutic alternative for patients with an increased risk of surgical complications.

Adult↗
PubMed1998

Esophageal visceral pain sensitivity: effects of TENS and correlation with manometric findings.

Increased esophageal visceral sensitivity has been suggested to be an important factor in the development of esophageal chest pain. Transcutaneous electrical nerve stimulation (TENS) has been found effective in the treatment of visceral heart pain in severe angina pectoris, but its effect on esophageal pain perception is not known. In this study, we used the method of graded intraesophageal balloon distension to study the effects of TENS on esophageal motility and pain sensitivity. In addition, we explored the relationship between manometric findings and esophageal susceptibility to pain. TENS reduced symptoms during balloon distension significantly and decreased peristaltic velocity. Increased visceral perception was positively correlated to the amplitude and duration of the esophageal peristalsis. This study suggests a correlation between increased peristaltic waves and visceral perception in the esophagus. TENS appears to reduce esophageal pain sensitivity and thus may be a useful treatment for noncardiac chest pain of esophageal origin.

Aged↗
PubMed1998

Effects of spinal cord stimulation on coronary blood flow velocity.

BACKGROUND: Spinal cord stimulation (SCS) has been used in the treatment of severe angina pectoris since the 1980s. Several studies have shown both an antianginal and an anti-ischaemic effect. There are several theories about the mechanism behind the anti-ischaemic effect of SCS, including the possibility that it is dependent on an increase in coronary flow velocity. OBJECTIVE: To determine if there were effects of SCS on coronary flow velocity during cardiac stress. METHOD: Eight patients with severe anginal pain secondary to coronary artery disease who had been implanted with an SCS device were included in the study. In addition, four patients with syndrome X were examined. If possible, a Doppler guidewire was placed in the vessel corresponding to the ischaemic area revealed on a prior myocardial scintigram. A temporary pacemaker electrode was placed in the right atrium. Atrial pacing started at 80 beats/min and increased by 10 beats/min every 2 min until the patient experienced moderate angina; the pacing frequency was then maintained at the same level. After 2 min of pacing at this frequency, SCS treatment commenced; after a further 5 min, pacing was stopped. Throughout the procedure, coronary flow velocity, assessed as average peak velocity (APV), was monitored continually. RESULTS: APV increased during pacing in all the patients with coronary artery disease (mean increase 53%; P < 0.02). There were no significant changes in APV during maximum pacing frequency when stimulation was introduced. CONCLUSIONS: The results of this study do not support the theory that the anti-ischaemic effect of SCS is dependent on an increase in coronary flow velocity.

Angina Pectoris↗
PubMed1998

Myocardial turnover of endogenous opioids and calcitonin-gene-related peptide in the human heart and the effects of spinal cord stimulation on pacing-induced angina pectoris.

Earlier studies have shown that spinal cord stimulation (SCS) has antianginal and anti-ischemic effects in severe coronary artery disease. In the present study, 14 patients were subjected to right-sided atrial catheterization and atrial pacing. The patients were paced to angina during a control session and during spinal cord stimulation. Myocardial extraction of beta-endorphin (BE) during control pacing (8 +/- 22%) changed to release at the maximum pacing rate during treatment (-21 +/- 47%, a negative value representing release). Furthermore, the results indicate local myocardial turnover of leuenkephalin, BE and calcitonin-gene-related peptide. In addition, it is implied that SCS may induce myocardial release of BE which could explain the beneficial effects in myocardial ischemia.

Aged↗
PubMed1998

Relations between self-rated musculoskeletal symptoms and signs and psychological distress in chronic neck and shoulder pain.

The purposes of the present study were to describe physical and psychological characteristics of 55 chronic pain patients with predominantly nociceptive neck and shoulder complaints, and to explore relationships between physical assessment methods, self-reported pain and psychological distress. The physical measures included cervical and shoulder mobility and muscle tenderness. The Pain Severity and Interference subscales from the Multidimensional Pain Inventory (MPI), Becks Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI-Y), and a pain drawing assessed self-reports of pain and psychological distress. The number of tender points (TP score) correlated significantly with pain severity, (p < 0.01) Interference (p < 0.05), pain drawing score (p < 0.05), BDI (p < 0.05) and state anxiety (p < 0.05). No significant correlation was seen between TP score and age, pain duration or trait anxiety. The results suggest that there are relationships between observers' ratings of muscle tenderness (TP score) and self-reports of pain severity, interference of pain and psychological distress in patients with chronic cervico-brachial pain.

Adult↗
PubMed1997

Effects of pacing-induced myocardial stress and spinal cord stimulation on whole body and cardiac norepinephrine spillover.

AIMS: Spinal cord stimulation has been used in the treatment of intractable angina pectoris since the beginning of the 1980s. This study was designed to investigate whether the documented anti-ischaemic effects of spinal cord stimulation are mediated through a decrease in sympathetic activity. METHODS AND RESULTS: Ten patients with a spinal cord stimulator implanted as anti-anginal treatment were included in the study. Atrial pacing until the patient experienced moderate angina was performed and after 50 min rest the procedure was repeated during spinal cord stimulation. Total body and cardiac norepinephrine spillover was calculated and the former was found to have increased during pacing (47%, P = 0.02). When spinal cord stimulation was applied, total body norepinephrine spillover decreased at a comparable pacing rate (18%, P = 0.02). Cardiac norepinephrine spillover was not affected during the procedure. CONCLUSION: The results of this study indicate that the anti-ischaemic effect of spinal cord stimulation is not due to reduced cardiac sympathetic activity. However, spinal cord stimulation decreases overall sympathetic activity which may benefit the heart, possibly by reducing oxygen demand.

Aged↗
PubMed1995

Spinal cord stimulation in severe angina pectoris.

Since 1985, 225 patients suffering from severe pectoris due to New York Heart Association classes III-IV have been treated with spinal cord stimulation (SCS). All patients have been considered not suitable for open heart surgery by technical reasons. The long-term follow-up has shown a very good positive response to stimulation with pain relief, less intake of medication and increased quality of life. Several invasive studies with catheters in the coronary sinus and peripheral arteries have shown a significant improvement with stimulation regarding heart muscle lactate metabolism, blood flow in the coronary sinus and oxygen demand. Recordings with the so-called Holter technique have demonstrated that SCS does not create arrhythmias, and pacing studies that SCS does not mask ischemia at extreme workload. In conclusion, apart from the positive effect on the quality of life, SCS in angina pectoris has demonstrated antianginal and anti-ischemic effects. The clinical results and the physiological and hemodynamic measurements will be presented in detail.

Angina Pectoris↗
PubMed1995

Spinal cord stimulation in cardiovascular disease.

Spinal cord stimulation in ischemic pain conditions has proved to be an effective method of treatment for many patients. The indications are ischemic pain in the extremities from peripheral vascular disease and angina pectoris. The long-term results show that the response rate for ischemic pain is 70% to 90%, while the corresponding results for neuropathic pain average approximately 50% to 70%, which actually makes ischemic pain a very good indication for SCS. SCS system implantation is a safe and quick operation performed under local anesthesia and well tolerated by the patient. A total implant of the lead and the pulse-generator in one stage seldom takes more than 1 hour. High sterility and prophylactic antibiotics are prerequisites to avoid postoperative problems. In atherosclerosis, SCS should be regarded as a method supplementary to vascular surgery, to be used for symptom recurrence after treatment or when there are technical obstacles to reconstructive surgery. SCS has proven to be extremely effective for the relief of ischemic rest pain, which constitutes the most severe problem for these patients. Today it is estimated that more than 7000 implants for PVD have been done in Europe. In a prospective randomized study, Jivegård et al have shown that SCS is a limb-saving treatment. For angina pectoris, SCS by now has become a routine supplementary method to conventional medical and surgical treatment. The technique is clinically effective, and several studies have shown decreased myocardial ischemia and decreased anginal pain during treatment. It is probable that the use of SCS in refractory angina will increase considerably in the 1990s.

Cardiovascular Diseases↗
PubMed1994

[Spinal cord stimulation in severe angina pectoris. Reduced ischemia and increased quality of life].

Promising clinical results have been obtained with spinal cord stimulation which in recent years has been used for treating the subgroup of patients with angina pectoris that has proved intractable to conventional medical and surgical treatment strategies. According to recent reports, the anti-angina effect of spinal cord stimulation is associated with a reduction in myocardial ischaemia due to decreased myocardial oxygen consumption. Candidates for the treatment require careful screening. It is important to ensure that the patient is capable of full co-operation, and that the chest pain is due to true reversible myocardial ischaemia. Results in the 206 patients given implants to date have been encouraging, with reductions both in the frequency of angina attacks and in the consumption of short-acting nitroglycerin.

Angina Pectoris↗
PubMed1994

A comparative study of the effect of high-intensity transcutaneous nerve stimulation and oral naproxen on intrauterine pressure and menstrual pain in patients with primary dysmenorrhea.

OBJECTIVE: Our purpose was to compare the effects of high-intensity transcutaneous electrical nerve stimulation and oral naproxen (500 mg) on intrauterine pressure and menstrual pain. STUDY DESIGN: An open, randomized crossover study was performed on 12 women with primary dysmenorrhea. Intrauterine pressure was recorded with a microtransducer catheter, and the pain score was assessed by a visual analog scale. RESULTS: Before treatment all patients displayed signs of uterine hyperactivity as judged by a high resting pressure (7.5 +/- 0.4 kPa), high active pressure (24.0 +/- 0.8 kPa), and a high frequency of pressure cycles (13.3 +/- 0.5 contractions per 0.5 hour). Oral administration of naproxen suppressed (p < 0.01) all uterine activity parameters. Treatment with transcutaneous electrical nerve stimulation induced a prompt onset of pain relief in a strictly segmental manner, but there were no significant changes in uterine activity. The pain score was significantly reduced (p < 0.001) from 30 to 60 minutes after treatment with transcutaneous electrical nerve stimulation and from 19 to 120 minutes after naproxen administration. CONCLUSIONS: Treatment with transcutaneous electrical nerve stimulation induced a prompt onset of pain relief without any significant changes in uterine activity. Possible mechanisms for the pain relief, decreased uterine ischemia or decreased activity in the pain transmission system at spinal or supraspinal levels, are discussed.

Administration, Oral↗
PubMed1994

Safety aspects of spinal cord stimulation in severe angina pectoris.

BACKGROUND: Spinal cord stimulation has been used over the past decade for the treatment of patients suffering from intractable angina pectoris, despite having received optimal medical therapy, and who are unsuitable for further surgical intervention. The clinical results are promising and several studies have shown that the antianginal effect of the treatment is associated with a reduction in myocardial ischemia. It has been suggested, however, that spinal cord stimulation may only attenuate the transmission of pain from the heart, without influencing myocardial ischemia. This is a major safety concern when applying this treatment strategy. METHODS: The aim of this study was to assess the potentially unfavourable aspects of spinal cord stimulation in patients with severe coronary artery disease and angina pectoris by means of repeated long-term ECG recordings. Nineteen patients who had been accepted for implantation of spinal cord stimulators for the treatment of severe angina pectoris were included. RESULTS: No increases were noted in the frequency of ischemic episodes, the total ischemic burden, or the number of arrhythmic episodes during treatment. CONCLUSION: The results of this study do not indicate any unfavourable effects of spinal cord stimulation in severe angina pectoris in terms of an increase in the frequency or severity of myocardial ischemia during treatment with spinal cord stimulation.

Aged↗
PubMed1993

Effects of spinal cord stimulation in angina pectoris induced by pacing and possible mechanisms of action.

OBJECTIVE: To investigate the effects of spinal cord stimulation on myocardial ischaemia, coronary blood flow, and myocardial oxygen consumption in angina pectoris induced by atrial pacing. DESIGN: The heart was paced to angina during a control phase and treatment with spinal cord stimulation. Blood samples were drawn from a peripheral artery and the coronary sinus. SETTING: Multidisciplinary pain centre, department of medicine, Ostra Hospital, and Wallenberg Research Laboratory, Sahlgrenska Hospital, Gothenburg, Sweden. SUBJECTS: Twenty patients with intractable angina pectoris, all with a spinal cord stimulator implanted before the study. RESULTS: Spinal cord stimulation increased patients' tolerance to pacing (p < 0.001). At the pacing rate comparable to that producing angina during the control recording, myocardial lactate production during control session turned into extraction (p = 0.003) and, on the electrocardiogram, ST segment depression decreased, time to ST depression increased, and time to recovery from ST depression decreased (p = 0.01; p < 0.05, and p < 0.05, respectively). Spinal cord stimulation also reduced coronary sinus blood flow (p = 0.01) and myocardial oxygen consumption (p = 0.02). At the maximum pacing rate during treatment, all patients experienced anginal pain. Myocardial lactate extraction reverted to production (p < 0.01) and the magnitude and duration of ST segment depression increased to the same values as during control pacing, indicating that myocardial ischaemia during treatment with spinal cord stimulation gives rise to anginal pain. CONCLUSIONS: Spinal cord stimulation has an anti-anginal and anti-ischaemic effect in severe coronary artery disease. These effects seem to be secondary to a decrease in myocardial oxygen consumption. Furthermore, myocardial ischemia during treatment gives rise to anginal pain. Thus, spinal cord stimulation does not deprive the patient of a warning signal.

Aged↗
PubMed1993

Assessment of the influence of spinal cord stimulation on left ventricular function in patients with severe angina pectoris: an echocardiographic study.

Patients with severe, widespread coronary atherosclerosis and patients who have undergone several coronary artery bypass operations are often poor candidates for coronary bypass surgery (CABG). Spinal cord stimulation (SCS) has been shown to have an anti-anginal effect that is probably associated with an anti-ischaemic effect. In the present investigation, 15 patients with severe angina (mean age 64 years, range 49-71) were studied. All patients had a history of intractable angina pectoris despite optimal medical treatment and previous coronary bypass operation. The patients had multi-vessel disease and graft occlusion or graft stenosis on postoperative coronary angiograms. Left ventricular function was assessed echocardiographically at rest and during provocation with adenosine infusion in a control session without treatment and during treatment with SCS. The recovery time was at least 3 h. The decrease in the ejection fraction during adenosine infusion was more pronounced in the control situation (44 to 37%; P < 0.05) than during SCS (48 to 44%; ns), and the time to echocardiographic signs of dysfunction and to anginal pain during adenosine infusion was significantly prolonged during SCS (P < 0.001). In addition, the recovery time for these parameters was shorter during SCS (P < 0.001). It is concluded that the deterioration in left ventricular function during adenosine provocation was less pronounced with SCS than without. This possible anti-ischaemic effect is in agreement with results from earlier studies.

Adenosine↗
PubMed1993

Spinal cord stimulation in angina pectoris with normal coronary arteriograms.

BACKGROUND: Patients with angina pectoris with normal coronary arteriograms, also known as Syndrome X (typical exercise-induced angina pectoris, positive exercise testing, and normal coronary arteriograms), are often difficult to treat with conventional forms of medical therapy. Spinal cord stimulation has been used in recent years for the treatment of severe angina pectoris refractory to conventional medical and surgical therapy in coronary artery disease. The aim of this study was to investigate the effects of spinal cord stimulation on angina pectoris with normal coronary arteriograms. METHODS: Twelve patients underwent five bicycle exercise tests, three tests without (control), and two tests with spinal cord stimulation treatment. RESULTS: The exercise tolerance of the patients increased (108 +/- 22 W versus 96 +/- 21 W; P < 0.001), the magnitude of ST-segment depression at comparable work load decreased (1.0 +/- 0.6 mm versus 1.5 +/- 0.9 mm; P < 0.01), time to angina increased (5.4 +/- 2.2 min versus 2.7 +/- 1.9 min; P < 0.01), and time to the appearance of ST-segment depression increased (3.5 +/- 1.9 min versus 2.4 +/- 1.6 min; P < 0.01). The rate-pressure product at maximum work load during treatment increased, compared with the maximum work load during the control session (28,038 +/- 6124 mmHg x bpm versus 25,222 +/- 4519 mmHg x bpm; P < 0.05) and the comparable work load during treatment (28,038 +/- th 6124 mmHg x bpm versus 24,795 +/- 5022 mmHg x bpm; P < 0.01). CONCLUSIONS: Spinal cord stimulation has beneficial effects in angina pectoris with normal coronary arteriograms in terms of relief of symptoms of angina pectoris and improvement of exercise tolerance. These effects may be associated with a reduction in myocardial ischemia.

Aged↗