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)

Intravenous trinitroglycerine (IV TNT) was used in 17 patients with myocardial pre-infarction syndrome defined by the presence of prolonged spontaneous attacks of attacks of angina, with electrocardiographic changes, persisting despite medical treatment with beta-blockers and oral nitrite derivatives. Seven patients had chronic angina, 7 had angina of recent onset and 3 patients had early post-infarction angina. IV TNT was used for 3 to 11 days at a mean dose of 40 micrograms/mn in 11 patients and 8 micrograms/mn in 6 patients. In the latter, cardiac output and pulmonary pressures were measured. IV TNT made it possible to decrease or stop angina attacks in all the patients except one. There was no significant variation in heart rate and mean blood pressure fell by 8 mmHg (p < 0.001). Cardiac index was maintained despite a fall in capillary pressure of 4.1 mmHg (p < 0.01). Coronary arteriography was performed in 16 cases, with circulatory assistance in 4 patients. Thirteen patients were treated by surgical revascularisation, with two operative deaths. IV TNT appeared to be effective and well tolerated treatment in these particularly severe forms of unstable angina.
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PMID:[Intravenous trinitroglycerin in the treatment of pre-infarction syndrome. Preliminary results (author's transl)]. 12 19

The authors selected, from a general sample of 3525 cardiopathic patients treated with 2 g daily of L-carnitine during 1 year, 220 stable effort angina TNT-responder patients, presenting more than 15 anginal episodes per month; moreover, other 59 anginal patients in congestive heart failure have been taken into account. The evaluation of the results obtained in these samples has been done in parallel with the ones of cardiopathic patients studied in 2 multicentric trials carried out, according to a very similar protocol, in Switzerland (148 patients treated at the same posology for 6 months) and Germany (143 patients, 3 months of treatment). The analysis of the three trials showed net reduction of both rate of anginal episodes and therapeutic use of nitrates, substantiated by improvement of physical performance (demonstrated by ergometric test in the German trial) as well as of the quality of life (the Swiss trial). Furthermore, from the general sample of 3525 patients the authors selected 737 subjects with clearly pathological levels of plasma cholesterol, in order to evaluate the effect of L-carnitine treatment on lipidemic parameters; after 12 months of administration only 282 patients showed abnormal levels of cholesterolemia. Analysis of the results of the three trials and a review of the literature on carnitine identify the compound as a fundamental drug for the treatment of patients with myocardial ischemia.
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PMID:[L-carnitine in the treatment of chronic myocardial ischemia. An analysis of 3 multicenter studies and a bibliographic review]. 153 43

In order to study the efficacy and tolerance of isradipine, a new Ca++ antagonist for the treatment of stable chronic angina, a multicentric cooperative study was carried out in eight Latin American countries (Argentine, Chile, Colombia, Ecuador, Mexico, Peru, Uruguay and Venezuela), which included 169 patients (60% men and 40% women), average age 62.6 +/- 9.7. Patients with more than 4 biweekly anginal crisis were accepted, with one or more of the following inclusion criteria: coronariographic evidence of obstruction greater than 60% in one or more vessels, IAM history, positive scintigraphy and positive effort test. The trial was single-blind, with placebo during the admission phase (2 weeks) and active treatment for 12 weeks. isradipine was administered in increasing doses of 2.5, 5, and 7 mg thrice a day, according to the presence or absence of anginal crisis. It was observed that the average frequency of weekly pains decreased from 8.2 +/- 7 under placebo to 6.3 +/- 7.5 under isradipine at low doses, and to 2.0 +/- 2.0 (p less than 0.001) under maximum doses. TNT intake decreased parallel also in a significant way. At the end of the trial, 37% of patients had become asymptomatic, and angina had reduced to less than two crisis a week in 33%. A clear relation doses-effect was observed. There was no alteration in laboratory exams neither in ECG. Seven patients had complications derived from the evolutional course of disease (2 IAM, 5 unstable angina and one sudden death). Adverse events were relatively frequent and the majority derived from vasodilator effect (tibial oedema 37%, flushing 17%, headache 23%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[The treatment of chronic stable angina with isradipine. A cooperative Latin American study]. 182 46

A randomized, double-blind, multicentric study has been carried out to compare the electrocardiographic tolerance and the clinical benefit of bepridil (B) (300 to 500 mg/day) and of diltiazem (D) (180 to 300 mg/day). 227 patients with stable coronary disease, aged 70 years or less (mean = 59.4 +/- 7.2 years) have received treatment (116 B vs 111 D) during 16 weeks. The standard ECGs at each visit (D 0-inclusion-, D 14, D 28, D 70, D 112) show that, in group D, 9 first degree auriculo-ventricular blocks (ABV), occur during the study while no ABV occur in group B. A significant prolongation of the QTc (+5%) is observed as from D 14 in group B patients compared to those in group D. This difference persists during all the study. The study of Holters of 24 hours, carried out on D 0, D 70 and D 112, shows the good tolerance of B in this type of population. The number of patients presenting attacks of angina, the frequency of these attacks and the amount of TNT consumed are not different for the two groups under treatment, whatever the period studied. The frequency of extracardiac and cardiovascular undesirable effects is not different for the two groups. The number of patients who left the trial is not different for the two groups. The biological tolerance remained within normal limits in both groups. The analysis of the individual data has never shown any pro-arrhythmic effect, attributable to B or D, in the patients with no initial arrhythmia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Comparative study of the mid-term electrocardiographic and clinical tolerability of bepridil versus diltiazem in patients with coronary disease]. 226 10

The antianginal effects of 360 mg/day of diltiazem were evaluated, using intrapatient comparisons, in a double/blind, randomized, placebo/controlled trial in 24 young patients (50 +/- 7 years) and in 16 elderly patients (67 +/- 3 years) with stable effort angina. All patients had angiographic documentation of significant coronary artery disease. An open-labelled, randomized, crossover design was employed. For 1 week prior to beginning the study, the patient was on no medication except sublingual nitrates. The study consisted of an initial 2-week single-blind placebo run-in period followed by a 4-week randomized double-blind crossover between diltiazem, 120 mg t.i.d., and placebo. A diary of chest pain and nitroglycerin usage was kept during this period and run-in. Exercise tests were carried out during the run-in period (2 tests) and at the end of the 4-week treatment. After diltiazem 12 of the 24 young patients stopped the exercise test because of angina. A similar number (9/16) of elderly patients stopped the exercise test because of angina. During diltiazem treatment, weekly angina frequency was significantly reduced in the young patients (1.25 +/- 0.67 vs 3.87 +/- 1.19-run-in, 4.08 +/- 1.24-placebo; p less than 0.01) and in the elderly patients (0.87 +/- 0.71 vs 4.06 +/- 1.48-run-in, 4.12 +/- 1.5-placebo; p less than 0.01). Weekly TNT consumption significantly decreased in both groups of patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Efficacy of diltiazem in elderly patients with stable effort angina]. 269 81

When the discoverer of dynamite (trinitrotoluene [TNT]), Alfred Nobel, was prescribed nitroglycerin for angina in 1895, he was certainly taken aback. Almost a century later, organic nitrates and their gaseous metabolic end product, nitric oxide (NO), were implicated in a vast array of biologically diverse activities. About 10 years ago, a series of discoveries from different avenues of research converged on NO, thrusting it into the limelight as a neurotransmitter, vasodilator, toxin, and modulator of immune function and inflammation. Nitric oxide has thus managed to capture the interest of scientists from a number of fields and holds center stage attention. Interest in NO among dermatologists has been slow to appear, however, and the literature on NO with respect to the skin is sparse when compared with the steep escalation in the number of articles published generally on NO since 1987 (Figure 1).
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PMID:From bedside to the bench and back. Nitric oxide and the cutis. 871 38

The landmark HMG-CoA reductase inhibitor (statin) studies have practical lessons for clinicans. The 4S trial established the importance of treating the hypercholesterolaemic patient with cardiovascular heart disease. Next, WOSCOPS showed the benefit of treating healthy, high-risk hypercholesterolaemic men. CARE, a secondary prevention trial, showed the benefit of treating patients with cholesterol levels within normal limits. This was confirmed by the LIPID trial, another secondary prevention study, which enrolled patients with cholesterol levels 155-271 mg/dl (4-7 mmol/l). The importance of treating patients with established ischaemic heart disease, and those at high risk of developing heart disease, regardless of cholesterol level, was being realized. In the MIRACL trial, hypocholesterolaemic therapy was useful in the setting of an acute coronary syndrome, while the AVERT study showed that aggressive statin therapy is as good as angioplasty in reducing ischaemic events in patients with stable angina. By showing the value of fluvastatin after percutaneous intervention, LIPS confirmed that benefit is a class action of the statins. The HPS randomized over 20 000 patients, and showed beyond doubt the value of statins in reducing cardiovascular events in the high-risk patient. Although PROSPER showed benefit in treating the elderly patients above 70 years, statin therapy in this trial was associated with an increase in cancer incidence. The comparative statin trials, PROVE-IT, REVERSAL, Phase Z of the A to Z, ALLIANCE and TNT, all showed that high-dose statins will better reduce cardiovascular events in the high-risk patient, although the adverse effects of therapy will also be increased. ALLHAT-LLT, ASCOT-LLA and CARDS showed that for statin therapy to demonstrate a significant benefit, hypertensive or diabetic patients must be at sufficiently high risk of cardiovascular events. The emphasis is now on the risk level for developing cardiovascular events, and treatment should target the high-risk group and not the lipid level of the patient. No therapy is free of adverse effect. Treatment of those most at risk will bring the most benefit; treatment of those not at high risk of cardiovascular disease may expose patients who would not benefit much from therapy to its adverse effects.
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PMID:The statin studies: from targeting hypercholesterolaemia to targeting the high-risk patient. 1600 1