bluuebunny/crossref_metadata_2025_split huggingface dataset:
Disturbance in rhythm in 2 patients with a permanent pacemaker and two endocardial electrodes
Authors: JOHANSEN J. KJERSGAARD 
Published: August 2010

ABSTRACT. Rhythm disturbances are described in 2 patients with an implanted permanent pacemaker. Both patients had nonfunctioning electrodes retained after previous complications. It was possible to observe, in both patients, during fluoroscopic examination that the electrodes occasionally touched each other.The etiology of the rhythm disturbances are discussed on the basis of the technical specifications of the pacemakers.The interpretation of rhythm disturbances in patients with implanted pacemakers presents special problems. Disturbances in rhythm can be spontaneous and have no relation to, but possibly modified, by the implanted pacemaker. However, the rhythm disturbances can also result from the technical specifications of the implanted pacemaker or from defects in the same.The following case histories describe disturbances in rhythm in two patients, who both had 2 endocardial electrodes of which only one was connected to the implanted pacemaker.
Treatment of Hypertension in the Community
Authors: Berglund Göran , Andersson Ove , Wilhelmsen Lars 
Published: August 2010

Abstract. The feasibility and efficacy of antihypertensive treatment within the Primary Preventive Trial against myocardial infarction and stroke in Göteborg, Sweden, are described. The study group consisted of 9967 men aged 47–54 years, chosen at random from the general population. 75% of them participated in a screening examination including a blood pressure (BP) measurement. Hypertension defined as BP above 175 mm Hg systolic or 115 mm Hg diastolic on two separate occasions or antihypertensive treatment was found in 9%.The drop‐out rate was 6.5% during the first year and 3.6% during the second year of treatment. The percentage of hypertensive subjects with uncontrolled BP decreased from 83% at screening to 16% after one year and to 9% after two years of treatment. The frequency of side‐effects of such severity as to cause withdrawal of drugs, was 16% during the first year and 7% during the second year.The morbidity in coronary heart disease and stroke in those hypertensives (n=696) treated at the Hypertension Clinic was compared with that of an untreated control group (n=330). The incidence of death and fatal plus non‐fatal myocardial infarction was significantly lower in the treated group than in the untreated comparison group, in spite of lower initially predicted risk of myocardial infarction in the comparison group. The findings indicate that antihypertensive treatment prevents the occurrence of coronary heart disease.
Rocket Immunoelectrophoresis of myoglobin in urine in patients with myocardial infarction
Authors: Kølendorf K. , Pedersen F. , Christiansen E. , Gad I. 
Published: August 2010

AbstractA rocket immunoelectrophoretic method with prepared antisera to rabbit myoglobin has been developed to study the urinary myoglobin excretion in patients with acute myocardial infarction. The method is able to detect a minimum urinary myoglobin concentration of 1—2 mg/l. Urine specimens from 156 patients admitted to the coronary care unit with a provisional diagnosis of acute myocardial infarction were analysed. Seventysix patients proved to have documented myocardial infarction. Twelve of them had at least one positive determination. Four of the 80 without infarction had myoglobinuria. 15 hours elapsed from the time of the initial event of chest pain to the first positive urine specimen. No statistically significant difference could be demonstrated in the mortality in patients with infarction with and without myoglobinuria.The present authors were unable to confirm the high incidence of myoglobinuria in acute myocardial infarction, described previously in other works. The possibility of renal tubular reabsorption of myoglobin as an explanation of this descrepancy is mentioned. Our preliminary results with the estimate of myoglobin in serum with a radioimmunoassay seem to valuable as an index of infarct size.
Development of Ketonemia in Fasting Patients with Hyperthyroidism
Authors: Bartels Paul D. , Kristensen Lars Østergaard , Heding Lise G. , Sestoft Leif 
Published: August 2010

ABSTRACT Concentrations of ketone bodies, free fatty acids, glycerol, lactate, glucose, insulin, glucagon and cortisol were determined 6‐hourly during 36 hours of fasting in 4 hyperthyroid patients and in 4 euthyroid controls. The concentrations of ketone bodies were elevated in hyperthyroid patients from the beginning and increased during fasting more rapidly and to higher values as compared to the controls. After 6 hours of fasting the blood ketone concentrations were 1.1‐1.8 mM in hyperthyroid patients and 0.3‐0.6 mM in the controls. After 36 hours the concentrations had increased to about 3.5 mM and 1.4 mM in hyperthyroid and control subjects, respectively. The concentrations of free fatty acids were identical in the groups compared postprandially, but increased significantly more in the hyperthyroid patients than in the controls during fasting. The glycerol concentration was higher in the hyperthyroid group throughout the observation period.The concentrations of insulin were slightly higher in the hyperthyroid group than in the control, whereas the concentrations of the “ketogenic” hormones, glucagon and cortisol were identical in the compared groups.It is concluded that hyperthyroidism leads to an increased tendency to ketosis, that is partly explained by increased concentrations of free fatty acids and that might also involve a direct action of long term thyroid hormone excess on enzyme activities (e.g. carnitine acyltransferase in liver).
Serum Lipoprotein Composition, Platelet Factor and Arterial Smooth Muscle Cells
Authors: Rönnemaa Tapani 
Published: August 2010

ABSTRACT. The incorporation of [3H] thymidine and the synthesis of glycosaminoglycans (GAG) by cultured human aortic smooth muscle cells were studied in the presence of human sera with high HDL cholesterol concentration, high LDL cholesterol concentration or with normal serum lipoprotein concentrations. The sera were prepared either conventionally (CPS, platelet factor present) or from platelet poor plasma by recalcification (PPPS). As compared to normolipidaemic sera, HDL‐aemic CPS decreased the incorporation of thymidine but LDL‐aemic sera had no effect. HDL‐aemic sera decreased markedly the synthesis of sulphated GAG but had no effect on the synthesis of hyaluronic acid (HA). Therefore, the sulphated GAG/HA ratio was decreased. The decrease in sulphated GAG was observed only in the presence of CPS, not in the presence of PPPS. LDL‐aemic sera decreased the synthesis of hyaluronic acid causing an increase in the sulphated GAG/HA ratio. This effect was observed in the presence of both CPS and PPPS.The results suggest that determination of the sulphated GAG/HA ratio in aortic smooth muscle cell cultures provides a useful method for estimating the atherogeneity of various sera. The anti‐atherogenic effect of HDL‐aemic sera seems to be dependent on the platelet factor while the atherogenic effect of LDL‐aemic sera may be independent of the platelet factor.
COMPARATIVE EFFICIENCY OF QUINIDINE AND VERAPAMIL IN THE MAINTENANCE OF SINUS RHYTHM AFTER DC CONVERSION OF ATRIAL FIBRILLATION A CONTROLLED CLINICAL TRIAL
Authors: Rasmussen Knut , Wang Harald , Fausa Dagfinn 
Published: August 2010

ABSTRACTFiftythree patients with chronic atrial fibrillation participated in a randomized cross‐over trial in order to compare the ability of two drug regimens to establish and maintain sinus rhythm. The patients were given orally either sustained release quinidine 0.4 g twice a day or verapamil 80 mg three times a day. Thirtyone patients tried both regimens. Quinidine was found to have a greater ability to induce conversion to sinus rhythm by drug alone (p <0.05) and also a greater ability to maintain sinus rhythm after conversion (after 3 months p < 0.05). There was, however, also a significantly larger proportion of patients on quinidine who were Withdrawn from the study due to side effects and two patients on quinidine died outside hospital.The study indicate that quindine is somewhat superior to verapamil both in the establishing and preserving of sinus rhythm in subjects who are able to tolerate the drug.
EFFECT OF INHIBITION OF LIPOLYSIS ON ACUTE MYOCARDIAL INJURY DURING CORONARY OCCLUSION IN NORMAL AND RESERPINIZED DOGS
Authors: Kjekshus John K. 
Published: August 2010

ABSTRACTRecent studies have shown that β‐pyridylcarbinol is effective in reducing the extent and magnitude of myocardial ischaemia following acute coronary occlusion. The purpose of the present study was to test the possibility that this effect is due to inhibition of lipolysis induced by cate‐cholamine release in the acutely ischaemic myocardium. Epicardial mapping of ST‐segment changes was used to quantitate the ischaemic injury during acute coronary occlusion. Occlusion alone increased ST‐segment elevation from 0.4 ± 0.1 to 5.5 ± 0.8 mV. During β‐pyridylcar‐binol administration, ST‐segment elevation was reduced to 3.0 ± 0.8 mV (P<0.001) following repeated occlusions of the same coronary artery. In animals pretreated with reserpine in order to deplete myocardial catecholamine stores, ST segments during acute coronary occlusion averaged 4.0 ± 0.5 mV before and 4.4 ± 0.6 mV during β‐pyridylcarbinol treatment (NS). Thus, inhibition of lipolysis during coronary occlusion reduces ischaemic changes in the epicardial ECG only when myocardial stores of catecholamines are intact. This supports the hypothesis that release of catecholamines in the acutely ischemic myocardium activates lipolysis from endogenous stores of triglycerides and that free fatty acids contribute to the ischaemic injury, probably because they increase myocardial oxygen demand.
CAPTOPRIL IN PRIMARY HYPERTENSION
Authors: Öhman K. Peter , Karlberg Bengt E. , Nilsson Ove R. , Wettre Staffan 
Published: August 2010

ABSTRACTThe effects of captopril (SQ 14.225), an orally active inhibitor of angiotensin converting enzyme, were investigated in a dose titration study of primary hypertension. In 32 patients 4 weeks titration with captopril gave a mean blood pressure (BP) reduction of 26/16 mmHg supine and 30/16 mmHg standing. No serious side effects were observed. The BP lowering effect was related to pre‐treatment plasma renin activity and was less in low renin hypertension (p < 0.05). Captopril reduced angiotensin II (p < 0.05), plasma (p < 0.005) and urinary aldosterone (p < 0.001) as well as urinary kallikrein excretion (p < 0.005).Captopril (SQ 14.225) is a competitive inhibitor of peptidyl dipeptide hydrolase, also known as angiotensin converting enzyme (ACE) or kininase II, which converts angiotensin I (A I) into angiotensin II (A II), hydrolyzes des‐Asp‐angiotensin I to angiotensin III (A III) and inactivates bradykinin (BK) (19). Captopril has potent antihypertensive effects when used in human hypertension (review, 3) especially when the renin‐angiotensin‐aldosterone system (RAAS) is activated.To further investigate the mode of action and the hypotensive effect of captopril, we measured plasma renin activity (PRA), A II, plasma (PA) and urinary aldosterone excretion (UA) and urinary kallikrein excretion (UK) in 32 patients with established primary (essential) hypertension.
Nature of Cardiac Arrhythmias and Electrolyte Disturbances
Authors: Olsson S. Bertil 
Published: August 2010

AbstractAtrial fibrillation is highly favoured by an accelerated atrial muscle repolarization. In hyperthyroidism, this occurs without changes in resting membrane potential level of the atrial muscle cells and without changes of the ionic composition of the cell. In patients prone to atrial fibrillation but without signs of hyperthyroidism, accelerated atrial repolarization can also be demonstrated. In such patients, a decreased atrial muscle potassium content seems responsible for the electrophysiological changes that highly favours the occurence of atrial fibrillation.
Exchangeable Electrolytes in Heart Disease
Authors: Olesen Knud H. 
Published: August 2010

AbstractThe results of measurements of body sodium, chloride and potassium by isotope dilution or whole body counting in patients with heart disease are reviewed. In patients with cardiac oedema exchangeable sodium and chloride are increased while body potassium tends to be decreased or normal. The findings in normonatraemic hypochloraemia, hypokalaemia and metabolic alkalosis, in diuretic hyponatraemia and in dilutional hyponatraemia are reviewed and their possible consequences in terms of changes in electrolyte gradients are discussed.The limitations and usefulness of measurements of exchangeable electrolytes in heart disease are mentioned.
Diuretics, Digitalis and Arrhythmias
Authors: Steiness Eva 
Published: August 2010

AbstractArrhythmias induced by digitalis are believed to be secondary to changes in ion concentrations in the myocardial cells or changes in the transcellular ion gradient.Both diuretic induced hypokalemia and digitalis inhibit the membrane‐Na+K+ATPase activity which cause a decrease of the intracellular potassium concentration. This may explain the risk of cardiac arrhythmias during digitalis treatment and during severe hypokalemia, and may further explain the increase for myocardial sensitivity for digitalis when hypokalemia is present.The myocardial uptake of digitalis however is markedly increased at low extracellular potassium concentration and this may be the explanation of the interaction between digitalis and hypokalemia.Not only the myocardial digoxin kinetic is changed during hypokalemia but the renal excretion rate of digoxin is markedly reduced during hypokalemia leading to increased serum digoxin concentration and thereby the risk of digitalis intoxication.
In‐hospital Ventricular Fibrillation and its Relation to Serum Potassium
Authors: Hulting Johan 
Published: August 2010

AbstractSerum potassium (S‐K) has been related to the incidence of ventricular fibrillation (VF) before admission to, and during observation in a coronary care unit (CCU). The series comprises 1315 patients. Acute myocardial infarction (AMI) was diagnosed in 537 patients. VF occurred in 46 patients. Fourteen of these had their VF before admission to the CCU. The incidence of VF within 12 h after CCU admission (early VF) was significantly raised (p < 0.01) in patients with an initial S‐K less than 3.9 mmol 1 I‐1. In this group, the incidence of early VF in all patients and in those with AMI amounted to 3.0 and 5.4%, respectively. Corresponding figures in patients with an initial S‐K of 3.9 mmol 1 I‐1 or above were 0.6 and 1.5%. Thus, a near 5‐fold increase in the incidence of early VF was observed with a S‐K below 3.9 mmol 1 I‐1. Patients with VF occurring later than 12 h after admission had significantly higher S‐K values than those with early VF. In AMI, the risk of primary and secondary VF seemed to be equally increased with low initial S‐K values. There was a strong correlation between myocardial infarction size and the risk of VF. No relationship, however, was noted between infarction size and initial S‐K.
THE IMPORTANCE OF THE COLLATERAL CIRCULATION FOR MYOCARDIAL SURVIVAL
Authors: Schaper W. , Nienaber C. , Gottwik M. 
Published: August 2010

ABSTRACTIn acute coronary occlusion the survival time of ischemic myocardium depends critically upon collateral blood flow and on oxygen uptake at the moment of, and during, occlusion. There are good reasons to believe that ischemic myocardium provides the stimulus for near‐maximal vasodilation of collateral blood vessels. Under these conditions the determinants of collateral blood flow are: a) the anatomically fixed hydraulic resistance of the collaterals proper, b) the arterial driving pressure, c) extravascular resistance (radial stress, pressure transmission across the LV‐wall, tissue pressure) and d) size of the ischemic bed. Under ideal conditions (maximal dilation of collaterals) overall collateral resistance is 3.5 resistance units, i.e. theoretically a perfusion pressure of 350 mmHg is needed to drive 100ml of blood per minute through 100g of tissue. Small ischemic beds receive a relatively larger amount of collateral flow and vice versa. This delays necrosis (but does not prevent it) following occlusion of small coronary arteries. The reason for this is the more favorable ratio of epicardial circumference (of the ischemic area) to ischemic volume because canine collaterals are exclusively located on the epicardial surface. ‐ Tissue pressure in acute occlusion is distributed in such a way that subendocardial collateral flow is lower than subepicardial flow. This leads to an earlier onset of irreversible damage in the subendocardium, earlier damage to subendocardial microvessels, i.e. earlier subendocardial no‐reflow phenomenon. Flow «offered» to but not «taken» by the subendocardium is at the disposal of the subepicardium which thereby increases its chances of survival. As a rule subendocardial flow decreases as a function of time after occlusion and subepicardial flow increases. In certain cases even subepicardial flow is too low shortly after occlusion. In this case it decreases further with time and a truly transmural infarct develops.
BETA BLOCKERS AFTER MYOCARDIAL INFARCTION ‐ ASPECTS ON STUDY DESIGN BASED ON CURRENT KNOWLEDGE
Authors: Vedin Anders , Wilhelmsson Claes 
Published: August 2010

ABSTRACTThe beta‐blocker trials published so far may be subdivided into three different categories: 1) retrospective, 2) prospective non‐conclusive, 3) prospective conclusive studies.The retrospective studies suffer the weaknesses of the retrospective method and may only be used as supportive evidence.There have so far been four prospective studies producing positive results, three with alprenolol and one with practolol. The studies presented support the concept that practolol and alprenolol reduce the long‐term mortality due to sudden death from ischemic heart disease after myocardial infarction.All the studies have been criticized on various grounds and a list of unanswered remaining issues may be made. Acute and long‐term effects of betablockade need not be the same. Our knowledge about the necessary doses and plasma levels is incomplete. All the studies published so far cover a maximum period of two years. If the study observation periods were prolonged it is likely that at some time the relative benefit becomes less. Ideal treatment should be reserved for those patients likely to derive significant benefit from it. At the present time identification of such patients is not sufficiently precise. Whether or not the beta‐blockers have an antiarrhythmic effect, for instance demonstrated on chronic PVC's, this information is of little value in interpreting the proper mechanism of the beta‐blockers in acute ischemia and lethal arrhythmias.In order to contribute new knowledge future studies should involve sufficiently large numbers of representative groups of patients, a stratified study design and a beta‐blocker with ancillary properties different from alprenolol.
INTERVENTION ON SMOKING AND EATING HABITS IN HEALTHY MEN CARRYING HIGH RISK FOR CORONARY HEART DISEASE. THE OSLO STUDY
Authors: Hjermann Ingvar 
Published: August 2010

ABSTRACT1232 healthy, normotensive, but coronary high risk men were selected for a 5‐year randomized trial in order to show if lowering of serum lipids and cessation of smoking was followed by prevention of coronary heart disease. The men included in the trial had serum cholesterol between 7.5 mmolll (290 mg/dl) and 9.8 mmol/l (380 mg/dl), coronary risk score (based on cholesterol, smoking and blood pressure) in the upper quartile of the distribution and systolic blood pressure <150 mm Hg.The men in the intervention group were recommended to stop smoking and to lower their blood lipids by dietary changes.On average, mean serum cholesterol concentration was 13 per cent lowered in the intervention group compared to the controls during the 5 years of the trial. Mean fasting serum triglycerides decreased by 20 per cent in the intervention group compared to the control group. Tobacco smoking was reduced about 50 per cent in the intervention group in relation to controls. (Eighty per cent of the men in both groups were daily cigarette smokers at the start of the study).Diagnoses of events of cardiovascular disease during the 5 years were made blindly by a diagnostic board not involved in the study, according to predefined criteria.At the end of the observation time the incidence of myocardial infarction (fatal and non‐fatal) and sudden death was 47% lower in the intervention group than in the controls (p=0.028, 2‐sided test).It is concluded that in healthy, coronary high risk, middle‐aged men, advice to change eating habits and to stop smoking, significantly reduces the incidence of a first event of myocardial infarction and sudden death.
The Value of Anti–Anxiety Drugs in the Management of Cardiac Disease
Authors: Wheatley David 
Published: August 2010

ABSTRACT. In 3 double–blind randomized trials, clorazepate was compared to placebo in post–infarction and pre–infarction patients, and diazepam was compared to placebo added to verapamil. There was a significant reduction in trinitrate requirement in the first clorazepate study but not in the second nor in the third, although this has not yet been completed. Taking all 3 trials together, there were 5 cases of myocardial infarction in 63 patients treated with placebo but not no cases in 64 patients treated with the anti–anxiety drugs (p < 0.05).Relief of anxiety was accompanied by reduction in the anginal attack rate with both active and placebo medications. In further similar studies in hypertension, relief of anxiety was also accompanied by reduction in blood pressure. However, in a 4–way comparison between lorezepam, bendrofluazide, lorazepam plus bendrofluazide and placebo, mean normotensive levels were only achieved in patients treated with the combination of anti–anxiety and antihypertensive medication.
Haemodynamic effects of α–receptor blockade during acute administration and chronic treatment
Authors: Rasmussen Knud 
Published: August 2010

ABSTRACT.Acute administration of relatively large doses of the postsynaptic α–adrenoceptor blocking agent prazosin results in a marked vasodilatation and blood–pressure reduction, often combined with tachycardia.Chronic administration results in a decrease in total peripheral resistance and blood pressure at rest and during exercise. Cardiac output is unchanged at rest but shows a slight increase during exercise. Peripheral blood flow is increased during chronic treatment.It is concluded that α–receptor antagonists may be able to normalize – completely or partly – the pathological haemodynamics of the hypertensive patient.
Rationale for combined α–β–adrenoceptor blockade: haemodynamic considerations
Authors: Koch Günter 
Published: August 2010

ABSTRACT.Increased peripheral vascular resistance is the cause of elevated blood pressure in most forms of systemic hypertension. Both structural changes in response to increased wall stress and functional alterations in vascular smooth muscle itself appear to contribute to the elevated resistance. As mediators of the vasoconstrictor responses, α–adrenoceptors apparently play an important if not predominant role in the initiation and/or maintenance of high resistance and pressure.In contrast to β–receptor blockade alone, combined α–β–receptor blockade lowers blood pressure predominantly by α–receptor–mediated reduction of the systemic vascular resistance, both when induced acutely and, in particular, during long–term administration. Cardiac output is maintained at pretreatment level, as is left ventricular filling pressure.Since a well–balanced blockade of both α– and β–receptors counteracts the pathophysiological changes causing and/or maintaining hypertension and tends to restore cardiovascular dynamics towards normal, combined α–β–receptor blockade appears at present to be one of the most logical and rational therapeutic approaches to hypertension.