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Biomedical subjects

H W Klempt

Publications and source records attributed to H W Klempt.

At least 19 recordsLinked to original sources
PubMed1999

[Partial inpatient cardiologic after-care].

In Germany the in-hospital rehabilitation of patients with cardiac diseases is standard. Especially because of criticism of effectiveness and wasting of resources we evaluated in a pilot study a rehabilitation program with an in-hospital start, followed facultatively on ambulatory basis at the same institution, at the cardiac rehabilitation clinic. The aims of the study were to find out the acceptance of the the program by the patients, the safety and the impact of the facultative ambulatory rehabilitation program on cardiovascular risk factors. From January 1993 to December 1995 the primary enclosing criteria (cardiac disease suitable for rehabilitation, age < 70 years, lodging < 40 km) were fulfilled by 612 patients, 122 female. 268 (43.8%) were disclosed on medical grounds because of the rigid pilot character of the study, for 74 (12.1%) patients was the participation on organisational grounds not possible. Sixty-six of the remaining 270 patients preferred the facultative continuation of the rehabilitation on ambulatory basis for 1 or 2 weeks, the entire rehabilitation lasting up to 4 weeks. During the ambulatory phase the patients slept at home, otherwise these patients followed the same procedure as the in-hospital participants. Despite of severe medical concerns 4 further patients wished to participate on facultative ambulatory continuation of the rehabilitation, among these were 2 women, only 5 of the total 70 patients of the facultative ambulatory program group being female. There were no significant differences among 24 patients with CAD of both groups during the rehabilitation and in a control after 14.8 months (Table 3). The impact on serum total cholesterol and LDL cholesterol was positive (Table 2), albeit after 14.8 months no more significant. Over the control period there were a negative development of serum triglyceride level and significant negative effects on the body weight. There were no complications among the 66 patients during the facultative ambulatory phase of the rehabilitation, in contrast to those 37 of 268 patients who had to be disclosed because of medical concerns (Table 1). During the rehabilitation the drug therapy was optimized for many participants. The control after 14.8 months revealed that these remedies were followed with great accuracy by the physicians at home (Figure 1). In conclusion, a cardiac rehabilitation program with an in-hospital start of 2 weeks, going over to ambulatory rehabilitation for 1 to 2 weeks, is as effective and safe as an in-hospital cardiac rehabilitation. As known, amelioration of the long-term results has yet to be achieved.

Adult↗
PubMed1998

Outflow acceleration assessed by continuous-wave doppler echocardiography in left ventricular hypertrophy: an analysis of 103 consecutive cases.

The effect of provocation on left ventricular (LV) outflow was studied by continuous-wave Doppler echocardiography in 103 nonselected, consecutively enrolled patients with LV hypertrophy (LVH), either due to pressure overload (97 patients) or hypertrophic cardiomyopathy (HCM, 6 patients). In 34 patients with LVH, outflow acceleration (gradients ranging from 18 to 122 mm Hg) was induced or accentuated by the Valsalva maneuver after 1.6 mg nitroglycerine sublingually independent of LVH etiology. Factors associated with LV outflow acceleration were female sex, small body surface area and LV cavity size, increased relative wall thickness, LV contractility, and resting LV outflow velocity, mitral anulus calcifications and systolic anterior movement of the mitral valve. It is concluded that dynamic, intracavity LV gradients are a nonspecific flow abnormality that merit consideration because they can be frequently found in LVH patients.

Aortic Valve Stenosis↗
PubMed1995

[Reproducible (latent) obstruction of the left ventricular outflow tract].

BACKGROUND AND OBJECTIVE: Left ventricular outflow tract obstruction (LVOTO) with flow acceleration in late systole (Vmax > or = 2.0 m/s and acceleration/ejection time [AT/ET] > or = 0.5) is often present in a latent form in left ventricular hypertrophy; it can be unmasked by administration of glyceryl trinitrate or with the Valsalva manoeuvre (preload reduction). It was investigated prospectively whether latent LVOTO also occurs on ergometric exercise. PATIENTS AND METHODS: 61 patients (19 female, 42 male, mean age 55.5 +/- 12.9 years) with left ventricular hypertrophy at rest were examined by Doppler echocardiography at rest, under provocation with glyceryl trinitrate and the Valsalva manoeuvre, and during bicycle ergometry. Manifest LVOTO was already present before the test in 3 patients. RESULTS: In 24 patients LVOTO occurred during the provocation (Vmax rose from 1.38 +/- 0.25 to 2.93 +/- 0.53 m/s; AT/ET rose from 0.47 +/- 0.16 to 0.68 +/- 0.09). In 19 of these 24 patients LVOTO also occurred during the ergometry. In four additional patients changes were marginal (AT/ET > or = 0.5; Vmax = 1.8 and 1.9 m/s, respectively). There was a highly significant correlation between provocation and ergometry with regard to Vmax, as well as AT/ET (with r = 0.84 and 0.76, respectively). CONCLUSIONS: These findings show that provokable LVOT gradients are likely to occur during exercise to a similar degree as those on preload reduction. Thus, course of disease could possibly be influenced by early treatment in patients with left ventricular hypertrophy.

Adult↗
PubMed1994

Dynamic intracavity gradients: a 'new' hemodynamic abnormality in the spectrum of secondary left ventricular hypertrophy.

The effect of provocation on left ventricular (LV) outflow was studied by continuous-wave Doppler echocardiography in 93 patients with LV hypertrophy (LVH), either due to pressure overload or hypertrophic cardiomyopathy (HCM), and in 39 healthy volunteers. In 50 patients with LVH, outflow acceleration (gradients ranging from 19 to 130 mm Hg) was induced or accentuated by at least one provocative situation independently of LVH aetiology. In normal persons LV outflow remained unchanged. Calcium antagonist treatment reduced outflow acceleration. It is concluded that dynamic LV gradients are a non-specific flow abnormality in the spectrum of LVH that merits consideration.

Administration, Sublingual↗
PubMed1991

[The provocation of dynamic obstruction of the left ventricular outflow tract in secondary myocardial hypertrophy].

The effect of the Valsalva manoeuvre before and after sublingual administration of 1.6 mg nitroglycerin on maximal velocity (Vmax), acceleration time (AT) and ejection time (ET) of left-ventricular outflow was measured by Doppler echocardiography in 49 patients (28 men and 21 women; mean age 65 [48-84] years) with secondary left-heart hypertrophy, and in 8 controls. Changes in flow profile typical of dynamic obstruction in the left-ventricular outflow tract (LVOT) occurred in 30 of the patients, Vmax increasing from a mean of 137 to 302 cm/s. Latent LVOT obstruction was associated with a thickened posterior wall, an accelerated left-ventricular outflow even at rest and systolic anterior motion of the anterior mitral leaflet (SAM phenomenon). The size of the provoked LVOT gradient correlated significantly with Vmax or the AT/ET ratio at rest. Obstruction of the LVOT is apparently a non-specific phenomenon which also occurs in secondary left-heart hypertrophy. These findings may have therapeutic consequences.

Aged↗
PubMed1982

[Antiarrhythmic efficacy of mexiletine, propafenone and flecainide in ventricular premature beats. A comparative study in patients after myocardial infarction (author's transl)].

In 12 patients with coronary artery disease, 11 of them with previous myocardial infarction, the antiarrhythmic effects of orally administered flecainide (F.), mexiletine (M.) and propafenone (P.) were examined. The doses amounted to 400 mg F., 600 mg M., and 900 mg P. daily. The administration was made randomized with a change between placebo and verum periods with a duration of 3 respectively 4 days. The 3 antiarrhythmic agents reduced significantly the number of ventricular premature beats (VPB), the reduction of VPB amounted to 94.2% (F.), 80.2% (P.), and 52.8% M.). Repetitive VPB were reduced about 98.8 % (F.), 96.8% (P.) and 83.33% (M.). The Lown-Index diminished by about 1.45 classes (F.) 1.18 classes (P.) respectively 0.55 classes (M.). A complete suppression of VPB was obtained only in one patient under medication with F. F. and P. lengthened the duration of P, PQ and QRS, whereas M. did not affect these parameters. Heart rate and QT remained unchanged. Subjective side-effects of the 3 agents were similar. Without of the influence on the ECG, objective side effects were missed. The long plasma half-life of F. (19.0 +/- 5.2 h) guarantees an antiarrhythmic effect over a period of 24 hours if the substance is administered twice daily. The large variance of plasma half-life can cause some difficulties in the finding of individually required dose of F.

Adult↗
PubMed1982

Relationship between plasma concentrations and suppression of ventricular extrasystoles by flecainide acetate (R-818), a new antiarrhythmic, in patients.

To assess the relationship between plasma levels of 2,5-bis-(2,2,2-trifluoroethoxy)-N-(2-piperidylmethyl)benz-amide acetate (flecainide acetate), a new antiarrhythmic, and the suppression of ventricular arrhythmias, a decreasing multiple oral dosage regimen (200 mg b.i.d. to 50 mg b.i.d.) was administered over 12 days to eight patients with chronic ventricular extrasystoles. 1-h ECG recordings and blood samples for plasma flecainide measurements were obtained prior to, during each day of dosage, and post-drug. Maximum plasma levels observed with the higher doses range from 413 to 789 ng/ml (mean 637 ng/ml); these levels are well tolerated and are associated with essentially complete (greater than 95%) suppression of arrhythmias. As dose is decreased, plasma levels decline and the arrhythmias progressively return. The lowest plasma levels associated with essentially complete suppression of ventricular extrasystoles on two consecutive days range from 217 to 414 ng/ml (mean 317 ng/ml); levels below about 230 ng/ml are associated with the initial substantial reappearance (less than 70% suppression) of arrhythmias. These data suggest that the minimum therapeutic plasma levels of flecainide for ventricular extrasystoles range from about 200 to 400 ng/ml and that no consequential side effects are associated with plasma levels two-fold higher than these minimum levels.

Anti-Arrhythmia Agents↗
PubMed1979

[Complication during the dipyridamole-test (author's transl)].

Performing the dipyridamole-test for evaluating coronary artery disease a man at the age of 57 years developed after application of 15 mg dipyridamole intravenously angina pectoris. For removal of angina pectoris 240 mg aminophylline were injected, after what bradycardia and finally cardiac arrest occurred. Resuscitation was successful. Possible reasons and some precautions were discussed.

Aminophylline↗
PubMed1976

[Diagnosis of left-to-right shunt. Dye dilution curves in patients with left-to-right shunt during physical exertion and after beta-receptor blockade].

In 79 patients, suffering from central left-to-right shunts, dye-dilution curves were recorded partially using a peripheral venous injection site during reactive hyperaemia. 47 investigations were carried out during ergometer exercise in supine position. 32 patients received injections of 1-2 mg Propranolol or 0,4-0,8 mg Pindolol. During exercise dye-dilution curves showed characteristic alterations, indicating a decrease of the relative shunt-flow, whereas beta-receptor blocking agents increased the relative shunt-flow. Dye-dilution curves written during exercise may be helpful in evaluating the indication for operative closure in patients with small atrial or ventricular septal defects. beta-receptor blocking agents can facilitate diagnosis of left-to-right shunt as a screening test.

Adolescent↗
PubMed1975

[Pulmonary vascular pressures and blood gases in young patients with thoracic scoliosis (author's transl)].

Pulmonary artery and pulmonary wedge pressures were measured at rest and during exercise in 25 young patients with moderate to severe scoliosis. Simultaneous determinations of arterial blood gases and pH were performed. The results of the vascular pressure measurements were compared with those obtained in 15 healthy young subjects. In all patients the pulmonary artery and pulmonary wedge pressure were normal at rest. During mild ergometer exercise, however, an abnormal rise in pulmonary artery pressure occurred in 9 patients. Moreover, an increased diastolic pressure gradient across the pulmonary vascular bed was found in some scoliotic patients indicating an elevated pulmonary vascular resistance. It is supposed that this haemodynamic abnormality is primarily due to a restriction of the pulmonary vascular bed. Relationships between pulmonary artery pressure and arterial oxygen tension and blood pH, respectively, could be found. The possible significance of these results is discussed.

Adolescent↗