Biomedical subjects
Publications and source records attributed to Helmut Gohlke.
Explore the source record for details and available documents.
With 31%, mitral insufficiency (MI) represents the second most common valve lesion and is most commonly of degenerative etiology. Sudden death is rare, in asymptomatic patients with flail leaflet and in sinus rhythm it occurs at a rate of 0.8%/year, and increases to a rate of 4.8%/ year when atrial fibrillation occurs. The effective regurgitant orifice area (ERO) is an important determinator of severity of MI and is of prognostic importance. An ERO of >or=40 mm(2) implies severe MI. These patients require further evaluation with exercise testing to determine functional and objective symptom status and exercise hemodynamics to identify pulmonary hypertension at rest or during exercise. This is of particular importance in patients with absent tricuspid insufficiency. Coronary angiography is indicated when symptoms or pathologic hemodynamics occur during exercise. Surgery in asymptomatic, severe MI is recommended when ejection fraction drops to <60%; left ventricular end-systolic diameter (LVESD) increases to >45 mm (LVESD index >26 mm/m(2)), when atrial fibrillation occurs or pulmonary hypertension with PAP syst >50 mmHg at rest and >60 mmHg during exercise), and if the valve is reparable.Patients without an indication for surgery need careful cardiac follow-up. Patients who underwent surgery according to guidelines had an 8-year survival rate of 89%. Clinical assessment together with echocardiography and exercise hemodynamics determine the optimal timing of surgery in asymptomatic patients with severe MI.
INTRODUCTION: During the last decades a large body of data has been accumulated indicating omega-3 fatty acids to exert beneficial effects on the prognosis of patients with cardiovascular disease. Especially, omega-3 fatty acids are regarded to be effective in reducing the risk of sudden cardiac death after acute myocardial infarction. However, treatment of acute myocardial infarction and secondary prevention considerably have been improved within the past years including early revascularization by PCI, the routine use of beta-blockers, statins and ACE-inhibitors as well as cardiac rehabilitation for improving life style measures. To date, there exists no controlled randomized trial testing the prognostic effect of omega-3 fatty acids after acute myocardial infarction in a double blind regimen under the conditions of modern treatment of myocardial infarction. MATERIALS AND METHODS: The present study therefore evaluates the effect of highly purified omega-3 fatty acid ethylesters (omega-3-acid ethyl esters 90=Zodin) on the rate of sudden cardiac death within 1 year after acute myocardial infarction. Secondary endpoints are total mortality, non-fatal cardiovascular events, rhythm abnormalities in holter monitoring and depression score. RESULT AND CONCLUSION: The recruitment-period started in October 2003 and is expected to last until December 2006. The results of the study are therefore expected for the beginning of 2008, when all patients will have completed the 12-months follow up-period.
BACKGROUND: The Western lifestyle contributes significantly to the high prevalence of coronary artery disease in Western nations. Smoking, a fat-loaded diet, low physical activity, obesity, diabetes, increased alcohol consumption contribute in a variable combination to the incidence and progression of coronary artery disease. The conventional risk factors are responsible for > 80% of cardiovascular events. Coronary artery disease is therefore a highly preventable disease. Randomized studies evaluating changes and lifestyle are difficult to conduct. Lifestyle is in many respects not governed by the intellect but the result of education, life long habits and possibly also genetically determined. Nevertheless, there is increasing evidence that modification of life style has a significant influence on the incidence and the course of coronary artery disease. SMOKING: Smoking is responsible for 50% of all avoidable death. There is a significant relation between the number of smoked cigarettes and the increase of cardiovascular risk. Despite the lack of randomized end point studies there is universal agreement that the advise for smoking cessation is a class-1-recommendation. NUTRITION: Prospective studies on different components and principles of nutrition (Western vs. Mediterranean diet) demonstrate a significant influence of the diet on the development of coronary artery disease and sudden death. Several randomized studies show evidence that consumption of fish or a Mediterranean diet have a significant influence on the improvement of prognosis. WEIGHT: There is a correlation between weight and cardiovascular disease and cardiovascular death. A body mass index of > 30 doubles the incidence of sudden death. A moderate increase of body mass index quadruples the risk for diabetes in males, in females the risk is 8-fold increased. Weight reduction improves endothelial function and decreases systemic inflammatory reaction. PHYSICAL ACTIVITY: There is a significant inverse relation between physical fitness or habitual physical activity on the one hand, and the incidence of coronary artery disease on the other hand. Physical activity improves exercise capacity, decreases angina pectoris and decreases cardiac events and hospital admissions after PTCA. Physical activity also decreases insulin resistance and delays the occurrence of diabetes. ALCOHOL CONSUMPTION: Moderate alcohol consumption was associated with a decrease of cardiovascular events in patients with increased cardiovascular risk. Nevertheless, alcohol consumption in the population is a significant source for avoidable premature death. CONCLUSION: The knowledge resulting from observational studies on the importance of lifestyle for the development of coronary artery disease is increasingly validated by prospective randomized studies. Despite the fact that much more research needs to be done the recommendation for improvement of lifestyle in terms of increasing physical activity decreasing overweight, using a Mediterranean diet and smoking cessation are class-1-recommendations. A nationwide improvement in lifestyle could result in a significant decrease in health care expenditures and could also have an important role in preventing or delaying coronary artery disease.
OBJECTIVES: The objectives of the present study were to determine prospectively return to work and its predictors in patients after cardiac rehabilitation. METHODS: Patients were enrolled at admission to inpatient cardiac rehabilitation centres (n = 18). Primary indications for admission were myocardial infarction, coronary artery bypass grafting or percutaneous transluminal coronary angioplasty. RESULTS: We included 2441 consecutive patients (1907 men, mean age: 60 +/- 10 years; 534 women, mean age: 65 +/- 10 years). A total of 43% of all patients had been actively employed before the event. Of these patients, 65% had returned to work six months and 67% 12 months after cardiac rehabilitation. Successful return to work after 12 months was significantly predicted by younger age, non-manual work, self-employment, a higher physical and mental quality of life, and a better exercise ECG result. CONCLUSION: Return to work is predicted by sociodemographic factors, quality of life, and the exercise ECG at the rehabilitation centre. The determination of early predictors for return to work may aid to identify patients particularly at risk for failure to return to work.