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Biomedical subjects

G Blümchen

Publications and source records attributed to G Blümchen.

At least 19 recordsLinked to original sources
PubMed1992

[Short stature as a risk indicator for coronary patients].

BACKGROUND: Short stature as an indicator of coronary disease in German men is described. PATIENTS AND METHODOLOGY: A total of 4,524 patients investigated by coronary angiography (history of myocardial infarction and at least one vessel greater than or equal to 75% stenotic or occluded on angiography and, in addition corresponding levocardiographic changes) and 722 age-matched test subjects with unremarkable coronary angiographic findings were admitted to the study. RESULTS: The patients with coronary heart disease were, on average, 1.9 cm shorter than those with unremarkable blood vessels. This difference in height was found in particular in the age group between 40 and 60 years old. The reason for this is not known.

Adult↗
PubMed1992

Relationship between stature and coronary heart disease in a German male population.

Short stature in men has previously been associated with a higher risk of coronary heart disease. In order to further investigate this observation, the physical characteristics of 4470 German men admitted to the Klinik Roderbirken between 1978 and 1989 with a documented myocardial infarction and with a stenosis greater than or equal to 75% in at least one vessel were compared to those of 711 male controls. Results indicated that the myocardial infarct group was significantly shorter by 1.8 cm than the control group (p less than 0.001). However, discriminant function analysis indicated that height accounted for only 1% of the variance between the cardiac and control patients. Classification analysis further indicated that on the basis of height, the percentage of subjects correctly classified for grouping was no better than 54% for the myocardial infarct patients and 57% for the controls. It was concluded that height exerted a minimal influence on coronary heart disease in this population.

Adult↗
PubMed1991

Randomized 4-week exercise program in patients with impaired left ventricular function.

BACKGROUND: This study was designed to determine the controlled effects of a short-term exercise rehabilitation program on patients with moderate-to-severe left ventricular dysfunction after a recent myocardial infarction. METHODS AND RESULTS: Thirty-nine male patients 51 +/- 8 years old with a large anterior myocardial infarction less than 10 weeks old were recruited for the study. The patients were randomly assigned to either one of two training or control groups on the basis of their resting ejection fraction: training, less than 30%; control, less than 30%; training, 31-50%; or control, 31-50%. Patients were evaluated for filling pressures, radionuclide ventriculography, heart volume, echocardiography, and work capacity. Patients who underwent training participated in an intensive 4-week in-hospital exercise program, whereas the control patients were restricted to a minimal activity program. Results indicated that there were no significant improvements in resting, submaximal, and maximal hemodynamic measurements as a result of the program. Mean work capacity and peak oxygen consumption improved significantly in the less-than-30% training group but was accompanied by a significant increase in mean pulmonary wedge pressure. Resting ejection fraction improved markedly in both less-than-30% training and control patients, but ejection fraction measures were not associated with work capacity. Training did not cause further deterioration in ventricular function. CONCLUSIONS: It was concluded that in the present study, exercise training had little or no effect on hemodynamic measurements and that the training effects achieved in patients with left ventricular dysfunction are most likely due to corrected impaired vasodilation, not necessarily to cardiac function. The importance of using a control group in this type of study and the wide interindividual variations in training responses are emphasized.

Exercise Therapy↗
PubMed1991

Ambulatory blood pressure and Holter monitoring during tennis play.

The effect of tennis play on blood pressure, heart rate response, and rhythm disturbances was evaluated in 21 men 39 to 61 years of age (M = 49.5 +/- 6.7 yrs). A Holter monitor was utilized for continuous ECG recording during tennis play and a portable ambulatory blood pressure recorder (Spacelabs) was used to measure blood pressures and heart rates periodically during tennis matches. The results indicated that blood pressure response to tennis (singles), although an activity of moderate aerobic intensity, can exert significant increases in systolic and diastolic blood pressure even in those persons who are normotensive at rest. Excessive body weight, and particularly abdominal deposition, appears associated with an increase in diastolic blood pressure to exercise. Few heart rhythm disturbances of consequence were uncovered. A simple submaximal step test such as the Canadian Aerobic Fitness Test, with ECG monitoring, could assist in detecting those individuals susceptible to an exaggerated blood pressure response and to heart rhythm disturbances at exercise.

Adult↗
PubMed1990

[Long-term course of conservatively and surgically treated patients with an intramural heart infarct].

Thirty patients with a first nontransmural myocardial infarction (MI) were examined retrospectively. The patients had been treated either surgically or conservatively on the basis of the clinical and morphological findings. Three years following infarction, 28 of the 30 patients were still alive (93.3%). 10 of the 13 patients with one vessel disease and 7 of the 17 patients with two or three vessel disease were gainfully employed. The unfavorable natural course of nontransmural myocardial infarction favors an aggressive diagnostic and therapeutic approach since the survival rate of these patients is only 60 to 70% after three years. The results of this study demonstrates convincingly the economic and social benefits of our diagnostic and therapeutical interventions.

Adult↗
PubMed1990

Metabolic equivalents (METS) in exercise testing, exercise prescription, and evaluation of functional capacity.

One metabolic equivalent (MET) is defined as the amount of oxygen consumed while sitting at rest and is equal to 3.5 ml O2 per kg body weight x min. The MET concept represents a simple, practical, and easily understood procedure for expressing the energy cost of physical activities as a multiple of the resting metabolic rate. The energy cost of an activity can be determined by dividing the relative oxygen cost of the activity (ml O2/kg/min) x by 3.5. This article summarizes and presents energy expenditure values for numerous household and recreational activities in both METS and watts units. Also, the intensity levels (in METS) for selected exercise protocols are compared stage by stage. In spite of its limitations, the MET concept provides a convenient method to describe the functional capacity or exercise tolerance of an individual as determined from progressive exercise testing and to define a repertoire of physical activities in which a person may participate safely, without exceeding a prescribed intensity level.

Activities of Daily Living↗
PubMed1990

[Four-week training of patients with large anterior wall infarct: comparison with a randomized untrained control group].

Thirty-nine male patients (average age 50.8 years +/- 8.4 years) with a large anterior myocardial infarction (average 45.6 days +/- 10.5 days ago) and with moderate to severe left-ventricular dysfunction (RNVA EF less than 50%) participated in the study. The patients were randomly assigned to either a training group or to a control group. They were also subdivided into training/control groups (EF less than 30% and EF = 30-50%). The training program consisted of three to four sessions per day, 5 days a week, at an intensity of up to 1 W/kg body wt. (approximately 4-5 METS). The following evaluations were recorded prior to and following the 4-week training program: relative heart volume (x-ray), echocardiographic data (enddiastolic diameter, ES-distance, and shortening fraction), and exercise stress test (work capacity, heart rate). Filling pressures, cardiac outpout, and stroke volume index were calculated from right-heart catheterization (Swan-Ganz) at rest and during exercise. Results indicate that there were no significant changes in relative heart volume, end-diastolic volume, ES-distance, resting heart rate, PCP at rest, and ejection fraction during exercise as a result of the training program. Shortening fraction showed a tendency to improve (not significant). Work capacity increased by 15 W (p less than 0.05) in the training group and by 28 W (1.5 METS, p less than 0.05) in the EF less than 30% training-group as compared with the control group. Cardiac output at rest decreased by 10% (p less than 0.05). Stroke-volume index increased in the EF greater than 30% training-group, while heart rate was reduced.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Output↗
PubMed1990

[A survey of the medical and psychosocial status of 140 workers 32 months following myocardial infarct].

We suspected there could be different social, psychological, and medical problems for women after a first myocardial infarction than those affecting men. 140 women (56.4 +/- 7 years) were interviewed by questionnaire 32 +/- 8.7 months after myocardial infarction; 83% (n = 119) responded (8.8% of the sample group had died), 12% suffered a reinfarction, and 11% underwent aortocoronary bypass surgery. For 84% of those responding it was harder to do their housework after myocardial infarction, but 73% did it without help. 51.5% showed a mood change that included increasing depression, anxiousness, and insecurity. In 12.5% of the women their relationship with their husband was adversely affected; in 6.6% their relationship with their children worsened. 83% (n = 89) saw their infarction as a result of stress. 45% could not relieve their stress after 32 months. A subjective feeling of stress decrease in 54% was achieved with a quieter life, in 39.5% by resigning their jobs, and in 6.5% by the death of the husband. Concerning somatic risk factors 74% of the smokers stopped smoking; oral contraceptives were discontinued in all cases. 90.5% (n = 97) of the women said they had their serum lipid values checked regularly, but these were only under control in 35%. We conclude the rehabilitation process does not end when patients leave a rehabilitation clinic. Patients should acquire household help, and their family situation should be discussed during their stay in the rehabilitation clinic. Concerning the somatic risk factors, women who survive myocardial infarction require better care and information.

Adult↗
PubMed1989

[Development of tolerance in continuous nitroglycerin infusion].

For treatment of unstable angina pectoris or recent myocardial infarction, intravenous NTG is frequently employed, beginning with doses of 3 mg/h or more; thereafter, dependent on the clinical course, in particular, if the blood pressure is lowered notably, the dose may be reduced to 1 or 2 mg/h. Reports published in recent years have documented to the development of tolerance to nitrates when given orally in higher doses three times daily or administered by the transdermal mode. Accordingly, we suspected that tolerance development would be the inevitable outcome during a continuous intravenous infusion of NTG. Consequently, this placebo-controlled study was undertaken to determine whether tolerance develops during a continuous 28-hour infusion of NTG and whether tolerance is reversible on interruption of the treatment with a twelve-hour infusion-free interval. The studies were performed in ten male patients ranging in age from 49 to 65 years, mean age 53 years. All patients had recovered from myocardial infarction (mean interval since infarction 42 days) and had reproducible, asymptomatic ST-segment depression of at least 0.2 mV during exercise testing after discontinuation of all antiischemic drugs with a washout period of three days. Exercise testing was performed at four hours after beginning the infusion of 1.5 mg/h NTG or placebo (2 p.m.), at 28 hours after beginning the infusion (2 p.m. on the second day) and, after having discontinued the infusion for a twelve-hour period (from 10 p.m. to 10 a.m.), at four hours after having re-started the infusion (2 p.m. on the third day).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

[Long-term automatic blood pressure measurement in clinical management].

Blood pressure control in arterial hypertension, as has been shown in randomized studies in 43,000 patients, based on a reduction of diastolic blood pressure of 5.8 mm Hg associated with a 40% reduction in stroke, is of substantial prognostic importance. Cardiac events were reduced insignificantly by 9%. Major problems with treatment are the limited acceptance of a lifelong therapy--in the Munich High Blood Pressure Study from 1982 well controlled and effective treatment was found in only 22% of the men and 16% of the women--uncertainty with regard to the indication and the question of whether the observed blood pressure elevation is situational or persistent in particular, in view of one study reporting that after three years of placebo in 48% of patients entered with diastolic values between 95 and 105 mm Hg, the blood pressure was found to lie in the normal range. Blood pressure determinations by the patients themselves may reflect resting values throughout the day but blood pressure fluctuations which can be substantial, can only be detected by ambulatory monitoring. The aim of this study, in addition to assessment of the reliability of the system employed, was to compare the response of the monitored blood pressure in patients with various stages of hypertension and in normal subjects at rest and during physical exertion to identify more accurately those in need of antihypertensive treatment. For ambulatory blood pressure monitoring, the SpaceLabs Model ICR 5200 was used. If Korotkoff sounds are not detected, the unit switches to oscillatory measuring. The storage capacity accommodates 200 measurements of systolic, diastolic and mean arterial pressure, heart rate and time of measurement.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Accuracy of ambulatory blood pressure monitoring in four exercise situations.

Although ambulatory blood pressure monitoring (ABPM) is still considered in its investigational stage, the technique has become increasingly popular in recent years. The rationale for its utilization is its ability to continuously monitor blood pressure (BP) response to situational stressors occurring over the course of a 24-hour period which cannot be detected by casual measurements. In addition, ABPM eliminates the so-called white-coat auscultatory BP response. However, the accuracy of ABPM under situations which are at the measurement limits of the technical characteristics and/or capabilities of the ABPM equipment, such as in exercise situations commensurate with daily life activities, has not been fully documented. The purpose of this study was to evaluate the accuracy of the Spacelabs ABPM monitor against auscultatory (AUS) determinations in four exercise situations: walking, stair climbing, cycling and a progressive step test (modified Canadian Aerobic Fitness Test). Analyses of variance (ANOVA) were computed to determine if significant differences occurred between ABPM and AUS measurements for systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) over the resting and four exercise conditions. Results indicate that, particularly at low to moderate levels of exercise intensity, there is no statistically significant difference between ABPM and AUS measurements for SBP and HR. In 20 of the 26 resting and exercise determinations, the difference in SBP was less than 6 mmHg. For HR the variation was no greater than 4 bpm. However, there was no such agreement between ABPM and AUS measurements for DBP. As the intensity of the exercise situations increased, there was a tendency for SBP ABPM measurements to register higher readings than those obtained by AUS. The major drawback in ABPM is its sensitivity to artifacts due to arm movement. It was concluded that ABPM, such as provided by the Spacelabs instrument, can provide reasonably accurate readings of SBP and HR, particularly at low to moderate intensities of exercise while at higher exercise intensities ABPM has a tendency to provide consistently lower SBP values than the AUS measurements. DBP ABPM was totally ineffective under any of the exercise conditions chosen for this study.

Adult↗
PubMed1988

[Walk-through phenomenon in angina pectoris: long-term study (10 years) of 10 patients].

The long-term results of ten patients (nine male, one female) are reported, who during their initial examinations (1977) complained of the classical symptoms of a "walk-through phenomenon" (WTPH). All patients showed typical signs of coronary insufficiency in the exercise-ECG and in the wedge pressure response during exercise. Nine patients (mean age 49 years) had documented myocardial infarctions, one suffered from coronary heart disease without infarction. In seven patients coronary angiography was performed. 10 months after the beginning of the WTPH, four patients continued to show signs of ischemia during exercise after anginal symptoms had disappeared. In the other six patients the ischemia disappeared together with the loss of AP. 10 years after the first examination nine patients are still alive. One patient died in 1981 due to a subsequent infarction of the posterior wall. Three of four patients who underwent aorto-coronary bypass operation (ACB) are now without signs of ischemia during exercise. The fourth patient with ACB suffered a re-infarction in 1982. None of the other five patients are still suffering from WTPH. Exercise tolerance decreased in one and increased in three patients, all being limited by typical AP showing signs of ischemia. In the group of WTPH-patients, the low morbidity and mortality is remarkable. However, in all patients WTPH appears to be apparent only in the first few months after onset. Thereafter, WTPH changes to classical stable AP.

Adult↗
PubMed1988

[Filling pressures (pulmonary capillary pressure, indwelling catheter) in combined static (handgrip) and dynamic (bicycle ergometer) stress in postinfarct patients].

79 male post-MI patients (mean age 50 years) underwent Swan-Ganz catheterization using handgrip (1.5 min using both hands at 1/3 of the maximum voluntary capacity), bicycle ergometry and a combination of both: handgrip added after 4 min of ergometry at each level of ergometry, a mean of 3 months after MI. Our aim was to determine to which level of dynamic exercise the chosen handgrip exercise could be compared; furthermore, to examine the left ventricular reaction (PCP) under these combined conditions, because it mimics daily life situations. Using this combination of tests, it should be possible to identify patients who should avoid static work. Our findings were as follows: 48 of the 79 patients showed pathological PCPs. Comparing the same level of double product, no significant differences of PCP were found between dynamic and combined static + dynamic exercise. Our handgrip exercise can replace dynamic exercise of 40 W. 19 patients showed highly pathological PCP reactions with delta PCP greater than or equal to 10 mm Hg following handgrip exercise. This extreme PCP reaction did not correlate with the appearance of ST-segment depression in the exercise ECG, nor with either infarction scar size nor heart volume as estimated by X-ray. These findings demonstrate the importance of a staticdynamic exercise combination in evaluating PCP reactions in post-MI patients. The test allows one to select those MI patients who should avoid isometric work.

Cardiac Catheterization↗
PubMed1987

Silent ischaemia in post-infarction patients: a 21-month follow-up study.

The purpose of this study was to determine the prevalence of silent myocardial ischaemia (SMI) in post-infarction patients and to follow its clinical evolution in the course of a 21-month follow-up period. Of the 12,500 patients treated at the Klinik Roderbirken between Jan 1980 and Jun 1983 40% had angina. Three-vessel disease was documented in 61% of the 3150 subjects who had a coronary angiography. SMI identifiable on the exercise ECG was observed in 680 patients (5.4%). Sixth-three subjects (mean age 52 +/- 5.5 years) were selected and followed on the basis of stringent criteria. Prevalence of SMI at an average of 6 weeks after MI was 1/200 or 0.5% in that sample. Prognosis was good with a low mortality rate of 3.2% during the 21-month follow-up period. Factors weighing negatively on the observed SMI prognosis are the prevalence of 3-vessel disease (74%) and of pathological ejection fractions (52%) as well as the presence of ischaemia itself. Conversely, factors weighing positively on the observed SMI prognosis are the reasonably high exercise tolerance level (102 +/- 32 W), the low arrhythmogenic potential (73% less than or equal to Lown II), and the normal chest X-ray in more than 80% of the patients. In this study, 43% of the patients were felt to require angiography and only 10% were considered for bypass surgery. Good prognosis may be seen as a contra-indication for revascularization surgery. Yet, the prevalence of 3-vessel disease and the fact that 2/3 of the SMI subjects became symptomatic during the follow-up period are arguments in favour of early angiography.

Adult↗
PubMed1987

Filling pressures in post-myocardial infarction patients: comparison between isometric and dynamic exercise.

The purpose of this study was to determine if isometric exercise (handgrip) using a substantial muscle mass and intensity could be substituted for dynamic exercise in the assessment of left ventricular function in myocardial infarct (MI) patients. Forty patients with documented MI were assigned, on the basis of their previous exercise ECG responses, to either an exercise-induced ischaemic group (Group 1) or to a non-exercise ischaemic group (Group 2). Eight apparently healthy males served as controls. Pulmonary capillary pressure (PCP) was measured at rest, during volume loading and during isometric and dynamic exercise. Mean PCP in Group 1 increased progressively from 7.5 +/- 2.9 mmHg at rest, to 11.6 +/- 3.8 mmHg during volume loading, to 18.8 +/- 10.2 mmHg during the isometric exercise and to 25.2 +/- 10.1 mmHg during the dynamic exercises. For Group 2, the respective values were 9.6 +/- 6.3, 13.1 +/- 6.4, 18.7 +/- 13.7 and 18.4 +/- 9.8 and for the controls 8.9 +/- 1.9, 11.3 +/- 1.2, 13.3 +/- 3.3 and 11.8 +/- 3.6 mmHg. The results of this study indicate that isometric exercise of 50% MVC using both hands can adequately replace dynamic exercise in the diagnosis of left ventricular function in post MI patients.

Adult↗