Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:3.4.15.1 (ACE)
 18,300 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Nitrates remain largely prescribed in heart failure. Their haemodynamic effects, a consequence of venous vasodilatation, have been clearly demonstrated in the acute situation, where they induce a fall in pulmonary pressure and left ventricular end-diastolic pressure, associated, at high doses, with an arterial vasodilator effect. Haemodynamic escape phenomena are observed during chronic administration and the peripheral vasodilator effect, in particular, tends to fade. Although, together with depletion of sulfhydryl radicals, activation of vasoconstrictor neuroendocrine systems, associated with haemodillution, plays an important role in this escape, coprescription of angiotensin converting enzyme inhibitors or diuretics has been shown to be unable to prevent these effects. The effects of nitrates on the exercise capacity remain controversial, although the combination of isosorbide dinitrate-hydralazine induced a significantly greater increase of maximal oxygen consumption than enalapril, together with a more marked increase in the ejection fraction. No trial has assessed the effects on mortality of nitrates, used as the only vasodilator agent, in heart failure, but in studies V-HeFT 1 and 2, the combination of isosorbide dinitrate-hydralazine significantly improved survival, with a 38% reduction of mortality at one year compared to placebo or prazosin groups. However, this reduction remained less than that obtained with enalapril. In the case of contraindication or impossibility of using angiotensin converting enzyme inhibitors, a combination of high doses of nitrates and hydralazine may be justified. On the other hand, when angiotensin converting enzyme inhibitors are already prescribed, nitrates can only be considered to improve symptoms in the case of persistence of dyspnoea. However, due to the hypotension which they can induce, their use should not interfere with the administration of the high doses of angiotensin converting enzyme inhibitor required. The dose of nitrates should then be determined as a function of their efficacy on symptoms and the blood pressure tolerance, while allowing an intervel of at least ten hours in order to attenuate the escape phenomenon.
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PMID:[Cardiac failure and nitrates]. 945 75

Three patients with chronic heart failure, men aged 29, 78 and 69 years, developed severe dyspnoea and oedema in spite of reduced sodium and fluid intake and medication including furosemide. Heart failure may become 'resistant to diuretics' due to pharmacokinetic and pharmacodynamic causes. High-dose continuous intravenous administration of a loop diuretic may afford relief in such cases, if necessary in combination with a thiazide derivative, an ACE inhibitor, an inotropic agent or an extracorporal technique. Monitoring and correction of the state of hydration of a patient with chronic heart failure may improve the prognosis and the quality of life.
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PMID:[Failing diuretics in severe chronic heart failure]. 954 78

A 47-year-old woman was admitted to our hospital for evaluation of general fatigue and dyspnea. She had been diagnosed with progressive systemic sclerosis (PSS) when she was 39 years of age, on the basis of Raynaud's phenomenon, proximal sclerosis, and pigmentation of the skin. On admission, her blood pressure was 206/128 mmHg. Funduscopy revealed grade III (Keith & Wagener) hypertensive retinopathy. Laboratory data showed positivity for anti-nuclear antibody and anticardiolipin beta 2 glycoprotein I antibody, and the plasma level of renin activity (PRA) was abnormally high. Chest X-ray and UCG revealed massive pericardial effusion. On the second hospital day, she was operated on for pericardiodiaphragmatic fenestration. The volume of pericardial effusion amounted to more than 2000 ml. Post operative malignant hypertension persisted. Laboratory data showed thrombocytopenia, hemolytic anemia, and acute renal failure. We diagnosed scleroderma renal crisis (SRC) associated with antiphospholipid syndrome. Following the initiation of angiotensin converting enzyme inhibitor (ACE-I) combined with calcium antagonist and alpha-one blocker, her blood pressure and PRA decreased. She also had been treated with aspirin 81 mg daily. These therapies were effective in recovering the platelet count and stopped the progression of anemia and renal failure. Although either the finding of large pericardial effusion or SRC is associated with poor prognosis in PSS, this case has had a good clinical course. In this case, the findings suggested that anti-phospholipid antibody may have contributed to the pericarditis and SRC.
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PMID:[A case of scleroderma renal crisis with massive pericardial effusion and positivity on antiphospholipid antibody test]. 965 14

Diuretics are required in the majority of patients with symptomatic congestive heart failure (CHF). The reduction of pulmonary venous congestion results in rapid improvement of dyspnoea and increased exercise tolerance. In contrast to arterial hypertension, there are only a few studies comparing diuretics with other drugs in CHF. In particular, no reliable data exist on the effect of diuretics on mortality and major cardiac events in CHF. Diuretic agents differ in their mode of action, pharmacodynamics and pharmacokinetic properties. Loop diuretics are used in acute CHF and in severe chronic CHF, while thiazides, having a longer duration of action, are suitable for long-term therapy of mild CHF in ambulatory patients. Potassium-sparing diuretics are usually prescribed in combination with other preparations to prevent electrolyte disturbances. No randomized prospective large-scale trials have been carried out to compare the efficacy and tolerability of the various types of diuretics. With adequately chosen dosage, the effects of the different loop diuretics appear to be similar in CHF. However, observational data in ambulatory patient populations indicate that loop diuretics with high bioavailability and longer half-life may offer advantages in terms of clinical stability and resource utilization for cardiac decompensation. In patients with severe pulmonary congestion and oedema, combined use of loop diuretics and thiazides may improve the therapeutic response. Spironolactone can also be prescribed to increase diuresis in patients who are resistant to a combination of loop diuretics and ACE inhibitors.
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PMID:Do diuretics differ in terms of clinical outcome in congestive heart failure? 988 6

Hypercholesterolemia can be adequately controlled by appropriate diet and maximum lipid lowering drug therapy in most patients. Nevertheless, there exists a group of patients, including those with familial hypercholesterolemia (FH), who remain at high risk for the development or progression of premature coronary heart disease (CHD). For these patients additional measures such as surgery and low-density lipoprotein (LDL) apheresis have to be considered. The objective of this multicenter trial, which included 30 clinical centers (28 in Germany and one each in Scotland and Luxembourg), was to determine if repeated LDL apheresis using the Liposorber LA-15 system (Kaneka Corporation, Osaka, Japan) could lead to an additional acute and time averaged lowering of total cholesterol (TC) and LDL-cholesterol (LDL-C) in severely hypercholesterolemic patients whose cholesterol levels could not be controlled by appropriate diet and maximum drug therapy. A total of 6,798 treatments were performed on 120 patients, including 8 with homozygous FH, 75 with heterozygous FH, and 37 with unclassified FH or other hyperlipidemias from 1988 through 1994. The mean TC and mean LDL-C levels at baseline were 410.0 mg/dl and 333.9 mg/dl, respectively. LDL apheresis was performed once a week or at least once every 2 weeks in all patients. During treatment with the Liposorber system the mean acute percentage reduction was 52.6% for TC and 63.1% for LDL-C. Very low density lipoprotein cholesterol (VLDL-C) and triglycerides (TG) were also substantially reduced to 60.6% and 47.5%, respectively. Fibrinogen, a potential risk factor for CHD, was reduced by 26.2%. In contrast, the mean acute reduction of high density lipoprotein (HDL) was only 3.4%. During the course of the treatment, the time averaged levels of TC and LDL-C were reduced by approximately 39% and 50%, respectively, compared to baseline levels. The adverse events (AEs) were those generally associated with extracorporeal treatments. The most common AE was hypotension, with 69 episodes corresponding to 1% of all treatments reported in 44 of the 120 patients treated. All other kinds of AEs occurred in less than 0.2% of the treatments. The treatment with the Liposorber LA-15 system was overall well tolerated. It should be noted, however, that a more severe type of hypotensive reaction associated with flush, bradycardia, and dyspnea was reported in patients taking concomitant angiotensin converting enzyme (ACE) inhibitor medication. Except for such anaphylactoid-like reactions associated with the intake of ACE inhibitors, the Liposorber LA-15 system represents a safe and effective therapeutic option for patients suffering from severe hypercholesterolemia that could not be adequately controlled by diet and maximum drug therapy.
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PMID:Low-density lipoprotein apheresis for prevention and regression of atherosclerosis: clinical results. 1022 46

A 65-year-old man was admitted to our hospital because of thirstyness and left lower abdominal pain. On admission, he was found to have urolithiasis, renal insufficiency (BUN: 73 mg/dl, Crt: 4.4 mg/dl), and hypercalcemia (13.2 mg/dl). Chest X-ray films and computed tomograms showed enlargement and calcification of the hilar lymph nodes, and thickened interlobar fissures in both lungs. Levels of angiotensin converting enzyme (30.2 IU/l) and 1.25 (OH)2VitD3 (66.4 pg/ml) were elevated. Histologic examination of the specimen obtained from transbronchial lung biopsy showed non-caseous epithelioid cell granulomas. Because the level of parathyroid hormone was normal and no malignancies were detected, a diagnosis of sarcoidosis was made. Treatment with extracorporeal shock wave lithotripsy, transurethral lithotomy, saline infusion, and prednisolone (30 mg/day) alleviated the urolithiasis, renal insufficiency, and hypercalcemia. After discharge, the patient was followed up and given prednisolone therapy. About 1 month after the prednisolone dose had been tapered to 15 mg/day, the patient experienced dyspnea and facial and pedal edema. Because congestive heart failure was diagnosed, he was re-admitted to our hospital for a second time. Although he was then placed on intensive therapy, he died of ventricular tachycardia associated with sarcoidosis of the heart.
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PMID:[Sarcoidosis with hypercalcemia, urolithiasis, renal insufficiency, and heart failure]. 1048 65

Twenty-two histopathologically proven cases of sarcoidosis were analyzed to determine the clinical presentation, lung function and the response to treatment. Laboratory data, chest x-ray and pulmonary function tests (PFT) were analyzed. Sarcoidosis was found to be more common in females in this study. Cough, breathlessness and weight loss were the predominant symptoms. Serum angiotensin converting enzyme (SACE) was elevated in 50% patients. Comparison of chest radiographs and PFT at the time of diagnosis revealed that stage I disease was associated with normal pulmonary function, 50% patients with stage II disease had mildly impaired PFT and 75% patient with stage III disease had severely impaired PFT. The indication for oral steroid treatment was respiratory symptoms in 58.8% of cases. Of the 13 patients who were available for follow up 10 (76.9%) had subjective improvement in symptoms. Majority of patients showed regression on chest radiograph but one patient progressed to stage IV disease. Pulmonary function data of the patients who were followed up showed improvement but this was not significant statistically. Oral corticosteroids improved symptoms but changes in pulmonary function seemed to be independent of steroid therapy. Further study of a larger number of patients over a longer period would be necessary.
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PMID:Pulmonary sarcoidosis in a south Indian hospital: clinical and lung function profile. 1053 39

Bronchopulmonary infections caused by trichomonads have been reported mainly in patients with pre-existing pulmonary or debilitating disease (e.g. bronchial carcinoma, lung abscess, bronchiectasis). Pulmonary trichomoniasis is most often due to infection with Trichomonas tenax, usually regarded as a harmless commensal of the human mouth, and may rarely be caused by other trichomonas species. A 45 year old female presented with a dry cough, exertional dyspnoea and malaise. These symptoms persisted for 6 months regardless of anti-inflammatory and anti-obstructive inhalative therapy. Sarcoidosis of the lungs, diagnosed 20 years prior, had been asymptomatic since and there was no coexistent disease. Laboratory data revealed increased ACE-levels (90 IE/ml) and lung function showed bronchial hyperreactivity on histamine challenge. No other abnormalities were found (chest x-ray, bronchoscopy, lung function test, blood count and serum calcium). The diagnosis was based on the cytological identification of numerous trophozoites of T. tenax in the bronchoalveolar lavage. Therapy with oral metronidazol for 40 days led to complete recovery from symptoms and normalisation of ACE serum levels. The patient has remained well for 12 months since. The pathogenicity of oral trichomonads in the non-immunocompromised host remains uncertain. Our patient had no known medical risk factors by comparison with published cases. The case illustrates the clinical relevance of pulmonary trichomoniasis in an otherwise healthy person.
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PMID:[Pulmonary trichomoniasis: diagnosis based on identification of irritation in bronchoalveolar lavage]. 1068 41

A 67-year-old man with a one-and-a half-year history of Raynaud's phenomenon was admitted to our hospital for progressive dyspnea occurring over the previous two weeks. Physical examination revealed a blood pressure of 200/124 mmHg, and slightly tight and smooth skin of the fingers, hands and forearms. Laboratory evaluation included serum creatinine of 5.42 mg/dl, plasma renin activity > 20 ng/ml/hr, and antinuclear antibody with a titer of 1 : 1,280. Renal biopsy was performed and the histopathological findings showed that some glomeruli exhibited ischemic retraction with wrinkling of the basement membranes, and that one arteriole exhibited significant intimal hyperplasia with luminal stenosis. These findings were compatible with scleroderma renal crisis (SRC). On the 5th day, serum creatinine had risen to 9.16 mg/dl, and he required temporary hemodialysis therapy. After the administration of captopril was started, his blood pressure fell to 160/86 mmHg and serum creatinine was reduced to 5.12 mg/dl. On the 9th day, he exhibited skin eruptions, and captopril was discontinued accordingly and temocapril started. Because of continued eruptions, temocapril was replaced by losartan. His blood pressure was controlled easily and his serum creatinine level reduced steadily. One year after the start of losartan, serum creatinine was 2.25 mg/dl and blood pressure was 130/82 mmHg. SRC is a life-threatening manifestation of systemic sclerosis. In the late 1970s, angiotensin converting enzyme (ACE) inhibitor was introduced and has dramatically improved the outcome in SRC patients. As ACE inhibitors act mainly on hyperreninemic renal vasoconstrictive hypertension in SRC, we would expect losartan, a selective antagonist of angiotensin receptor subtype 1, to be interchangeable with ACE inhibitors in SRC. In 1997, Caskey and colleagues reported the failure of losartan to control hypertension in a patient of SRC, and the reason has remained unclear. We report here, a case of SRC whose blood pressure was controlled successfully and his renal failure reversed by the administration of losartan.
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PMID:[Successful use of angiotensin II receptor antagonist (losartan) in a patient with scleroderma renal crisis]. 1077 77

Cardiac involvement in pheochromocytoma is rare but may be associated with serious clinical deterioration. A 70-year-old woman arrived at our Emergency Department because of chest discomfort, blood pressure lability, mild dyspnea and electrocardiographic signs suggesting an acute myocardial infarction. However two-dimensional echocardiogram did not show any segmental wall motion abnormalities but diffuse and severe left ventricular hypokinesia. The patient was treated with ACE-inhibitors and diuretics and did not receive thrombolytics or beta blocking agents. Creatine kinase-MB and troponin I were normal. Electrocardiogram and echocardiogram completely returned to normal within 1 week and a coronary angiography demonstrated normal coronary arteries. An increase in the catecholamine concentration in a 24-hour urinary sample suggested a pheochromocytoma that was confirmed by abdominal computerized tomography. During surgery, marked hypertension developed treated with sodium nitroprusside and labetalol, and after removal of the tumor severe hypotension required infusion of norepinephrine for several days.
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PMID:[Acute myocardial damage from a pheochromocytoma]. 1083 35


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