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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

1. Using a calcium buffer system, the effect of severe calcium lack on the shape of K-contracture of the guinea-pig's taenia coli was studied. Under conditions of calcium lack, the initial phasic response was preferentially affected and it disappeared completely at concentrations below 10(-7)M, while the ensuing tonic response persisted, though considerably diminished in size, even at the concentration of 10(-8)M.2. In calcium-free media, various multivalent cations, which according to Frank (1962) can support the K-contracture of a skeletal twitch muscle fibre in calcium-free solution, augmented the remaining tonic response, but did not restore the phasic response, when it was eliminated in calcium free environment.3. When K-contractures were induced in normal calcium media, these cations produced, in contrast, an abolition of the phasic response together with a partial depression of the tonic phase. They also inhibited a part of the fully developed contracture. The last effect was no longer obtainable in calcium-free media.4. It is concluded that the phasic response and a part of the tonic response of taenia coli depend upon the extracellular calcium for their initiation (and also for maintenance of tension in the case of the latter) and that the rest of the tonic response draws on a store of ;bound' calcium for its evolution.
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PMID:Actions of calcium and certain multivalent cations on potassium contracture of guinea-pig's taenia coli. 603 17

In order to study the possible relation between blood viscosity and exercise ST segment depressions in hyperlipidemia the former was lowered by infusion of dextran and by treatment with clofibrate 1 g twice daily. Acute decrease of blood viscosity with dextran infusion in two cases increased the ST segment depressions during work. Nine subjects with asymptomatic hyperlipidemia, hyperfibrinogenemia and exercise ST segment depressions were treated with clofibrate in order to lower plasma fibrinogen and serum lipids. This did not influence the area of ST segment depression with either Frank leads or CH leads as determined by computer estimation. As the plasma fibrinogen level is of major importance for the blood viscosity it is concluded that the ischaemic ST segment depression seen in hyperlipidemia is not due to increased blood viscosity but more likely to a premature subclinical coronary atherosclerosis.
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PMID:Effect of blood viscosity decrease on exercise ST segment depressions in hyperlipidemia. 616 35

In order to elucidate the hemodynamic significance of exercise-induced ST-segment shifts in ischemic heart disease, left ventricular cineangiography was carried out in 41 patients at rest and during supine bicycle ergometer exercise. These patients were divided into 2 groups, that is, a normal coronary artery group (6 patients), having neither significant coronary artery stenosis nor exercise-induced ST-segment shifts, and a diseased group (35 patients) having significant coronary artery stenosis (inner-diameter stenosis greater than or equal to 75%). The latter was further divided into 3 subgroups according to exercise-induced ST-segment shifts: ST-unchanged group (17 patients), ST-depression group (11 patients) and ST-elevation group (7 patients). In the normal coronary artery and ST-unchanged groups, exercise produced an increase in left ventricular end-diastolic volume index (LVEDVI), a decrease in left ventricular end-systolic volume index (LVESVI) and increases in stroke index and ejection fraction. In the ST-depression group, the appearance or aggravation of left ventricular wall motion abnormality was induced at the site of coronary artery stenosis by exercise in 9 patients. Both LVEDVI and LVESVI increased, stroke index remained unchanged, and ejection fraction decreased during exercise. In the ST-elevation group, ST-segment elevation was induced in leads with abnormal Q waves. In 2 patients, exercise induced aggravation of wall motion abnormality at the infarctional segment. LVESVI increased, but LVEDVI showed little increase, and stroke index and ejection fraction tended to decrease during exercise. In the ST-depression group, exercise-induced left ventricular pump dysfunction was due to lowered contractility (increased LVESVI) caused by transient myocardial ischemia. In the ST-elevation group, exercise-induced pump dysfunction was mainly due to lowered contractility, and in some of them, the findings suggested that transient myocardial ischemia at or around the region of infarction might be the cause of pump dysfunction. In addition, a poor compensatory effect of the Frank-Starling mechanism seemed to play a role in the onset of such dysfunction in this group.
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PMID:Hemodynamic evaluation of exercise-induced ST-segment depression and elevation in ischemic heart disease. Left ventricular cineangiography during exercise. 666 58

We evaluated the effects of intravenous verapamil, a calcium antagonist, on hemodynamics and regional left ventricular (LV) performance in patients with acute myocardial infarction (AMI). Twenty patients having uncomplicated infarction or moderate heart failure were randomized to receive either verapamil or placebo and were studied a mean of 12 hours after onset of symptoms. Verapamil, 7.5 mg intravenously, acutely reduced systolic arterial pressure (p less than 0.0005), systemic vascular resistance, and LV stroke work (p less than 0.005) and rate-pressure product (p less than 0.05); the heart rate did not alter. The Frank-Starling relationship by Swan-Ganz catheter did not change for 1 hour. Segmental wall motion amplitudes were recorded from eight standardized segments around the left ventricle by a multidirectional M-mode echocardiographic technique. The systolic wall motion of the uninvolved LV segments and LV cavity size did not change after verapamil. Verapamil improved mechanical performance in the ischemic segments (p less than 0.005). Therefore, the overall regional contractile function of the left ventricle improved as well (by 11% to 13%, p less than 0.05). This echocardiographic improvement continued after the acute vasodilatory response of intravenous verapamil subsided and was preserved for 1 week, the patients having had oral verapamil, 240 mg daily. Chest pain was relieved in five of the six patients having ongoing slight pain before verapamil injection. No sequential hemodynamic or echocardiographic changes occurred in the placebo-treated patients. Thus, in patients with uncomplicated AMI, verapamil improve contractile function of the acutely ischemic LV segments by hemodynamic unloading and/or by direct myocardial effect, without manifest depression of the uninvolved myocardium.
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PMID:Effects of verapamil in patients with acute myocardial infarction: hemodynamics and function of normal and ischemic left ventricular myocardium. 669 58

Three patients with severe pre-eclampsia-toxemia were studied with thermodilution tip pulmonary artery catheters. All patients were delivered by cesarean section with general anesthesia and endotracheal intubation. The left ventricular stroke work indices (LVSWI) of these patients were higher than those of normal nonpregnant subjects. There was no evidence of myocardial depression in terms of either cardiac index or the LVSWi-pulmonary capillary wedge pressure (Frank-Starling) relationship. Pulmonary arteriolar resistance (PAR) was found to be within or below the normal nonpregnant range, suggesting that in severe toxemia the pulmonary vasculature is not involved in a primary vasospastic process. At delivery a rise in cardiac index (CI) and mean pulmonary capillary wedge pressure (PCWP) occurred. The PCWP was higher in the postpartum period than prior to delivery. This was felt to represent an increase in circulating blood volume. The therapeutic significance of these findings is discussed.
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PMID:Hemodynamics in patients with severe toxemia during labor and delivery. 741 16

Ninety patients in the maintenance therapy phase of the Pittsburgh Study of Maintenance Therapies in Recurrent Depression (Frank et al., 1990) were studied to determine possible relationships between the type of therapy (imipramine versus no drug) and the level of sexual functioning. The level of sexual functioning was determined by a composite subscale score of the Social Adjustment Scale which assessed (1) current level of enjoyment and interest in sex; (2) change in interest; (3) current frequency of sexual intercourse; (4) change in frequency; and (5) pain and/or difficulty reaching orgasm. Loss of libido was assessed by both the Hamilton Rating Scale for Depression and the SCL-90. Logistic regression analysis revealed no relationship between treatment with active imipramine and sexual functioning for the total group, or for females alone. Analysis of males alone revealed a decreased interest in sex among those treated with imipramine, but no significant differences in frequency or problems. The implications for maintenance pharmacotherapy and the cost/benefit ratio of unacceptable side effects versus drug efficacy are discussed.
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PMID:Imipramine and sexual dysfunction during the long-term treatment of recurrent depression. 794 40

Frank mental disorders, such as depression and panic disorder, are prevalent in primary care; they cause people substantial suffering and interfere with daily functioning. Even subthreshold or "subsyndromal" conditions, with fewer symptoms than necessary for making a diagnosis, cause substantial morbidity. Recent literature on mental disorders in primary care, where many, if not most, people with mental health problems are seen, is reviewed with focus on recognition and diagnosis issues, management of these problems in primary care, obstacles to accurate diagnosis and appropriate treatment, and prevention issues. In addition to a review of recent research, there is an effort to place these topics in the context of various directives, including research and Federal documents, that have direct implications for better treatment in primary care of people with mental disorders (for example, practice guidelines). Mental health problems and disorders seen in primary care are a public health problem meriting immediate attention and substantial work at many levels--clinical, educational, organizational, and budgetary.
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PMID:Mental disorders in primary care services: an update. 815 77

Load-induced contractility depression, in which supernormal left ventricular ejection fraction and contractility at rest decrease by added afterload, is most often found in children with mitral valve prolapse who have symptoms. Patients have high ventricular end-diastolic pressure at rest, which is further increased by afterload challenge. The Frank-Starling mechanism may be maximally mobilized with high preload even at rest to compensate for the intrinsically depressed inotropic state. Therefore, preload reserve may be easily exhausted due to afterload addition. We aimed to determine left ventricular end-diastolic fiber length, stroke work, and contractility before and during handgrip by echocardiograms to obtain evidence for the Frank-Starling mechanism in patients and controls, including patients treated with coenzyme Q10. The subjects were divided into four groups, each consisting of 30 children aged 6-16 years: group 1, normals; group 2, patients; group 3, the same patients as in group 2 after coenzyme Q10 therapy; and group 4, patients with asymptomatic mitral valve prolapse. Baseline values and percentage increases in systolic blood pressure, heart rate, and left ventricular wall stress showed no differences among the groups. Only in group 2 were the percentage increase in ejection fraction, fiber shortening velocity, contractility, and end-diastolic dimension strongly negative, despite supernormal baseline levels. In other groups, these were significantly positive, without intergroup differences. We conclude that in the heart with load-induced contractility depression, the Frank-Starling mechanism deviates from normal. The normal Frank-Starling mechanism was recovered due to coenzyme Q10, which may improve disturbed bioenergetic function at the molecular level.
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PMID:Recovery of the Frank-Starling mechanism by coenzyme Q10 in patients with load-induced contractility depression. 824 1

Assessment and evaluation of cardiac function have become commonplace in the care of cardiac patients with acute or chronic disorders, since therapy of most cardiac diseases is designed specifically to improve ventricular function. Now, various techniques are available for quantitative measurements of the size, shape and motion of the ventricle. Ventricular dysfunction is defined with two components, systolic and diastolic dysfunction, and can be described hemodynamically in terms of the ventricular pressure-volume diagram. Pure systolic dysfunction is associated with a depression in the end-systolic pressure-volume relation, using the Frank-Starling relation to restore cardiac output toward normal. In contrast, pure diastolic dysfunction is associated with preservation of the end-systolic pressure-volume relation but distortion of the diastolic relation, showing higher diastolic pressure at any given volume. However, in patients presenting clinically with heart failure, both systolic and diastolic dysfunction are usually observed. In this context, factors and disorders that influence ventricular dysfunction are described, considering extrinsic or intrinsic to the ventricular chambers.
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PMID:[Assessment and evaluation of cardiac function]. 833 84

Head-out water immersion shifts venous blood to the central vasculature and heart and subsequently increases cardiac preload. In healthy men, cardiac output and stroke volume are greater during upright leg cycle exercise in water than on land. Heart rate is similar during work loads < 50% of peak oxygen consumption but is decreased in water at higher work intensities. To determine if men with myocardial infarction (MI) show a similar response, 15 men with a documented MI exercised upright on a leg cycle ergometer on land and immersed in water (31 +/- 1 degree C) to the level of the shoulders. Heart rate, cardiac output (carbon dioxide rebreathing procedure) and oxygen consumption were measured at rest and at work loads corresponding to approximately 40, 60 and 75% of peak oxygen consumption in both environments. At rest, cardiac output and stroke volume were elevated (p < 0.05) in water. During exercise, heart rate, cardiac output and stroke volume did not differ between water and land. When subjects were given beta-blocking medications (n = 8) and subjects with exercise-induced ST-segment depression (n = 5) were separately excluded from the analysis, water immersion still did not significantly change exercise responses. These results suggest that MI alters the normal cardiac response to increased preload during exercise. The alteration may involve reduced myocardial compliance or near-complete use of the Frank-Starling reserve, or both, during land exercise.
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PMID:Effect of enhanced preload with head-out water immersion on exercise response in men with healed myocardial infarction. 847 66


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