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)

Silent myocardial ischaemia (significant ST depression without chest pain) is a common occurrence in most forms of coronary heart disease and can be associated with permanent changes in myocardial structure. The haemodynamic and ECG manifestations of silent episodes are similar to those observed in painful ischaemia. Exercise testing is the most appropriate method for assessing the severity of coronary artery disease; increased sensitivity can be obtained by combining it with radionuclide scintigraphy or ventriculography. Ambulatory ECG monitoring may fail to detect ischaemic changes revealed by exercise provocation. The treatment approach should depend on the degree of ischaemia. Numerous clinical investigations in stable and unstable angina and in patients with a previous myocardial infarction indicate that the prognosis of patients with myocardial ischaemia does not depend on whether the ischaemia is silent or symptomatic. Silent and symptomatic episodes alone represent the same degree of coronary disease. Moreover, it appears that ischaemic episodes are a more powerful adverse prognostic influence than left ventricular function or the extent of coronary artery disease. All anti-ischaemic agents, such as beta-blockers, calcium antagonists and nitrates, and interventions such as coronary balloon angioplasty or coronary bypass surgery, are very effective treatments for myocardial ischaemia. All efforts should be made to prevent ischaemic episodes, whether silent or symptomatic, since the severity of disease rather than the presence or absence of symptoms more accurately reflects the need for intervention.
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PMID:Silent ischaemia in the 1990s. 171 95

Vigorous physical activity can improve the health of both adults and children. Among adults, regular physical activity can reduce risk for chronic diseases such as coronary heart disease, hypertension, noninsulin-dependent diabetes mellitus, colon cancer, and depression, as well as lower all-cause death rates (1,2). Among children, regular physical activity can reduce chronic disease risk factors such as obesity, elevated cholesterol, and hypertension (3). Physical activity patterns established during childhood may extend into adulthood (4). This report examines the prevalence of vigorous physical activity among U.S. students in grades 9-12.
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PMID:Vigorous physical activity among high school students--United States, 1990. 173 Nov 78

The clinical and haemodynamic effects of adrenaline infusion (30 ng kg-1 min-1) producing plasma adrenaline concentrations in the range seen during acute myocardial infarction and of placebo were investigated in a crossover design in 14 patients with stable coronary heart disease. Adrenaline infusion resulted in electrocardiographic evidence of myocardial ischaemia (greater than or equal to 1 mm (0.1 mV) horizontal or downsloping ST segment depression) in 10 patients and angina in four, although the mean (SEM) increase in heart rate was modest (14 (2) beats/min) and mean coronary vascular resistance fell from 1.56 (0.21) to 1.16 (0.14) mm Hg min ml-1 (p less than 0.005). New or increasingly frequent or complex ventricular arrhythmias occurred in five patients. Placebo infusion had no effect on the variables measured. Supine bicycle exercise during infusion of the saline placebo was associated with a similar degree of ST segment depression (0.9 (0.2) mm) as adrenaline infusion at rest (0.9 (0.1) mm) but exercise performed during adrenaline infusion (10 patients) resulted in more pronounced ST segment depression (1.9 (0.3) mm) (p less than 0.005) than either intervention alone. Angina occurred in three of 11 patients during control exercise and in six of 10 during the combination of adrenaline infusion and exercise. Such potentially adverse consequences of low dose adrenaline infusion in patients with stable coronary heart disease are consistent with the suggestion that adrenal activation is detrimental during acute myocardial infarction, being both arrhythmogenic and proischaemic.
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PMID:Myocardial ischaemia and ventricular arrhythmias precipitated by physiological concentrations of adrenaline in patients with coronary heart disease. 138 26

Thirty-four patients with coronary heart disease who had silent myocardiac ischemic episodes as evidenced by long-term ECG monitoring were examined. Silent ST-segment elevations and depressions were encountered 2.7- and 4.9-fold as compared to manifest ones. The fact that the CHD patients had silent ST-segment depressions and/or prolonged high-amplitude silent ST-segment elevations suggests a grave severity of abnormal myocardial processes. There was a reduction in the number, duration of silent ST-segment elevations and depression episodes and in the amplitude of silent ST-segment depressions. This may indirectly indicate that the agent affects predominantly coronary blood flow and coronary vascular tone.
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PMID:[Effect of diltiazem on silent myocardial ischemia]. 175 70

A sample of 45 patients with a history of coronary heart disease and documented myocardial ischemia during exercise testing were evaluated in an investigation of the possible relationships between psychological factors (depression and Type A behavior pattern), plasma beta-endorphin response and pain experience during maximal exercise-induced ischemia. Depression was assessed using the MMPI-D subscale, while Type A was evaluated using the Structured Interview. All patients developed ischemia during exercise as defined by ST-segment depression; however, only 18 patients reported anginal pain. Patients with high depression scores (MMPI-D greater than or equal to 70; n = 13) showed lesser increases in plasma beta-endorphin levels, tended more often to report anginal pain and rated pain as more severe during exercise than patients with low depression scores (MMPI-D less than 60; n = 18). Hemodynamic responses and severity of ischemia (assessed by ejection fraction changes and wall-motion abnormalities) did not differ between depression groups. Even after adjustment for group differences in exercise duration, depression was significantly associated with a lesser beta-endorphin response in the sample as a whole and, among patients reporting angina, with earlier pain onset and greater pain duration and severity. In contrast, when Type A versus B/X subgroups were compared, no differences in pain experience, beta-endorphin response or measures of ischemia were obtained. These findings suggest that in patients with ischemic heart disease, there may be a relationship between depression and anginal pain which may in part involve a blunted or absent beta-endorphin response.
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PMID:Depression and type A behavior pattern in patients with coronary artery disease: relationships to painful versus silent myocardial ischemia and beta-endorphin responses during exercise. 175 50

The antianginal effect and tolerability of isosorbide mononitrate (ISMN), 20 mg 2-3 times daily, orally were investigated in an open study in 28 patients, suffering from coronary heart disease and stable angina pectoris. Ergometric exercise tests were carried out before treatment and 2 h after drug intake, every 3 months during the first year and at 6-month intervals during the following 2 years. At the conclusion of the 3-year study the reduction of ST-segment depression, which had amounted to 58% after 1 year, could be improved to 78% (p less than 0.01). The frequency of angina was markedly reduced during the treatment with ISMN. While 14 of the patients had more than 3 episodes per day prior to the study, 16 patients were symptom-free at the end of the three years' therapy, and none of the patients had more than 1 or 2 attacks per day. The consumption of sublingual nitroglycerin diminished by 94% after one year and by 98% after 3 years of therapy (p less than 0.01). Headache was the only adverse effect observed in some of the patients (at the initiation of the treatment only). In conclusion this study demonstrated (1) the good tolerability of ISMN, at the doses used, and (2) the fact that the antianginal efficacy may be enhanced during the course of the therapy.
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PMID:Evaluation of effectiveness and tolerability of isosorbide mononitrate during a three-year period in patients with angina pectoris. 176 Aug 29

In a 6-week, randomized, double-blind trial, the drug effects of the calcium antagonists, fendiline (75 mg twice daily) and diltiazem (90 mg twice daily), as measured by subjective and objective parameters of coronary heart disease, were studied in 79 patients with stable angina pectoris. The statistical analysis included the data of 71 patients. The results of exercise-ECG tests showed that both medications were effective anti-ischaemic agents. Fendiline was found to be effective in reducing ST-segment depression at maximum comparable load (71 watts) as well as at the time of reaching the individual maximum tolerated load (discontinuation of exertion). Diltiazem, on the other hand, proved effective only at maximum comparable load (72 watts). There was no significant difference between the groups with regard to the reduction after 6 weeks. As regards work tolerance, the duration of exercise and time until appearance of a ST-segment depression of 0.1 mV, before and after treatment comparisons revealed significant changes only in the group receiving diltiazem and the differences between fendiline and diltiazem were statistically significant with regard to these three parameters. Reduction in the frequency of anginal attacks and the diminution of nitroglycerin consumption were comparable in both medication groups, and the changes from baseline were statistically significant. Assessment of the efficacy and tolerability of the medications by patients as well as by investigators revealed no statistically significant differences between the two groups. Blood pressure and heart rate were clearly lowered by diltiazem, whereas fendiline induced only a slight decrease in blood pressure. The results indicate that both medications are equally suited for the treatment of stable angina pectoris.
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PMID:Double-blind, randomized study of the anti-anginal and anti-ischaemic efficacy of fendiline and diltiazem in patients with coronary heart disease. 176 56

To define the prognostic significance of profound ST segment depression (greater than or equal to 3mm) during exercise test, 106 patients of definite coronary heart disease enrolled in a prospective study were followed for up to 9 years. Group A (56 patients) had profound (greater than or equal to 3mm) ST segment depression (3.56 +/- 0.74mm) and Group B (50 patients) had less than 3mm ST segment depression (1.23 +/- 0.35mm, P less than 0.01) during treadmill testing. Group A patients tolerated exercise for a lesser duration in comparison to group B patients (7.22 +/- 3.35 vs. 10.18 + 4.07 minutes, p less than 0.01). At the end of the study, 21 (37.5%) group A patients either died or underwent coronary artery bypass surgery as compared to 8 (16.0%) group B patients (p = 0.02). The difference in the incidence of cardiac deaths between the two groups was not statistically significant (19.6% in group A and 14.0% in group B). However, sudden deaths were significantly more common in group A as compared to group B patients (10 of 11 (90.9%) vs 4 of 7 (57.1%), p = 0.02). These data suggest that profound ST segment depression (greater than 3mm) during treadmill stress test indicates an adverse long term prognosis with the risk in particular, of sudden cardiac death.
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PMID:Prognostic value of profound ST segment depression during treadmill stress test in coronary heart disease: nine years follow-up study. 180 Mar

The diagnostic potentialities of bicycle ergometry (BEM) and treadmill test were comparatively analysed in 57 males aged 37-64 years who were examined to detect coronary heart disease. In 34 cases, the results of BEM and treadmill test were consistent, of them 13 were positive, 15, negative, 3 intermediate, and 3 inadequate. With positive results, the treadmill test was more reliable than BEM in revealing the criteria for ischemia from statistically significantly more pronounced ST-segment depression at a lower threshold heart rate. Inconsistency of the BEM and treadmill test results was found in 23 cases. In 14 of 18 patients who had indefinite BEM results, the treadmill test allowed one to make a definite conclusive diagnosis, showing 6 positive and 8 negative results. This is accounted for by lower cases when the treadmill test was discontinued due to a hypertensive reaction of blood pressure or fatigue. The study indicated that the treadmill test was more sensitive and better tolerated than BEM.
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PMID:[Comparing the informative value of bicycle ergometry and treadmill tests in the evaluation of the coronary reserve]. 180 56

The diagnostic potentialities of the unique procedure of transesophageal cardiac pacing (TECP) exercise test were examined. The accelerated one-stage TECP test was started just at a rate equal to the heart rate submaximal for a patient's age, and continued up to 1 min. The test was considered to be positive with horizontal or obliquely descending ST segment depression greater than or equal to 2 mm. The procedure was used to examine 116 patients: 75 with coronary heart disease and 41 with neurocirculatory dystonia. A high (93 versus 84%) diagnostic sensitivity was displayed by the proposed modified exercise test versus the graded test. Noteworthy, it is possible to substantially reduce the duration of exercise test (1 min versus 5-7 min of the graded test). The accelerated TECP test is safe for patients, easy-to-use and fails to cause any complications.
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PMID:[Accelerated exercise test for the evaluation of transesophageal cardiac pacing]. 180 60


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