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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The efficacy of beta adrenergic blocking agents has been observed in the treatment of a variety of cardiac arrhythmias. Electrophysiological experiments demonstrated that beta receptor blocking drugs prevent catecholamine-induced alterations of the transmembrane action potential. Clinically used beta blocking agents are effective in preventing arrhythmias provoked by sympathetic stimulation such as sinus tachycardia, paroxysmal junctional tachycardia, atrial, nodal, and ventricular premature contractions. Beta receptor blocking drugs are especially useful in tachycardias based on hyperkinetic heart syndrome and in exercise-induced premature beats in patients suffering from coronary heart disease. Beta blocking agents are--at least in our hands--most useful in combination with class I antiarrhythmic drugs with the intention to reduce the dosage--i.e. the side effects--of various antiarrhythmic drugs. In hyperthyroidism beta adrenergic blocking agents are effective complementary to the specific treatment. In cases of intoxication with beta blocking drugs complicated by myocardial depression and severe bradycardia glucagon must be regarded as a very useful compound.
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PMID:[Spectrum of effects of beta receptor blockade in cardiac arrhythmias]. 243 70

Twelve patients with stable angina pectoris due to coronary heart disease received single oral doses of 5, 10, and 20 mg bisoprolol in a placebo-controlled double-blind crossover study. A significant, dose-related increase in exercise tolerance in symptom-limited bicycle exercise tests performed 2.5 h after administration (p less than 0.05) was demonstrated. The dose-effect relationship was especially marked in reduction of heart rate, rate-pressure product, and ischemic ST-segment depression at the highest comparable workload (p less than 0.01). Compared with placebo, mean improvements in work performance (determined by the maximal workload attained, i.e., W X minutes) increased to 105% with 5 mg, to 122% with 10 mg, and to 131% with 20 mg bisoprolol. The lower incidence rate of exercise-induced symptoms of angina pectoris at an identical workload was marked at the 10- and 20-mg dose.
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PMID:Effect of bisoprolol on exercise tolerance in patients with coronary heart disease: placebo-controlled double-blind crossover study. 243 86

This report summarizes the most important results of 11 studies regarding efficacy and safety of bisoprolol in patients with stable angina pectoris due to coronary heart disease. Assessments carried out 2-3 h after the administration of the beta 1-selective adrenoceptor blocking agent bisoprolol revealed that the dose of 10 mg produced maximum effects in terms of improvement of exercise capacity (W X min) and reduction of ST segment depression at peak exercise. Duration of action was maintained over 24 h after administration of 5 and 10 mg bisoprolol. Thus, the data indicate no relevant loss of effect 24 h after single or repeated administration of 5-20 mg/day. Open uncontrolled long-term studies over 1 year demonstrated that bisoprolol in the dose range of 5-20 mg once daily is safe and highly effective. The evaluation was based on the bisoprolol effects on bicycle exercise tests, weekly anginal attack rates, the incidence of untoward side effects, and clinical routine laboratory investigations.
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PMID:Summary of short- and long-term studies with bisoprolol in coronary heart disease (CHD). 243 90

No comprehensive theory of social support and psychological adjustment to chronic illness such as coronary heart disease (CHD) exists. This article reviews the literature on social support and adjustment to CHD from the perspective of Johnson's behavioral system model. It is argued that the quality of social support or nurturing is the major factor predicting cardiac crippled behaviors or dependency following myocardial infarction (MI). The variables of self-esteem, anxiety, depression, and perceptions of functional capacity are identified as variables affecting choices such as return to work and adherence to the treatment regimen and the behavioral outcome of dependency following MI.
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PMID:Social support and psychological adjustment to chronic coronary heart disease: operationalization of Johnson's behavioral system model. 249 71

Fourteen patients with typical exercise-induced angina and ST-segment depression received 0.025 mg nitroglycerin intravenously or placebo directly before exercise testing in a double-blind cross-over study. The sum of ST-segment depressions during stress and recovery was 12.8 +/- 4.8 mm after placebo and 8.9 +/- 4.6 mm after nitroglycerin (p less than 0.001). The symptom-free exercise time increased from 3.1 +/- 1.4 to 4.3 +/- 1.9 min (p less than 0.1), whereas severity of angina during exercise decreased significantly (p less than 0.05) after nitroglycerin. There was no influence on either heart rate or blood pressure. In a second randomized double-blind study, 40 patients with coronary heart disease received either 0.025 mg nitroglycerin or placebo intravenously. Before and 2 min after injection the aortic and left ventricular pressures were recorded and coronary angiography was performed. Mean heart rate, blood pressure, left ventricular filling pressure and pre- and poststenotic coronary artery diameter, as well as the diameters of representative distal coronary artery segments showed no significant changes. Coronary artery stenosis diameters remained unchanged after placebo, but increased significantly after nitroglycerin from 1.15 +/- 0.68 to 1.32 +/- 0.73 mm (p less than 0.01). It can be hypothesized from these results that dilatation of coronary stenosis plays an important role in the antianginal action of nitroglycerin. Coronary artery stenoses seem to be more sensitive to nitroglycerin than are other vessel segments.
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PMID:[Anti-angina and coronary dilating effect of low-dose nitroglycerin]. 251 93

In 15 patients with coronary heart disease (mean data: age 60.4 years, body-weight average 72.5 kg, four females, eleven males, six patients with myocardial infarction) the long-term treatment with verapamil (340 mg/die p.o.) was replaced by gallopamil (123 mg/die). In six patients the additional treatment with long-lasting nitrates was continued. During a period of 1 year symptom-limited exercise tests (bicycle ergometry) were performed repeatedly (baseline, 1, 3, 6, and 12 months later). In comparison to the pretreatment with verapamil the calcium channel blocker gallopamil proved to be equally effective on the overall exercise performance, heart rate, and blood pressure regulation. Parameters of myocardial ischemia (maximal ST-depression, onset of significant ST-depression, duration of ST-changes after cessation of work) are less evident. Minor side effects include prolongation of the PQ-interval (0.24 on the mean in five patients) and arterial hypotension (two patients). One patient underwent coronary artery surgery as the complaints of angina pectoris worsened.
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PMID:[Exercise capacity of coronary heart disease patients in long-term follow-up with gallopamil in comparison with premedication with verapamil]. 251 57

In an open randomized study, hemodynamic and antianginal effects of nifedipine and the new dihydropyridine derivative isradipine were compared in patients with stable, angiographically confirmed coronary heart disease. Right heart hemodynamics, systemic arterial blood pressure, ECG, and drug plasma concentrations were measured before medication at rest and exercise, after infusions of increasing doses at rest, and again after treatment at rest and exercise. A linear relationship between serum concentrations and cumulated dosages was obtained for both drugs. At rest, both drugs significantly increased cardiac output and heart rate. The reduction of arterial blood pressure was significantly greater after isradipine (systolic from 148 +/- 3 to 104 +/- 3 mmHg; diastolic from 90 +/- 4 to 58 +/- 2 mmHg) than after nifedipine (systolic 149 +/- 6 to 125 +/- 4 mmHg; diastolic 92 +/- 4 to 76 +/- 3 mmHg). The minimal effective plasma level of isradipine regarding blood pressure reduction was estimated at 5 ng/ml (nifedipine: 10-25 ng/ml). During exercise both medications significantly reduced mean pulmonary artery pressure (isradipine: 40 +/- 3 to 20 +/- 1 mmHg, nifedipine: 37 +/- 4 to 22 +/- 1 mmHg), pulmonary artery wedge pressure (isradipine: 23 +/- 3 to 10 +/- 1 mmHg, nifedipine 24 +/- 3 to 14 +/- 1 mmHg), and diastolic arterial pressure (isradipine: 103 +/- 3 to 73 +/- 4 mmHg, nifedipine: 99 +/- 3 to 91 +/- 2 mmHg), whereas systolic pressure was reduced by only isradipine (189 +/- 4 to 147 +/- 5 mmHg). Neither medication significantly changed electrocardiographic ST depression during exercise.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Hemodynamic and antianginal effects during rest and exercise of intravenous isradipine, a new dihydropyridine calcium antagonist. 252 75

When 51 patients with proven coronary heart disease and stable angina pectoris underwent exercise testing, 22 experienced painful myocardial ischemia during both leg and arm exercise testing (group L + A), whereas 29 patients had such episodes only during the leg testing (group L). Upright bicycle exercise was performed with the legs first, followed 2 days later by arm testing. Exercise was stopped when typical anginal pain and greater than 1-mm ST horizontal depression occurred during leg testing, and when greater than 1-mm ST horizontal depression was noted during arm testing. Heart rate, systolic blood pressure and rate-pressure product for leg and arm testing, either at the beginning of anginal pain or at the time when 1-mm ST depression was noted, were similar. Two-dimensional echocardiography showed that the L group had higher (p less than 0.01) end-systolic volume at rest and decreased (p less than 0.05) ejection fraction during exercise. Coronary angiography showed that the L group had a greater (p less than 0.001) number of patients with 3-vessel disease, a decreased (p less than 0.001) ejection fraction and less patients with 1-vessel disease. In these patients, absence of anginal pain during arm exercise suggests defective segmental transmission of pain sensation related to severe coronary artery disease. Thus, arm testing, in addition to leg testing, seems to be a simple and useful tool for the detection of severe coronary disease.
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PMID:Painful versus silent myocardial ischemia during leg and arm exercise testing in stable angina pectoris. 254 97

The effects of 5 and 10 mg bisoprolol once daily for 7 days on exercise ECG, myocardial perfusion and left ventricular function in 25 patients with stable coronary heart disease have been assessed in a double-blind, randomized, parallel group trial design. ST-segment depression during exercise was reduced by 56% by 5 mg bisoprolol and by 64% after 10 mg; the difference between the dose levels was significant. Heart rate, systolic and diastolic blood pressure and the rate-pressure product were reduced to similar extent both at rest and during exercise by both doses. Left ventricular thallium-201 scintigrams indicated a significant reduction in myocardial perfusion defects after 10 mg bisoprolol compared to baseline; however, the difference between the two active treatments was not significant. Left atrial and left ventricular diameters obtained by one-dimensional echocardiography, and the calculated shortening fraction, remained unchanged after bisoprolol, and so gave no evidence of a negative inotropic action. It is concluded that 5 mg bisoprolol was effective in once-a-day treatment of angina pectoris due to coronary heart disease, and a further improvement can be expected on increasing the dose to 10 mg.
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PMID:Effect of bisoprolol on cardiac performance in coronary heart disease. 256 61

A new transdermal system (BIO TSD) containing the beta-adrenergic blocker mepindolol was assessed in a placebo controlled clinical trial in 12 patients with coronary heart disease. On therapy, the number of anginal attacks and the consumption of oral nitroglycerin (glyceryl trinitrate) were reduced significantly. During ergometer exercise the exercise tolerance was improved and the ischemic ST-segment depression was reduced significantly. Holter monitoring revealed significant reductions of the number of manifest and silent episodes and the total duration of ischemia. No relevant side effects were observed.
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PMID:[Anti-ischemic action of the transdermally applied beta-receptor blocker, mepindolol in patients with stable angina pectoris]. 257 3


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