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)

The effectiveness of nitroglycerin ointment in vasospastic angina pectoris at rest was evaluated in 10 patients selected for study. The study was performed after a 24 hour control period, and a randomized single-blind crossover experimental design was followed. Two percent nitroglycerin ointment (15 mg) or placebo ointment was administered every 6 hours for a period of 48 hours each; the first treatment period was followed by a second in which each preparation was used for a 24 hour period. All patients were hospitalized in the coronary care unit; an objective evaluation was carried out using a multichannel electrocardiographic recording to assure recognition of the painless ischemic episodes. Coronary angiography showed critical stenosis of one or two vessels in 9 of the 10 patients; spasm was demonstrated in 3. Results of the ergonovine test were positive in nine of nine patients. Nitroglycerin ointment produced a significant reduction in the mean daily number of episodes during the first (12.5 +/- 3.9 versus 0.5 +/- 0.4, p less than 0.02) as well as the second treatment period (10.6 +/- 3.8 versus 0.6 +/- 0.4, p less than 0.02). These results demonstrate that nitroglycerin ointment provides effective, long-lasting protection against angina due to coronary spasm.
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PMID:Treatment of vasospastic angina pectoris at rest with nitroglycerin ointment: a short-term controlled study in the coronary care unit. 678 66

A series of 12 consecutive patients with Prinzmetal's variant angina is presented. There was a preponderance of males (eight/12) and individuals less than 60 years of age (nine/12). Delay in diagnosis was frequent, primarily due to difficulty in achieving a proper 12 lead ECG recording of the attack which often occurred late at night or in the early morning, subsiding within minutes. In some cases, moreover, ST-depression was observed in the ECG monitoring lead as a reciprocal manifestation of subepicardial ischaemia or due to incorrect polarity in the monitoring lead. The incidence of serious arrhythmias, AV-block and ventricular tachycardia was high (eight/12); two patients had to be DC-converted. Coronary arteriography revealed a spectrum from normal or nearly normal coronary arteries to single vessel disease. Nitroglycerin was well suited for treatment of acute attacks. Long-term treatment with calcium antagonists was effective and without serious side-effects. The follow-up time was from 8 months to 5 years (mean 2 years). It is concluded that Prinzmetal's variant angina as such is a rare disease, but that coronary artery spasm is most likely an important contributory factor in the clinical manifestations of coronary artery disease: arrhythmias, sudden death and myocardial infarction.
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PMID:Prinzmetal's variant angina. 678 40

Nadolol, a new nonselective beta 1 and beta 2 adrenergic blocking agent, has a plasma half-life of 17 to 23 hours. We studied 37 volunteers with stable angina pectoris who had five or more episodes of pain per week and who also had a 1 mm or greater ST segment depression 80 msec past the J point during a Bruce protocol treadmill test. An eight-week placebo controlled run-in period preceded double-blind randomization to nadolol administered once per day (17 patients) or identical appearing placebo for four weeks (20 patients), after which an exercise test was done. Diaries for pain episodes and nitroglycerin consumption were kept. Exercise tests were performed 24 hours after the last nadolol or placebo dose. Episodes of pain per week were reduced 59.8 percent after nadolol and 28.2 percent after placebo (P less than .01). Nitroglycerin consumption after nadolol was reduced 66.8 percent while after placebo it was reduced 36.2 percent (P less than .05). Resting and peak heart rates and peak rate-pressure products showed typical reductions due to beta-blockade 24 hours after nadolol compared with stability of these during placebo, all P less than .001. Exercise time after nadolol increased 42.2 percent, which was more than the 14.5 percent increase after placebo (P less than .05). Exercise work after nadolol increased 64.7 percent, greater than the 22 percent increase after placebo (P less than .05). Mean ST segment depression at end of exercise was little changed before and after treatment in both groups, reflecting consistency of effort. Improvement in symptoms and work capacity associated with nadolol significantly exceeded the placebo group responses. Unlike other available agents of this class, a single daily dose of nadolol produced therapeutically effective 24-hour beta-blockade in patients with disabling angina pectoris.
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PMID:Comparison of nadolol, a new long-acting beta-receptor blocking agent, and placebo in the treatment of stable angina pectoris. 679 83

Nitroglycerin (Ng) is a potent and short-acting coronary and systemic vasodilator, widely used in anginal pain treatment. When given to patients with pneumonia or chronic lung disease, Ng was found to cause a further decrease in arterial oxygen tension (PaO2) by increased perfusion of poorly ventilated territories in the lungs. In order to investigate the potential hazard in Ng decreasing the PaO2 in ischemic heart disease patients, who develop acute pneumonia, we administered 0.4 mg Ng sublingually to 11 patients who suffered concomitantly from ischemic heart disease and acute pneumonia. Arterial blood gases were monitored before, 2, 5 and 10 min following Ng administration, as well as a standard 12-lead electrocardiogram that was monitored as the same time. 8 out of the 11 patients showed a decrease in PaO2 which was mild to moderate, during the study period of time, none of them showed an increase, and there was tendency for the lower (less than 60 mm Hg) initial PaO2 to show a lesser decrease in the PaO2 in comparison to the higher (greater than 60 mm Hg) initial PaO2. There was no statistical significant correlation between the decrease in PaO2 and patients' age, sex, coexisting chronic obstructive lung disease and severity of systemic heart failure. Our conclusion is that the hazard in lowering PaO2 by Ng in ischemic heart disease patients who develop acute pneumonia is minimal, but the drug should be used with caution.
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PMID:Arterial hypoxemia following the administration of sublingual nitroglycerin in patients with ischemic heart disease and pneumonia. 679 69

We report on a patient with Prinzmetal's variant angina. The coronary angiogram demonstrated a subtotal stenosis in the left anterior descending artery. The provocative test with Ergonovine increased the stenosis to a higher degree and the patient became symptomatic (Angina pectoris, ST-elevation). The angiographic control after Nitroglycerin revealed a normal vessel so that the stenosis was identified of spastic origin. To avoid misinterpretation in asymptomatic coronary artery spasm an angiographic control after Nitroglycerin is necessary in patients with Prinzmetal's variant angina and coronary stenosis.
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PMID:[Nitroglycerin-application in order to differentiate a spastic from an organic coronary obstruction in a case of Prinzmetal's variant angina (author's transl)]. 679 42

Lidoflazine is a synthetic drug with calcium-channel blocking effects. In a 7-month study, 36 patients with stable angina pectoris were tested during a 3-month single-blind placebo phase. Nineteen were then randomized by double-blind methods to lidoflazine and 17 to placebo therapy. The lidoflazine group had a significant (p less than 0.01) reduction in anginal attacks; the placebo group did not. Exercise testing demonstrated that lidoflazine therapy was associated with a 34% increase in total work performance and a 15.6% increase in peak calculated oxygen uptake during double-blind treatment (both p less than 0.004 compared with the placebo group). Heart rate was significantly reduced at submaximal levels of exercise during lidoflazine therapy (p less than 0.04). Nitroglycerin consumption and electrocardiographic changes at the end of exercise did not change during the double-blind phase. In a second study of six similar patients, single-blind administration of lidoflazine was associated with improved myocardial perfusion during exercise as determined by thallium-201 stress scintigraphy. These studies demonstrate that lidoflazine therapy is associated with relief of angina, an increased physical work capacity, and improved regional myocardial perfusion during exercise.
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PMID:The effects of lidoflazine on exercise performance and thallium stress scintigraphy in patients with stable angina pectoris. 679 88

During constant uninterrupted exercise with mild angina present, either placebo, nitroglycerin, isosorbide dinitrate or erythrityl trinitrate was given by buccal membrane absorption. Placebo produced no relief and exercise had to be stopped. Nitroglycerin produced rapid complete relief and the long-acting drugs effected relief more slowly but of long duration as shown on repetitive walks as long as 3 h after drug administration.
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PMID:Treadmill exercise protocols to demonstrate effectiveness of nitrate drugs in relief of angina pectoris; duration of action and degree of functional enhancement. 679 34

Nitroglycerin, first introduced over a hundred years ago, is now finding wider clinical applications. To a large degree, the renewed interest in the clinical pharmacologic usage of nitroglycerin is due to the availability of new formulations and drug delivery systems. The current review focuses on the physiological and pharmacological actions of nitroglycerin in mammals. Routes of nitroglycerin metabolism, biochemistry and absorption are discussed. The phenomenon of nitroglycerin tolerance is illustrated and related to specific quantitative alterations occurring at the cellular level. The cardiovascular effects of nitroglycerin are discussed in terms of its effects on coronary flow, the myocardium itself, and on the peripheral vasculature. The early speculation of Murrell (3) that nitroglycerin "would probably prove of service in the treatment of angina pectoris ... and other vascular disorders ..." has now been realized.
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PMID:Animal pharmacology of nitroglycerin. 680 52

We investigated the possibility that high dosages (480 mg/d) of isosorbide dinitrate might reduce the frequency of angina attacks in selected patients who had not responded to low dosages of the drug (40 mg/d), and that the patients could tolerate the high levels of medication and maintain their responsiveness over the long term. In the single-blind phases of this trial 24 patients with grade 3 stable angina pectoris were given a placebo for 4 weeks and then increasing doses of isosorbide dinitrate for a further 6 weeks. The 19 patients who both responded to and tolerated high doses of the drug kept taking 480 mg/d for an average of 1 year. The average weekly rate of angina attacks fell by 74%, from 6.05 in the placebo phase to 1.6 during long-term active treatment (p less than 0.01). Nitroglycerin consumption decreased accordingly. The patients' assessments of their levels of activity and well-being and their angina thresholds showed improvement among most of them. The trend of angina frequency was stable in 12 cases, downward in 6 and upward in only 1 case. Exercise performance as evaluated by a graded treadmill test showed a small but nonsignificant improvement of 18%. It was concluded that some patients who do not respond to the antianginal action of low-dosage isosorbide dinitrate and cannot be given beta-blockers may respond to high dosages and tolerate them for over a year. Isosorbide dinitrate may be clinically useful in patients with coronary heart disease even though their exercise performance is not significantly improved.
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PMID:High-dosage isosorbide dinitrate therapy for angina. 682 33

1. Canine circumflex coronary artery ring segments were contracted in vitro by ergometrine, serotonin, phenylephrine, noradrenaline (with propranolol) and a thromboxane A2 analogue, U46619. 2. Ergometrine was classified as a serotonin agonist since concentration-response curves were competitively inhibited by methysergide but not by alpha-adrenoceptor antagonists. 3. Glyceryl trinitrate (IC50 18.6 nmol/l) relaxed the coronary rings precontracted with serotonin, phenylephrine or U46619. In contrast (+/-)-verapamil (0.1-10 mumol/l) was more effective against serotonin than phenylephrine or noradrenaline and was almost inactive against U46619. 4. In a blood perfused left anterior descending coronary artery preparation external diameter was measured by sonomicrometry. Serotonin, U46619 and ergometrine infusions (i.a.) decreased diameter by up to 18% without causing spasm (zero lumen diameter). Lowering the perfusion pressure from 90 to 60 mmHg increased the fall in diameter during serotonin infusions. 5. The negative inotropic potency of verapamil against noradrenaline induced beta-adrenergic stimulation in guinea-pig left atria was compared with the vasodilator potency of verapamil in noradrenaline constricted dog coronary artery rings. Verapamil was eighteen times more potent in cardiac muscle than in coronary smooth muscle. 6. This apparent tissue selectivity of verapamil was confirmed in anaesthetized dogs where plasma concentrations of verapamil 50-150 ng/ml (in the therapeutic range) lowered blood pressure and heart rate and increased P-R interval without greatly reducing the constrictor response to serotonin in the coronary artery. 7. These studies suggest that inhibition of constrictor responses in large coronary vessels may not be an important site of action of verapamil in patients with variant angina.
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PMID:Verapamil: a selective antagonist of constrictor substances in dog coronary artery: implications for variant angina. 695 74


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