| 1. |
- Dellborg, M, et al.
(författare)
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ECG changes during myocardial ischemia. Differences between men and women
- 1995
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Ingår i: Journal of Electrocardiology. - : Churchill Livingstone. - 0022-0736 .- 1532-8430. ; 27:suppl., s. 42-45
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Tidskriftsartikel (refereegranskat)abstract
- Women have a higher short-term mortality in acute myocardial infarction (MI) compared with men. This may be partly explained by differences in risk factors such as age and diabetes. However, several reports have focused on the occurrence of a sex bias making women less likely to be subjected to angiography and revascularization as well as aggressive pharmacologic treatment of acute MI. The decision to initiate these procedures is often based on ischemic changes of the electrocardiogram. It was therefore investigated whether differences between men and women in magnitude of electrocardiographic changes during myocardial ischemia could explain some of the differences previously reported. A total of 178 patients with chest pain suggestive of MI (135 men and 43 women) included in a study of thrombolytics were monitored for 24 hours with continuous vectorcardiography. Also, 81 patients with stable angina pectoris undergoing elective angioplasty were monitored during the procedure. In patients admitted with suspicion of MI, the initial summated ST deviation was 178 +/- 146 microV for men as compared with 105 +/- 91 microV for women (P = .002). During angioplasty, men had significantly more pronounced maximum ST deviation during inflation of the balloon (235 +/- 165 vs 156 +/- 89 microV; P = .036). In conclusion, men have more pronounced ST changes than women during myocardial ischemia. When fixed magnitudes of ST deviation are required for initiating therapy such as thrombolytics, this will favor treatment of men. A sex-adjusted limit for administrating thrombolytic drugs may be warranted in the light of the above findings.
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| 2. |
- Herlitz, Johan, et al.
(författare)
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Development of congestive heart failure after treatment with metoprolol in acute myocardial infarction
- 1984
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Ingår i: British Heart Journal. - : BMJ Group. - 0007-0769. ; 51:5, s. 539-544
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Tidskriftsartikel (refereegranskat)abstract
- In a double blind study of metoprolol in the treatment of suspected acute myocardial infarction 698 patients (study group) received metoprolol and 697 a placebo (control group). Metoprolol was given in an intravenous dose of 15 mg as soon as possible after admission to hospital followed by 50 g by mouth four times a day for two days and thereafter 100 mg twice a day for three months. A placebo was similarly given. Congestive heart failure occurred in a similar percentage of patients in both the study (27%) and the control groups (30%). Its severity was estimated by calculating the total dose of frusemide given during the first four days in hospital. Less frusemide was given to patients treated with metoprolol compared with those given a placebo in the total series. An appreciably lower total dose of frusemide was given to patients included in the trial less than or equal to 12 hours after the onset of pain and treated with metoprolol compared with a placebo, while no difference was seen among patients treated later. The initial heart rate, systolic blood pressure, and infarct site affected the results.
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| 3. |
- Herlitz, Johan, et al.
(författare)
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Effect of metoprolol on chest pain in acute myocardial
- 1984
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Ingår i: British Heart Journal. - : BMJ Group. - 0007-0769. ; 51:4, s. 438-444
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Tidskriftsartikel (refereegranskat)abstract
- A total of 1395 patients aged 40 to 74 years were included in a double blind trial with the beta 1 selective blocker metoprolol in suspected acute myocardial infarction. Metoprolol was given intravenously (15 mg) as soon as possible after admission to hospital followed by 200 mg daily for three months. A placebo was given in the same manner. The severity of chest pain in the acute phase was calculated by recording the number of injections of analgesics given and the time from the start of blind treatment to the time when the last analgesic was given (duration of pain). The patients receiving metoprolol were given a lower mean number of injections of analgesics during the first four days and after randomisation than those receiving a placebo. The estimated duration of pain was shorter in the metoprolol group than in the placebo group. These effects were related to the initial heart rate, the initial systolic blood pressure, and the final site of the infarct as determined electrocardiographically. Thus metoprolol given in the acute phase of suspected or definite myocardial infarction appears to reduce the severity of chest pain.
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| 4. |
- Herlitz, Johan, et al.
(författare)
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Effect of metoprolol on indirect signs of the size and severity of acute myocardial infarction
- 1983
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Ingår i: American Journal of Cardiology. - : Elsevier Excerpta Medica, Inc.. - 0002-9149 .- 1879-1913. ; 51:8, s. 1282-1288
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Tidskriftsartikel (refereegranskat)abstract
- In a double-blind randomized trial, 1,395 patients with suspected acute myocardial infarction (MI) were investigated to evaluate the possibility of limiting indirect signs of the size and severity of acute MI with the beta1-selective adrenoceptor antagonist metoprolol. Metoprolol (15 mg) was given intravenously and followed by oral administration for 3 months (200 mg daily). Placebo was given in the same way. The size of the MI was estimated by heat-stable lactate dehydrogenase (LD[EC 1.1.1.27]) analyses and precordial electrocardiographic mapping. Lower maximal enzyme activities compared with placebo were seen in the metoprolol group (11.1 ± 0.5 μkat · liter−1)when the patient was treated within 12 hours of the onset of pain (13.3 ± 0.6 μkat · liter−1; n = 936; p = 0.009). When treatment was started later than 12 hours, no difference was found between the 2 groups. Enzyme analyses were performed in all but 20 patients (n = 1,375). Precordial mapping with 24 chest electrodes was performed in patients with anterior wall MI. The final total R-wave amplitude was higher and the final total Q-wave amplitude lower in the metoprolol group than in the placebo group. Patients treated with metoprolol ≤12 hours also showed a decreased need for furosemide, a shortened hospital stay, and a significantly reduced 1-year mortality compared with the placebo group, whereas no difference was observed among patients treated later on. After 3 months, however, there was a similar reduction in mortality among patients in whom therapy was started 12 hours and >12 hours after the onset of pain. The results support the hypothesis that intravenous metoprolol followed by oral treatment early in the course of suspected myocardial infarction can limit infarct size and improve longterm prognosis.
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| 5. |
- Herlitz, Johan, et al.
(författare)
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Effect of metoprolol on the prognosis among patients with suspected acute myocardial infarction and indirect signs of congestive heart failure. (A subgroup analysis of the Göteborg Metoprolol Trial)
- 1997
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Ingår i: American Journal of Cardiology. - : Excerpta Medica, Inc.. - 0002-9149 .- 1879-1913. ; 80:9B, s. 40J-44J
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study is to describe the impact of early treatment with metoprolol on prognosis during 1 year of follow-up in patients with suspected acute myocardial infarction (AMI) and indirect signs of congestive heart failure (CHF). Patients aged 40-74 years who presented within 48 hours of onset of symptoms raising suspicion of AMI were assessed for inclusion. All patients participated in the Göteborg Metoprolol Trial and had indirect indices of CHF according to various clinical criteria. As soon as possible after hospital admission, patients received either placebo or metoprolol (15 mg) divided into 3 intravenous injections, then oral treatment, 200 mg daily for 3 months. Thereafter, most patients in both treatment groups received metoprolol in an open manner. Among the 1,395 randomized patients, 262 (19%) had signs of mild-to-moderate CHF before randomization. Of these, 131 were randomized to metoprolol and 131 to placebo. During the first 3 months, mortality was 10% among patients randomized to metoprolol versus 19% among patients randomized to placebo (p = 0.036). The corresponding figures for the first year were 14% and 27%, respectively (p = 0.0099). Patients randomized to placebo who showed signs of CHF had a 1-year mortality rate of 28% compared with 10% among patients without such signs (p <0.001). The results suggest that early treatment with metoprolol markedly reduces mortality in patients having suspected AMI and signs of CHF.
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| 6. |
- Herlitz, Johan, et al.
(författare)
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Effects of work and acute beta-receptor blockade on myocardial noradrenaline release in congestive cardiomyopathy
- 1979
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Ingår i: Clinical Cardiology. - : John Wiley & Sons, Inc. - 0160-9289 .- 1932-8737. ; 2:6, s. 424-430
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Tidskriftsartikel (refereegranskat)abstract
- Systemic hemodynamic changes and noradrenaline concentrations in coronary sinus blood were studied at rest and during work before and after acute beta-receptor blockade. Patients with congestive cardiomyopathy were compared to patients with primary valvular diseases and to healthy subjects. Noradrenaline concentrations were higher in coronary sinus blood than in arterial blood and increased after beta blockade and during work. Noradrenaline concentrations were more increased in patients with more pronounced myocardial failure and did not seem to separate patients with congestive cardiomyopathy from those with valvular disease. Patients with congestive cardiomyopathy showed a good hemodynamic tolerance toward acute beta blockade.
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| 7. |
- Herlitz, Johan, et al.
(författare)
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Effects on mortality during five years follow-up after early intervention with metoprolol in suspected acute myocardial infarction
- 1988
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Ingår i: Acta Medica Scadinavica. - : Wiley-Blackwell. - 0001-6101. ; 223:3, s. 227-231
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Tidskriftsartikel (refereegranskat)abstract
- This study reports the mortality over a 5-year-period determined a double-blind trial, which evaluated the effect of early intervention with metoprolol in suspected acute myocardial infarction. In all, there were 1,395 randomized patients, 698 and 697 of whom were allocated to metoprolol 200 mg daily and placebo treatments, respectively, for the first 3 months. Thereafter, the two groups were treated in a similar fashion implying beta-blockade to a majority. Within the first 3 months, mortality in the metoprolol group was 5.7% versus 8.9% of the placebo group (p = 0.02). This difference persisted after 2 years (metoprolol 13.2%; placebo 17.2%; p = 0.04). Over a 5-year-period, 24.2% of the patients who originally were allocated to metoprolol had died as compared to 25.7% of those originally allocated to placebo (p greater than 0.2). Among patients in whom treatment started early (less than or equal to 8 hours after onset of pain = the median delay time), enzyme activities in the metoprolol group was lower (p = 0.03) than in the placebo group. Mortality during the first 2 years among these patients treated early was lower in the metoprolol (11.8%) than in the placebo group (17.3%; p = 0.04). Corresponding figures after 5 years were 22.0% and 25.3%, respectively (p greater than 0.2). Among patients in whom treatment started later than 8 hours onset of pain, there was neither any difference in enzyme activity nor in mortality after 2 and 5 years. It can be concluded that early treatment with metoprolol in suspected acute myocardial infarction reduced mortality during the first 3 months compared with placebo. The difference persisted after 2 years. However, 5 years after randomization, no significant difference in mortality was observed between the two treatment groups.
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| 8. |
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| 9. |
- Herlitz, Johan, et al.
(författare)
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Enzymatically and electrocardiographically estimated infarct size in relation to pain in acute myocardial infarction
- 1984
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Ingår i: Cardiology. - : S. Karger AG. - 0008-6312 .- 1421-9751. ; 71:5, s. 239-246
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Tidskriftsartikel (refereegranskat)abstract
- In 563 patients with acute myocardial infarction and no previous myocardial infarction, the estimated infarct size was related to the estimated duration of pain and the amount of analgesics given. The size of infarction estimated from analyses of heat-stable lactate dehydrogenase (EC 1.1.1.27) at 12-hour intervals for 48-108 h and from Q- and R-wave changes in the ECG correlated positively, although weakly with duration of the pain and the amount of analgesics given. These data support the hypothesis that larger infarcts, as a group, evolve over a longer time period than smaller infarcts and that the duration of pain in many patients might be an indicator of the infarct size. In the individual patient, however, one cannot predict the size of the infarction from the severity of pain.
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| 10. |
- Herlitz, Johan, et al.
(författare)
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Goteborg Metoprolol Trial : clinical observations
- 1984
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Ingår i: American Journal of Cardiology. - : Excerpta Medica, Inc.. - 0002-9149 .- 1879-1913. ; 53:13, s. 37-45
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Tidskriftsartikel (refereegranskat)abstract
- Heart rate, systolic blood pressure and rate-pressure product were analyzed during the first 18 hours and 4 days after intravenous metoprolol or placebo. On injection of metoprolol there was an immediate decrease in mean heart rate from 72.9 0.6 to 62.7 0.4 beats/min, but no change was found in the placebo group. The difference in heart rate remained during the first 4 days. Systolic blood pressure was reduced from 144.1 0.9 to 134.6 0.9 mm Hg after intravenous metoprolol and was lower than that in the placebo group during 4 days of follow-up. Indirect signs of congestive heart failure tended to be less severe in patients given metoprolol within 12 hours of the onset of symptoms than in those given placebo. The duration of hospitalization also tended to be shorter in patients given early metoprolol treatment than in those given placebo early.
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