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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The antianginal effect of perhexiline was evaluated in a placebo-controlled double-blind study of 20 patients with stable angina pectoris. Only patients with documented myocardial infarction of more than 6 months' standing and with ST-segment depression on exercise were admitted to the study. Objective parameters of bicycle stress tests at a submaximum level of 50 watts and a maximum exercise level were evaluated. Subjective data such as nitroglycerin consumption and incidence of anginal attacks per week were obtained from the patients' self-maintained records. No negative chronotropic effect of perhexiline was found at rest. At a submaximum exercise level with unchanged double-product, a significantly lower heart rate (p less than 0.05) and a significant reduction in ST-segment depression were observed in comparison with the placebo. At maximum exercise level an increase in exercise tolerance of 8.1% and in aerobic capacity of 8.3% resulted in a significant increase in the double-product (p less than 0.01), with a shift in the blood pressure/heart rate ratio. Discontinuation of exercise occurred at the same heart rate, but at a markedly higher level of exercise attainment. Heart rate on exercise proved to be the most valuable parameter in this study for the evaluation of the aerobic capacity of the individual patient. Nitroglycerin consumption and frequency of anginal attacks per week were reduced, but were not of statistical significance. Side-effects occurred in 6 patients, but these did not require termination or reduction of medication. The selective effect on heart rate during exercise opens a new field of application for perhexiline in comparison with beta-blocking agents.
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PMID:[Clinical efficacy of perhexiline maleate in stable angina pectoris (author's transl)]. 69 49

3 patients with different clinical and electrocardiographic manifestations of coronary artery spasm are discussed. All 3 patients had anginal attacks at rest. In addition, 2 of these patients, who did not have significant preexisting narrowing of their coronary arteries, also had anginal pain related to exercise. During pain, 1 patient showed ST-segment elevation, the other ST-segment depression, while the third showed ST-segment depression shortly followed by ST-elevation on the electrocardiogram. At coronary angiography, spontaneous or induced spasm of one of the major coronary arteries could be demonstrated in all 3 patients. In 2 cases, sublingual nitroglycerin failed to completely relieve the spasm. This raises the question whether a residual stenosis after NTG conclusively proves a fixed organic narrowing. It is concluded that the clinical spectrum of spasm of the coronary arteries is wider than was originally reported by Prinzmetal and coworkers. Clinical and electrocardiographic manifestations are probably dependent on the site and severity of the spasm, which may cause different degrees of myocardial ischemia.
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PMID:Variant forms of angina pectoris. 71 Apr 90

The response to electrocardiographically monitored submaximal exercise stress testing has been studied in 44 patients with mitral leaflet prolapse (MLP). With exercise, ventricular premature contractions occurred in 7, ventricular tachycardia in 1, and atrial fibrillation in 1. Exercise was terminated short of target heart rate in 18 patients, because of chest pain (5), fatigue (7), ventricular arrhythmia (4), dizziness (1) or ST segment depression (1). 23 patients developed postexercise ST segment abnormalities, of whom 5 had 'ischemic' patterns and arteriographically proven coronary artery disease (CAD); among the 18 others, the ST segments were depressed and minimally downsloping in 2, slowly ascending from depressed J point in 3, horizontal for greater than or equal to 80 msec with J depression of less than 1 mm in 12, and cupped in 1. The incidence of arrhythmias provoked by submaximal exercise stress testing in patients with MLP was lower than suggested in previous reports. In all 5 cases where MLP and CAD coexisted, the classical 'ischemic' electrocardiographic response to exercise was not obscured. Even in the absence of CAD, postexercise ST segment abnormalities were common with MLP (18/39 = 46%) and differed from the progressively resolving ST segment deviation characteristic of CAD with angina. Exercise testing can safely be recommended, subject to standard contraindications, in patients with MLP and yields useful information.
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PMID:The electrocardiographic response to exercise in 44 patients with leaflet prolapse. 71 Apr 93

One hundred patients with angina pectoris underwent 16-point electrocardiographic (ECG) mapping of the left hemithorax during a standardised exercise test. Forty-five patients had maximum ST-segment depression at position V5, while 35 had no ECG signs of ischaemia at this position. In 20 V5 was on the edge of the precordial area, which showed less severe ST-depression than the central positions. An Oxford ECG recorder and highspeed analyser were modified and used in 50 of the patients with daily angina for recording ST-segment changes over 24 hours. Serial 24-hour ambulatory recordings from the edge of the precordial area of ischaemia identified during exercise detected a mean of only 14 +/- SD 3% of the episodes of ST-segment changes recorded from the centre of the same area. Only 16 +/- 2% of the episodes detected by ECG were accompanied by chest pain. More episodes occurred between 4 am and 6 am than at any other time during the night. This study shows the importance of recording ECG evidence of ischaemia from the precordial position showing maximum changes during exercise. ECG evidence of ischaemia occurs more frequently than anginal pain. These objective measurements add important information to the frequency of chest pain reported by patients with ischaemic heart disease.
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PMID:Myocardial ischaemia in patients with frequent angina pectoris. 72 37

A technique for praecordial surface mapping of the exercise electrocardiogram is described. This showed the area, time course, and severity of ST segment depression as projected onto the front of the chest after exercise. Twenty normal volunteers and 20 patients with coronary artery disease have been studied. No changes were seen after exercise in the normal subjects but areas of ST segment depression appeared in all 20 patients with angina pectoris. In 5 of the 20 patients with coronary artery disease, the exercise test was repeated on a later date. There were no significant differences in the area of severity of electrocardiographic abnormalities recorded during the two tests. This technique may prove to be useful for diagnosis and assessing medical and surgical treatments in patients with ischaemic heart disease.
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PMID:A method for praecordial surface mapping of the exercise electrocardiogram. 73 91

The reproducibility of serial upright exercises in patients with ischaemic heart disease was tested. Five short term exercises (4--8 min) with continuous load increase and with 30 min rest intervals between tests were used. No tendency to change was found concerning work time to appearance of angina (APT), maximal working time (MWT) or time for disappearance of angina after exercise (DPT). The coefficient of variation was low for APT and MWT but considerably higher for DPT, being 9, 5 and 27%, respectively. MWT was considered as the end-point of choice. The ST depression at MWT showed no tendency to change and the variation was moderate (14%), while at APT and DPT the variation was high (52%), but, likewise, with no tendency to change. The maximal heart rate increased slightly and significantly (P less than 0.001), while the maximal blood pressure was constant throughout tests, thus the maximal rate pressure product tended to increase. This indicates a slight improvement of the myocardial performance at serial exercises, which, however, does not affect the reproducibility of the anginal reaction.
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PMID:Reproducibility of work performance at serial exercises in patients with angina pectoris. 74 Dec 3

Variant angina pectoris, usually not precipitated by exertion or emotional stress, often is more severe and lasts longer than classic angina. The pain tends to recur at about the same time each day. Arrhythmias, usually ventricular, occur in about 50% of cases during the peak of pain. Electrocardiograms show a characteristic ST segment elevation during pain, which is in contrast to the ST segment depression of classic angina pectoris. Pain may be due, at least in some cases, to a temporary increase in tonus of a single, large, narrowed coronary artery. Chemical changes in the myocardium and plasma catecholamine changes differ from those occurring in classic angina pectoris. The course of the disease is highly variable but the prognosis must be regarded as grave, since single large vessel disease, present in most cases, is associated with severe myocardial ischemia. Patients with variant angina pectoris should be studied early with coronary arteriography and considered for coronary artery bypass surgery if appropriate.
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PMID:The variant form of angina pectoris. 76 70

Propranolol and practolol were tested in patients with repeated daily occurrence of spontaneous angina. Twenty-one showed ST segment depression (type I) and 15 ST segment elevation (type II) during angina. The efficacy of the treatment was evaluated in subjective (number of reported episodes of pain) and objective terms (number of episodes of electrocardiographic abnormalities documented during periods of continuous recording): practolol was fully effective in 42 per cent and propranolol in 38 per cent of type I cases; in type II angina 73 per cent of the cases fully responded to propranolol, none of the patients in this group given practolol improved. The study also showed that: (a) the effects on angina are strictly dose-dependent, and optimal results are achieved at individualized doses; (b) within the same subject the response may be preferential to one beta-blocker as opposed to the other; (c) propranolol is more effective in type II angina; (d) the occurrence of heart failure is uncommon even with high doses of beta blockers;(e) the relief of angina is due to prevention of ischaemia and not to a placebo or anaesthetic effect; (f) the prevention of ischaemia is not adequately explained by reduction of the mechanical effort and the oxygen need of the myocardium; (g) the antianginal effect is possibly dissociated from the beta blockade of the heart. The hypothesis that beta-blocking agents influence the conronary vasomotion is discussed.
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PMID:Treatment of spontaneous angina pectoris with beta blocking agents. A clinical, electrocardiographic, and haemodynamic appraisal. 77 91

We evaluated the effect of ethanol on exercise performance until angina in 12 patients in a double-blind, randomized study. The mean resting heart rate times systolic blood pressure was not changed after Fresca but was increased after 2 ounces of ethanol (P less than 0.001) and after 5 ounces of ethanol (P less than 0.01). Compared to the control periods, the mean exercise time until angina was not different after Fresca but was decreased after 2 ounces of ethanol (P less than 0.001) and after 5 ounces of ethanol (P less than 0.001). Compared to the control periods, the mean maximal ischemic ST-segment depression after angina was not changed after Fresca but was increased after 2 ounces of ethanol (P less than 0.01) and after 5 ounces of ethanol (P less than 0.001). Drinking 5 ounces or 2 ounces of ethanol decreases exercise duration until angina and increases ischemic ST-segment depression after angina.
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PMID:Effect of ethanol on angina pectoris. 77 61

A double-blind cross-over study was performed on 12 men sith stable angina pectoris in order to determine the effect of antilipolytic treatment on exercise tolerance and exercise-induced electrocardiographic changes. The men were exercised to the onset of anginal pain using a reproducible and standardized ergometric load. A nicotinic acid analogue was used to reduce plasma free fatty acids and free glycerol before and during exercise testing and to eliminate their post-exercise rise. This was associated with significant reduction of exercise-induced ST segment depression (p less than 0-005), though there was no significant difference in the duration of exercise before the oneset of pain. A change in the prportions of lipid and carbohydrate for oxidation by the ischaemic myocardium, making relatively more glucose available, is a likely explanation.
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PMID:Antilipolytic therapy in angina pectoris. Reduction of exercise-induced ST segment depression. 79 43


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