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Thirteen patients with advanced hypertensive disease insufficiently controlled by conventional drugs were treated with minoxidil in combination with a beta-blocking agent and a thiazide in a long-term study. A reduction from 214 +/- 5/122+/3 to 166 +/- 7/95 +/- 3 mm Hg in the mean supine blood pressure was obtained. The dosage range of minoxidil was 7.5-35 mg per day (mean 18.8 mg), and in all cases beta-blockade was necessitated by the occurrence of reflex tachycardia. Only two of the patients were found to be unsatisfactorily controlled on combined therapy. In five cases, minoxidil was disontinued during the observation period, but only in three cases was the discontinuation due to side effects, v.z. sodium retention and augmented hair growth. Stable diabetes developed in one patient, and in two cases of established, dietetically treated diabetes oral antidiabetic drugs had to be administered. Five non-diabetic patients showed no significant changes in fasting plasma glucose and the K values in intravenous glucose-tolerance tests. Minoxidil seems to be a safe and potent antihypertensive drug for long-term use in severe arterial hypertension, but it cannot be recommended for routine treatment.
Acta Cardiol 1977
PMID:Long-term experiences with minoxidil in combination treatment of severe arterial hypertension. 30 92

Twenty-eight patients with subendocardial infarction (Group A) were compared with 28 patients with unstable angina (Group B) and 28 with stable angina (Group C) matched for age and sex. The three groups did not differ in prevalence of diabetes, hypertension, old infarction or duration of disease. There were no significant differences in number of diseased vessels, coronary score, abnormal left ventricular wall motion or left ventricular end-diastolic pressure. Angiograms performed 2 weeks postoperatively revealed closure of 3 of 31 grafts (16 patients) in Group A, closure of 3 of 34 grafts (17 patients) in Group B and closure of 6 of 50 grafts (22 patients) in Group C (differences not significant). Postoperative angiograms showed improved wall motion in 37 percent of Group A, 53 percent of Group B and 36 percent of Group C (differences not significant). Postoperative new Q waves appeared in one hospital in Group A and in two patients in Groups B and C. There were no hospital or late deaths. In a mean follow-up period of 29 months, 68 percent of patients in Group A, 61 percent in Group B and 54 percent in Group C were asymptomatic. Thus, bypass grafting was performed with similarly low mortality and morbidity in patients with subendocardial infarction and in those with angina; more than one third of postoperative angiograms in the three groups showed improved wall motion; and late follow-up studies demonstrated functional improvement in the majority of patients in all three groups.
Am J Cardiol 1978 Aug
PMID:Results of aortocoronary bypass grafting in patients with subendocardial infarction: late follow-up. 30 5

To evaluate the efficacy of coronary bypass surgery in reduction of sudden death, the prognosis of 286 similar patients with multivessel coronary stenosis was studied prospectively and the results of medical therapy (Group I, 114 patients) were compared with those of surgical therapy (Group II, 172 patients) after cardiac catheterization and coronary arteriography. During 39 months' evaluation of both groups, mortality from congestive heart failure and noncardiac causes did not differ (Group I, 14 percent; Group II, 8 percent) (P greater than 0.05). Sudden was evaluated in the remaining 217 patients (Group I, 96; Group II, 121 patients) who were matched for age (Group I, 52 years; Group II, 51 years); duration of overt coronary disease (Group I, 3.8 years; Group II, 4.0 years); angina pectoris (Group I, 83 percent; Group II, 95 percent); prior myocardial infarction (Group I, 77 percent; Group II, 74 percent); and congestive heart failure (Group I, 30 percent; Group II, 23 percent) (all P greater than 0.05). In addition, the prevalence of coronary risk factors was the same (P greater than 0.05) in both groups (hypertension, cigarette smoking, diabetes mellitus, lipid abnormalities and family history of coronary disease). Importantly, arteriography and catheterization established a similar extent and location of major coronary arterial stenoses and of ventricular dysfunction; two vessel disease (Group I, 32 percent; Group II, 33 percent) and three vessel disease (Group I, 68 percent; Group II, 67 percent); left ventricular end-diastolic pressure (Group I, 13; Group II, 14 mm Hg);cardiac index (Group I, 2.85; Group II, 2.91 liters/min per m2); and coronary collateral vessels (Group I, 58 percent; Group II, 61 percent) (all P greater than 0.05). Fifty-six percent of patients in Group II had multiple bypass grafts and a late patency rate (average 21 months) of 87 percent of one or more grafts. During subsequent prospective evaluation of over 3 years, bypass surgery provided greater symptomatic benefit of improved functional capacity (Group I, 12 percent; Group II, 69 percent) (P less than 0.05) and complete anginal relief (Group I, 30 percent; Group II, 60 percent) (P less than 0.05). Moreover, bypass surgery was associated with marked reduction in sudden death (Group I, 24 percent; Group II, 6 percent) (P less than 0.05). Thus, in patients with multivessel coronary disease carefully matched for clinical factors, hemodynamics, atherogenic precursors and coronary pathoanatomy, effective aortocoronary bypass surgery appeared to prolong survival by decreasing the incidence of sudden death, possibly by a decrease of unexpected fatal arrhythmias.
Am J Cardiol 1977 May 26
PMID:Improved longevity due to reduction of sudden death by aortocoronary bypass in coronary atherosclerosis. 32 59

160 consecutive CCU-treated AMI patients below 66 yr were investigated for ventricular ectopic beats (VEB) by 6-h telemetry prior to discharge and after 1 yr. During the follow-up year 11 patients died suddenly and 20 suffered reinfarction. By stepwise discriminant analysis three independent prognostic parameters were found: (1) radiologic cardiomegaly; (2) severe VEBs prior to discharge; (3) diabetes mellitus. Previous infarct, angina, functional class II to IV, smoking, higher age and radiologic cardiomegaly were significantly more frequent in patients with VEBs prior to discharge. History of heart failure, functional class deterioration, higher age, male sex, large first infarct, VT or VF in CCU, transmural infarction, radiologic cardiomegaly were more frequent in patients with severe VEBs prior to discharge. VEB severity increased significantly during the follow-up year in survivors without reinfarction. This increase occurred in patients with previous infarction, angina pectoris, higher age and heart failure.
Eur J Cardiol
PMID:Ventricular arrhythmias after an acute myocardial infarction. Prognostic weight and natural history. 35 1

A study about gout associated with hypertension, diabetes, ischemic cardiopathy and different alterations in the sanguineous levels of lipids was conducted on 80 patients of the Rheumatology Service at the National Institute of Cardiology in Mexico City. We found abnormal levels of tryglicerids in the blood of 55% of the patients and a high level of cholesterol in only 5%. In 27% of the patients, some alteration showed in the carbo-hydrates methabolism, and in 22,5% of them we found systemic arterial hipertension. Slight ischemic cardiopathy was showing in a 37% of the patients, but uric acid level in blood seemed to be of little importance for the frequency, type or severity of the coronary heart disease. We made a comparison between the results we obtained through these studies and those found among the Mexican population and with information found in international medical publications.
Arch Inst Cardiol Mex
PMID:[Incidence of coronary disease and other metabolic diseases in 80 gout patients]. 43 57

Groups of patients such as the elderly, the diabetic and women have been studied to evaluate the effectiveness of coronary revascularization. In this report 77 patients under age 40 years undergoing coronary revascularization were studied. There was a high prevalence rate of predisposing factors. Sixty-eight percent reported a family history of heart disease and 27 percent a history of diabetes; 57 percent were hypertensive, 43 percent were overweight, 91 percent smoked, 5 percent were diabetic and 16 percent had abnormal glucose tolerance curves. Sixty-four percent had hypercholesterolemia (cholesterol 250 mg/100 ml) and 56 percent hyperlipidemia. Forty-four percent had had a previous myocardial infarction; 95 percent had angina pectoris, 12 percent preinfarction angina and 9 percent congestive cardiac failure. There were no operative deaths. The incidence rate of perioperative myocardial infarction (new Q waves in the electrocardiogram) was 4 percent. The mean length of of follow-up was 26 months (range 6 months to 5 years). The late mortality rate was 4 percent. Eight percent had a late myocardial infarction. Overall graft patency was 85 percent. Sixty-seven percent of patients were free of angina, and 17 percent were in improved condition. Seventy-one percent returned to work, while 29 percent remained unemployed. This study shows that in young patients, coronary revascularization is associated with low mortality and morbidity rates and that, despite the wide prevalence of predisposing factors, the prognosis and graft patency rate of these patients are similar to those of other groups.
Am J Cardiol 1978 Mar
PMID:Coronary revascularization under age 40 years. Risk factors and results of surgery. 62 35

A total of 4,000 consecutive electrocardiograms covering an 8-yr period was studied and all cases with pure left anterior hemiblock reviewed on the basis of clinical diagnosis and subsequent follow-ups. There were 66 cases in all, representing 1.6% of the total series with an age range of 30--81 and a mean of 53.4 yr; 43 males to 23 females--a ratio of approximately 2 : 1. 34 cases (51.5%) were hypertensives all with a minimum diastolic pressure of 120 mm Hg before treatment. Congestive cardiomyopathy accounted for 16 cases (24.3%) and diabetes mellitus unassociated with other ailments for another 6 cases (9.1%). Other causes included mixed aortic valve disease with 2 cases (3%), endomyocardial fibrosis with 2 cases (3%). In 6 patients (9.1%), all above the age of 70, who had been admitted for minor surgical operations, no cause could be found. This etiological pattern differs from that seen in white populations where ischemic heart disease is by far the commonest cause. The extreme rarity to left anterior hemiblock in rheumatic mitral valve disease is considered of help in separating cases of lone rheumatic regurgitation from those of mitral regurgitation complicating congestive cardiomyopathy if and when diagnostic difficulty arises.
Eur J Cardiol 1978 Mar
PMID:Left anterior hemiblock in adult Africans. 64 77

In Munich, 1477 employees (868 males and 609 females) of a large industrial firm were examined with regard to coronary heart disease risk factors. The known risk factors--overweight, disorders of the lipometabolism, diabetes, cigarette smoking, hypertension, pathologic ECG, physical inactivity--as well as certain somatic complaints and mental stress were checked for their distribution within the various social levels. With the exception of cigarette smoking among women and professional worries among men, in both sexes the members of the upper social group are less burdened with danger factors than the average. Aside from high blood pressure and disorders of the lipometabolism, which predominate in males in the middle layers, and cigarette smoking, which prevails among females in the upper social group, the risk factors pile up in the lowest social level. Our results will be discussed and compared with other studies.
Basic Res Cardiol
PMID:[Coronary risk factors and social class. Screening in employees of a large industrial firm (author's transl)]. 65 21

Twenty four cases with myocardial rupture among 259 patients with autopsy after death due to myocardial infarction, were compared with patients with acute myocardial infarction and death secondary to other causes. Myocardial rupture occured during the first 72 hours in 58% of the patients and all cases within the first five days. Two thirds of the patients were males and 46% were 70 years of age. There were 24 myocardial ruptures (9.5%). Previous history of arterial hypertension and un-remittent anginal pain were predisposing factors for rupture (p=0.05). Other previously reported bad prognostic factors such as persistent hipertension after acute infarction, severe exercise before infarction and history of Diabetes Mellitus were not statistically significant in this study. Ruptured myocardium was not influenced by a previous history of myocardial infarction, hospitalization delay in the C.C.U., administration of anticoagulants, digitalis or pressor amines. There was no significant difference among the groups compared in enzyme curves or magnitude of leucocytosis. Electromechanic dissociation, sinus bradycardia, nodal rhythm followed by idioventricular rhythm and asystole, were observed following myocardial rupture.
Arch Inst Cardiol Mex
PMID:[Rupture of the free wall of the heart as cause of death in acute myocardial infarct]. 66 44

In secondary prevention, the treatment of serious disorders is undoubtedly necessary. This applies to the treatment of latent or manifest heart failure with digitalis glycosides, the treatment of coronary insufficiency with suitably active medicaments, and the administration of antiarrhythmics to patients with cardiac arrhythmias, who could be particularly endangered under certain circumstances. Raised arterial blood pressure, one of the most important risk factors of coronary heart disease, requires suitable drug treatment. Similarly, the additional administration of medicaments that affect lipid metabolism and of substances that lower raised uric acid levels together with a suitable diet is often inevitable. It is patently obvious that diabetes mellitus must be optimally controlled. Whether the long-term administration of beta-sympatholytics has a protective effect on the onset of sudden deaths through cardiac arrhythmias or on the incidence of reinfarction is, in the present state of knowledge, quite possible, but still not definitely proven. Different indications and dosages of the medicament, and thus the absence of standardized conditions, scarcely permit an assessment of the success of associated drug therapy in secondary prevention.
Adv Cardiol 1978
PMID:Secondary prevention and associated drug therapy. 67 65


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