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Biomedical subjects

T Bodemann

Publications and source records attributed to T Bodemann.

7 recordsLinked to original sources
PubMed1997

Hemodynamic action of captopril in coronary patients with heart failure tolerant to nitroglycerin.

BACKGROUND: At present there is little dispute that clinical tolerance of organic nitrates occurs during long-term treatment of patients with stable angina pectoris and congestive heart failure. HYPOTHESIS: Captopril exerts a favorable hemodynamic effect in coronary patients with heart failure who are clinically tolerant to nitroglycerin. METHODS: Development of nitrate tolerance was observed during intravenous nitroglycerin treatment (10 mg/h) in 16 of 19 patients (7 women, 12 men; mean age 56 +/- 8 years) with coronary heart disease [stenosis > or = 75%, New York Heart Association (NYHA) classes II-III). The criterion applied was a loss of efficacy of at least 50% with regard to mean pulmonary capillary wedge pressure compared with the maximum effect of nitrate. The effect of captopril (50 mg p.o.) was determined in a blank test. Captopril (50 mg p.o.) was administered again at the stage of clinically manifest nitrate tolerance. RESULTS: Compared with the effect of captopril alone, significantly more pronounced reductions in mean pulmonary capillary wedge pressure (33% compared with 27%) and in mean pulmonary arterial pressure (36% compared with 17%) and significantly greater increases in cardiac index (14% compared with 7%) and stroke work index (34% compared with 18%) (p < 0.05 in each case; Wilcoxon test for linked random samples) were measured. Maintaining nitroglycerin infusion, the effect of captopril (at least 90% of the maximum effect) lasted for 123 +/- 24 min. The baseline values (at least 75% decline in the effect of captopril) were only reached after 369 +/- 34 min. CONCLUSION: The results document a favorable hemodynamic effect of captopril in nitrate tolerance which is significantly better than that of captopril alone.

Aged↗
PubMed1993

[Hemodynamic effect of molsidomine in coronary patients with heart failure with clinically manifest nitrate tolerance].

Objective of the present study was to investigate the hemodynamic response to molsidomine in nitrate tolerance state. In 13 out of 16 patients (5 women, 11 men, 62 [53/71] years [median, 25%/75%-percentiles]) with chronic heart failure (NYHA stage II-III; median angiographic ejection fraction (EF) 55%) and coronary artery disease (stenosis of at least 75%) the development of tolerance under the continuous infusion of high doses of nitroglycerin (10 mg/h) was observed. Tolerance was defined as a benefit loss of at least 50% of the initial nitroglycerin effect with respect to the pulmonary capillary wedge pressure. Compared to the state of tolerance to nitroglycerin the infusion of 10 mg molsidomine over 15 minutes resulted in significant changes of the median values (25%/75%-percentiles) of mean right atrial pressure from 16 (12/21) to 9 (5/12) mmHg (p < 0.01), mean pulmonary artery pressure from 37 (30/40) to 24 (20/30) mmHg (p < 0.001), mean pulmonary capillary wedge pressure from 22 (18/25) to 15 (10/22) mmHg (p < 0.01) and cardiac output from 4.1 (3.5/4.7) to 5.2 (4.2/5.6) l/min (p < 0.01). This action of molsidomine corresponded to a complete overcoming (> 100%) of the benefit loss observed during the development of nitrate tolerance with respect to all above-mentioned hemodynamic parameters. Under parallel maintainance of nitroglycerin infusion (10 mg/h) these hemodynamic effects of molsidomine, i.e. at least 90% of the peak effect, lasted for 147 (130/182) minutes (median, 25%/75%-percentiles). Baseline values, i.e. a loss of at least 75% of the molsidomine effect, were only reached after 363 (319/412) minutes (median, 25%/75%-percentiles).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

[Nitrate tolerance and its management by N-acetylcysteine (studies of patients with severe chronic heart failure)].

The mechanisms responsible for the development of nitrate tolerance are not completely clear, and their clinical importance remains controversial. This study examined the possible development of nitrate tolerance under the continuous infusion of high doses (10 mg/h) of nitroglycerine (NTG) and the effect of an additional N-acetylcysteine (NAC) injection in respect of hemodynamic changes. Eighteen patients with severe chronic heart failure (NYHA stages III-IV) were investigated. In 16 patients, NTG produced a marked improvement of the hemodynamic parameters; in two patients it caused a moderate amelioration only. In 13 patients there was a complete loss of the initial hemodynamic effect of NTG within 12 to 36 h. NAC reversed the NTG tolerance in 11 out of the 13 patients. In the two patients who showed a milder response to NTG and who did not develop a tolerance, NAC improved the effectiveness of NTG significantly. There was no additional NAC effect in the three patients without NTG tolerance. NAC itself produced no hemodynamic changes. These results confirm the relevance of the depletion of sulfhydryl-groups for the development of nitrate tolerance under the continuous infusion of NTG.

Acetylcysteine↗
PubMed1988

[Repeated early systemic lysis in acute myocardial infarct with recurrent ventricular fibrillation].

A 46-year-old man sustained an extensive acute inferoposterior myocardial infarction with cardiogenic shock. Recurrent ventricular fibrillation was controlled and enlargement of the infarct prevented by systemic thrombolysis, first begun in the ambulance and later twice repeated. Coronary angiography demonstrated isolated 50% stenosis of the circumflex branch in a left-dominant coronary circulation. Subsequent ventriculography demonstrated normal left-ventricular function.

Angiography↗
PubMedDate not supplied

Age-related hemodynamic changes during diastole: a combined M-mode and Doppler echo study.

To determine the effect of aging on the diastolic function of the left ventricle (LV) echo examination was performed in 115 subjects (47 women, 68 men) without any evidence of organic heart disease (2D and Doppler echo; exercise electrocardiography) aged 21 to 72 (mean +/- SD: 41 +/- 14) years. Transmitral flow with the characteristic early and late diastolic E-wave (E) and A-wave (A) was derived by pulsed Doppler ultrasound, whereas isovolumetric relaxation period (IVRP) was assessed by simultaneous M-mode registration of the aortic and mitral valve. Significantly increased values in older individuals (41 to 72 years; n = 57) as compared to younger subjects (21 to 40 years; n = 58) were found for the A/E ratio of the peak velocities (PAV/PEV) (90 versus 64%; p less than 0.001) and the velocity-time integrals (VTI-A/E) (79 versus 36%; p less than 0.001), atrial contribution to LV filling (AFF) (45 versus 26%; p less than 0.001) and isovolumic relaxation period (IVRP) (81 versus 72 ms; p less than 0.001). Age significantly correlated with PAV/PEV (r = 0.74; p less than 0.001), VTI-A/E (r = 0.83; p less than 0.001), AFF (r = 0.81; p less than 0.001) and IVRP (r = 0.74; p less than 0.001). Thus, age-related hemodynamic changes during diastole are characterized by a prolongation of IVRP and an increase of atrial contribution to LV filling.

Adult↗