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Biomedical subjects

G Kugler

Publications and source records attributed to G Kugler.

At least 19 recordsLinked to original sources
PubMed1979

Myocardial release of lactate, inosine and hypoxanthine during atrial pacing and exercise-induced angina.

The coronary venous efflux of lactate, inosine and hypoxanthine during pacing-induced angina has been compared with myocardial extraction of the catabolites during exercise-induced angina. Inosine and hypoxanthine were analyzed by enzyme assay after separation by column chromatography. Myocardial lactate extraction at rest (15 +/- 9%, mean +/- SD) was converted to production levels (-34 +/- 26%) during pacing-induced angina (p less than 0.0005) and increased (24 +/- 13%) during exercise (p less than 0.05). The arterial values at rest (850 +/- 330 mumol/1) were unchanged during pacing and increased five-fold during exercise (4380 +/- 1860 mumol/1). The mean myocardial inosine extraction at rest (33 +/- 10%) was transformed to release values (-41 +/- 30%) during pacing (p less than 0.0005) as well as during exercise (-20 +/- 27%) (p less than 0.0005). The hypoxanthine extraction at rest (25 +/- 11%) decreased during pacing (-7.8 +/- 29%) (p less than 0.0025) and exercise (10 +/- 25%) (NS). The slight increase of arterial inosine and hypoxanthine values was not significant. Myocardially produced lactate, a sensitive marker of pacing-induced ischemia, was obscured by elevated arterial concentrations during exercise. However, inosine significantly correlated with lactate during pacing, and was useful in detecting ischemic myocardial energy deficiency during exercise-induced angina.

Angina Pectoris↗
PubMed1979

Myocardial release of inosine, hypoxanthine and lactate during pacing-induced angina in humans with coronary artery disease.

The applicability of the adenosine triphosphate (ATP) catabolites, inosine and hypoxanthine as markers of myocardial ischemia in humans with coronary artery disease has been investigated. Inosine and hypoxanthine were assayed enzymatically after separation by a new column chromatographic method. The myocardial lactate extraction at rest (17 +/- 13%) changed to production values (-23 +/- 28%) during pacing-induced angina (P less than 0.0005). Coronary venous inosine values increased from 535 +/- 185 nmol/l at rest to 1030 +/- 740 nmol/l during angina (P less than 0.005), the arterial values amounted to 770 +/- 325 nmol/l and 805 +/- 515 nmol/l respectively (P, NS). The calculated myocardial uptake of inosine at rest (27 +/- 16%) changed to production values (-25 +/- 29%) during angina (P less than 0.0005). Coronary venous hypoxanthine increased from 1000 +/- 760 nmol/l at rest to 1235 +/- 800 nmol/l during angina (P, NS), the arterial values amounted to 1300 +/- 1040 nmol/l and 1235 +/- 800 nmol/l respectively (P, NS). The myocardial extraction changed from 20 +/- 18% at rest to -5.4 +/- 29% during angina (P less than 0.0025). The significant positive correlation (r = 0.61, P less than 0.0025) between myocardial release and uptake of inosine and lactate during severe angina demonstrates that anaerobic glycolysis is accompanied by ATP breakdown. During a second pacing period at less increased pressure--rate product after nitroglycerin, lactate production (-1.7 +/- 22%) already occurred whereas extraction of inosine (19 +/- 19%) and hypoxanthine (24 +/- 15%) did not change. In conclusion, lactate functions as a sensitive marker of myocardial ischemia and inosine is useful in detecting ischemic myocardial energy deficiency by the indication of insufficient glycolytic ATP supply.

Adenosine Triphosphate↗
PubMed1977

[Progress in the differential diagnosis of myocardial infarction by determining isoenzyme CK-MB with inhibitory antibodies (author's transl)].

Sensitivity and value of the quantitative measurement of the isoenzyme creatine kinase-MB by means inhibitory antibodies were studied in a number of experiments. The results indicate that concentrations of more than 3 U/1 are abnormal: they were found only in patients with myocardial cell damage but not after intramuscular injection or physical exercise. Determining CK-MB apparently offers a better way of assessing low or moderate increases of total CK activity than, e.g., the CK/GOT ratio. The method should therefore be introduced into clinical diagnosis. But the question of whether CK-MB measurement can differentiate between myocardial infarction and reversible myocardial cell damage remains unanswered: it is not 100% specific for myocardial infarction.

Adolescent↗
PubMed1976

[Effect of isosorbide dinitrate in relation to posture and age].

Rapid tilting into the 90 degrees upright position after 20 mg ISDN sublingually demonstrates a better orthostatic tolerance of the older group (in spite of a lower cardiac output) in comparison to the younger one. This can be explained by a higher tone of the resistance vessels and a stronger stretch resistance of the arteries of the elastic type (and probably of the veins), which are opposing the hydrostatic effects of orthostasis and guarantee a minor shifting of blood to the lower extremities. The increase of rigidity of the blood vessels with aging declares the better drug resistance of the older group but also points - on the other hand - to the borders of ISDN therapy.

Adolescent↗
PubMed1975

[Ventricular aneurysm and coronary heart disease. Pathophysiology, differential therapy, and postoperative haemodynamics (author's transl)].

In the course of coronary heart disease an aneurysmal dilatation of the left ventricle may occur. This may be an additional risk for the patient by changed haemodynamics. Depending on the extent of the aneurysm and the contractile potency of the remaining myocard the cardiac compensation may be sufficient. A reduction of the pump efficiency is not necessarily the consequence. In case there is an increasing cardiac insufficiency by means of a pathologic ventricular filling pressure pulse, the best therapy is digitalis in combination with a reduction of volume by sodium-selective diuretics. Under same haemodynamic conditions the treatment of angina pectoris consists of long acting nitrites in combination with a betablocking agent having some intrinsic activity. Special care for the choic of medicaments has to be taken in relation to the sufficiency of the remaining myocard, if an antiarrhythmic therapy is necessary. If there is no stabilisation of the haemodynamic parameters by conservative therapy, the left ventricular function is meliorated by surgical aneurysmectomy. The data demonstrate, that under resting condition a normalisation and under exercise condition at least a melioration of pulse pressure and circulation is achieved after resection of the aneurysma. A small but measurable decrease in cardiac output under exercise condition is the consequence of a persisting cardiodepressive effect due to the operation.

Adrenergic beta-Antagonists↗
PubMed1975

[Isosorbide dinitrate in coronary heart disease. Effects of a delayed-action preparation during acute load and in chronic use].

The antianginal effectivity of a sustained release isosorbiddinitrate Sorbidilat Retard drug was examined by the number of spontaneous attacks and by ergometry with a constant work load in a double blind trial with cross over technique. An effect on the stress duration, on the ST segment depression, on the "double product", on heart rate, and blood pressure could be proved, which is interpreted as an therapeutic advantage of serum against placebo. The number of spontaneous attacks could be reduced in the verum period significantly. Ergometry every 2 hour after drug adminstration shows an oral effectivity of about 10 hours.

Administration, Oral↗
PubMed1975

[Electrode problems in pacemaker wearers (experiences with three electrode types) (author's transl)].

3 types of electrodes (Medtronic 6903, EMT 588, MIP 2000) of 123 patients are examined by following criterial 1. rate of dislocation, 2. development of threshold, 3. time of application. We found: The Medtronic has the smallest rate of dislocation, the lowest range of threshold and is quickly placed in the right ventricle. The rate of dislocation of the EMT 588 is still just acceptable and it also has a sufficient low threshold, but in comparison to the other helical-wire electrodes the disadvantage of being rather difficult to place in the right ventricle. The MIP 2000 has not proved to be useful due to its large rate of dislocation.

Electrodes, Implanted↗
PubMed1975

[Course of coronary disease. Evaluation of prognosis and progression of coronary insufficiency with atrial pacing and ergometry].

Significant reduction of angina threshold (145 Imp./min to 134 Imp./min) and increase of ST-segment depression (0.13 to 0.17 mV) indicating progression of coronary artery disease was seen in 34 subjects studied by atrial pacing at intervals betion (0.22 mV to 0.12 mV) during exercise, which correlated significantly with decrease of heart rate (121 to 110 beats/min), is interpreted as consequence of diminished sympathetic activity and myocardial O(2)-demand. The change of hemodynamic parameters during controlled exercise does not allow evaluation concerning the progress of coronary artery disease, whereas cardiac stress test with atrial pacing is reproducible. There was no difference in relation to reduction of angina threshold between the group after combined longterm medication with nitrate and ss-blocking agent and the control group. Plasma lipid abnormalities were predictive of subsequent reduction of angina threshold. Severe 2 and 3 vessel obstruction was seen more frequently in patients exhibiting reduction of angina threshold. Level of uric acid, obesity, hypertension, age, combination of risk factors, the initially studied myocardial lactate production and angina threshold during exercise and atrial pacing had no predictive value concerning reduction of angina threshold.

Adult↗
PubMedDate not supplied

The effect of nitroglycerin on myocardial release of inosine, hypoxanthine and lactate during pacing-induced angina.

The efficacy of nitroglycerin as an antianginal drug has been evaluated by calculation of myocardial extraction and production values of lactate and the adenosine triphosphate (ATP) catabolites inosine and hypoxanthine. Coronary venous and arterial blood was sampled at rest, during pacing-induced angina and 4--6 min after nitroglycerin at identical paced heart rates for enzymatic assay of inosine and hypoxanthine after separation by column chromatography and for determination of lactate. Sublingual nitroglycerin given to 10 patients with coronary artery disease decreased coronary venous lactate values from 1175 +/- 320 mumol/l during pacing-induced angina to 950 +/- 240 mumol/l (p less than 0.05). The calculated myocardial lactate production during angina (-31 +/- 19%) diminished after nitroglycerin (-1.7 +/- 22%) (p less than 0.0025). Coronary venous inosine values during angina (1275 +/- 865 nmol/l) decreased after nitroglycerin (795 +/- 555 nmol/l) (p = n.s.), the arterial values (885 +/- 610 nmol/l) increased (960 +/- 580 nmol/l) (p = n.s.), the myocardial inosine release (-26 +/- 20%) changed to extraction values (19 +/- 19%) (p less than 0.0005). Coronary venous hypoxanthine values during angina (1540 +/- 1035 nmol/l) were reduced (1110 +/- 675 nmol/l) (p = n.s.); the arterial values (1625 +/- 1050 nmol/l) decreased (1510 +/- 935 nmol/l) (p = n.s.), the myocardial hypoxanthine extraction (0.3 +/- 29%) with a wide individual variability increased after nitroglycerin (24 +/- 13%) (p less than 0.025). The myocardial release of inosine and lactate during severe angina with significant positive correlation (r = 0.66, p less than 0.0025) demonstrates that anaerobic glycolysis is accompanied by ATP breakdown. The unchanged myocardial inosine and hypoxanthine extraction after nitroglycerin indicates that nitroglycerin is capable of attenuating this effect. In spite of reduced mean myocardial lactate production after nitroglycerin ischemic myocardial energy deficiency may be less marked. Thus, the enhanced myocardial inosine uptake may be one factor contributing the beneficial effects of nitroglycerin including the improvement of myocardial oxygen balance.

Angina Pectoris↗