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Biomedical subjects

E Goldhammer

Publications and source records attributed to E Goldhammer.

At least 37 records · Page 2Linked to original sources
PubMed1990

An exercise hemodynamic comparison of verapamil, diltiazem, and amlodipine in coronary artery disease.

A prospective, randomized study compared the effects of equivalent intravenous doses of three slow calcium-channel blockers (verapamil, diltiazem, and amlodipine) on rest and exercise haemodynamics in 30 ischemic heart disease patients. Following a stable control period during which rest and exercise (supine bicycle) hemodynamics were assessed, equivalent hypotensive doses of each compound were administered over 20 minutes and rest/exercise parameters were assessed 10 minutes later. At rest all agents similarly reduced systemic blood pressure; the fall in systemic vascular resistance and the increase in cardiac indices was ranked: amlodipine greater than diltiazem greater than verapamil. The heart rate increase for amlodopine differed from verapamil and diltiazem (+19.4% vs. +1.5% vs. -7%; p less than 0.01). On exercise, similarly greater falls in the systemic vascular resistance index followed amlodipine, compared with verapamil and diltiazem (p less than 0.05). Only amlodipine significantly reduced the exercise pulmonary artery occlusion pressure (PAOP). Exercise cardiac stroke volume improved after diltiazem and amlodipine. In terms of cardiac performance, both amlodipine and diltiazem produced an improvement, whereas verapamil depressed cardiac pumping activity. Thus, hemodynamic differences between slow-calcium-channel blocking drugs may be demonstrated in humans. These differences would be compatible with a predominant peripheral vascular site of action for amlodipine, in contrast with mixed cardiac and peripheral sites for diltiazem and verapamil.

Amlodipine↗
PubMed1990

How does posture influence the haemodynamic assessment of a cardiovascular drug? Experience with nicardipine.

The extent to which posture altered the haemodynamic response to slow calcium channel blocker nicardipine was evaluated in 22 male patients with angiographically confirmed coronary artery disease. Patients were randomly allocated to supine or upright posture and an otherwise identical protocol performed in each group. At rest, following a control saline period, four doses of the drug (log cumulative dosage: 1.25, 2.5, 5.0, and 10.0 mg) were administered by i.v. infusion over a total period of 40 min; haemodynamic indices were recorded during the 3-5 min following each 5 min infusion. The exercise effects of the drug, in each posture, were determined by comparison of a control predrug exercise with observations at the same workload following the maximal cumulative dose. Nicardipine reduced resting mean blood pressure (MBP) and systemic vascular resistance index (SVRI) in both postures, the decrease being more pronounced when upright (MBP, -12%, -18%; p less than 0.01: SVRI, -30%, -46%; p less than 0.01). The increases in cardiac index (CI) and stroke volume index (SVI) were higher when upright (29 and 54% vs. 10 and 27%; p less than 0.01). Pulmonary artery occluded pressure (PAOP) increased by 29% when upright, without change when supine. On exercise, the effects for HR, MBP, CI, SI, and SVRI responses were independent of posture; however, a qualitative difference was apparent for PAOP (-17% vs. +14%; p less than 0.05). Thus, although the actions of nicardipine were qualitatively similar, quantitative differences related to posture were confirmed. These differences appeared to relate to posture-related baseline haemodynamic differences between the groups but with similar postnicardipine absolute values.

Adult↗
PubMed1990

Comparative analysis of cardiopulmonary responses during dynamic exercise with wrist weights in the elderly versus young hypertensive responders.

Endurance exercise is usually prescribed with caution for hypertensive patients because of the possible adverse effects of increased blood pressure on cardiorespiratory function. Cardiopulmonary responses were studied in 11 young (37 +/- 4 years) and 10 elderly (65 +/- 4 years) male subjects during treadmill exercise with wrist weights (WW) and with no weights (NW) at constant 60% of their maximal heart rate for 8 min at each exercise condition. The results revealed that both groups had similar responses at rest. During maximal stress test, heart rate, oxygen consumption and minute ventilation were significantly (p less than 0.01) higher in the younger subjects. During 60% WW and NW exercises heart rate, oxygen consumption and minute ventilation were significantly (p less than 0.01) lower in the elderly than in the younger group. Diastolic and mean arterial blood pressures were significantly (p less than 0.01) higher in both groups during WW compared to NW exercise. However, minute ventilation and rate-perceived exertion were significantly (p less than 0.01) higher during NW compared to WW exercise. These measurements indicated a similar pattern of hemodynamics in younger and elderly hypertensive responders, with variable respiratory responses to endurance exercise. In addition, careful observation of blood pressure during exercise with WW is recommended for both groups where an increased afterload is contraindicated. We recommend the usage of controlled WW exercise for hypertensive responders of all age groups as part of their rehabilitative program.

Adult↗
PubMed1990

Cardiac arrhythmia in chronic renal failure: Holter monitoring during hemodialysis and intermittent peritoneal dialysis.

Twenty patients undergoing intermittent peritoneal dialysis (IPD) and 20 patients on hemodialysis (HD) for end-stage kidney disease underwent Holter ECG monitoring for a continuous 24-h period, starting prior to the onset of dialysis and continuing until several hours after it. Clinically significant ventricular arrhythmias were found in only 2 of 20 patients in the HD group; no such ventricular arrhythmias were observed in the IPD group. Supraventricular arrhythmias were equally prevalent in both groups. Thus, the differences between IPD and HD are not great and it seems that HD is, at most, a mild arrhythmogenic procedure. However, in patients with proven heart disease or signs of left ventricular hypertrophy, peritoneal dialysis (intermittent or continuous ambulatory) appears to be preferable to HD.

Adult↗
PubMed1989

Effects of nicorandil on left ventricular hemodynamics and volume at rest and during exercise-induced angina pectoris.

The hemodynamic effects of nicorandil (20 mg) were compared with placebo in a double-blind study of 20 patients with angiographically proved coronary artery disease at rest before and 7, 15, 30 and 60 minutes after oral dosing. The impact of the drug on left ventricular (LV) hemodynamics and volume during exercise-induced angina was determined by repeating exercise 60 minutes after drug administration, at the same work load that reliably induced angina during control predrug exercise. At rest, nicorandil reduced all components of systemic arterial pressure without change in cardiac or stroke volume indexes or heart rate. Pulmonary artery occluded pressure was reduced without change in LV ejection fraction or systemic vascular resistance index. Effects were evident at 7 minutes and peaked at 30 minutes with attenuation at 60 minutes. Compared with control supine bicycle exercise, the drug (at 60 minutes) reduced mean systemic arterial pressure and LV filling pressure without change in cardiac stroke volume indexes and heart rate. There was a smaller increase in LV ejection fraction. These data suggested greatest impact on LV function during exercise when substantial decreases in filling pressure occurred at maintained cardiac pumping indexes.

Adult↗
PubMed1989

Doppler assessment of the effects of isometric stress on left ventricular filling in hypertensive young adults.

Doppler interrogation at the in-flow of the left ventricle was used to test the effects of isometric stress on ventricular filling in 7 hypertensive subjects with mild to moderate left ventricular hypertrophy, aged forty-two +/- seven years, compared with 9 matched healthy control males. In the hypertensive patients at rest, peak early diastolic (E) velocity was lower, and atrial (A) velocity higher, with lower E/A peak velocity ratios than in normals (p less than 0.05). These differences were more accentuated during isometric stress. Atrial filling fractions were higher in hypertensives (37 +/- 6%) than in normals (24 +/- 7%) at rest, p less than 0.05, and this difference increased during isometric stress (44 +/- 9% versus 30 +/- 11%). Thus, isometric stress accentuated the reliance of left ventricular filling on atrial contribution and may be applied for the detection of early ventricular filling abnormalities in patients with mild hypertension. The systolic blood pressure and the hypertrophic process were both important determinants of left ventricular diastolic filling.

Adult↗
PubMed1988

Left ventricular and hemodynamic responses during upright isometric exercise in normal young and elderly men.

Cardiovascular responses were studied echocardiographically in 10 young (23 +/- 3 years) and 10 elderly (67 +/- 4 years) men, during upright isometric handgrip and deadlift. During handgrip and deadlift both groups showed significant increases in systolic and diastolic blood pressure. Those responses were significantly greater in both groups during deadlift. Heart rate was significantly higher in both groups during deadlift than resting and handgrip values. Oxygen uptake increased progressively and significantly across conditions, and was significantly higher for the younger subjects. Ejection fraction remained unchanged during handgrip in both groups. During deadlift it remained unchanged in the elderly while it increased significantly in the younger. Both groups increased significantly heart volumes from rest to handgrip. During deadlift end systolic volume was significantly lower from resting and handgrip values only in the young group. These data indicate a similar cardiovascular response to acute pressure overload in both groups.

Adult↗
PubMed1988

Aging and the effect of increased after-load on left ventricular contractile state.

Hemodynamic and contractile states were studied echocardiographically in 10 young (28 +/- 3 yr) and 10 elderly (67 +/- 4 yr) male subjects at rest and during upright isometric exercise which involved the hands, hips, legs, and lower back muscle groups (deadlift) at 30% of maximum voluntary contraction for 3 min. During deadlift, both groups showed similar and significant increases in blood pressure and heart rate, compared to the resting values. Ejection fraction at rest did not differ significantly between the two groups. During deadlift, it remained unchanged in the elderly white ejection fraction increased significantly in the younger subjects. No significant changes in left ventricular end-diastolic volume occurred in either group during deadlift. End-systolic volume remained unchanged in the elderly while it decreased significantly in the younger subjects. These data indicate that cardiovascular responses and contractile state in normal young men and normal exercise-trained elderly subjects were augmented during upright sub-maximal isometric deadlift exercise, utilizing large muscle mass. However, left ventricular contractility increased less in the elderly subjects compared to the younger subjects.

Adult↗
PubMed1987

Temporary transvenous pacing: analysis of indications, complications and malfunctions in acute myocardial infarction versus noninfarction settings.

The clinical records of 339 consecutive patients who had received temporary transvenous pacemakers were analyzed for indications, complications and malfunctions. Of the 156 patients who had had an acute myocardial infarction (AMI), 50% had had anterior wall and 43.6% inferior wall involvement. The route of electrode insertion was the antecubital vein in 71%, subclavian vein in 24%, internal jugular vein in 4%, and a femoral vein in the remainder. The indication for pacing in the AMI group was atrioventricular (A-V) block in 55%, fascicular block in 32% and other arrhythmias in 13% of the cases. In the non-AMI group, the indication for pacing was A-V block in 46.4%, sick sinus syndrome in 25%, preparation for noncardiac surgery in 12%, and diagnostic purposes in the remainder. Ventricular fibrillation (VF) occurred only in the AMI group and appeared in 9 (5.66%) of these cases. The site of infarction did not significantly affect the incidence of VF. Ventricular premature beats (VPBs) and ventricular tachycardia (VT) appeared in 28.8 and 12.8% of the AMI group and 4.4 and 3.3% of the non-AMI group, respectively. No difference in the incidence of myocardial perforation, sepsis, and phlebitis was encountered between the AMI and non-AMI groups. Total malfunction rate was significantly higher in the AMI group (15%) vs. the non-AMI group (4%). A higher rate of pacing malfunction was found when a semifloating electrode was used through the subclavian vein (14.3%) vs. a 6 or 7 French electrode through the antecubital vein (7%). Thus, temporary pacing is safe and associated with lower incidence of complications and malfunctions in non-AMI than in AMI subjects. Moreover, a lower incidence of malfunction was encountered when a 6 or 7 French electrode was inserted through the antecubital vein.

Aged↗
PubMed1985

[Mexiletine].

Explore the source record for details and available documents.

Humans↗
PubMed1984

Pulmonary varices, benign congenital anomalies simulating perihilar masses of various etiologies.

Pulmonary varices are rare and relatively benign congenital malformations. These localized aneurysmatic dilatations of pulmonary veins drain normally to the left atrium. Their radiological appearance may simulate perihilar masses of neoplastic or granulomatous origin and pulmonary arteriovenous fistulae, thus, potentially leading to diagnostic pitfalls. The diagnosis is made during the venous phase of pulmonary angiography which is always necessary in order to avoid unnecessary surgical procedures. An illustrative case and discussion of the subject is presented herein.

Arteriovenous Fistula↗
PubMed1983

Campylobacter enteritis associated with recurrent abortions in agammaglobulinemia.

Campylobacter enteritis and habitual abortions occurred in a 28-year-old patient suffering from agammaglobulinemia. Campylobacter jejuni has been recently recognized to be a common treatable cause of diarrhea in man. Since bacterial overgrowth of the small intestine is increased in hypo- or agammaglobulinemia, Campylobacter is expected to be found in those patients. As this patient's abortions might have been due to the same infection, Campylobacter should be considered in the differential diagnosis of habitual abortions, especially if associated with diarrheal disease. This treatable disease must be sought in every case of agammaglobulinemia and gastro-intestinal complaints, before complicated diagnostic procedures are performed or potentially toxic drugs are administered.

Abortion, Habitual↗