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Biomedical subjects

T Lundman

Publications and source records attributed to T Lundman.

At least 19 recordsLinked to original sources
PubMed1987

Mononitrates as monotherapy in the prophylactic treatment of angina pectoris.

This article reviews the results of double-blind comparative studies on the therapeutic use of isosorbide 5-mononitrate as monotherapy in the prophylaxis of angina pectoris. Isosorbide 5-mononitrate appears at least as effective as the same dosage of isosorbide dinitrate and is probably superior to the calcium antagonists. Recent data have shown that isosorbide 5-mononitrate in a controlled-release formulation given once daily has a significantly better antianginal effect than placebo without inducing the development of tolerance.

Angina Pectoris↗
PubMed1987

Pharmacokinetics of felodipine and effect on digoxin plasma levels in patients with heart failure.

Some calcium antagonist drugs used in hypertension and cardiac diseases have been shown to increase plasma digoxin levels mainly as a result of reduced renal clearance. Felodipine is a new dihydropyridine calcium antagonist drug with cardiovascular effects, whose pharmacokinetics and effects on plasma digoxin levels have been studied in patients with left ventricular failure. 12 patients (11 men) on long term digoxin therapy were given 2.5 or 5 mg felodipine bid for 7 days followed by 1 week on 10mg bid. Plasma levels of digoxin and felodipine were measured before dosage and 30, 60 and 90 minutes and 2, 3, 4, 6, 8, 10 and 24 hours after the first dose and after 1 week of therapy (steady state). The area under plasma concentration versus time curve was calculated after the first dose and in steady state both for digoxin and felodipine. The absorption characteristics Cmax and Tmax were calculated both for felodipine and digoxin on the different felodipine doses. There was a linear relationship between dose and plasma level of felodipine. Plasma half-life in the 4- to 10-hour period of felodipine was 5.5 hours after a 10mg single dose, and 12 hours after 10mg bid. Felodipine 2.5mg, 5mg and 10mg all transiently increased peak plasma digoxin concentrations (by about 40%) at 1 hour after intake. Urinary excretion of digoxin during the day was unchanged, but impaired renal clearance may account for the transient increase in digoxin plasma level after felodipine.

Aged↗
PubMed1986

The effect of isosorbide-5-mononitrate (5-ISMN) Durules on exercise tolerance in patients with exertional angina pectoris. A placebo controlled study.

Twenty-four patients with stable exercise-induced angina pectoris entered a double-blind cross-over study. Isosorbide-5-mononitrate (5-ISMN) 60 mg in a controlled release formulation (Durules) given once daily was compared with identical placebo. The exercise tolerance was determined by bicycle ergometry before and 3 h after a single dose of 5-ISMN and following one week's treatment with 5-ISMN and placebo. Nineteen patients completed the study. Exercise tolerance until the onset of chest pain and until 1 mm ST segment depression increased significantly 3 h after dose. The same increase was seen both after a single dose and the same dose under steady-state conditions. No increase was seen with placebo. The heart rate and systolic blood pressure reactions in the standing position were less pronounced 3 h after dose in steady-state than after a single dose of 5-ISMN. Headache was the only bothersome side-effect reported. The study demonstrates that 60 mg 5-ISMN in a Durules formulation given once daily has a significant anti-anginal effect and that tolerance does not develop.

Adult↗
PubMed1986

Unexpected death in patients suffering from eating disorders. A medico-legal study.

Medico-legal investigation into causes of unexpected death of five persons who suffered from eating disorders did not give distinct pathoanatomical explanations. The analysis disclosed a number of risk factors whose interplay may have resulted in a circulatory catastrophy. These factors were of organisational and ideological character: simultaneous treatment at different departments, lack of contact with psychiatrists, or unclear criteria for admission to hospital; or somatic: circulatory and electrocardiographic S-T and T wave abnormalities, hypopotassemia and hypoglycemia, as well as anergy of the emaciated patient which may have led to symptoms of bronchopneumonia being overlooked. Morphological investigation revealed heart atrophy as well as recent lesions such as haemorrhages, fragmentation and contraction bands of the myofibres. In two extremely emaciated patients there was a disproportion between the size of the mitral valves and the atrophic ventricular wall, an appearance similar to "floppy valves". In one instance an erroneously inserted gastric tube contributed to vomiting, hypopotassemia and sudden death.

Adolescent↗
PubMed1985

Long-term treatment with metoprolol after myocardial infarction: effect on 3 year mortality and morbidity.

The effects of metoprolol treatment in patients surviving acute myocardial infarction have been investigated in a double-blind randomized study. The patients were stratified according to age, infarct size and type of ventricular arrhythmias before administration of metoprolol, 100 mg twice daily (n = 154), or placebo (n = 147). All patients were followed up for 36 months. There were 31 (29 cardiac) and 25 (20 cardiac) deaths in the placebo and metoprolol groups, respectively. Subgroup analyses showed a significant reduction of cardiac death in patients with a large infarct (32.1% with placebo versus 12.5% with metoprolol, p less than 0.05) as a result of active treatment. Sudden death rates were 14.7% in the placebo versus 5.8% in the metoprolol group (p less than 0.05). The incidence of nonfatal reinfarction was 21.1% in the placebo versus 11.7% in the metoprolol group (p less than 0.05). The reduction in nonfatal reinfarction was similar in all pretreatment risk strata. The difference between the two groups in cumulative number of cardiac deaths and patients experiencing nonfatal reinfarction increased throughout the study. Furthermore, cerebrovascular events (p less than 0.05) and coronary bypass surgery (p = 0.058) were more frequent in the placebo group. In conclusion, after 36 months of metoprolol treatment after myocardial infarction, there was a significant reduction of nonfatal reinfarction and sudden death in all patients and a reduction of cardiac death in those with a large infarct.

Aged↗
PubMed1983

Genetic and environmental determinants of cholesterol and HDL-cholesterol concentrations in blood.

Serum cholesterol and HDL-cholesterol have been studied in 274 Swedish nuclear families. The families were ascertained through the Swedish twin registry and consisted of married mono- and dizygous twins, their spouses and with at least one adult child. Total cholesterol was determined using an enzymatic colorimetric method and HDL-cholesterol by the heparin-manganese chloride precipitation method. The genetic analysis was performed using a path analytic model to resolve genetic and cultural heritability, marital correlations and maternal effects. Genetic heritability was 0.50 and 0.37 for total cholesterol and HDL-cholesterol, respectively. Cultural heritability was small, 0.04, for cholesterol but substantial 0.22, for HDL-cholesterol. A maternal effect was evident for cultural inheritance for HDL-cholesterol but not for cholesterol.

Adult↗
PubMed1983

Ventricular arrhythmias and left ventricular dysfunction in familial cardiomyopathy.

In familial cardiomyopathy (CM), different forms of myocardial abnormalities including asymmetric and symmetric hypertrophy and dilated left ventricles are presented, mostly showing varying hereditary penetrance. This study presents a family with CM including three major clinical manifestations: severe ventricular arrhythmias, repolarization abnormalities and left ventricular hypertrophy. This triad was strikingly consistent in the two generations examined. The familial pattern with an autosomal dominant inheritance did not show any linkage to the HLA region.

Adult↗
PubMed1979

Early and sudden deaths after myocardial infarction. A report from the Swedish CCU study.

1329 patients were discharged alive after acute myocardial infarction initially treated in a CCU. In a five-year follow-up, 537 (40%) of the patients died. Routine data registered uniformly during the CCU period showed that, apart from age, the most important factors regarding long-term prognosis in general were previous ischaemic heart disease and direct or indirect signs of heart failure registered in the CCU. The possibilities to predict sudden death (130 patients died within 2 hours of onset of final symptoms during the follow-up period) were small, although a definite dominance of this mode of death was noted in patients below 60 years of age. The clinical profile of the majority of the 134 patients who died during the first half-year was distinguished by a history of prior myocardial infarction and signs of left heart failure during the CCU stay. However, in a significant number of patients dying early after discharge, none of the ordinary unfavourable prognostic signs had been registered.

Acute Disease↗
PubMed1979

Early mobilization and discharge of patients with acute myocardial infarction. A prospective study using risk indicators and early exercise tests.

Consecutive patients (n=184) surviving 48 hours in a coronary care unit were divided into one rapidly (RM) (n=55, 30%) and one conventionally mobilized (CM) group (n=129, 70%). The selection of RM patients was based on the absence of five early risk indicators (RI), reflecting electrical and mechanical heart dysfunction. During after-care, five late RIs were evaluated, including a submaximal bicycle exercise test to 50 W, which excluded nine (16%) additional patients from the RM group. After excluding four patients for non-cardiac reasons, the remaining 42 RM patients were rapidly mobilized and discharged after a mean of nine days, in contrast to a mean of 19 days in the CM group, comprising 121 patients. No RM patient dies in hospital and only one patient died during a six-month follow-up, compared to 17 (p less than 0.01) and 28 (p less than 0.01) patients respectively, in the CM group. Both reinfarction and mortality increased with the number of positive RIs. The early exercise test excluded four patients from the RM group. Altogether 22 of 45 patients showed some abnormality during exercise. Half of these 22 patients were readmitted due to cardiac complications during the follow-up period. These findings indicate that it is possible to identify a group of patients with AMI suitable for early discharge, and that an early exercise test in selected good risk patients is safe and identifies a group prone to complications during the early follow-up period.

Aged↗
PubMed1979

Dobutamine in left heart failure after acute myocardial infarction.

Dobutamine, a new positive inotropic drug, was given as i.v. infusion at a rate of 2.5--7.5 micrograms/kg/min to nine male patients with a moderately severe left heart failure. The patients were treated in our CCU for acute myocardial infarction (AMI) and had PEP/LVET above 0.40 on routine registrations of systolic time intervals, PEP (preejection phase), PEPI (PEP corrected for heart rate), LVET (left ventricular ejection time) and LVETI (LVET corrected for heart rate). Dobutamine increased contractility, measured as shortening of PEP and PEPI, and also increased ejection fraction, measured as PEP/LVET. Concomitantly, heart rate increased significantly but no changes were noted in systolic or diastolic BPs. The positive inotropic effect of dobutamine was thus accompanied by a positive chronotropic effect, which limits the usefulness of the drug in patients with recent AMI.

Acute Disease↗
PubMed1978

The relationship between QT interval and ventricular arrhythmias in acute myocardial infarction.

Out of a total of 947 patients admitted to the CCU at Serafimerlasarettet during 2 years, all those with AMI and vintricular fibrillation (VF) or ventricular tachycardia (VT) during the CCU stay were selected. The QT interval could be measured in 15 patients with VF and 12 with VT before the event. The QT interval was also measured in two control groups; one consisted of 27 consecutively admitted patients with AMI without ventricular arrhythmias (VA), the other of 27 non-AMI patients treated in the CCU. Most patients in the group with VA showed pathologically prolonged QT intervals and there were statistically significant differences between this group and the control groups regarding corrected mean QT intervals. If these findings are confirmed, QT measurements might be of value in the prediction of malignant VA in AMI.

Acute Disease↗
PubMed1978

Prognostic implications of ventricular arrhythmias registered before discharge and one year after acute myocardial infarction.

The prognostic weight of ventricular ectopic beats (VEBs) was evaluated in 160 patients discharged after a CCU-treated acute myocardial infarction (AMI) and followed for two years. VEBs were registered prior to discharge by 6 hours of telemetry (3 hours during daytime including exercise and 3 hours at night) and again one year after the AMI. During the first year of follow-up, 11 patients died suddenly and 20 suffered reinfarction. Sixteen (55%) of these had shown severe VEBs, i.e. multiform, paired, R-on-T, or ventricular tachycardia, as compared to 42 (29%) of the remainder. During the second year of follow-up, eight patients suffered reinfarction and five died suddenly. The occurrence of severe VEBs prior to discharge was not of prognostic value for the second year per se but continued to carry prognostic weight for the first plus the second year. One year after the AMI the VEB incidence in 122 survivors without reinfarction increased insignificantly from 71 to 78%. VEB severity increased in 43% and decreased in 27% and the shift towards severe forms is significant. Severe VEBs one year after the AMI carry a prognostic weight for the second follow-up year, as 18% of patients with severe VEBs reinfarcted or died suddenly against 5% of those with nor or uniform VEBs only. Patients who had severe VEBs both prior to discharge and one year later did especially badly.

Acute Disease↗
PubMed1977

A survey for circulating immune complexes in patients with acute myocardial infarction. Use of a C1q-binding assay with soluble protein A as indicator.

A new assay for the detection of circulating C1q-binding immune complexes (IC) is described. The assay makes use of solid-phase C1q and iodinated soluble protein A, extracted from the cell wall of Staphylococcus aureus. In a model system the assay could detect heat-aggregated IgG down to a concentration of about 50 ng/ml. This method and three other assays, previously described, were used to survey the appearance of IC activity in sera from hospitalized patients with acute myocardial infarction. Depending on the assay system used, from 56% to 66% of the patients investigated were found to develop circulating IC. The earliest appearance of circulating IC was noted 5 days after infarction. The highest incidence of positive reactions and the strongest reactions occurred 2 to 3 weeks after hospitalization; thereafter the IC positiveness tapered off, and all patients were negative 6 weeks after infarction.

Acute Disease↗