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Biomedical subjects

G Blümchen

Publications and source records attributed to G Blümchen.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1987

Exercise hypertension in the perspective of systemic arterial hypertension. An overview.

Systemic arterial hypertension is one of the most wide-spread diseases in the world. It is a chronic disease with a very long asymptomatic phase. At an estimated prevalence in the developed countries of 15 to 20%, it can be assumed that approximately 80% of men and 60% of women with hypertension are either unaware of their condition or are not treated adequately. These figures show that reliable diagnostic measures are needed to provide efficient detection of high blood pressure in a given population. In this regard, exercise testing has proven particularly well-suited. Using standardized ergometry, patients with latent, borderline or manifest hypertension can be identified. Exercise hypertension is defined on the basis of an abnormal blood pressure increase during physical exercise in persons with normal blood pressure at rest. Because of marked interindividual fluctuation in blood pressure, values measured at rest may be of only limited usefulness in the diagnosis of hypertension. In contrast, the blood pressure during dynamic exercise may be particularly informative with respect to probability of future development of manifest hypertension and treatment of high blood pressure. Long-term studies have shown that within five years up to one-third of patients with exercise hypertension develop manifest hypertension at rest. Based on the Canada Fitness Survey data indicating that about 2% of the population demonstrate exercise hypertension, it can be estimated that approximately 200,000 Canadians will develop manifest hypertension within five years. Similar statistics are also applicable for most of the developed countries of the world.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Exercise hypertension in healthy normotensive subjects. Implications, evaluation and interpretation.

Exercise hypertension, defined as a blood pressure response to a dynamic exercise stressor which is considered excessive to what is normally observed in a healthy population, is currently the subject of much discussion. This interest appears to be related to the recent concerns that are being expressed in the utilization of hypertensive drugs with respect to their long-term benefits and risks. I would seem that the proper selection of patients for drug therapy will become as important as the treatment itself, not only for clinical purposes but to insure the quality of life of a patient in the pursuit of his/her daily activities. Also, a number of retrospective studies have shown that an exaggerated blood pressure response to exercise in resting normotensive persons could be a useful indicator to assist in detecting those persons who may be on the way to developing sustained hypertension. The literature suggests that this is a tenable hypothesis but one that will require testing by prospective research. In this respect, it has been suggested that if the blood pressure response to a dynamic exercise in borderline or labile hypertensives is normal, it is possible to dismiss the diagnosis of hypertension, at least temporarily. However, if the blood pressure response is exaggerated, then the diagnosis of hypertension should be considered. In Canada, the Canadian Aerobic Fitness Test (CAFT) has been utilized to assist in detecting exercise hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Personality psychological correlates of blood pressure behavior. Group comparison of hypertensive, exercise hypertensive and normotensive heart patients].

It has been well established that individuals with exercise hypertension are at risk of subsequently developing manifest hypertension at rest. In this regard, there is little data available on psychological aspects which may be related to this transition. Accordingly, this study was undertaken to determine whether persons with exercise hypertension and those with manifest hypertension differ in personality traits. With the aid of a personality inventory (FPI-R), a comparative analysis of personality structure was carried out in 60 patients with coronary artery disease (20 with manifest hypertension, 20 with exercise hypertension and 20 normotensive patients). Three differing personality profiles were found. Hypertensive patients had above average values for inhibition, excitability, suffer from stress, psychosomatic complaints and emotional susceptibility; their values for contentment with life were below the average. Persons with exercise hypertension also had above-average values for excitability while normotensive individuals had higher values for extraversion. With regard to prevention of development of manifest hypertension, it would seem reasonable, in patients with exercise hypertension, to encourage the learning of stress management techniques to suppress excitability.

Adaptation, Psychological↗
PubMed1987

[Left ventricular function assessment using a floating catheter in dynamic and isometric (handgrip) stress in normal and heart infarct patients].

UNLABELLED: Left ventricular function was examined in a control group of 8 healthy men (average age 26 +/- 6.2 years) and was compared to 40 post-MI patients (average age 50 +/- 8.2 years, 39 men, one woman). It was measured using the floating-catheter technique under isometric exercise (50% of maximal voluntary contraction using both hands) and also under dynamic exercise (progressive supine bicycle-ergometry). In the control group, there was a significant increase in heart rate, arterial blood-pressure and the average PCP from rest to isometric exercises. PCP was noted to stay within its normal range (less than 20 mm Hg) under both modes of exercise. There was no significant difference comparing the effects of dynamic and isometric exercise (isometric: PCP 13.3 +/- 3.3 mm Hg; dynamic: PCP 11.8 +/- 3.6 mm Hg). In Group I (20 post-MI-patients showing ischemia during exercise-ECG) PCP stayed normal under isometric exercise (PCP 18.8 +/- 10.2 mm Hg). Under dynamic exercise, their PCP increased up to a pathological level (PCP 24.9 +/- 10.1 mm Hg, p less than 0.01). In Group II (20 post-MI-patients with lacking proof of ischemia during exercise-ECG) there was no significant difference between the increase in PCP under isometric vs dynamic exercise (isometric: PCP 18.7 +/- 13.4 mm Hg; dynamic: PCP 18.5 +/- 10.0 mm Hg). CONCLUSION: The results lead to the conclusion that isometric exercise alone (50% of maximal voluntary contraction using both hands, handgrip) can replace dynamic exercise in the diagnosis of LV malfunction in post-MI patients who do not show ischemia during exercise-ECG.

Adult↗
PubMed1986

[Follow-up (4.6 years) of patients with latent cardiomyopathy].

25 patients with latent cardiomyopathy (LCM) (filling pressure elevated during exercise) were followed. After 4.6 years 15 patients were re-examined (10 female, 5 male, mean age at first examination 47 years). 6 patients could not be reexamined, but it is certain that all 6 patients lived. 3 patients of whom 2 were foreigners could not be followed. 9 of these 15 re-examined patients showed 4.6 years after the first examination a normalization of filling pressures during exercise. Findings remained constant in 4 and became worse in 2 patients. There was a tendency for arterial blood pressure to increase during the 4.6 years. This small group of retrospectively followed patients with latent cardiomyopathy showed a favourable long-term result. The findings do not support the hypothesis that LCM is an early manifestation of dilated congestive cardiomyopathy.

Adult↗
PubMed1985

[Significance of the ejection fraction at rest and by stress using radionuclide ventriculography for the prognosis of myocardial infarct patients--comparison with other study methods].

We examined 221 patients with postmyocardial infarctions 8 weeks after MI using radionuclide ventriculography (RNVA) at rest (EFR) and during supine submaximal exercise (delta EF). Mortality rates were evaluated 2 1/2 and 3 1/2 years later by interviewing patients and/or their homephysicians. Sixteen patients were dead (6.7%) 2 1/2 years after MI, 28 (12.7%) were dead after 3 1/2 years. Thirty percent of patients with a resting EF less than 30% had died 2 1/2 years after MI, and 40% were dead within 3 1/2 years. The mortality rate was significantly higher than in patients who had EF greater than or equal to 30% 8 weeks after MI. Patients with a decrease of delta EF (greater than or equal to 5%) showed a 2 1/2 year mortality of 10.8% and after 3 1/2 years of 18.5%. Mortality was significantly higher in patients with decreasing EF during exercise than in those who increased their EF during exercise. This prognostic value of EFR and delta EF was compared with other parameters (angina pectoris, ECG at rest and during exercise, heart volume, Holter ECG, floating catheter PCP [rest and exercise], coronary angiography). Radionuclide ventriculography at rest and during exercise showed a tendency to be the best determining factor for prognosis, and is therefore recommended to determine prognosis in post-MI patients.

Adult↗
PubMed1984

[Long-term behavior of exercise-induced hypertension in patients with myocardial infarction].

Blood pressure and clinical course in 83 heart infarction patients with exercise hypertension were compared after 7 years with a control group of infarction patients without exercise hypertension after 8 years. 62% of the exercise hypertension patients and 23% of the control group developed manifest hypertension. 11% of the exercise hypertension patients and 56% of the control group had normal blood pressure values. The death rate after 7 years for the exercise hypertension group and 8 years for the control group was relatively equal at 12% and 17%, respectively. The exercise hypertension patients who died demonstrated the highest blood pressure values. The clinical course deteriorated in patients who developed manifest hypertension from exercise hypertension, especially in the case of patients with angina pectoris symptoms. The results of the study suggest prognostic significance for blood pressure behavior during exercise in heart infarction patients.

Angina Pectoris↗