Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0002962 (angina)
 21,142 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Provocative testing has provided a method of evaluating the important role of vasomotor tone in coronary artery disease. The most sensitive test is the ergonovine (Methergin) test. This is a specific and reliable method of defining the clinical situations in which coronary spasm is common: --focal coronary artery spasm is mainly observed in resting angina alone or in association with effort angina. The prognosis of spasm is excellent with calcium antagonist therapy provided there is no other associated pathology such as left ventricular failure or triple vessel disease; --in the six weeks following myocardial infarction, focal coronary artery spasm is a common event: 20% of coronary angiographies. After six weeks, spasm is much less frequent. It does not influence the prognosis. This type of spasm is probably related to the scarring process; --coronary artery spasm is frequently associated with restenosis after coronary angioplasty, a process which is histologically related to proliferation of smooth muscle; --diffuse increase in coronary vasomotor tone is a much rarer pathology, perhaps related to global changes in vascular tone as its association with the Raynaud syndrome and with migraine would suggest. It presents clinically with resting angina and sometimes by typical Prinzmetal angina; --finally, vosomotor tone plays an important role in the daily life of coronary patients. Holter recordings for the detection of silent myocardial ischemia have shown episodes of myocardial ischemia at lower myocardial oxygen consumption levels than those usually recorded during exercise stress testing, which suggests a reduction in oxygen supply, that is to say coronary vasoconstriction. Changes in coronary vasomotor tone can modify the diameter of healthy coronary arteries by 100%.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Vasomotor activity and coronary insufficiency]. 205 36

Ovarian steroids have effects on blood circulation involving the mechanisms which control blood flow and the changes that occur in the pathogenesis of atherosclerosis. Estrogens appear to protect women from cardiovascular disease through their effects on lipid metabolism as well as more direct effects on arterial walls which appear to inhibit atherosclerotic plaque formation. There is increasing evidence that estrogen replacement after menopause can markedly reduce female mortality due to vascular disease. Effects of hormone imbalance and deficiency on vasomotor control are clinically significant and hormone treatment appears to be effective in the management of a variety of conditions due to abnormal blood flow including vasomotor instability, migraine, vaginal dryness and, perhaps, some forms of angina. Most review articles have focused on the effects of ovarian steroids and lipid metabolism as well as the findings of recent epidemiologic studies. This is understandable as those investigations have proved so valuable in understanding the protective effects of estrogens. The present discussion, in contrast, focuses on the effects of ovarian steroids, estrogens in particular, on circulatory mechanisms. At the present time there is increasing interest in these studies. Findings thus far appear to contribute to understanding estrogen cardioprotection and also raise awareness of a variety of clinical conditions in which estrogen treatment could be indicated because of its effects on circulation.
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PMID:Ovarian hormones and the circulation. 221 71

Vasospasms in the eye are often combined with digital vasospasms, as can be diagnosed with a nailfold capillaroscopic local cooling test. In 16 patients with a history of cold hands and feet the presence of peripheral vasospasms without any underlying disease was demonstrated by means of nailfold video-capillaroscopy. These patients showed the phenomenologic diagnosis of low-tension glaucoma with visual field defects characteristic of glaucoma even though intraocular pressure above 21 mmHg was excluded. The visual field defects were not homonymous, indicating a prechiasmal location of the vascular disturbance. Ocular vasospasms cause visual field damage that can be aggravated or provoked by cooling one hand in cold water and that often improves after treatment with the calcium channel blocker nifedipine. The results suggest that vasospasms not only are present in Raynaud's disease, migraine, and Prinzmetal's variant angina but also may be an important factor in the genesis of low-tension glaucoma. This is a new finding and may be related to a general vasospastic syndrome.
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PMID:Do vasospasms provoke ocular diseases? 231 50

Calcium-channel blockers may well be the drugs of choice for treating angina, hypertension, and supraventricular arrhythmia in the elderly. They are effective, have no serious side effects, and when wisely matched to the patient, are very well tolerated. Most calcium-channel blockers can be administered once or twice daily. A choice of four is available; only verapamil and diltiazem hydrochloride are useful for supraventricular arrhythmia. All four, however, are effective for the treatment of hypertension and angina. Expanding uses of calcium-channel blockers include peripheral vascular disease and migraine. There may be a theoretical advantage in humans from the point of view of the anti-atherosclerosis demonstrated in animals.
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PMID:Calcium-channel blockers and the elderly. 237 3

The mechanism of action of calcium channel modulators, a class of drugs that includes 3 chemical groups--1,4-dihydropyridines, phenylalkylamines and benzothiazepines--has been extensively reviewed. The best known representatives of these 3 groups are nifedipine, verapamil and diltiazem, respectively. These drugs bind reversibly, stereospecifically and with high affinity to both the membrane-bound and the purified receptor complex. Non-dihydropyridines allosterically regulate dihydropyridine binding. This has been shown by using (-) [3H]202-791 and (+) [3H]PN200-110 as labeled ligands. The purified receptor complex that possesses binding sites for all 3 chemical groups is likely to be related to the voltage-dependent calcium channel. As the result of a drug-receptor interaction, voltage-dependent calcium channels are either activated or inactivated. The drugs that activate channels act by promoting long-lasting channel openings. The drugs that inhibit calcium channels, the calcium entry-blocking agents, act by preventing channel openings upon membrane depolarization. A complex pharmacologic, electrophysiologic, biochemical, immunologic and molecular genetic approach is required to determine the molecular mechanism of action of calcium channel modulators. Clinically, calcium entry-blocking agents are recommended for the treatment of angina pectoris, hypertension, posthemorrhagic cerebral vasospasm, supraventricular tachycardia, migraine and asthma and the protection of the ischemic myocardium.
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PMID:Receptor pharmacology of calcium entry blocking agents. 243 27

Twenty-one consecutive patients with testicular cancer treated with bleomycin, vinblastine, and cisplatin (PVB) were evaluated for acute vascular ischaemic events during chemotherapy. Angina pectoris occurred in 8/21 (38%) patients, a median 5.6 weeks after initiation of chemotherapy and persisted for 2-7 days. Raynaud's phenomenon was detected in seven (33%) subjects, transient ischaemia of the toes was found in six (29%) patients, one patient complained of migraine, but none had major cerebrovascular accidents. Patients with and without angina pectoris and/or Raynaud's phenomenon did not differ in respect of age, histology of tumor or medication. Ischaemia occurred at any time during the course of chemotherapy. No correlation was found between dosage of drugs and time of onset of ischaemic reactions. However, arterial occlusive event is a frequent and common toxicity and a result of treatment with PVB.
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PMID:Acute vascular toxicity after combination chemotherapy with cisplatin, vinblastine, and bleomycin for testicular cancer. 245 30

In 1988 the fourth Joint National Committee (JNC IV) issued new guidelines for the detection, evaluation, and treatment of hypertension. Pharmacologic along with nonpharmacologic therapy is indicated for hypertensive patients whose diastolic blood pressures average greater than or equal to 95 mmHg over a period of time and for patients who have a diastolic blood pressure of 90 mmHg to 94 mmHg with evidence of target organ disease and/or other major risk factors. In the absence of target organ disease and/or other major risk factors, a trial of nonpharmacologic treatment is recommended for patients with a diastolic blood pressure of 90 mmHg to 94 mmHg. The JNC IV report recommends initiating pharmacologic treatment with any one of the following classes of drugs: diuretics, beta blockers, calcium channel blockers, or ACE inhibitors. In general, diuretics and calcium channel blockers are especially indicated for elderly and black patients and beta blockers and ACE inhibitors for young and white patients, but there are many exceptions. In selecting the appropriate step-one agent for a given patient, the therapeutic "two-for-one" concept is emphasized whereby one antihypertensive drug may also be beneficial for a coexisting condition. Examples are: diuretics or ACE inhibitors in congestive heart failure; calcium channel blocking drugs or beta blockers in angina pectoris or paroxysmal supraventricular tachycardia; and beta blockers for migraine headache or senile tremor.
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PMID:Mild hypertension: critical analysis of different therapeutic approaches. 266 23

The vasospastic diseases form an important group of ailments. The recognition of the different types of vasospasms is essential if the physician is to correctly advise and treat. Attention must be paid to the history of attacks of cold hands and feet combined with a predisposition to migraine and hypotension. The high prevalence of migraine, Raynaud's phenomenon. Prinzmetal's variant angina and visual acuity disturbance of ophthalmologically unexplained origin in patients with peripheral vasospasms indicates the existence of a generalized vasospastic disease. There is most often no underlying disease detectable. In cases of unknown origin, supplementary investigations are necessary. The management of vasospastic disorders is still unsatisfactory at the present time. These difficulties reflect the uncertainty in the etiology and pathogenesis of the disorder.
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PMID:[Raynaud's syndrome: diagnosis and therapy in general practice]. 267 63

The 1984 report of the Joint National Committee on Detection, Evaluation, and Treatment of Hypertension for the first time recommended beta blockers as an alternative to diuretics for step 1 of stepped-care treatment. Numerous studies have shown that beta blockers are as effective as diuretics for monotherapy in patients with mild hypertension. They are the only antihypertensive drugs that have been shown to be cardioprotective following a myocardial infarction. Beta blockers are especially indicated for step 1 therapy in young patients (particularly those with evidence of hyperkinetic circulation), in patients who have had a myocardial infarction, and in patients with angina, migraine, or hereditary tremor because they are helpful in treating these conditions as well as in managing hypertension. Angiotensin converting enzyme inhibitors and calcium channel blockers are challenging beta blockers and diuretics as the drugs of choice for initial therapy of hypertension in selected patients. Time will ultimately determine the relative roles of each as step 1 therapy.
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PMID:Management of hypertension. What is the role of beta blockers? 289 61

beta-Blocking therapy is used extensively is conditions as diverse as hypertension, angina pectoris, arrhythmias, thyrotoxicosis, hypertrophic cardiomyopathy, migraine, glaucoma, and myocardial infarction. Studies show they beneficially influence sinus node and atrioventricular conduction, but excessively high doses may cause sinus arrest or sinoatrial block. Nonselective beta-blockade in asthmatic patients may aggravate bronchoconstriction, whereas increased airways resistance is less likely with beta 1-selective, partial agonist, or alpha-beta-blocking drugs. Hypoglycemia can be prolonged; beta 1-selective or partial agonist drugs may cause less interference with glucose metabolism. beta-Blockade affects free fatty acids, lipids and lipoproteins, thyroid hormones, and parathormone. beta-Blockade may normalize abnormal platelet aggregation. Finally, the choice of the most effective drug depends on the clinician's knowledge of the various pharmacodynamic and pharmacokinetic drug profiles, allied with familiarity of the patient's medical condition.
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PMID:Circulatory and metabolic aspects of beta-adrenoceptor blockade. 290 49


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