Diastolic filling in idiopathic dilated cardiomyopathy shows a good correlation to heart rate and ejection fraction but not to blood pressure as in healthy subjects.
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Blood Pressure↗
Biomedical subjects
F M Fruhwald
Publications and source records attributed to F M Fruhwald.
Left ventricular function in response to the transition from aerobic to anaerobic metabolism.
The purpose of this investigation was to study myocardial function at rest, during three phases of energy supply, and during recovery. Radionuclide angiography was performed during the aerobic phase (phase I, rest-first lactate increase), the aerobic-anaerobic transition phase (phase II, first lactate increase-second lactate increase), the anaerobic phase (phase III, second lactate increase-maximal work performance (Pmax)), and during recovery. Thirty-eight male patients (59 +/- 7 d after myocardial infarction) were compared with 19 healthy control subjects and 21 sport students of comparable age. Left ventricular ejection fraction (LVEF) increased from rest to phase I and from phase I to phase II in sports students and control subjects. During phase III, LVEF did not change significantly in sports students, but it decreased significantly in control subjects. This is in contrast to the patients, who showed an increase of LVEF from resting values (47 +/- 3%) to phase I (50 +/- 1%), no change during phase II (51 +/- 2%), and a decrease to resting values (45 +/- 2) during phase III. All subjects showed an increase in stroke volume (SV) during phase I and II, reaching a maximum at phase II. This was evidenced by an improvement of the systolic function with a constant left ventricular end-diastolic volume (EDV) in control subjects and sports students. In contrast, an improved SV in patients was achieved through an increase in EDV and a less distinct increase in the left ventricular end-systolic volume (ESV). Maximal LVEF values were measured during the first 90 s of recovery in all subjects. Values during recovery are not representative of load dependent myocardial function. This increase in LVEF does not cause an increase in cardiac output but is a consequence of changes in the EDV and ESV, which decrease again immediately after the end of exercise performance.
Adult↗
[Serum digoxin level in patients with dilated cardiomyopathy].
To investigate whether measuring levels of digoxin in patients with idiopathic dilated cardiomyopathy (IDC) is helpful in dose adjustment of digoxin we did the following study. In 77 patients (63 male, 14 female) with invasively verified IDC serum-digoxin levels were measured after a treatment period with beta-acetyldigoxin of at least 6 months. All patients received digoxin, 76 had ACE-inhibitors and 69 used diuretics. Mean serum-levels of digoxin were 0.96 ng/ml while using a mean daily dose of digoxin of 0.24 mg. Those who showed a serum level of digoxin within the recommended range took a slightly higher daily dose of digoxin when compared to those with low levels of digoxin (0.26 vs. 0.23 mg/day, p < 0.05). Therefore, we conclude that low serum-levels of digoxin are mainly caused by low intake of digoxin and it is justified to measure digoxin-levels in IDC-patients even if it increases costs.
Adult↗
[Current aspects of ACE inhibitor therapy from the cardiologic viewpoint].
From a cardiologist's view there are several established indications for the use of ACE-inhibitors like hypertension, heart failure and acute myocardial infarction. In other forms of coronary artery disease like stable and unstable angina and prevention of arteriosclerotic complications. ACE-inhibitors are under discussion. As antihypertensives ACE-inhibitors are about equally effective as calcium blockers, betablockers and diuretics without the negative effects on lipid metabolism and insulin sensitivity. Vascular and cardial remodelling are prevented with ACE-inhibitors at least to a certain degree. In heart failure ACE-inhibitors reduce morbidity and mortality, if left ventricular ejection fraction is reduced. In acute myocardial infarction ACE-inhibitors are indicated in overt heart failure, depressed left ventricular function and high-risk-patients. In silent ischaemia and secondary prevention ACE-inhibitors are under discussion.
Angiotensin-Converting Enzyme Inhibitors↗
[Smoking behavior and views on the smoking topic in the Styrian population--results of a survey at the Graz autumn convention].
Cigarette smoking has been identified as a major risk factor for cardiovascular diseases apart from hypercholesterolemia and arterial hypertension. Diseases of the respiratory system and several neoplasms as well as complications of pregnancy are considered to be "smoking-related", too. In order to survey the smoking habits and views on smoking in the Styrian population, a questionnaire was issued to 1034 visitors of the Graz Autumn Fair 1992. Pleasure proved to be the main motivation for smoking both in men and in women, habit, addiction, stress and boredom being further motivations. Not only non-smokers, but also smokers were assessed to be aware of smoking being a health hazard. Prohibition of tobacco advertising was accepted most widely as a mean of anti-smoking campaign. About half the non-smokers are exposed to environmental tobacco smoke, at place of work more frequently than at home. Percentage of smokers differs with age and job classes, however, no geographical variations were found. Further anti-smoking measures should be considered. Smoking restrictions at place of work and in public could prevent passive smoking. Ban on advertising seems to be the most effective anti-smoking campaign.
Adolescent↗
Dependence of soluble tumor necrosis factor receptor 1 and 2 values on the severity and duration of ischemic heart disease.
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Case-Control Studies↗
Systemic thrombolysis for early intracoronary stent thrombosis.
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Angioplasty, Balloon, Coronary↗
[Thrombosis of a prosthetic mitral valve in the anticardiolipin syndrome].
A 40-year-old woman in whom the mitral valve had to be replaced with a prosthetic one (St. Jude's) had to be reoperated 8 months later because of endocarditis on the second prosthetic valve (Carbo-Medics). Four months later her general condition deteriorated progressively with cough and dyspnoea, requiring hospitalization. Auscultation revealed moist rales over both lung bases; heart sounds were distant but otherwise normal. The "international normalized ratio" was 2.5, while erythrocyte sedimentation rate, white cell count and C-reactive protein were normal. Transthoracic echocardiography demonstrated a hardly moving mitral valve prosthesis with an opening area of 0.8 cm. Subsequently this decreased further and measurement of the anticardiolipin antibody titre revealed an IgG fraction of 37.9 U/ml (normal up to 12 U/ml). Within 48 hours thrombolysis with streptokinase had increased the valve's opening area to 1.8 cm. The patient made an uneventful recovery under strict anticoagulation. This case illustrates that the anticardiolipin syndrome can be a cause of an otherwise unclear genesis.
Adult↗
Transient reduction of autoantibodies against oxidized LDL in patients with acute myocardial infarction.
Fifteen consecutive patients (mean age 66 +/- 14, range 31-82) with an acute myocardial infarction (MI) suitable for thrombolytic therapy were included in this study. Autoantibodies against oxidized low-density lipoprotein (LDL) were determined by enzyme-linked immunosorbent assay (ELISA). Patients (n = 10) with marked elevation of the MB isoenzyme of creatinine kinase (CK-MB)-mass had significant decreases of oLDL-Ab during the acute phase, with a minimum after 8 h following the onset of thrombolytic therapy (within-group significance: p < .001; between groups: p = .01). Patients (n = 5) with CK-MB-mass values less than 70 ng/ml did not show this phenomenon. Furthermore, significant correlations existed between CK-MB-mass and oLDL-Ab after 6 and 8 h (n = 15; r = .72; p = .003) and the time of the highest CK-MB-mass values (after 12 h) and the time of the maximal decrease of oLDL-Ab (after 8 h) (r = .74; p = .003). Our observations provide further evidence for the release of free radicals and for increased lipid peroxidation during reperfusion after prolonged ischemia. The decrease of oLDL-Ab appears to be a marker for the severity of MI.
Adult↗
[Coronary aneurysm in a 69-year-old patient. Transthoracic echocardiography].
This case report is on a 69-year old male patient treated with cephalosporins because of suspected myocarditis due to borreliosis. Using transthoracic echocardiography a big aneurysm of the proximal part of the left coronary artery was detected. Coronary angiography revealed an aneurysm 1.2 cm in diameter at the origin of the left anterior descending branch and confirmed the initial diagnosis. In addition, coronary three-vessel disease with reduced left ventricular function was found. Coronaritis due to Lyme borreliosis could not be ruled out with certainty. The patient was relatively asymptomatic, and hence conservative therapy was recommended. The case described here serves as a basis for a discussion on the aetiology, clinical manifestation, diagnosis and therapeutic management of coronary aneurysms.
Aged↗
Effects of treadmill exercise protocol with constant and ascending grade on levelling-off O2 uptake and VO2 max.
In order to investigate the effect of an exercise protocol on the levelling-off O2 uptake and VO2 max values, ten male subjects aged 28 +/- 5 yrs, height 1.8 +/- 0.05 m, body mass 76 +/- 6 kg performed two treadmill exercise protocols: 1) constant grade (CG) of 5%, with increasing running speed starting at 6 km.h-1 and increments of 2 km.h-1 every 3 minutes. 2) ascending grade (AG) starting at 0% and increments of 5% every 3 minutes, with constant running speed of 5 km.h-1. During each protocol oxygen uptake (VO2), pulmonary ventilation (VE), tidal volume (Vt), and breathing rate (BR) as well as blood lactate concentration (La) and heart rate (HR) were measured. In CG a levelling-off phenomenon of VO2 in all cases was observed. Aerobic capacity expressed as VO2 max in CG was 46.2 +/- 6.0 ml.min-1.kg-1. In contrast, VO2 max was 35% higher in AG (62.6 +/- 7.2 ml.min-1.kg-1). The behaviour of VO2 indicates a lower efficiency with increasing work load in AG as compared to CG. Regarding maximum performance it can be concluded that VO2 in CG seems to be limited by a mechanical or neuromuscular constraint on the depth of breathing, which is confirmed by a distinct flattening of Vt. The levelling-off of the VO2 in CG, something which is not observed in AG, can be explained plausibly this way.
Adult↗
Changes in thyroid hormone parameters after acute myocardial infarction.
Abnormalities in circulating thyroid hormone levels are very common in systemic nonthyroidal illnesses, such as acute myocardial infarction. In this study, thyroid parameters were determined in a series of 16 consecutive infarction patients treated by thrombolysis. Blood samples were taken before therapy as well as 2, 4, 6, 8, 12 and 72 h following admission. Total and free serum thyroxin and triiodothyronine decreased and reverse T3 increased significantly showing no major variations up to 72 h, whereas thyroid-stimulating hormone values remained almost unchanged during the observation period. Subjects with CK-MB levels of more than 150 ng/ml (n = 10) revealed similar changes in thyroid parameters in comparison to those with lower values (n = 6; NS). Thus, although hormone modifications very often occur following acute infarction, thyroid status may not serve as a marker for the extent of left ventricular dysfunction in the early phase of myocardial infarction.
Aged↗
[Hypertension and hemorheology].
A number of epidemiologic studies have provided evidence for an increased blood viscosity in hypertensive patients. Increased viscosity could result either from hemoconcentration, thus constituting a secondary phenomenon, or, alternatively, result directly from increased intracellular calcium concentrations in erythrocytes. The latter would augment the aggregating potential of these cellular blood compounds. This currently hypothetic view remains to be elucidated. Enhanced viscosity, however, may result in increased peripheral resistance and lead to hypertensive complications. The evaluation of antihypertensive therapy should therefore take possible effects upon blood viscosity into account.
Antihypertensive Agents↗
[Thrombolytic therapy of acute myocardial infarct in advanced age (based on 2 case reports)].
The introduction of thrombolysis has reduced the mortality of acute myocardial infarction (MI) by 25%. Large-scale studies have revealed that especially patients over 65 benefit from this therapy. Nevertheless, many centers apply an age limit for thrombolytic therapy due to the higher risk of stroke or bleeding in elderly patients. In 1993 181 patients suffering from acute MI were admitted to the intensive care unit of the University Clinic of Internal Medicine, Graz, and 54 (29.4%) of them were treated with fibrinolytic drugs. In this paper we report on the successful thrombolytic management of acute MI in two male patients (87 and 88 years old) who were treated with 100 mg recombinant tissue-type plasminogen activator complex. As a sign of successful reperfusion a rapid increase in plasma creatinine kinase levels and fast amelioration of the ischemia-related ECG changes were observed. In the follow-up examination after four months the first patients showed only minimal exertional dyspnea and was otherwise well. The second patient died one month after MI following a laparotomy for ileus. We draw the conclusion that patients of advanced age also benefit from thrombolytic treatment of acute myocardial infarction, but the indications and contraindications have to be carefully observed.
Aged↗
[Dilated cardiomyopathy--diagnosis and conservative therapy].
Diagnosis of dilated cardiomyopathy (IDC) is a diagnosis of exclusion. Physical examination of the patient, non-invasive tests and invasive tests have to be done to exclude secondary dilated cardiomyopathies. Treatment can be divided into baseline therapy, established treatment, e.g. ACE-inhibitors, digitalis and diuretics and optional treatment including betablocker, anticoagulation and an natural course of IDC for an individual patient is not clear although there are several prognostic parameters for this disease.
Angiotensin-Converting Enzyme Inhibitors↗
Long-term outcome and prognostic factors in dilated cardiomyopathy. Preliminary results.
UNLABELLED: To investigate long-term follow-up and identify prognostic factors in patients with dilated cardiomyopathy (DCM) the authors investigated 167 consecutive patients on an outpatient basis. All patients underwent left- and right-heart catheterization; follow-up comprised clinical and echocardiographic investigations. RESULTS: After a mean follow-up period of ninety-three +/- thirty-six months 82 patients (49%; 71 men, 11 women, mean age fifty-five +/- eleven years) were alive. 29 of them (27 men, 2 women, mean age fifty-two +/- nine) showed normal left ventricular ejection fraction (LVEF) after a mean follow-up period of one hundred four +/- forty months. The remaining 53 patients (44 men, 9 women, mean age fifty-six +/- eleven) revealed LVEF similar to that of the first examination. Eighty-five patients died (51%; 73 men, 12 women). Causes of death were the following: progressive heart failure, 24; sudden death, 23; stroke, 3; pulmonary embolism, 2; noncardiac death, 4; unknown causes, 29. The median period from the onset of first symptoms until definite diagnosis was two months in patients with stable conditions, three months in those with normalization of LVEF and twenty-four months in those who died, respectively (P < 0.01). At the time of diagnosis, patients with stable outcome had a mean LVEF (LVEF 1) of 37%, those who returned to normal had 40% (ns). Patients who died had a mean LVEF 1 of 32% and therefore differed significantly from both groups of survivors (P < 0.001). Left ventricular end-diastolic pressure (LVEDP) at the time of diagnosis was highest in patients who died (22 mmHg) and therefore differed significantly from both groups of survivors (normalization: 16 mmHg, stable patients: 18 mmHg, P < 0.001). CONCLUSIONS: According to their results, time until diagnosis, LVEF, and LVEDP are prognostic indicators. No difference was noted between the groups concerning etiology, medical treatment, or functional classification according to the New York Heart Association.
Adult↗
[10-year-follow-up of patients with silent Cohn type 1 myocardial ischemia].
Prevalence of type 1 silent myocardial ischemia (SMI; completely asymptomatic patients) is reported to appear 2 to 4% of the general population. The prognosis of these patients is said to be similar to that of patients with angina pectoris. Our study investigated a 10-year follow up of silent myocardial ischemia detected by bicycle exercise testing in comparison to a comparable control group. 10 years later 127 patients were reinvestigated by bicycle ergometry, 33 patients out of the SMI-group (group A) and 84 patients out of the control group (group B). Mean age in group A was 62 +/- 7 years (range 42 to 71 years), in group B 56 +/- 7 years (range 29 to 69 years). After 10 years there was no statistical significant difference between the 2 groups on using beta-blockers, calciumchannel-blockers and nitrates, on arterial hypertension, diabetes mellitus, smoking history and positive family-history as well as in total cholesterol, HDL- and LDL-cholesterol, triglycerides, blood glucose and uric acid. 1 patient of A and 2 of B died from a sudden cardiac death, 2 of A and 7 of B survived a myocardial infarction, 11 of A and 11 of B developed angina pectoris (p < 0.05). A statistical significant difference was found in the ergometric working capacity (maximal workload in Watt) between the 2 groups (p < 0.001) that did not change over the 10 years, the control group worked better in both investigations. SMI type 1, detected by bicycle ergometry seems to be only a risk factor for developing "loud ischemia" (= angina pectoris) but not for "hard events". A routine screening of completely asymptomatic persons with bicycle ergometry seems to have no prognostic relevance.
Adult↗
[Physical activity at intermediate altitude by healthy probands and patients with coronary sclerosis].
For the majority of the population, exposure to altitudes higher than 2000 m above sea level constitutes a situation of pronounced stimulation of the organism. The question comes in of the health relevance of physical activity at intermediate altitudes for the healthy subjects, but above all for people with heart problems. At first, there is an acute adaption on the cardiovascular and the respiration system as well as the system of oxygen carriage, until the chronic adaption processes of the same systems are completed. Doubtlessly, these adaption processes at intermediate altitudes and in particular training in such regions considerably improve the endurance capacity under conditions of the kind mentioned. However there is little evidence, for an absolute improvement of the maximal aerobic capacity. As a rule, the effects of adaption to higher altitudes can also be expected in patients with coronary sclerosis. But a lowered level of capacity must be taken into account in these cases. Accordingly, the medication as well as the intensity of stress should be adapted to altered conditions of this kind. Training intensity must be reduced according to altitude, and any treatment for angina, must be intensified. It may be necessary to re-determine the appropriate training intensity as well as the dosage in pharmacotherapy by ergometric methods to match the new requirements. However, when a comparison is tried to kinetotherapy under normal conditions, an immediate therapeutical effect of exposition to higher altitudes appears to be at least doubtful.
Acclimatization↗