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)

Each of 13 patients with angina had either chewable isosorbide dinitrate, nitroglycerin (sublingual therapy), or placebo administered on each of three different days when mild anginal pain had been induced by walking on a treadmill. Both therapy with isosorbide dinitrate and therapy with nitroglycerin were effective in bringing about complete relief of the angina in less than ten minutes of uninterrupted continuous walking on the treadmill in 11 of the 13 subjects, while administration of placebo afforded complete relief in none. The duration of action of the drug was determined by following the first effort (during which the tested drug was given) by successive ten-minute walks at the same workload that first induced anginal pain. Half-hour resting periods separated the repeated periods of exercise, and the duration of action was taken to be the time from administration of the agent to the return of angina on one of the repetitive efforts. No prolonged protection was afforded by administration of the placebo. Nitroglycerin protected for slightly longer than one hour, while isosorbide dinitrate protected for 2 1/2 to 3 hours.
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PMID:Comparison of placebo, nitroglycerin, and isosorbide dinitrate for effectiveness of relief of angina and duration of action. 10 34

One thousand forty-five spontaneous episodes of S-T segment elevation were observed in three patients over a total of 72 days of continuous electrocardiographic monitoring. Eighty-nine percent of episodes were asymptomatic; chest pain tended to occur with episodes longer than 3 minutes, and ventricular ectopy occurred almost exclusively with symptomatic episodes. Nitroglycerin regularly relieved angina or S-T elevation, or both. Plasma and urinary catecholamines and their metabolites were normal. Episodes of variant angina were not associated with a generalized increase in sympathetic outflow because serum catecholamine levels at the onset and termination of the S-T abnormalities were not elevated. Controlled trials of propranolol showed no significant beneficial effect. Propranolol significantly increased the length of episodes of S-T elevation in one patient, increasing ventricular irritability. The overall course of variant angina was quite variable, with spontaneous and long-lasting remissions, necessitating cautions interpretation of clinical trials.
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PMID:Variant angina pectoris: investigation of indexes of sympathetic nervous system function. 10 89

1. Voluntary hyperventilation during rest in the recumbent position induces a fall in H+ concentration, PCO2 and PO2 in mixed venous blood and in the blood of the coronary sinus. 2. If the breathing volume is increased during voluntary hyperventilation between 2- and 2.5 fold above the volume at rest, O2 uptake increases by only 6% but CO2 excretion rises by 66%. 3. Cardiac output decreases by 8% and the O2 extraction of the myocard increases by 12%. There is a quantitative relationship between arterial pH or PCO2 and changes in the systemic and coronary circulation. Blood pressure decreases in the pulmonary circulation. 4. Nitroglycerin during hyperventilation produces an additional reduction in cardiac output but no effect on the O2 extractions of the myocard. 5. With dipyridamol, the O2 extraction of the myocard is reduced and the PO2 in the blood of the coronary sinus increases. 6. In the case of severe coronary obstruction, the effect of dipyridamol can cause acute angina pectoris and left heart insufficiency due to poststenotic ischemis (steal syndrome).
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PMID:[Hyperventilation and oxygen supply of the myocardium. II. Effect of nitroglycerin and dipyridamole]. 10 17

Changes in left ventricular size may be of importance in the development of angina and in its amelioration by glyceryl trinitrate, but left ventricular dimensions have not been measured during exercise in the upright position, the circumstance in which angina most often occurs. To assess changes in left ventricular end-systolic and end-diastolic dimensions, echocardiograms were obtained from 5 normal subjects and 6 patients with angina during rest and exercise upright, both before and after glyceryl trinitrate. The end-systolic dimension was considered an index of regional performance rather than an estimate of overall left ventricular behaviour. During exercise the end-diastolic dimension rose both in the normal subjects and in the patients. The end-systolic dimension fell progressively with exercise in the normal subjects but changed inconsistently in the patients. Glyceryl trinitrate lowered the end-diastolic dimension during exercise below comparable pretreatment values in both groups; the glyceryl trinitrate-induced decrease in end-diastolic dimension in the patients diminished at higher exercise levels. In all normal subjects and in 4 of the 6 patients with normal systolic shortening (= end-diastolic--end-systolic dimension) glyceryl trinitrate caused relatively small changes in the end-systolic dimension and systolic shortening on exercise. In contrast, in the 2 patients with hypokinetic ventricles glyceryl trinitrate conspicuously decreased the end-systolic dimension and increased systolic shortening. Thus, during exercise, in the normal subjects and in the patients with normally functioning left ventricles on echocardiography, glyceryl trinitrate caused a modest fall in the end-diastolic dimension and little change in the end-systolic dimension, but in patients with ventricular hypokinesia it greatly improved regional contractile performance. Alleviation of ischaemic hypokinesia during exercise may be an important part of the benefit of glyceryl trinitrate.
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PMID:Effect of glyceryl trinitrate on echocardiographic left ventricular dimensions during exercise in the upright position. 11 68

Nitroglycerin should be the first agent prescribed for patients with angina pectoris. When nitroglycerin is used daily, a trial with longer-acting nitrates (eg, isosorbide dinitrate) is warranted. If angina persists, use of beta-adrenergic blocking agent (propranolol) should be considered. Appropriate use of nitrates and propranolol, singly or in combination, will relieve angina pectoris due to coronary heart disease in most patients.
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PMID:Medical management of angina pectoris. 40 51

The significance of asymptomatic episodes of ischemic type S-T segment depression was studied in 20 patients with coronary heart disease. Continuous 10 hour electrocardiographic recordings accompanied by detailed daily diaries of activity and symptoms were obtained periodically during a mean time of 16 months. All patients had ischemic type S-T depression associated with angina pectoris during treadmill exercise. Measurements of heart rate, S-T depression and exercise level at the onset of angina obtained during repeated controlled exercise tests at the start of each study period were compared with the measurements recorded during daily activity. After 2,826 hours of recording, 411 transient epidsodes of ischemic type S-T depression were noted during usual daily activity. Only 101 (25 percent) of these episodes were associated with angina. The remaining episodes were unrelated to other symptoms or to posture. All occurred at heart rates significantly lower than those observed at the onset of angina during exercise testing. Of these episodes of asymptomatic S-T depression, 72 percent occurred only at rest or during very light activity such as slow walking or sitting. Nitroglycerin administered hourly significantly reduced the frequency of these episodes, thus supporting the concept that they represent painless ischemia. Because the episodes of asymptomatic ischemic type S-T depression occurred more frequently than angina during usual daily activity and were evident at heart rates and activity levels well below those expected to evoke ischemia, they may be caused by factors other than those that cause angina.
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PMID:Transient asymptomatic S-T segment depression during daily activity. 40 3

1. A quantitative in vitro study has been made of the actions of glyceryl trinitrate and sodium nitrite on vascular smooth muscle (dog femoral artery and saphenous vein; rat portal vein); these have been compared with the actions of papaverine, isoprenaline, salbutamol, pentaerythritol tetranitrate and trimetazidine. 2. Glyceryl trinitrate was more active on the saphenous vein than on the femoral artery in inhibiting noradrenaline and potassium-induced tone. 3. Unlike glyceryl trinitrate, sodium nitrite and isoprenaline, papaverine and diazoxide inhibited noradrenaline-induced contractions of venous and arterial smooth muscle to the same extent. 4. The selective dilator effects of glyceryl trinitrate on venous smooth muscle may explain its action in alleviating the pain of angina pectoris. It is suggested that the use of these three vascular smooth muscle preparations (arterial, and veins with and without spontaneous myogenic activity) is a useful initial screening procedure for prospective antianginal drugs acting by venodilatation.
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PMID:Comparative effects of glyceryl trinitrate on venous and arterial smooth muscle in vitro; relevance to antianginal activity. 40 60

The pathophysiology of angina pectoris is best understood as an imbalance between oxygen supply and demand. The primary determinants of myocardial oxygen demand are heart rate, arterial pressure, heart size, myocardial contractility, and myocardial mass. The medical therapy of angina pectoris is directed toward reducing myocardial oxygen demand by reducing the workload of the heart and the specific determinants listed. The most common medications used in the treatment of angina pectoris are nitroglycerin and propranolol. Nitroglycerin reduces myocardial oxygen demand primarily by reducing heart size and arterial pressure. Propranolol reduces oxygen demand primarily by reducing heart rate. Medical therapy is generally effective in controlling the symptoms of angina pectoris in 80% or more of the patients and allows them to lead useful and productive lives.
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PMID:Medical therapy of angina pectoris. 41 39

The role of coronary artery spasm in the production of myocardial ischemia has recently become the focus of increased attention. This phenomenon is now well established as a causative mechanism underlying the resting chest pain attacks in Prinzmetal's variant angina. There is also evidence that coronary spasm may play a more significant role in the broad spectrum of ischemic heart disease than can be documented by current techniques. The autonomous nervous system constitutes a major element in the pathophysiology of spasm. Coronary arteriography, in spite of important limitations, remains the only technique for final documentation of this phenomenon, but radionuclide scintigraphy appears to be promising. Nitroglycerin is effective for the relief of the acute attack, while long acting nitrates and the calcium antagonists: nifedipine, perhexiline and verapamil are useful in the prevention of recurrences.
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PMID:Coronary artery spasm: its role in the pathogenesis of myocardial ischemia. 50 1

The antianginal effect of perhexiline was evaluated in a placebo-controlled double-blind study of 20 patients with stable angina pectoris. Only patients with documented myocardial infarction of more than 6 months' standing and with ST-segment depression on exercise were admitted to the study. Objective parameters of bicycle stress tests at a submaximum level of 50 watts and a maximum exercise level were evaluated. Subjective data such as nitroglycerin consumption and incidence of anginal attacks per week were obtained from the patients' self-maintained records. No negative chronotropic effect of perhexiline was found at rest. At a submaximum exercise level with unchanged double-product, a significantly lower heart rate (p less than 0.05) and a significant reduction in ST-segment depression were observed in comparison with the placebo. At maximum exercise level an increase in exercise tolerance of 8.1% and in aerobic capacity of 8.3% resulted in a significant increase in the double-product (p less than 0.01), with a shift in the blood pressure/heart rate ratio. Discontinuation of exercise occurred at the same heart rate, but at a markedly higher level of exercise attainment. Heart rate on exercise proved to be the most valuable parameter in this study for the evaluation of the aerobic capacity of the individual patient. Nitroglycerin consumption and frequency of anginal attacks per week were reduced, but were not of statistical significance. Side-effects occurred in 6 patients, but these did not require termination or reduction of medication. The selective effect on heart rate during exercise opens a new field of application for perhexiline in comparison with beta-blocking agents.
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PMID:[Clinical efficacy of perhexiline maleate in stable angina pectoris (author's transl)]. 69 49


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