Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0012833 (dizziness)
 9,689 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The efficacy and safety of bepridil hydrochloride (200 to 400 mg/day) were evaluated in patients with chronic stable angina refractory to maximal tolerated doses of diltiazem (median 360 mg/day) in a randomized, multicenter, double-blind, parallel study. Baseline diltiazem data were obtained during a 2-week period, after which 86 patients were randomized to bepridil (n = 46) or diltiazem (n = 40). Angina frequency, nitroglycerin consumption and ischemic manifestations induced by exercise treadmill testing were evaluated over 8 weeks. Bepridil significantly (p less than 0.05) increased time to angina onset, time to 1 and 2 mm of ST-segment depression, total exercise time and total work over baseline values. Changes in time to angina onset and time to 1 mm of ST-segment depression were significantly (p less than 0.05) greater for bepridil than for diltiazem. Angina frequency and nitroglycerin consumption did not differ significantly between groups. Compared with baseline, bepridil significantly (p less than 0.001) decreased heart rate (mean 4 beats/min) and prolonged QTc (mean 35 ms). The most frequent adverse effects in both groups were nausea, asthenia, dizziness, headache and diarrhea. Four patients taking bepridil and 1 taking diltiazem withdrew from the study because of adverse reactions. No sudden deaths, myocardial infarctions or instances of sustained ventricular tachycardia or torsades de pointes occurred in either group. The data indicate that bepridil provided safe and effective antianginal and antiischemic therapy in patients with chronic stable angina who exhibited less than optimal response to maximal tolerated doses of diltiazem.
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PMID:Comparative efficacy and safety of bepridil and diltiazem in chronic stable angina pectoris refractory to diltiazem. The Bepridil Collaborative Study Group. 185 72

The main symptoms of aortic stenosis (AS), angina pectoris, dyspnoea, and syncope/effort dizziness, are thought to reflect the severity of AS. This assumption is based on studies in relatively young patients, and may not apply to older age groups. Thus, in 100 consecutive adults (age 41-79 years) referred to cardiac catheterization with suspected AS, clinical and haemodynamic variables were assessed in relation to significant (less than or equal to 0.50 cm2 m-2) (n = 70) and nonsignificant AS (n = 30), and to symptoms. Prevalence of symptoms, functional class, and systolic murmur grade greater than or equal to 3, was similar in the groups. However, patients with significant AS more often had an abnormal second heart sound, electrocardiographic left ventricular (LV) hypertrophy with strain, severe echocardiographic aortic valve calcification, and increased LV wall thickness. Multivariate analysis identified an abnormal second heart sound, and aortic calcification grade, as independent predictors of significant AS. When the Doppler mean gradient was added to the analysis, it became the best predictor. Angina pectoris (n = 74) was related to coronary artery disease, but not to severity of AS. However, 31% of patients without angina also had coronary artery disease. Dyspnoea (n = 69) was only related to age, and syncope/effort dizziness (n = 26) was more frequent in women. Functional class grade was not related to severity of AS. Thus, in adults with assumed symptomatic AS, clinical symptoms do not predict severity of AS. Therefore, the decision for valve replacement should rely on Doppler assessment of the severity of AS. Furthermore, in adults with AS, coronary artery disease cannot be excluded without selective coronary angiography.
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PMID:Clinical and haemodynamic features in relation to severity of aortic stenosis in adults. 162 99

We describe a case of coronary-subclavian steal syndrome treated with percutaneous transluminal angioplasty. A 58-year-old female who had her first coronary bypass operation 6 years previously and a second operation 3 years previously involving the left internal mammary artery and right gastroepiploic artery, developed unusual angina on effort characterized by left precordial pain, pain in the left shoulder and arm, tinnitus and dizziness. Angiography revealed retrograde flow to the left subclavian artery via the left vertebral artery and left internal mammary artery. Severe stenosis of the left subclavian artery was demonstrated at its ostium. Restoration of antegrade flow to the vertebral artery and left internal mammary artery by transluminal angioplasty resulted in complete resolution of these symptoms.
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PMID:Coronary-subclavian steal corrected with percutaneous transluminal angioplasty. 201 35

Nicardipine and nifedipine are structurally similar dihydropyridine calcium channel blockers with demonstrated efficacy in the treatment of stable angina pectoris. The present study was a prospective randomized trial designed to evaluate the relative incidence of dizziness, flushing, headache, pedal edema, and palpitations during use of these drugs in patients with angina pectoris. Of 250 patients who entered into the comparative treatment part of the study, 140 patients were susceptible to developing symptoms to nifedipine as identified during a 1-month open-label treatment with nifedipine. These patients were compared with a parallel cohort of 110 patients, who were identified during the same open-label period, but remained mostly asymptomatic. After a 1-week washout of nifedipine, equal numbers of patients in each cohort began an 8-week period of randomized, double-blind treatment with nifedipine (20 mg three times daily) or nicardipine (30 mg three times daily). Patients who experienced these symptoms during the open-label nifedipine treatment had a higher incidence of the same symptoms during the blinded treatment regimen. Nicardipine-treated patients had a lower incidence of each of the symptoms than did the nifedipine-treated patients. Statistically significant differences were reported for dizziness, the most common of the side effects. Patients who were free of these symptoms in the open-label period usually remained free of them in the blinded comparison. However, even among those free of dizziness during the open-label nifedipine treatment, more patients reported experiencing dizziness in the blinded phase from nifedipine than from nicardipine (18% vs 6%; p = 0.02).
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PMID:Randomized double-blind comparison of side effects of nicardipine and nifedipine in angina pectoris. The Nicardipine Investigators Group. 240 16

The clinical features of an inner-city population of 304 patients presenting with acute myocardial infarction (MI) with and without typical chest pain, were studied retrospectively. This population consisted of 172 men and 132 women; 155 (51%) were black, 88 (29%) hispanic, and 61 (20%) white, by self-identification. Typical ischemic chest pain was the presenting symptom in 85% (258); 15% (46) presented with nonchest symptoms, most frequently shortness of breath, abdominal pain, and dizziness. But the frequency of such nonchest symptoms was similar in both groups. When patients were grouped by the presence or absence of chest pain, the proportions of those without chest pain were significantly higher for blacks (22.7%) than hispanics (9.1%, P = 0.001) or whites (4.9%, P less than 0.01). Patients without chest pain also had higher admission systolic (P less than 0.01) and diastolic (P less than 0.01) blood pressures and more frequent histories of congestive heart failure (P less than 0.05), and more often presented with pulmonary edema (P = 0.001) than those with chest pain. Both groups were similar in age, sex, history of hypertension, and presence of hypertension on admission, defined as greater than or equal to 160/95 mmHg, prevalence of diabetes, history of smoking, previous MI, type of MI, history of angina, and mortality rates. Patients without chest pain were characterized by black race, history of congestive heart failure, elevated blood pressure and pulmonary edema than those with typical ischemic chest pain. Thus significant delays in the diagnosis and treatment of this important clinical entity may be reduced by alerting clinicians to these features and by educating selected patient groups.
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PMID:Clinical features of patients with acute myocardial infarction presenting with and without typical chest pain: an inner city experience. 252 Aug 50

Nicorandil is a vasodilator that acts on the venous and arterial beds of the systemic circulation. It reduces both cardiac preload and afterload, as well as improving coronary blood flow. The present study assessed the efficacy, tolerability, duration of action and optimal single dose of nicorandil in patients with stable angina pectoris. Treadmill exercise tests were undertaken by 8 patients at 2 and 6 hours after single oral doses of 20, 40, and 60 mg of nicorandil, and placebo. Doses were administered at weekly intervals in this double-blind, cross-over study. The duration of exercise to onset of angina was increased by 58, 96 and 125 seconds over baseline values (p less than 0.01) with the 20-, 40- and 60-mg doses of nicorandil, respectively. Significant improvement in exercise capacity compared with the effects of placebo was maintained at 6 hours after administration. The antianginal activity was accompanied by a marked reduction in blood pressure both at rest and during exercise, which resulted in severe dizziness and fainting in 2 of 6 patients after the 60-mg dose. However, significant reflex tachycardia occurred only at 2 hours after the 60-mg dose. Plasma concentrations of nicorandil correlated with percent reductions in blood pressure at 2 hours after administration (p less than 0.001) and with increasing total exercise work load (p less than 0.01). The incidence of adverse events appeared to be dose related. Headache and dizziness accounted for most of the reported events. The 20-mg single dose of nicorandil was considered to provide the best combination of antianginal activity and tolerability in this study.
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PMID:A controlled single-dose study of the efficacy, dose response and duration of action of nicorandil in angina pectoris. 252 28

In 242 patients with hypertension and/or angina pectoris, a new cardioselective betablocker without ISA, bisoprolol (Concor), was tested. The average mean value of 168/102 mm Hg was lowered in the 174 hypertensive patients by a systolic value of 17 and a diastolic value of 11 mm Hg. A normal diastolic pressure of 95 mm Hg or below was attained within 4 weeks in 73% of patients. Angina pectoris improved from 7 attacks per week before treatment to 3 attacks after 2 weeks; patients with additional hypertension showed a further improvement after another two weeks to an average of 1.7 attacks per week. Side effects were most frequently dizziness, headache and fatigue and also a few patients with gastrointestinal symptoms, an unusual side effect with this treatment. The results show the effective antihypertensive and antianginal action of bisoprolol in a large group of outpatients.
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PMID:[A new beta 1-receptor blocker in the therapy of essential hypertension and angina pectoris]. 256 85

The specific competitive alpha 1-postsynaptic blocking action and haemodynamic effects of prazosin (Minipress) have been summarized. Prazosin causes dilatation of arterioles and veins, reduces total peripheral resistance as well as preload and afterload. Cardiac output does not change at rest, stroke volume and subsequent cardiac output increase during exercise. The changes in heart rate have non-significant. It does not cause sympathetic counter-regulation, plasma renin activity does not increase, aldosterone level decreases, salt- and fluid retention may rarely be observed. It does not provoke angina. The authors report on the results of their examinations with the first dose of prazosin in 61 patients (in 33 cases by the double-blind cross-over method by placebo control), and summarize the observations made with the drug in long-term treatment in Hungary. The authors and other teams used prazosin as a long-term treatment (of approximately 3 months) in combination with other drugs in a total of 344 patients, and as monotherapy in 159 patients. In the course of combination treatment side-effects were observed in 15% of the patients (dizziness, headache, weakness, occasionally palpitation). During monotherapy, side-effects occurred in 12% of the patients (tachycardia, headache, weakness, dizziness). Hungarian results confirm the usefulness of prazosin in all stages of hypertension. It is effective in 30-35% of the cases as a monotherapy (this rate is congruent with the efficacy of beta-blockers, calcium antagonists and antihypertensive drugs of central action). Earlier prazosin had been used as a third agent in combination treatment of hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The mechanism of the action of Minipress. Examinations in hypertension. 257 64

During the intervening years since metoprolol was first reviewed in the Journal (1977), it has become widely used in the treatment of mild to moderate hypertension and angina pectoris. Although much data have accumulated, its precise mechanisms of action in these diseases remain largely uncertain. Optimum treatment of hypertension and angina pectoris with metoprolol is achieved through dose titration within the therapeutic range. It has been clearly demonstrated that metoprolol is at least as effective as other beta-blockers, diuretics and certain calcium antagonists in the majority of patients. Although a twice daily dosage regimen is normally used, satisfactory control can be maintained in many patients with single daily doses of conventional or, more frequently, slow release formulations. Addition of a diuretic may improve the overall response rate in hypertension. Several controlled trials have studied the effects of metoprolol administered during the acute phase and after myocardial infarction. In early intervention trials a reduction in total mortality was achieved in one moderately large trial of prolonged treatment, but in another, which excluded patients already being treated with beta-blockers or certain calcium antagonists and where treatment was only short term, mortality was significantly reduced only in 'high risk' patients. Overall results with metoprolol have not demonstrated that early intervention treatment in all patients produces clinically important improvement in short term mortality. Thus, the use of metoprolol during the early stages of myocardial infarction is controversial, largely because of the requirement to treat all patients to save a small number at 'high risk'. This blanket coverage approach to treatment may be more justified during the post-infarction follow-up phase since it has been shown that metoprolol slightly, but significantly, reduces the mortality rate for periods of up to 3 years. Metoprolol is generally well tolerated and its beta 1-selectivity may facilitate its administration to certain patients (e.g. asthmatics and diabetics) in whom non-selective beta-blockers are contraindicated. Temporary fatigue, dizziness and headache are among the most frequently reported side effects. After a decade of use, metoprolol is well established as a first choice drug in mild to moderate hypertension and stable angina, and is beneficial in post-infarction patients. Further study is needed in less well established areas of treatment such as cardiac arrhythmias, idiopathic dilated cardiomyopathy and hypertensive cardiomegaly.
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PMID:Metoprolol. An updated review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy, in hypertension, ischaemic heart disease and related cardiovascular disorders. 294 80

We studied six patients with atrial myxoma, 5 occurred in left atrium and one in the right atrium, the diagnosis was verified with echocardiogram and surgery, we determined the clinical, electrocardiographic and radiological differences between the mitral stenosis and myxoma. We found that patients with atrial myxoma have no history of rheumatic fever, the dyspnea was less severe of shorter and duration, patient had paroxysmal dyspnea. In contrast dizziness, faintness, hemiparesis and/or angina were the more frequent symptoms. A diastolic mitral snap was a very frequent finding, less frequent was the diastolic rumble no patient had pre-systolic murmur. The left atrium was generally not dilated and the left atrial appendage as well as the pulmonary artery were not prominent in chest X-Rays. The P wave in lead II was not more than 0.11 sec and the ventricular complex in VI did not show tall R ware. With the previous elements it is possible to suspect the diagnosis of left atrial myxoma. The diagnosis should, of course, be confirmed by echocardiography.
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PMID:[Clinical diagnosis of left auricular myxoma based on its echocardiographic and surgical verification]. 295 58


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