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)

This study comprised 165 cases of coronary artery spasm (147 men and 18 women) with an average age of 49,2 years (range 27 to 73 years). Smoking was a particularly significant risk factor. Symptoms were usually of recent onset (80%) and dominated by attacks of angina pectoris either at rest alone or associated with angina of effort. 14% of cases of spasm were observed during acute myocardial infarction. Some cases presented with syncope due to cardiac arrhytmias. The basal electrocardiogramme was normal in 53% of cases. Exercise stress testing may be normal (30/65 cases) or positive (ST depression recorded in 26/65 cases). In 5 cases, ST elevation was observed. Left ventricular function was usually normal: 115 patients (70%) had organic atherosclerotic lesions, with 1, 2 and 3 vessel disease in 40%, 18% and 22% respectively. Spasm was spontaneous in 24,2% of cases but most commonly provoked by ergometrine. Criteria of spasm only applied to focal spasm and exclused catheter--induced spasm. The most common site of spasm was the right coronary artery (50,3% of cases), followed by the left anterior descending (31% of cases) and left circumflex (10,3% of cases). The outcome of these 165 cases depended on the therapeutic options (surgical treatment in 48 cases). The medium term results were generally good with a low mortality rate and follow up showed that the calcium antagonists provided effective prophylaxis against recurrence of spasm.
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PMID:[Coronary artery spasm. Apropos of 165 cases]. 641 13

The effects of the calcium-channel-blocking agent Gallopamil (D 600) were assessed in 20 patients with stable exertional angina pectoris in a randomized placebo-controlled double-blind protocol using serial exercise tests. Both after a single oral dose and during long-term treatment over 3 weeks, Gallopamil caused a dose-dependent increase in exercise duration and a reduction in ischemic ST segment depression that became clinically relevant using single doses of 50 mg. Since the rate-pressure product was not significantly affected by Gallopamil, its anti-anginal action cannot adequately be explained by a reduction in myocardial oxygen consumption as a result of this mechanism. The only side effects observed were asymptomatic second-degree sinoatrial block in one and first-degree atrioventricular block in another patient, each on 150 mg gallopamil daily. It thus seems justifiable to study the effectiveness of higher doses.
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PMID:[Acute and long-term effects of gallopamil (D 600) in stable angina pectoris--a randomized double-blind study]. 642 Oct 2

Nitrates are effective in the management of exertional angina pectoris primarily due to their peripheral effects i.e. venodilation and arterial dilation, and thereby reduction in myocardial oxygen demand. These drugs also improve collateral blood flow in ischemic areas and in some patients may increase coronary blood flow by modifying tonus in the conductive or conduit coronary vessels. Sublingual nitroglycerin is the most effective antianginal agent but its prophylactic use is limited by its short duration of action. Until recently, the efficacy of long-acting oral nitrates was seriously questioned. However, recent data suggests that when given acutely in adequate doses, oral nitrates, transcutaneous and buccal preparations of nitroglycerin all exert prolonged hemodynamic and antianginal effects. Development of tolerance to the circulatory and antianginal effects during chronic therapy, however, remains a concern. Published literature suggests that tolerance to the circulatory effects and to headaches develops rapidly during sustained therapy with long-acting nitrates. However, reports regarding the development of tolerance to the antianginal effects and reduction of ST segment depression remain conflicting. Partial tolerance to the antianginal effects has been well-documented during chronic therapy with isosorbide dinitrate. Duration of improvement in exercise tolerance during four times daily therapy with isosorbide dinitrate has been shown to be shortened compared to prolonged effects following acute therapy. Recent data suggests that given in high doses, beneficial effects of ST segment depression during exercise may also diminish during chronic therapy with long acting nitrates. Tolerance to antianginal and circulatory effects can be reversed by withholding long-acting nitrates for 24 to 36 hours. Furthermore, initial studies suggest that tolerance to antianginal effects during sustained therapy can be avoided by giving smaller but effective doses of ISDN (20 to 40 mg) twice a day rather than prescribing larger doses more frequently.
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PMID:Nitrates for angina pectoris. A critical review of therapeutic efficacy and tolerance. 643 Jul 66

Nisoldipine (Bay K5552), a newly-developed dehydropyridine derivative with calcium antagonistic properties, was found to have a duration of action twice as long as its parent compound, nifedipine, in laboratory experiments. To evaluate the anti-ischemic potency and duration of action, the effects of 10 mg nisoldipine after acute administration and at the end of three weeks of treatment with 10 mg twice daily were compared with those of 120 mg verapamil three times daily in a double-blind, randomized, crossover, placebo-controlled study. In twelve patients with angiographically-documented coronary artery disease and stable exertional angina pectoris, bicycle ergometry was performed before and at three and seven hours after medication on the first and 21st days of the three respective treatment phases. The control value at 8 a.m. on the 21st day corresponded with the ten-hour value on the 20th day of treatment. Between the three treatment phases, there was a one-week wash-out period during which the patients received placebo three times daily. At the time of the ergometric studies, blood was drawn for determination of verapamil plasma concentrations and, additionally, each patient recorded anginal attacks and nitrate consumption. Analysis was carried out for ST-segment depression in each patient at the highest comparable workload achieved in all treatment phases, the time to onset of 1 mm ST-segment depression as well as the response of the heart rate, systolic arterial blood pressure and the heart rate-blood pressure double-product both at rest and during exercise.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Comparison of the anti-ischemia effect of nisoldipine and verapamil. Double-blind randomized cross-over and placebo-controlled acute and long-term study]. 643 87

To determine the incidence and the significance of anginal chest pain during abnormal exercise testing (S-T greater than or equal to 0.1 mV) in patients with recent myocardial infarction we reviewed a series of 353 patients who underwent maximal bicycle exercise stress 4-8 weeks following acute myocardial infarction. Of the 353 patients, 26 had ischemic ECG changes and chest pain (group A); 85 patients had ischemic ECG changes but no chest pain (group B). The two groups differ significantly only in the frequency of a history of typical angina pectoris more than 6 months prior to acute myocardial infarction (group A 42.3% vs. group B 15.2%, p less than 0.01). Typical chest pain is more frequent in anterior versus inferior myocardial infarction (50 vs. 14.4%, p less than 0.001). The patients were followed up for 28.8 +/- 8.7 months with clinical and exercise testing controls. The incidence of exertional angina during the follow-up was significantly more frequent in group A patients than in group B patients (80.7 vs. 24.7%, p less than 0.001). Unstable angina pectoris was more frequent in group A (34.6 vs. 11.8%, p less than 0.01). There was no statistically significant difference in mortality (group A 3.8% vs. group B 5.9%) and cardiac events (group A 3.8% vs. group B 5.9%) between the two groups. Thus, we concluded that the occurrence of anginal pain associated with S-T segment depression during exercise testing does not increase the prognostic risk.
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PMID:Incidence and prognostic significance of symptomatic and asymptomatic exercise-induced ischemia in patients with recent myocardial infarction. 648 28

Coronary bypass surgery is a palliative procedure and medical management after surgery is best provided by the private physician in cooperation with the surgical center. Whereas digitalis is rarely indicated in patients after bypass surgery, several prospective and randomized studies have shown that the early use of anticoagulants or platelet inhibiting agents improves graft patency after surgery. This medication should be given for about one year. Complex ventricular arrhythmias (Lown III-V) are 2-3 times as frequent 6-8 weeks after aortocoronary bypass surgery as before the operation. However, they are of less prognostic importance than similar arrhythmias occurring one year after surgery. Exercise-induced angina with ST segment depression occurs in 3% of patients per year with complete revascularization, as compared to 6-10% of patients/year with less than complete revascularization. Repeat angiography after surgery is performed if limiting angina recurs. In some instances coronary angioplasty may reestablish successful bypass surgery. Mortality and morbidity of reoperation are slightly higher and the success rate is slightly lower than with a first operation. Postoperative complications, such as post-pericardiotomy syndrome, left ventricular dysfunction and hepatitis, are briefly discussed.
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PMID:[Postoperative care of coronary surgery patients]. 661 Sep 38

To examine the antianginal effects of felodipine, a new calcium antagonist, 8 patients with coronary artery disease and exertional angina pectoris were studied. Hemodynamic measurements were made at rest, during submaximal exercise and during angina-limited exercise before and 30 minutes after oral administration of 0.1 mg/kg of felodipine. Angina pectoris was always prevented after the drug was given and the exercise intensity was increased until recurrence of angina (5 patients) or exhaustion (3 patients). Hemodynamic data were also recorded at this higher exercise capacity. At rest and during submaximal exercise, felodipine increased heart rate and decreased arterial blood pressure and systemic vascular resistance. The prevention of angina pectoris was accompanied by lower mean pulmonary capillary wedge pressure, systemic vascular resistance and ST-segment depression; the pressure-rate product was unchanged. The 20% greater exercise capacity after felodipine was attended by a 20% increase in maximal cardiac output, a 17% increase in maximal heart rate and a 13% increase in maximal pressure-rate product; the maximal arterial blood pressure and ST-segment abnormalities were unchanged and the systemic vascular resistance was lower. The relation between ST-segment depression and the pressure-rate product during exercise was favorably influenced by felodipine. Thus, felodipine is an active antianginal drug; its major mechanism of action is to lower the systemic vascular resistance. The data also suggest that it improves coronary blood flow during exercise.
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PMID:Hemodynamic effects of felodipine at rest and during exercise in exertional angina pectoris. 661 67

To investigate the mechanism by which nifedipine improves exercise tolerance in patients with coronary artery disease, we studied 14 patients with stable exertional angina and left anterior descending artery disease by measuring great cardiac vein flow (GCVF) and calculating anterior regional coronary resistance (ARCR) during exercise before and after sublingual administration of 20 mg of nifedipine. After nifedipine seven patients (group I) had no increase in exercise capacity and showed a similar magnitude of ST segment depression at peak exercise, while another seven patients (group II) had prolonged exercise duration (p less than .001) with less ST segment depression at peak exercise (p less than .01). Such effects were achieved despite a significant increase in double product, an indirect index of myocardial oxygen consumption. In group I patients no significant change was induced by nifedipine in GCVF or in ARCR either at rest or at peak exercise. In contrast, in group II patients nifedipine significantly increased GCVF at rest (p less than .05) and at peak exercise (p less than .001). Moreover, resting ARCR was decreased (p less than .01) and remained significantly lower at peak exercise (p less than .01) compared with the prenifedipine values. These data show that nifedipine may increase GCVF and decrease ARCR at rest and at peak exercise in patients with left anterior descending artery disease. Such increase in myocardial oxygen supply seems the most likely mechanism by which nifedipine may improve exercise capacity in patients with stable exertional angina.
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PMID:Effects of nifedipine on coronary hemodynamic findings during exercise in patients with stable exertional angina. 661 87

Infusions of DL-carnitine are reported to improve the tolerance to atrial pacing of patients with angina pectoris. In the present study, six patients with angina of effort and triple vessel disease received two placebo and two carnitine infusions administered in a double-blind randomized fashion. Carnitine did not affect either the double product (heart rate X systolic blood pressure) at maximal pacing (ST depression: 2.3 +/- 0.2 mm, +/- SEM) or the tolerated pacing time. Intravenous carnitine, in the dose given, is of no therapeutic benefit in myocardial ischemia precipitated by tachycardia. It could be effective when free fatty acids are elevated as during catecholamine stimulation.
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PMID:Intravenous dl-carnitine fails to increase the double-product during atrial pacing in patients with effort angina. A double-blind randomized study. 666 14

Molsidomine (M), a new anti-angina drug, was studied by stress tests in 50 cases of stable angina and clinically in 33 patients not controlled by beta-blockers. One hour after sublingual administration of 2 mg of M. to 10 patients, the work required to cause ST depression of 1 mm (WST1) was increased by 94 per cent (p less than 0.005), the total work was increased by 52 per cent (p less than 0.005) and the maximal ST depression (ST max) was reduced by 45 per cent (p less than 0.01). The resting heart rate was unchanged and the blood pressure dropped mildly. In 4 of the 10 patients with exertional angina even while taking beta-blockers, the synergistic effect of M was remarkable. With a sublingual dose of 1 mg, the WST1 and the ST max are very significantly improved. The effect is even more marked at a dose of 2 mg. With a sublingual or oral of 2 mg, WST1 and ST max are very significantly improved at 1 hour and at 3 hours (p less than 0.005). Data from the literature show a significant anti-ischaemic effect until the 6th hour. In two series of 10 patients, 2 mg of M administered orally were compared to 20 mg of isosorbide dinitrate and to 10 mg of nifedipine at the 2nd hour. The WST1 and ST max were very significantly improved by all three drugs to a similar degree.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Molsidomine in exertion angina]. 668 96


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