Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A randomised, crossover, double-blind study was carried out in sixteen coronary patients with stable effort angina to compare the effects of verapamil (360 mg) and propranolol (120 mg). All the patients received placebo for 2 days, underwent a coronary angiography which confirmed coronary heart disease and were then randomised into two groups to receive an initial treatment of either verapamil or propranolol for three days. The patients then took placebo for 3 days, then the second drug after cross-over also over 3 days. The therapeutic efficacy was assessed by stress testing on a treadmill (Bruce protocol) with automated analysis of the results (Case-Marquette), carried out on the last day of each of the phases with placebo and the test drug. The duration of the stress test increased significantly with propranolol (p less than 0.01) and verapamil (p less than 0.05) with respect to placebo. In comparison with placebo, propranolol and verapamil resulted in a similar decrease in ST segment depression at the time of maximum effort (p less than 0.01). The resting systolic blood pressure decreased with propranolol (p less than 0.02) and verapamil (p less than 0.01), whereas resting diastolic blood pressure only decreased with verapamil (p less than 0.01). Resting heart rate decreased during the propranolol phase (p less than 0.001). The systolic blood pressure at the time of maximum effort decreased especially with propranolol (p less than 0.05), whereas the diastolic blood pressure on exertion decreased during the verapamil phase (p less than 0.01). Heart rate during exertion only showed a significant decrease with propranolol (p less than 0.001) as compared with placebo.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Verapamil versus propranolol in stable effort angina. Randomized, crossed, double-blind study]. 328 63

Multivariate analysis has been proposed to enhance diagnostic accuracy of the exercise test in coronary artery disease. To quantify the improvement given by multivariate analysis in comparison with ST segment depression alone during exercise test, 558 men without previous myocardial infarction were studied retrospectively. All the patients underwent a symptom-limited Bruce protocol with computer-averaged recordings in V5, aVF, V2. Coronary angiography was performed within the following 90 days. Prevalence of coronary artery disease (diameter narrowing of 50% or greater) was 0.56. Among 12 clinical and exercise parameters studied by stepwise multivariate analysis, five were found to reach the maximal accuracy: (1) exercise duration, (2) history of typical angina, (3) typical angina during the test, (4) age, (5) maximal heart rate. In comparison with ST depression, multivariate analysis significantly improves accuracy (74.6 vs. 66.8%, P less than 0.01) by increasing sensitivity (0.68 vs. 0.59, P less than 0.05) without affecting specificity (0.83 vs. 0.76, NS). Thus, in a group of men without infarction and a low prevalence of coronary artery disease, multivariate analysis with five easily collected variables is more accurate than ST segment depression alone during exercise. In addition, ST depression did not appear as discriminant as exercise duration for diagnostic purposes. This finding emphasises the importance of performing a symptom-limited exercise test.
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PMID:Enhanced efficacy of computerized exercise test by multivariate analysis for the diagnosis of coronary artery disease. A study of 558 men without previous myocardial infarction. 332 88

The effectiveness and duration of the anti-anginal action of two sustained-release preparations, molsidomine (8 mg) and isosorbide dinitrate (20 mg), were assessed by means of serial exercise tests in 12 patients with angina of effort. The tests, which were limited by the symptoms, were carried out on three consecutive days using the Bruce protocol. Each patient was tested four times each day: the first test was performed before treatment and the others were carried out 1, 4 and 8 h after administration of the drug or placebo. One hour after administration of molsidomine, the appearance of signs of ischaemia in the ECG were considerably delayed and they were reduced in magnitude. Furthermore, the length of time during which the patients were free of angina increased. After 4 h both drugs significantly delayed the onset of angina and depression of the ST segment by 1 mm. The conclusion is that at the doses used both drugs prolong the length of time in which there is no angina, but that they have no significant effect at 8 h.
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PMID:An assessment of single doses of 8 mg sustained-release molsidomine using serial exercise tests. 338 79

In 105 patient pairs, matched for sex, aged within a ten-year range and with closely similar coronary disease, the sensitivity and specificity of treadmill testing using the Bruce Protocol was compared to cycle ergometry using the 100 kpm/min (16 W/min) increment protocol, and found to be similar. The parameters of use were ST segment depression (sensitivity of 52% for treadmill and 61% for cycle), test angina (65% and 61%), significant work impairment (66% and 68%) and impaired blood pressure response (31% and 20%). The sensitivity was increased (treadmill to 84%, cycle to 89%) if the four parameters were grouped, and abnormality in any one of them was regarded as a positive test. The equivalent severity of coronary disease resulted in more severe work impairment on the cycle than on the treadmill. The mean work level of the treadmill group was 80%, and of the cycle group, 61% of their respective, nomographically predicted, normal values. The difference was similar for the zero, single and multivessel disease groups. This difference should be recognised when comparing the two techniques.
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PMID:A matched pairs comparison of cycle ergometry and treadmill exercise testing in the evaluation of coronary heart disease. 344 58

During a 43-month period (May 1981 to December 1984), 77 consecutive patients underwent multiple (eight or more) coronary artery bypass procedures using saphenous vein conduits for severe diffuse triple-vessel coronary artery disease. Patients received from 8 to 14 grafts (average 9). All coronary arteries and branches that were at least 1.5 mm in diameter and greater than 50% obstructed were bypassed. The operative mortality rate was 1.3%. Seventy-six of 77 (98.7%) patients are alive at a mean follow-up of 2 years. According to the Canadian Cardiovascular Society Angina Criteria, before surgery 5 patients (6%) were classified class I, 8 (10%) class II, 43 (56%) class III, and 21 (27%) class IV. After surgery all 76 patients were class I. Of 59 patients who had undergone bypass surgery who were followed by exercise testing according to the modified Bruce protocol, 47 exercised to greater than or equal to 85% heart rate. Among these patients, 44 (94%) had a normal exercise test result and only 3 had greater than or equal to 1 mm ST segment depression. Thus, patients with severe diffuse coronary disease can undergo multiple (eight or more) bypass grafting procedures with low mortality rates and improved exercise tolerance and functional classification.
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PMID:Multiple (more than eight) bypass grafts in severe diffuse coronary disease: improved exercise tolerance and functional classification in seventy-seven consecutive patients. 349 62

A new treadmill exercise protocol, modified from the standard Bruce method, was designed to improve ST segment/heart rate slope accuracy and applicability by reducing heart rate increments between exercise stages. In 150 patients exercised according to the new protocol and in 150 patients exercised according to the Bruce protocol, similar exercise tolerance and similar overall heart rate, systolic blood pressure and double product responses to exercise were observed. The mean increment in heart rate between exercise stages of the new protocol was ten beats/minute, which was significantly lower than the 27 beats/minute/stage found with the Bruce protocol. The accuracy of computer-measured ST segment depression was validated by comparison with physician measurement in a separate subgroup of patients with angina pectoris, and serial testing demonstrated stronger interest reproducibility for the ST segment/heart rate slope than for either measured ST segment depression, peak heart rate achieved or duration of exercise.
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PMID:A modified treadmill exercise protocol for computer-assisted analysis of the ST segment/heart rate slope: methods and reproducibility. 354 Jan 74

Little information is available regarding left ventricular (LV) functional recovery from treadmill exercise. Accordingly, we used a recently described ultrasound index of LV function, the isovolumic index (IVI), to assess LV performance before and after exercise in 9 normal middle-aged men and 12 male patients with coronary artery disease (CAD). The IVI was measured at rest and at each minute for at least 10 min after completion of the Bruce protocol; normals had maximal tests and CAD patients had symptom limited studies. At rest the IVI value for normals was 26.2 +/- 2.1 (SD) and it was 43.5 +/- 8.2 for CAD patients (p less than 0.001); isovolumic times were longer in CAD patients (137 +/- 26 vs. 89 +/- 8 ms, p less than 0.001). The rate of recovery from exercise did not differ between normals and CAD patients. We conclude that despite depression of resting LV performance in CAD patients, the time course of functional recovery of the left ventricle from exercise is not different from normal subjects.
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PMID:Left ventricular functional recovery from exercise in normals and patients with coronary heart disease. 356 49

The authors report the case of a 26 year old non-migrainous man who presented over a 5 week period with a cluster of classical migrainous attacks associated with CSF lymphocytosis. The association of this type of CSF response with attacks of migraine is unusual; in migraine the CSF is normal or may show an isolated increase in protein content (with the exception of the very rare familial hemiplegic migraine). In the reported case, other conditions liable to give rise to migraine and CSF lymphocytosis having been excluded (acute DLE, brucellosis...), this association corresponded to a benign and spontaneously regressive condition, possibly a migraine symptomatic of benign acute lymphocytic meningitis. The authors suggest that a primary meningeal inflammation may have been the cause of the cluster of migraine attacks which in this case were more accompanied perhaps because they induced a wave of depression of cortical activity.
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PMID:[Migraine manifestations and lymphocyte pleocytosis of the cerebrospinal fluid]. 363 29

The treadmill exercise test with the Bruce protocol was performed in three patients with post-myocarditic myocardial hypertrophy (PMH) and ten patients with cardiomyopathy, including three with dilated cardiomyopathy (DCM), five with hypertrophic obstructive cardiomyopathy (HOCM), and two with hypertrophic and nonobstructive cardiomyopathy (HCM). The endurance time was below the normal level in all but one case and was normal or near normal in the three cases with PMH. ST depression was observed in five cases, none of which were of HCM. A marked increase in amplitude of the negative phase of the P wave in V1 was observed in one patient with DCM. The response of blood pressure during the exercise was abnormal in patients with DCM and HCM but was normal in PMH.
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PMID:Treadmill exercise test in children with cardiomyopathy and postmyocarditic myocardial hypertrophy. 372 84

In patients with cerebral transient ischemic attacks or stroke myocardial infarction is the leading long-term cause of death. Despite the importance of coronary artery disease, patients with cerebrovascular insufficiency are seldom evaluated for the detection of ischemic heart disease and usually the cardiological evaluation is limited to the patients with angina or previous myocardial infarction. In order to identify asymptomatic coronary artery disease 74 consecutive patients with cerebral ischemia, and without symptoms or electrocardiographic signs of ischemic heart disease, underwent a maximal exercise treadmill test according to the Bruce protocol. An exercise Thallium myocardial scintigraphy was performed in patients with positive exercise test. A control group of 74 asymptomatic subjects underwent the same study protocol. The study population (Group I) included 57 men and 17 women; the age ranged from 22 to 72 years (mean age 54 years). An adequate exercise test was obtained in 67 patients. Exercise test was positive (ST-segment depression greater than or equal to 1.5 mm) in 19 cases (28%). The end points were exhaustion in 15 patients, ST-segment depression greater than 3 mm in 2 and systolic blood pressure greater than 240 mmHg in 2. The exercise Thallium myocardial scintigraphy was normal in 2 and abnormal in 17: reversible perfusion defects were detected in 12 cases and fixed defects in 5. In the control group (Group II), comparable for age and sex, exercise test was positive in 4 cases (5%; p less than 0.01 percentage of positive exercise tests in Group I vs Group II); the exercise myocardial scintigraphy was normal in 1 and abnormal in 3 subjects.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Early identification of ischemic cardiopathy in patients with cerebrovascular insufficiency.A prospective study with exertion test and perfusion myocardial scintigraphy]. 373 22


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