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Biomedical subjects

M Kaltenbach

Publications and source records attributed to M Kaltenbach.

At least 19 recordsLinked to original sources
PubMed1979

[Effect of prazosin in therapy-resistant chronic cardiac failure (author's transl)].

In addition to standard treatment with digitalis and diuretics prazosin (20 mg/d) and placebo were given to 14 patients with chronic therapy-resistant cardiac failure mainly of stage III for periods of 6 weeks each. Cardiac frequency, blood pressure, cardiac volume, pulmonary artery pressures and cardiac minute volume were assessed at rest and during physical exercise. Body weight, congestive changes in the chest radiograph, oedema and complaints were evaluated. During the acute trial using 2 mg of prazosin a significant increase of cardiac minute volume was demonstrable at rest and during exercise (2 P less than 0.05). After administration for 6 weeks cardiac minute volume increased from 3.2 to 4.0 l/min at rest and from 6.9 to 8.0 l/min during exercise (2P less than 0.005; n=12). There was a noticeable decrease of cardiac size from 1440 to 1306 ml/1.73 m2 (2 P less than 0.02). Haemodynamic improvement paralleled the decrease of complaints which was equivalent to an improvement of half to one stage of the New York Heart Association. In severe cardiac failure prazosin has thus an additional therapeutic effect beyond digitalis and diuretics.

Adult↗
PubMed1979

[Frequency of life-threatening complications associated with exercise testing (author's transl)].

Most of the statistics on complications of ergometric exercise tests come from the United States and are largely related to treadmill ergometry. A questionnaire was sent in the summer of 1978 to 198 investigative units in the German-speaking regions. The results of 1065 923 person-tests were made available. Exercise testing of 353 638 sports-persons revealed no serious complications. On the other hand, testing of 712 285 patients, predominantly with coronary heart disease, lead to 17 deaths and a total of 96 life-threatening complications. The result of this survey indicates that one must expect one such complication for every 7500 ergometry tests. The danger of pulmonary oedema on exercise in recumbency is about five times higher than that on sitting or standing. The most frequent complication was ventricular fibrillation. A defibrillator should therefore always be immediately available during exercise tests.

Coronary Disease↗
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↗
PubMed1979

[Comparison of bicycle ergometry and step-ladder exercise (author's transl)].

Repeat exercises (three hours apart) on a bicycle ergometer and a vertical step-ladder were performed in a randomised series on 79 subjects: 13 doctors, 44 patients and 22 sportsmen. Duration of exercise was on average 250% longer in the three groups on the step-ladder than the bicycle. Correspondingly, exercise-pulse sums, recovery-pulse sums and exercise indices were two-and-a-half to three times higher than on bicycle ergometry. As a sign of comparability of the exercise by the two methods there was, on average, no significant difference with regard to the final heart rate, although duration of exercise was longer on the step-ladder. 67% of subjects discontinued the exercise because of peripheral muscle fatigue on the bicycle ergometer, compared with only 8% on the step-ladder. During bicycle ergometry lactate concentration rose by 6.7 mmol/l compared with only 0.78 mmol/l during step-ladder exercise. These results indicate that the value of bicycle ergometry exercise is limited by muscle fatigue in the legs: step-ladder exercise can be extended much longer. The practical significance is that patients with coronary heart disease especially have symptoms and/or ECG changes of ischaemia only at higher levels of physical exercise.

Adolescent↗
PubMed1979

Treatment of hypertrophic obstructive cardiomyopathy with verapamil.

Twenty-two patients with hypertrophic obstructive cardiomyopathy were treated with the calcium inhibitor, verapamil, which was administered in a mean oral dose of 480 mg per day. After an average of 15 months of treatment (4 to 24 months), the QRS amplitude in the electrocardiogram was significantly reduced from 4.2 to 3.8 mV. Heart volume calculated from chest x-ray films in the supine position decreased significantly from 858 to 766 ml per 1.73 m2. In 10 patients, follow-up heart catheterisation showed a decrease in left ventricular muscle mass in 7 patients and a slight increase in 3 patients. Coronary artery diameter decreased in 7 patients, increased in 1, and was unchanged in 2. The reduction in coronary artery diameter is considered to be a consequence of a reduced heart muscle mass. From all available clinical data it is concluded that verapamil treatment is superior to beta-blocker therapy.

Adult↗
PubMed1979

[Diameter of coronary arteries before and after bypass grafting (author's transl)].

Patients with patent coronary bypass grafts showed the followings: 1. a decrease in prestenotic coronary diameter due to a reduction in flow. 2. An increase of the poststenotic segment of the bypassed vessel due to an increase in flow via the venous graft. 3. An increase of the bypassed stenosis, mainly due to a general decrease of vessel diameter proximal to the stenosis. 4. No change in diameter in non bypassed arteries. The postoperative changes in diameter were not dependent on the time elapsed since surgery and were independent from the severity of coronary sclerosis and the number of risk factors. A correlation was found between the amount of the diameter changes and the amount of reduction in exercise induced ST-segment depression. The decrease in coronary diameter proximal to the stenosis is not due to progression of coronary sclerosis but to a functional change. A narrow poststenotic vessel does not constitute a contraindication for bypass grafting because its true diameter is flow dependent and cannot be judged with certainty from the preoperative angiogram.

Coronary Angiography↗
PubMed1979

[Influence of perhexilinmaleat on the exercise electrocardiogram (author's transl)].

In 15 patients with angiographically proven coronary heart disease and reproducible exercise induced ischemic ST-segment depression the antianginal effect of Perhexilinmaleat was tested in a cross-over randomized double-blind trial. The patients were treated 4 weeks with a placebo, 2 weeks with 200 mg and 2 weeks with 400 mg/day Perhexilinmaleat. The exercise-induced ischemic ST-segment depression was significantly reduced (p less than 0.001) by Perhexilinmaleat. This calcium-antagonist drug also prolonged the PQ-interval and reduced the heart rate during exercise. Some liver specific enzymes were slightly elevated. These and other side effects more often occurred at the higher dose of 400 mg/day.

Coronary Disease↗
PubMed1979

[The meaning of the systolic progression of the mitral valve for the outflow tract obstruction in hypertrophic obstructive cardiomyopathy (HOCM). Studies by means of a valve model].

We constructed two valve models in order to investigate the cause of SAM of the mitral valve and the cause of the outflow tract obstruction in HOCM. With model 1 we were able to demonstrate that a subvalvular obstruction created a SAM of the mitral valve, there was also a pressure gradient distal to the obstruction, the valve itself did not create any obstruction. With model 2 we demonstrated that three causes were responsible for an outflow tract obstruction: 1. A narrow outflow tract even after removal of the mitral valve. 2. A position of the mitral valve close to a protruding septum and relatively short chordae tendineae. 3. A SAM of the mitral valve with apposition to the septum due to a Venturi effect. We were able to create a typical bisferiens poststenotic pressure curve in presence of a monophasic prestenotic curve. We conclude from our investigation that for the SAM of the mitral valve as well as for the outflow tract obstruction different anatomic structures may be responsible, which cause simular hemodynamic abnormalities. These abnormalities are most prominent in HOCM but not necessarily linked with this disease.

Cardiomyopathy, Hypertrophic↗
PubMed1978

[Percutaneous transluminal dilatation of chronic coronary stenoses. First experiences].

The technique of percutaneous transluminal dilatation of coronary artery stenosis consists of a catheter system introduced via the femoral artery under local anesthesia. A preshaped guiding catheter is positioned in the orifice of the coronary artery and through this a dilatation catheter is inserted into the branches if the artery. This dilatation catheter (outer diameter 0.5--1.25 mm) is equipped with a sausage-shaped distensible segment (balloon) at the tip. The balloon is inflated to a pressure of 5 atm. This pressure compresses the atherosclerotic material in a direction perpendicular to the wall of the vessel, therby dilating the lumen. Up to now 29 patients have been treated with primary success in 23 (79%) and long-lasting success in 21 (72%). Three patients underwent emergency coronary surgery to avoid infarction. Dilatation is indicated in patients with disabling angina which jeopardizes their quality of life and with coronary lesions which are proximal, subtotal, concentric and non-calcified.

Angiography↗
PubMed1978

[Diagnosis, therapy and longterm results of atrial myxoma (author's transl)].

Refering to a case report of five patients with atrial myxoma the symptoms, diagnosis, and therapy of this disease were described. In one case a biatrial tumor was found. In four cases atrial myxoma imitated a mitral-valve disease. An elevated BSR was found in all patients. The non invasive diagnostic procedure of ultrasound-echocardiography led in the last two cases to the correct diagnosis before heart-catheterization. The diagnosis was ascertained in all cases by angiocardiography. If left atrial tumor is suspected transpulmonary laevocardiography can be considered as a save diagnostic procedure better than the direct injection into the left atrium after transseptal puncture. Even the left ventricular angiogram in right anterior oblique position led in four of the five cases to the diagnosis of left atrial tumor. Coronary-angiography was performed in three patients and revealed pathologic atrial vessels in all three cases. Immediate operation is the indicated therapy. Two of the five patients were reviewed over a eight year period after operation without any signs of recurrence of the tumor.

Adult↗