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H Klepzig

Publications and source records attributed to H Klepzig.

At least 109 records · Page 6Linked to original sources
PubMed1982

[Combined first-pass-/equilibrium radionuclide ventriculography for non-invasive evaluation of aortic valve incompetence].

In 15 patients with pure aortic valve incompetence and 5 patients with normal valvular function we determined cardiac output by first-pass-radionuclide ventriculography. In addition, left ventricular stroke volume was evaluated by equilibrium radionuclide ventriculography. The difference between those two volumes in relation to left ventricular stroke volume is the regurgitant fraction. Stroke volume index was calculated as the ratio of enddiastolic-endsystolic count differences of left and right ventricle. Patients with aortic insufficiency demonstrated a regurgitant fraction between 20 and 88%, whilst controls never exceeded 10% (on average-2%). Sensitivity therefore was 100%. In contrast, 2 of 15 patients with aortic valve incompetence showed a stroke volume index within normal range (sensitivity 87%). Regurgitant fraction correlated well with aortographically determined severity of valvular incompetence (r = 0.94). We conclude that combined first-pass-/equilibrium radionuclide ventriculography is a highly sensitive quantitative method for evaluation of aortic insufficiency.

Adult↗
PubMed1981

[Cardiac ischemia on exercise. Effect of nifedipine and acebutolol singly and in combination (author's transl)].

In a double placebo-controlled, partly single blind and partly double blind ergometric trial, the acute action of acebutolol and nifedipine singly and in combination on cardiovascular parameters and ischemic reactions was studied. Neither nifedipine nor acebutolol lowered the resting heart rate nor the resting blood pressure significantly. At the highest load the heart rate, systolic blood pressure and the pressure-frequency product were significantly reduced, the changes due to acebutolol being more marked than those of nifedipine. nifedipine alone reduced the ST segment by 1/3, acebutolol by a half. The combined administration of acebutolol and nifedipine produced without exception significant reductions of heart rate, blood pressure, pressure-frequency product, ST segment, and ischemic pain as compared with placebo.

Acebutolol↗
PubMed1981

[Circadian variation of ischaemic ST lowering in exercise ECG (author's transl)].

The circadian variation of ischaemic ST lowering was investigated in 10 patients with coronary heart disease. The placebo phase of a randomised double blind ergometry study on the extent and duration of the action of molsidomine was used for this purpose. Non-significant tendencies with minimal expression of ST lowering were seen at 11.00 a. m. There was no dependency on changes of the pressure frequency product. In one patient ischaemic reactions recognizable at other times would not have been diagnosed at 11.00 a. m. A retrospective analysis of data gives evidence for errors in evaluation of duration and extent of action of cardiac drugs caused by diurnal variation. Consideration of time of day must be included in control investigations.

Adult↗
PubMed1981

[Improved myocardial function after transluminal coronary angioplasty (author's transl)].

To assess the results of transluminal coronary angioplasty (TCA), 42 patients (mean age 50 years) with for coronary artery disease were investigated at rest and during exercise with the ECG (n = 40), thallium-201 myocardial scintigraphy (n = 23) and equilibrium-radionuclide ventriculography (n = 32). Each method of stress testing was quantified: the exercise ECG by means of an ischemia score, incremented with increasing ST-segment depression and decremented as a function of duration of exercise and workload in watts; thallium-201 scintigraphy by means of an index for minimal to maximal perfusion region (vitality index) and redistribution factors; equilibrium-radionuclide ventriculography by means of global ejection fraction and maximum systolic volume change with respect to the end-diastolic volume. The patients were divided into three groups: 30 had successful TCA defined as demonstrating at least a 20% reduction in the stenosis; six underwent aortocoronary bypass operation (nine grafts; complete revascularization in four patients); and in six patients TCA was unsuccessful. TCA was successful in 24 LAD stenoses, 5 RCA stenoses, and in one proximal anastomosis of an aortocoronary bypass graft. Dilatation could not be achieved in three LAD stenoses and three stenoses of the RCA. In those in whom it was successful, TCA yielded an average reduction of coronary artery stenosis from 84 to 43%. Both TCA and bypass operation (OP) led to comparable degrees of functional improvement. The ischemia score decreased from 2.8 to 0.9 after TCA and from 1.6 to 0 after OP. The vitality index increased from 67 to 77% and from 74 to 81% after TCA and OP respectively while the corresponding redistribution factors decreased (TCA: at 1 hour from 5 to 1% and at 3.5 hours from 11 to 4%; OP: at 1 hour from 2.2 to 1.4% and at 3.5 hours from 7.6 to 4.1%. The global ejection fractions at rest improved from 46 to 52% and from 38 to 45% and during exercise from 42 to 50% and from 36 to 43% after TCA and OP respectively. The maximum--dV/dt/EDV increased at rest (TCA: from 2.7 to 3.5 per second; OP: from 2.1 to 3.8 per second) and during exercise (TCA: from 3.1 to 4.0 per second; OP: from 2.6 to 3.3 per second). In the group with unsuccessful TCA, no significant differences in the latter parameters were observed. Ten of the 30 patients who had undergone successful dilatation were reinvestigated after three months. Maintenance of good functional results could be documented in eight while deterioration was seen in two patients, one with a significant restenosis and one who developed a new narrowing distal to the successfully dilated stenosis. Thus, the results show that in selected cases, TCA can render improved ventricular function and perfusion comparable to that of aortocoronary artery bypass surgery.

Adult↗
PubMed1980

Controlled study of intravenous nitroglycerin treatment for two days in patients with recent myocardial infarction.

Hemodynamic measurements were obtained for 48 h in 46 patients with recent myocardial infarction. Patients were randomized to treatment with (n = 22) and without nitroglycerin (NTG) n = 24). In patients with diastolic pulmonary arterial pressure (PAEDP) less than 20 mmHg (group I), NTG decreased PAEDP from 15 to 11 mmHg (n = 13); in the untreated control group PAEDP remained unchanged (n = 15). Cardiac output decreased in the NTG group from 5.4 to 5.0 1/min and in the control group from 4.7 to 4.4 1/min. Mean arterial pressure decreased in both groups, in the NTG group from 106 to 97 mmHg and in the control group from 102 to 94 mmHg. In patients with left ventricular failure and PAEDP greater than 20 mmHg (group II) the decrease in left ventricular filling pressure was significantly greater (25 to 17 mmHg, n = 9) than in the control group (24 to 20 mmHg, n = 9). Cardiac output increased during NTG treatment from 4.2 to 5.1 1/min. In the control group, however, cardiac output decreased from 4.2 to 3.6 1/min. Mean arterial pressure decreased from 103 to 95 mmHg in the NTG group and from 114 to 96 mmHg in the control group. Heart rate did not change significantly. Thus, PAEDP decreased significantly in patients who received NTG treatment for 48 h compared to an untreated control group. Cardiac output increased in treated patients, especially those with left ventricular failure, but decreased in the control group. Mean arterial pressure decreased to the same degree in treated patients and in controls.

Aged↗
PubMed1980

[Reduction of CK and CK-MB enzyme levels as indicators of infarct size by intravenous nitroglycerin (author's transl)].

Intravenous nitroglycerin has beneficial effects on hemodynamics and on myocardial ischemia. The aim of the present study was to investigate whether it also reduces final infarct size. In 60 patients with myocardial infarction serial blood samples were tested for creatine kinase (CK) and its isoenzyme CK-MB activity for infarct size calculations. Hemodynamic parameters were measured every 4 hours. Patients were randomized to a control (n = 29) and a nitroglycerin group (n = 31). In the early intervention group continuous perfusion of nitroglycerin for 48 hours was started < 8 hours (mean 4.5 hours) after onset of symptoms, and in the late intervention group > 8 hours (mean 12.8 hours) after onset of symptoms. In early intervention (n = 22) peak CK activity was 871 U/l in control patients and 544 U/l (p < 0.05) in the nitroglycerin group. The rate of CK release was reduced from 79 to 33 U/l x h, i.e. by a total of 58%, as was total CK and CK-MB release (p < 0.02). Calculated CK infarct size was 69 g equiv. in controls and 48 g equiv. in the nitroglycerin group. (CK-MB: 68 versus 43 g equiv., p < 0.05). In late intervention (n = 28) the differences were less pronounced. Nitroglycerin reduced left ventricular filling pressure significantly and increased cardiac output. Blood pressure changed insignificantly and peripheral vascular resistance decreased. In conclusion, nitroglycerin reduces CK and CK-MB release and hence calculated infarct size, particularly when treatment is begun within the first 8 hours after onset of symptoms.

Aged↗
PubMed1980

[Transluminal angioplasty: control of efficiency by nuclear medical methods after non-operative dilatation of critical coronary artery stenoses (author's transl)].

Preliminary results are reported using 201Tl-myocardial scintigraphy (MSC) with quantitated analysis of redistribution kinetics immediately after ergometry (climbing step test) two to four hours later respectively and (Dual-ROI-) Equilibrium-Radionuclide-Ventriculography (ERNVG) with 99mTc-in vivo-labeled erythrocytes during bicycle exercise prior to and after nonoperative transluminal angioplasty (TAP) in nine patients with critical coronary artery stenosis. ERNVG showed a good reproducibility (r = 0,972, n:20 double check) of LVEF. Successful TAP was associated with 1. increase of LVEF from 41,8 (before) to 49,8% (after TAP), 2. increase of mean normalized systolic ejection rate (MNSER = LVEF/ET) from 1,30 (before TAP) to 1,66 (after TAP), 3. increase of maximal volume change during systole (dV/dtmax/EDV) from 2,12 (before TAP) to 3,03 s-1 (after TAP). Parameters of 201Tl-redistribution kinetics (in MSC) were normalized. Ischemic reaction index increased from 62,9 +/- 5,5 (before) to 79,1 +/- 6,9% (after TAP). The degree of 201Tl-redistribution was normalized from 10,3 +/- 7,4 (before TAP) to 2,1 +/- 1,9 (after TAP, between three and four hours after exercise) as a sign of disappearance of exercise-inducible regional myocardia ischemia after successful TAP. These preliminary results underline the effectiveness of non-operative TAP in selected cases of critical coronary artery stenosis.

Cardiac Output↗
PubMed1979

[IX. Randomized study of the effect of nitroglycerin on CK and CK-MB infarct size. Preliminary report (author's transl)].

In 38 patients with acute myocardial infarction the effect of nitroglycerin on infarct size was studied. Patients were randomized into two groups. 16 patients received continuous nitroglycerin infusions of 0.6 to 6.0 mg/h (mean 2.3 mg/h) over a 48 h period, 22 patients received no specific therapy and served as control. Nitroglycerin was given in the mean 12 +/- 5 (+/- 1 SD) hours following onset of chest pain and 8 +/- 5 after the increase of CK values. Infarct size was determined according to the time activity curve of creatine kinase (CK) and of its myocardial isoenzyme (CK-MB). In all but one patient hemodynamic parameters (left ventricular filling pressure, blood pressure, cardiac index) were measured. The mean infarct size was 51 +/- 30 CK-g-equiv. in control patients, and 48 +/- 33 g in nitroglycerin treated patients. Infarct size as calculated from CK-MB values was 60 +/- 36 g (n=16) in control, and 52 +/- 41 g (n=11) in treated patients. At left ventricular filling pressure values (LVFP) below 20mm Hg infarct size amounted to 43 +/- 30 g (n=12) in control, and to 41 +/- 32 g (n=11) in the nitroglycerin group. At LVFP values above 20 mmHg infarct size was 61 +/- 29 g (n=10) in control as opposed to 64 +/- 32 g (n=5) in treated patients. There was no difference between infarct size as predicted during the first 7 h and the observed infarct size. - Despite the known beneficial effect of nitroglycerin on hemodynamics and on myocardial ischemia, infarct size seems not to be greatly reduced, however, intervention occurred fairly late (12 h). In early intervention beneficfial effects seem likely.

Adult↗
PubMed1978

[The normalizing effect of ECG in exercise tolerance tests under molsidomine in different dosages (author's transl].

In 15 patients with coronary heart disease and typical ST-segment depression during and/or after increasing physical effort in supine cycloergometry the normalizing effect of different dosages of Molsidomine on the electrocardiogram under effort was investigated in 74 exercise tolerance tests. Already after application of 0,5 mg Molsidomine there was observed a significant positive effect in comparison to an identical workload without drug. The normalizing effect was further increased by raising the dosage ot 1 mg or 2 mg respectively. To the administration of 3 mg only 1 out of 10 patients in the trial responded with an additional normalizing effect on the ECG since the rest of the patients showed already normal ECGs on 2 mg. This dose relationship also was observed in the pressure-rate-product. There was a dose-dependent decrease from which we can conclude a relief of the working myocardium. Under effort without drug 13 of 15 patients complained about stenocardia. Under the same effort and under Molsidomine however there were no more of these complaints. Because of these results it is recommended to use 2 mg of Molsidomine as a dosage in daily routine. It is needed 2 or 3 times dialy since in previous investigations there was shown a long-lasting effect over more than 5 hours. 3 out of 15 patients showed side effects which were only weak headache or weak congestion in the head.

Aged↗
PubMed1978

[Lip cyanosis].

Explore the source record for details and available documents.

Cyanosis↗
PubMed1977

[The influence of doxepin on the efficiancy of the human heart (author's transl)].

This work was aimed at clarifying whether the anti-depressant doxepin had a cardiodepressant action, or favoured or initiated arrhythmias and/or ventricular conduction disorders, when administered orally for 14 days at a daily dosage of 75 mg. Under doxepin therapy there was a slight increase in mean heart rate on effort in comparison to the placebo. This increase, which amounted to 2 to 6 beats per minute, was most marked among the younger patients, but had neither clinical nor statistical significance (cocaine-like effect of tricyclic psychotropic drugs). No significant changes of ECG, blood-pressure, x-ray determination of heart volume (by the method of Klepzig and Frisch), and maximum performance on the cycle ergometer were stated under doxepin therapy in comparison to the placebo. On the basis of these results it appears justified to state that administering oral doses of about 75 mg doxepin per day for moderately long periods produces no cardiotoxic side-effects.

Age Factors↗
PubMed1976

[Studies on the influence of Molsidomin on coronary heart disease (author's transl)].

A new agent, Molsidomine, with anti-anginal effect was investigated in 43 patients with coronary heart disease by means of 121 exercise tolerance studies. A good effect was observed 1 hour after sublingual or enteral absorption of 2 mg, which was comparable to 20 mg of Isosorbiddinitrate administered sublingually. Recorded and evaluated were the depression of ST-segment in the ECG, heart rate, systolic and diastolic blood pressure as well as subjective parameters. In comparison to the controls there was a highly significant reduction of anginal pain and ST-depression equivalent to that obtained 1 hour after Isosorbiddinitrate. The effect of Molsidomine could be established already 10 min after sublingual administration and sustained 5 to 6 hours afterwards with a highly statistic significance after sublingual as well as after enteral absorption. Side effects were noticed in 3 out of 43 patients, 2 of them with headache. The remarkable advantages of the drug are to be seen in its simple dosage and administration, its good tolerability, and its intrinsic retard-effect. A combination with beta-blocking agents seems to be possible in the same way as with Isosorbiddinitrate.

Blood Pressure↗
PubMed1976

[Long term therapy over nine years with Spironolacton in hydropic cardiac insufficiency].

The effect of the aldosterone-antagonist Spironolacton in decompensated hydropic cardiac insufficiency is explored with patients not re-compensated under a glycosid-diuretica-therapy. This analysis is based on the clinical records and other documents of 34 patients with most serious oedematous cardiac insufficiency of different genesis. For elucidation of the result of the clinical treatment two casuistic cases are described. The probability of mortality or survival-rate is calculated, periods of observation could be achieved up to more than nine years. It is endeavoured to compare the results with observations of patients-collectives, that are known from the literature. Statistically significant decreases in weight are objectified. When examining the reactions of blood-pressure at the Spironolacton-therapy no statistically significant alterations of blood-pressure could be observed with those cardiac-decompensated patients. 6.25 per cent of the considered serum-potassium-data were underneath the limitations of lower standard, at 1.875 per cent of the measured values a hyperkalemia existed. No clinical side-effects could be observed except the incidence of a gynaecomastia with two male patients. A protracted therapy with Spironolacton for patients with decompensated hydropical myocardial insufficiency is appropriated to support recompensation in addition to the hitherto conventional possibilities of therapy, and to maintain this achieved re-compensation.

Aged↗