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)

The exercise response to a single oral dose (25 mg) of a new beta-blocking agent that also has potent vasodilating properties, carvedilol, was assessed in 15 patients with stable exertional angina, positive exercise tests (greater than or equal to 1 mm ST depression) and coronary artery disease. A placebo-controlled, randomized, crossover study was carried out. Compared with placebo, carvedilol significantly reduced both resting heart rate (HR) and blood pressure (BP) at rest. After the administration of carvedilol, 10 of the 15 patients did not have angina at peak exercise and 5 had ST shifts less than 1 mm. Total exercise time and time to 1 mm ST depression were prolonged, and ST segment depression at peak exercise was significantly reduced. Systolic BP was reduced both at peak exercise and at 1 mm ST depression whereas mean HR at peak exercise did not change significantly compared with placebo. Overall, mean HR-BP product at peak exercise was significantly reduced by carvedilol compared with placebo. However, four patients achieved similar or higher HR-BP product and yet did not experience angina and had less ST depression (or no ST segment shifts) during exercise. This indicates an increase in their coronary flow reserve. These results suggest that carvedilol is effective therapy for effort-induced angina, and this may be related to its combined beta-blocking and vasodilatory properties.
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PMID:Efficacy of carvedilol in exercise-induced myocardial ischemia. 245 60

The efficacy of nitroglycerin ointment was determined by treadmill exercise testing through a randomized, double-blind crossover trial with placebo in 22 patients with chronic stable exertional angina. On different days, 3 cm of nitroglycerin ointment (NGO, 18 mg) and placebo ointment were applied over the epigastric region, followed by the exercise test 1 hour later. The maximal exercise time was 459 +/- 124 seconds after application of placebo and 510 +/- 113 seconds after application of NGO, and the exercise time to 1 mm of ST-segment depression was significantly extended to 297 +/- 110 seconds after placebo and 366 +/- 134 seconds after NGO (p less than 0.01, p less than 0.001, respectively). ST-segment depression at the endpoint of exercise was significantly reduced from 2.4 +/- 1.2 mm to 1.5 +/- 0.7 mm after application of NGO (p less than 0.01). There was no difference in rate-pressure product at the endpoint of exercise between placebo and NGO. Adverse reactions were elicited in 5 of 22 patients. The results of this present study suggest that NGO is effective in the treatment of exertional angina.
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PMID:The effect of nitroglycerin ointment on exercise-induced angina: a multicenter trial. 251 79

The prognostic value of early exercise testing after successful coronary angioplasty was determined in 196 and 225 consecutive patients with single-vessel and multivessel coronary disease, respectively, who underwent a symptom-limited exercise test within 30 days of the procedure. The incidence of exercise-induced ST segment depression greater than or equal to 1 mm was significantly greater in patients with multivessel versus single-vessel disease (27% versus 14%; p less than 0.005) and in patients with multivessel coronary disease who had incomplete versus complete revascularization (36% versus 10%; p less than 0.001). An abnormal exercise ECG result was associated with a significantly increased risk of cardiac events in patients with multivessel disease but not in patients with single-vessel disease. Exercise-induced angina occurred in a small and similar proportion of patients with single and multivessel coronary disease (8% versus 12%). The presence of exercise-induced angina was associated with a higher incidence of follow-up cardiac events in patients with multivessel disease and incomplete revascularization (52% versus 33%; p less than 0.05). Exercise duration was significantly less in patients with multivessel disease who had a subsequent cardiac event compared with that in patients who did not have such an event (458 +/- 168 versus 519 +/- 156 seconds; p = 0.01). Thus an abnormal exercise ECG finding within 1 month of successful coronary angioplasty is predictive of subsequent cardiac events in patients who have multivessel disease. The prognostic content of the test might be further improved if the test were performed several months after the procedure when the risk of restenosis is greatest.
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PMID:Prognostic value of early exercise stress testing after successful coronary angioplasty: importance of the degree of revascularization. 252 72

We surveyed the clinical characteristics, treatment, and prognosis of 162 patients with unstable angina, who were admitted to our center between 1985 and 1987. There were 112 males and 50 females, with a mean age of 65 years. The clinical characteristics according to the American Heart Association classification were new angina of effort in 21%, changing pattern in 61%, and new angina at rest in 18% of the patients. ECG recordings during attacks of angina were obtained in 70%, and ST elevation was detected in 11%, ST depression in 54%, and T wave abnormality in 5%. Coronary arteriography performed in 42% of the patients revealed single vessel lesion in 21%, two vessel lesion in 10%, three vessel lesion in 5%, and left main trunk lesion in 3% of the patients. Seventy-seven percent of the patients were controlled by medical therapy, including nitrates, calcium antagonists, and, in some cases, beta blockades. Three percent of the patients were controlled with intra aortic balloon pumping in addition to medical therapy. Coronary artery bypass graft surgery (CABG) was performed in 6% of the patients. Since 1987, percutaneous transluminal angioplasty (PTCA) was introduced in our center and PTCA was performed in 9 patients (6%). Restenosis of the dilated portions of the coronary artery was observed and PTCA was again performed in 2 of 9 patients (22%). All patients who received CABG or PTCA survived and have been free from angina or myocardial infarction. Non-fatal myocardial infarction occurred in 10 cases (5.6%) and fatal infarction occurred in one patient (0.6%).
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PMID:[Clinical characteristics of unstable angina in 162 consecutive cases]. 259 19

The purpose of this study is to clarify the causative mechanism as well as the clinical significance of myocardial ischemic attacks in patients suffering from angina pectoris. The subjects were 127 patients upon whom 24-hour Holter electrocardiographic monitoring was performed. The patients were classified into the four types of angina pectoris: exertional angina (56 cases, EA), exertional and rest angina (28 cases, ERA), and rest angina (4 cases, RA), all of which show ST-segment depression during ischemic attacks; and variant angina (39 cases, VA) which shows ST-segment elevation. The Holter electrocardiographic findings were classified into the four above-mentioned types and were analyzed. The frequency of symptomatic ischemic attacks in descending order was EA, ERA, RA and VA, while the frequency of asymptomatic ischemic attacks was in the reverse order. EA was significantly higher than the other three types of angina. In the daytime, however, the frequency of ischemic attacks in descending order was EA, ERA, RA and symptomatic and asymptomatic ischemic attacks was in the same order. The peak occurrence of hourly ischemic attacks was at 10:00 am and 1:00 pm in the case of EA, 7:00 am in the case of ERA, 2:00 am in the case of RA and 5:00 am in the case of VA. The magnitude and duration of ischemic attacks and maximal heart rates during attacks were greater in symptomatic ischemic attacks than in asymptomatic ischemic attacks in each type of angina pectoris. The maximal heart rates during symptomatic ischemic attacks were in descending order, EA, ERA, RA and VA. On the other hand, the maximal heart rates during attacks recorded on a Holter electrocardiograph were lower than those during induced attacks on treadmill exercise testing, and the difference in rates was significant in both EA and VA. In patients with angina pectoris showing ST-segment depression during attacks, no relation was observed between the magnitude and duration of ST-segment depression and the severity of coronary artery lesions. In conclusion, it may be stated that the situation and the mechanism of the occurrence of the myocardial ischemic attacks varied based on the types of angina pectoris. Moreover, it was clarified that the mechanism of ischemic attacks was different between spontaneous and exercise induced attacks as the threshold of the occurrence of the former group was lower than that of the latter group. Therefore, it was concluded that the circadian alternation of the increased coronary vascular tonus is one of main causes of the spontaneous ischemic attacks.
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PMID:[A study on the clinical significance of myocardial ischemic attack and its causative mechanism in angina pectoris. An assessment using Holter's electrocardiogram]. 273 5

The effects of gallopamil, a calcium channel blocker methoxy derivative of verapamil, recently introduced into clinical use in Germany, were evaluated in 20 patients with stable exertional angina. Two different dosages of the drug were used: 25 mg tid and 50 mg tid. It was observed that both dosages improved exercise tolerance (355 +/- 95 sec after placebo; 462 +/- 78 sec, p less than 0.01 and 511 +/- 97 sec, p less than 0.01 after the two doses) while the time taken to produce ischemia (-1 mm ST depression) was significantly prolonged only by the higher dose of the drug (204 +/- 101 sec after placebo; 324 +/- 135 sec after gallopamil 150 mg, p less than 0.05). Both dosages of gallopamil caused a significant reduction in the double product in the first phases of the exercise (double product 3 degrees min of exercise x 10(2): 173 +/- 140 after placebo; 153 +/- 34, p less than 0.05 and 145 +/- 30, p less than 0.05 after the two doses), while they did not affect this parameter at the end of the exercise. Our data seem to confirm that gallopamil works through a lowered myocardial metabolic demand as a consequence of the reduction of the afterload. Both dosages of the drug decreased the number of episodes of angina, but the higher dose was more effective. The drug is safe and well tolerated. All patients completed the study. Furthermore, no particular haemodynamic problems were observed.
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PMID:[Gallopamil in stable effort angina. Effects of 2 different dosages]. 274 13

The exercise response to a single oral dose (25 mg) of a new beta-blocking agent that also has potent vasodilating properties, carvedilol (BM 14,190), was assessed in 15 patients with stable exertional angina, positive exercise test responses (greater than or equal to 1 mm of ST depression) and coronary artery disease. A single-blind, placebo-controlled, randomized, crossover design was used. Compared with placebo, 25 mg of carvedilol significantly reduced both heart rate (HR) and blood pressure (BP) at rest (p less than 0.01). After administration of carvedilol, 10 of 15 patients did not have angina at peak exercise (p less than 0.01) and 5 had ST shifts of less than 1 mm (p less than 0.05). Total exercise time and time to 1 mm of ST depression were prolonged and ST-segment depression at peak exercise was significantly reduced (p less than 0.01). Systolic BP was reduced both at peak exercise and at 1 mm of ST depression (p less than 0.05), whereas mean HR at peak exercise did not change significantly compared with placebo. Overall, mean HR-BP product at peak exercise was significantly reduced by carvedilol compared with placebo (p less than 0.05). However, 4 patients actually achieved a higher HR-BP product but did not have angina and had less ST depression (or no ST-segment shifts) at peak exercise. This indicates an increase in their coronary flow reserve. These results suggest that carvedilol is effective therapy for effort-induced angina, and this may be related to its combined beta-blocking and potent vasodilatory properties.
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PMID:Efficacy of carvedilol (BM 14,190), a new beta-blocking drug with vasodilating properties, in exercise-induced ischemia. 286 38

The prognostic value of abnormalities resulting from predischarge submaximal treadmill exercise testing was evaluated in 222 patients after myocardial infarction. The presence of the following variables--ST segment depression and elevation, an abnormal blood pressure response, limited exercise duration, angina pectoris, ventricular arrhythmias--were predictive of subsequent cardiac events (P less than 0.001) among the 154 patients with one or more of these abnormalities. When the presence or absence of specific variables was assessed, only an abnormal blood pressure response, limited exercise duration (P less than 0.001), and ST segment elevation and shift (P less than 0.05), were significantly associated with cardiac death. Exercise-induced angina was predictive only of the development of subsequent angina (P less than 0.05), and ST depression was associated only with future coronary surgery (P less than 0.01). Ventricular arrhythmias had no independent prognostic value. Markers of left ventricular dysfunction elicited by submaximal exercise testing are therefore valuable in identifying patients at high risk of death after infarction. Hallmarks of residual reversible myocardial ischaemia are of limited prognostic importance. The test result may be useful in selecting patients for coronary angiography.
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PMID:Submaximal predischarge exercise testing after myocardial infarction: prognostic value and limitations. 286 49

The antianginal efficacy of slow-release metoprolol (SRM) alone and associated to a transdermal therapeutic system containing nitroglycerin (TTS-TNG), was investigated in 10 patients with chronic, stable exertional angina and angiographic evidence of obstructive coronary artery disease, by means of a double blind, cross-over trial. Each patient performed a symptom-limited exercise test 4 and 24 hours after single blind placebo on day 1, and double blind SRM (200 mg) alone or SRM plus TTS-TNG, on days 3 and 5, in a randomized sequence. The protocol of Redwood was employed. Compared to the beta-blocker alone, the combined administration of SRM and TTS-TNG was associated to a significant increase in mean exercise duration 4 hours (528 +/- 180 vs 412 +/- 110 sec.; p less than 0.001) and 24 hours (432 +/- 115 vs 391 +/- 100 sec.; p less than 0.05) after drug administration. A significant increase in mean total work performance 4 hours (4626 +/- 1070 vs 3272 +/- 803 kgm; p less than 0.01) and 24 hours (3445 +/- 1045 vs 2941 +/- 773 kgm; p less than 0.01) after drug administration was observed as well. During placebo all the tests were stopped due to angina associated with ST depression greater than or equal to 1 mm. Conversely, the test was terminated due to fatigue by 8 patients at 4 hours and 5 patients at 24 hours after combined therapy, and respectively by 5 and 1 patient after SRM alone. No side effects were observed after the administration of SRM alone, whereas 5 patients complained of mild headache after SRM and TTS-TNG.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[TTS-nitroglycerin and slow-release metoprolol: efficacy in patients with stable exercise-induced angina]. 286 88

A double-blind, placebo-controlled study was performed to assess whether a new calcium antagonist, nisoldipine, in doses of either 5 mg or 10 mg daily, in combination with beta-adrenergic-blocking drugs (combination therapy) was more effective than beta-adrenergic-blocking drugs alone (single therapy) in the treatment of chronic stable angina. Treatments were assessed at two-week intervals, using exercise electrocardiography and patients' anginal diaries. A significant improvement in exercise capacity and reduction in anginal attacks occurred only during nisoldipine (10 mg daily) combination therapy compared with single therapy. Mean exercise time increased from 419 +/- 146 s (single) to 454 +/- 158 s (p less than 0.02) after combination therapy. Exercise time to onset of 1 mm ST-segment depression improved from 326 +/- 145 s (single) to 331 +/- 139 s after combination therapy, although the change was not significant. Mean number of anginal attacks decreased from 21 +/- 22 (single to 15 +/- 19 (p less than 0.01) during combination treatment, with an associated significant reduction in glyceryl trinitrate consumption. Adverse effects during combined therapy were minor and tolerable. Thus patients limited by exertional angina despite beta-adrenergic-blocking drugs may obtain supplemental relief of angina and myocardial ischemia with the addition of nisoldipine in a dose of 10 mg daily.
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PMID:Efficacy of nisoldipine combined with beta-adrenergic-blocking drugs in the treatment of chronic stable angina. 288 17


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