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Biomedical subjects

H Zilcher

Publications and source records attributed to H Zilcher.

At least 19 recordsLinked to original sources
PubMed1988

Ketanserin combined with a beta-blocker or diuretic in essential hypertension. A multicentre study.

The antihypertensive effect of ketanserin 40 mg b.d. in combination with a beta-adrenergic blocking agent or a diuretic was assessed in an open study in 35 patients with essential hypertension, who had not responded to treatment with beta-blockers, diuretics or their combination. The ketanserin/beta-blocker combination decreased mean sitting systolic/diastolic blood pressure (SBP/DBP) from 169/107 mmHg to 156/91 mmHg at the end of the 12-week active treatment period. The decrease in systolic blood pressure was significant only at Week 8, while the decrease in diastolic blood pressure was highly significant at all times. A significant reduction in heart rate by 10 beats.min-1 was observed with the ketanserin + beta-blocker combination. The ketanserin/diuretic combination led to a significant reduction in mean SBP/DBP from 164/106 mmHg to 146/92 mmHg after 12 weeks, with no significant change in heart rate. Body weight slightly increased in both groups. There were significantly fewer adverse reactions with the ketanserin/diuretic combination than with the ketanserin/beta-blocker combination. The results indicate a potentially useful therapeutic role for ketanserin in combination with beta-blockers or diuretics.

Adrenergic beta-Antagonists↗
PubMed1983

[Modern aspects of cardiogenic shock].

Since the introduction of coronary care units the in-hospital mortality decreased in acute myocardial infarction (AMI), but not the mortality which persisted at about 90% in cardiogenic shock (CS). the definition of CS is based on a cardiac index of greater than 2.2 1/min/m2 and an advancing lactate acidosis with lactate values of about 4.0 mmol/1 which leads to death in most cases by the so-called secondary ventricular fibrillation. Measurements of invasive haemodynamic parameters like cardiac index etc. were superseded by clinical parameters because of methodological problems in clinical routine. Forrester deals with clinical parameters and the pulmonary wedge pressure to separate 4 haemodynamically different subsets in the acute stage of AMI. The treatment of cardiogenic shock uses the manipulation of pre- and/or afterload. Nitrates reduce an increased PCV to normal values because of dilating the capacity vessels (preload) which leads to venous pooling. The cardiac index increases up to 20%. Vasodilators (Na-nitroprusside, phentolamine, prazosin, hydralazine, captopril) also caused an increase of the cardiac index because of afterload reduction. This therapeutic strategy demands exact continuous arterial blood pressure monitoring. A perfusion pressure greater than 80 mm Hg on an average will extend the infarction area in narrowed coronary arteries. Positive inotropic drugs (dopamine, dobutamine, amrinone) increase the contractility of the injured myocardium. From the haemodynamic point of view the best results can be achieved by application of temporary intraaortic counterpulsation (IABP) by reducing afterload and increasing diastolic perfusion of the coronary arteries. Nevertheless IABP is of restricted value because of high rate of pump-dependence.

Hemodynamics↗
PubMed1979

[Measures to reduce infarct size (author's transl)].

Reduction of infarct size is a concept limited in clinical practice by the long period elapsing before hospital admission. Most patients are admitted only after the critical period of 6 to 8 hours following infarction when it might be possible to save the ischaemic, but not yet necrotic myocardium. Nevertheless, patients with altered haemodynamics and, therefore, a disturbed myocardial balance between oxygen requirement and oxygen supply may benefit from optimum management of the haemodynamic situation. This is achieved primarily by manipulation of preload and afterload and by enhancement of the collateral circulation to the ischaemic myocardium. However, the effects of cardiac surgery are limited by the negative sequelae of late reperfusion 6 hours after coronary ligation. Intra-aortic balloon pumping can be used only in large cardiosurgical centres because most of the so-treated patients remain pump dependent. The described measures have improved the hospitalisation period in patients with acute myocardial infarction, but the further prognosis is dictated by the nature and extent of underlying coronary heart disease.

Animals↗
PubMed1979

[Hemodynamic guidelines in the treatment of acute myocardial infarction by means of vasodilators].

Two types of vasodilators are used for treatment of acute myocardial infarction: Nitrates on the one hand with predominant venodilation and agents like Phentolamie and Nitroprusside on the other hand with venodilation as well as arteriolar vasodilation. Different opinions exist with respect to indication of these vasodilators. They are used for reduction of arterial blood pressure, for reduction of left ventricular filling pressure and for increase of cardiac output. A marked decrease in ejection fraction is the hemodynamic basis of application of vasodilators in the latter indication. By reduction of peripheral vascular resistance emptying of the left ventricle in these patients is enhanced.) As a working hypothesis in clinical situation elevated filling pressure indicates a decreased ejection fraction. The first part of this investigation deals with relation of left ventricular and diastolic pressure to ejection fraction. A good correlation between these two parameters was found in 717 patients with coronary artery disease. However variability was so wide that regression from enddiastolic pressure to ejection fraction in the individual seemed impossible. In 26.6% of patients with ejection fraction over 0.6%, filling pressure was 20 mm Hg or more. On the other hand, in 34.7% of patients with ejection fraction below 0.3% filling pressure was 20 mm Hg or less. As a consequence of practical value, reduced ejection fraction has to be assumed, if a patient presents elevated filling pressure and reduced cardiac output. In the second part, the hemodynamic effects of Phentolamine in 12 patients with acute myocardial infarction and elevated filling pressure (PCV resp. PADP greater than 18 mm Hg) are described. Maximal effects on hemodynamic variables were: reduction of peripheral vascular resistance by 31.4%, of left ventricular filling pressure by 16.2%, and of mean arterial pressure by 17.0%. Cardiac output increased by 25.8% and heart rate rose by 14.8%. At optimal efficacy, stroke volume increased by 23.7%. Further increase of infusion rate with concomitant fall of peripheral vascular resistance resulted in decrease of stroke volume and tachycardia. Most serious side effects consisted in sudden fall of blood pressure. Therefore intraarterial monitoring of blood pressure is demanded. The third part deals with hemodynamic effects of nitrates (Isosorbiddinitrate 10 mg p.o.) in patients with acute myocardial infarction and elevated filling pressure. One hour after application peripheral vascular resistance decrease by 16.5%, filling pressure by 20.8%, and mean arterial pressure by 9.0%. Cardiac output stroke volume and heart rate did not change significantly. No side effects were observed with Isosorbiddinitrate although two cases of nitrate syncope occurred with Nitroglycerin, resulting in bradycardia and hypotension. Indications for vasodilator therapy therefore has to be handled as follows: Nitrates should be given to patients with elevated filling pressure and normal cardiac output...

Arrhythmias, Cardiac↗
PubMed1979

[Non arrhythmogenic sudden death as complication of coronary heart disease].

In a cohort of 417 patients admitted consecutively to the Coronary Care Unit for acute myocardial ischemia (unstable angina pectoris in 121, acute myocardial infarction in 296 patients) 21 cases of non arrhythmogenic sudden death occurred within 24 hours after admission. 16 of these patients suffered from acute myocardial infarction and 5 from unstable angina pectoris. Cause of death was cardiac rupture in 12 and pump failure in 4 patients with acute myocardial infarction, whereas all patients with unstable angina pectoris died from pump failure. Patients with cardiac rupture within 24 hours after admission, had significantly higher systolic and diastolic blood pressure in comparison with the other groups and with patients dying from cardiac rupture on the third day, or later. All patients dying from pump failure with unstable angina pectoris and one of the patients dying from pump failure with acute myocardial infarction had beta blocker therapy. Beta blockers were given to 68 of the patients with unstable angina pectoris. Acute pump failure occurred in this group only. The risk of pump failure with beta receptor blocking drugs is indicated by angina decubitus, marked dyspnea during anginal attacks (even in patients free of signs of cardial insufficiency outside their attacks) and a lack of responsiveness to beta blocking therapy. In these patients rapid coronary angiography and bypass surgery seems to be the prefered method of management. Beta blockers should not be given to these patients or discontinued in cases which lack responsiveness.

Adrenergic beta-Antagonists↗
PubMed1979

[Rehabilitation potential after myocardial infarction].

For determination of the individual rehabilitation potential in patients after myocardial infarction, factors were extracted which are of importance for exercise capacity and its influence upon rehabilitation measures. Further results of exercise tests were correlated with psychological tests (Freiburg-personality-inventory) and the results of a patients' questionnaire for individual self-assessment, with concerning restitution by means of rehabilitation measures. 147 patients were admitted to a controlled rehabilitation program 10 weeks after myocardial infarction or later. Mean increase of exercise capacity after one year of rehabilitation was 21.6% of the initial test. Significantly greater increases of exercise capacity were achieved in patients with regular attendance particularly in younger patients in comparison with older patients. As evidenced by ergometric test data initially low maximal heart rate, low increase of heart rate, low exercise capacity and low double product were correlated with greater increase of exercise capacity. Patients with anterior-wall myocardial infarction tended to increased exercise capacity more. A relation between "psychosomatic disturbance" at onset of rehabilitation and a greater increase of exercise capacity could be determined as a trend. Connections between psychosocial factors and determinants of exercise capacity in influencing the rehabilitation potential are discussed.

Adult↗
PubMed1978

[Haemodynamic response to antihypertensive treatment with atenolol in patients with hypertension (author's transl].

The antihypertensive effect of atenolol, a cardioselective beta-blocker, was examined in 8 patients with essential hypertension. The most important haemodynamic changes observed were a significant reduction in heart rate (reduction in maximum heart rate at the end of symptom-limited exercise by 23% p less than 0.01) and a moderate fall in systolic blood pressure (reduction at submaximum level of exercise by 22%, p less than 0.01). The antihypertensive effect was attributable in half the patients to a drop in peripheral vascular resistance and in the other half evenly to a predominant reduction in cardiac output or to a reduction in both parameters. In view of the compensatory rise in stroke volume a significant reduction in cardiac output was not found. Symptom-limited exercise tolerance was increased in all patients. These results lead to the conclusion that the antihypertensive action of the cardioselective beta-blocker, atenolol is based on a lowering of the increased peripheral vascular resistance and a reduction in cardiac output; the latter mechanism is predominantly found in patients with hyperkinetic features.

Adolescent↗