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 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

New knowledge of the pathophysiology of coronary disease has helped determine the therapy for angina pectoris. Calcium antagonists have the advantage of being direct coronary vasodilators as well as decreasing overall demand by systemic vasodilatation. Verapamil has the same anti-anginal effect during exercise as beta-adrenoceptor blockers but has the advantage of increasing rather than decreasing the cardiac output and so fatigue both at rest and exercise commonly seen with beta-adrenoceptor blockers is not found with verapamil. The longterm incidence of side-effects with verapamil are few and it can be used as a single anti-anginal therapy in a three times daily dosage. Left ventricular function where normal and near-normal is not depressed. Tolerance to therapy has not been recorded. The anti-anginal effects have been shown to remain effective over at least a 5 year period. Verapamil should be considered as initial therapy for patients with stable angina pectoris.
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PMID:Verapamil in angina pectoris. 287 28

Although beta blockers are effective for the treatment of angina pectoris, chronic adverse effects produced by these agents--including lethargy, fatigue, and male impotence--can adversely affect patient acceptance and treatment compliance. To assess the clinical effects of switching from anti-anginal treatment with beta blocker only (phase I) to half-dose beta blocker plus the calcium blocker nifedipine (phase II) or nifedipine alone (phase III), 18 patients with chronic stable angina pectoris and side effects to beta blockers were evaluated in a 12-week, open-label trial. Three patients did not complete the study, one secondary to new unstable angina and two secondary to nifedipine side effects. Of the 15 patients completing the trial (13 men and two women; mean age, 54 +/- 5 [SEM] years), all sequentially participated in the one-month phases. Weekly angina frequency assessed from patient diaries was significantly less for treatment with nifedipine only (phase III) as compared with beta blocker (phase I) (1.7 +/- 1 versus 3.9 +/- 1 episodes per week), while phase II was not significantly different. Exercise test time was maintained throughout all phases (phase I, 457 +/- 39; phase II, 458 +/- 40; and phase III, 498 +/- 48 seconds, p not significant). All 15 patients in phase I (100 percent) had side effects to beta blockers, but these side effects were lessened in 12 patients (80 percent) in phase II and 13 patients (86 percent) in phase III, with total alleviation of symptoms in two patients (13 percent) in phase II, and eight patients (53 percent) in phase III. Thus, in patients with side effects to beta blockers, switching to nifedipine is associated with a significant reduction in beta blocker adverse symptoms and equal anti-anginal efficacy.
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PMID:Alternative medical treatment for patients with angina pectoris and adverse reactions to beta blockers. Usefulness of nifedipine. 287 34

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

To determine the prognosis of patients with painless strongly positive exercise electrocardiogram, the 6-year cumulative survival rate was computed for 298 medically treated patients who terminated their exercise test with or without angina. All had horizontal or downsloping ST depression greater than or equal to 2 mm during a treadmill exercise test according to the standardized multistage Bruce protocol. Of the 298 patients, 119 terminated the exercise test because of dyspnea or fatigue and 179 stopped because of angina. Among the 119 patients without angina, there were 18 deaths, 16 from coronary artery disease (CAD), of which 8 occurred suddenly. Among the 179 patients with exercise-induced angina, 36 died, 33 from CAD, of which 13 were sudden deaths. The overall 6-year survival rate was 85 +/- 3% for patients without angina and 80 +/- 3% in those with angina (p less than 0.05). However, patients without angina achieved a significantly longer duration of exercise and had higher maximal heart rate and systolic blood pressure during exercise. In both groups, survival decreased with decreasing duration of exercise. In patients without angina, the 6-year survival rate was 97 +/- 3% in those achieving stage IV (greater than or equal to 541 s), 87 +/- 4% in stage III (361 to 540 s), 64 +/- 13% in stage II (181 to 360 s) and 60 +/- 15% in stage I (less than or equal to 180 s).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Survival with painless strongly positive exercise electrocardiogram. 317 36

We studied 34 patients with proven coronary heart disease to determine whether the presence or absence of angina pectoris during exercise testing was associated with greater disease, ST segment depression or fall in left ventricular ejection fraction. Angina pectoris was the limiting symptom in 19 and fatigue/breathlessness in 15 patients. Exercise time [421(31) vs. 455(64) s], ST depression [1.4(0.3) vs. 1.1(0.3)mm], fall in left ventricular ejection fraction [13(2) vs. 12(2)] and coronary score and fall in left ventricular ejection fraction [15(2) vs. 8(3), P less than 0.02]. The degree of ST segment depression correlated with the coronary score (r = 0.6) and fall in left ventricular ejection fraction (r = 0.5). ST segment depression but not angina pectoris during exercise predicted the extent of disease and its functional consequences.
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PMID:Angina pectoris during exercise--relationship to coronary anatomy and myocardial function. 324 51

We investigated exercise capabilities of the elderly patients with significant coronary artery lesions and angina pectoris. The heart rate increased according to workload, but there were few cases in which maximal heart rate was obtained. There was a marked increase in VO2 at endpoint before sufficient work load was achieved. It suggested an increase in O2 demand of the myocardium and entire body. Left ventricular dysfunction from skeletal muscle fatigue and work load-induced myocardial anoxia were also suggested. The conditions of coronary arteries of aged patients and the method of treatment were studied on the basis of coronary angioplastic findings and exercise tolerance. We reviewed percutaneous transluminal coronary angioplasty (PTCA) performed in 49 aged patients (older than 70 years) with angina and investigated long-term results. In this group including 18 patients (43%) with multivessel disease, there was a high success rate (90%), and significant improvements in workload responses were achieved in early stages after PTCA. The rate of recurrence was higher in this group than non aged patients, however, angioplasty was repeated successfully in all of the patients. Dilated sites were recognized as patent in a majority of patients. Late cardiac events occurring six months after PTCA were acute myocardial infarction in only one case (2.2%) and unstable angina in three cases (6.8%). There was no cardiac death. The five-year cumulative survival rate was high (97%). During a follow-up interval of averaged 32 months, chest pain disappeared in 70% of patients and 48% enjoyed daily life without restriction. Since the quality of life appears to be improved and long term results are sufficiently acceptable, we concluded that PTCA is highly recommended for the elderly patients.
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PMID:[Clinical characteristics of ischemic heart disease in the aged: significance of coronary revascularization and role of PTCA]. 327 11

Ambulatory ECG monitoring for detection of transient myocardial ischemia is useful because most ischemic episodes that occur outside the exercise laboratory are not accompanied by symptoms. Special considerations, not required for AEM when used for arrhythmia analysis, must be employed. Although many commercially available recorders provide excellent ST-segment reproduction, some playback systems may have a nonlinear phase response resulting in signal distortion, making ST-segment analysis difficult. Conventional Holter-type AEM devices do not allow for patient or physician intervention during acute myocardial ischemia. Considerable cost and time are required to analyze ST-segment data of prolonged monitoring periods from these tape-recorded signals, and human error and fatigue play an important role in diminishing accuracy of ST-segment interpretation. Automated analysis is done with computer and technician interaction but the accuracy and validation of the various systems for ST-segment analysis from tape recordings requires further detailed study. Newer, real-time ambulatory ECG analyzers are designed for prolonged monitoring periods and directed toward ST-segment analysis. Some devices also alert the patient to an acute ischemic or arrhythmic event allowing for intervention immediately. Some real-time systems have undergone some very encouraging validation studies. These recent studies suggest excellent sensitivity and specificity for detection of ischemic-type ST-segment depression. However, more work is needed before the accuracy of other such devices is known with certainty. As the central goal of therapy for patients with coronary artery disease evolves from simply controlling angina to reduction or elimination of ischemic episodes and their consequences, use of AEM devices will play an increasingly important role in management of these patients.
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PMID:Ambulatory ECG (Holter) monitoring in management of acute myocardial ischemia. 328 67

This study assessed behavioral activity, dietary and emotional variables among patient cohorts with angina pectoris, atypical chest pain, and no chest pain in whom coronary disease is suspected. Questionnaire responses of 3,899 employed male patients at the time of coronary arteriography were analyzed. Patients with angina pectoris had high levels of coronary-prone and neurotic attitudes, and fatigue variables including feeling unrested on awakening, easy fatiguability, reducing activity at work and arriving home tired. Atypical chest pain patients showed coronary-prone and neurotic attitudes similar to the angina pectoris group but had less coronary occlusion and lower levels of fatigue variables. Compared to the other groups, atypical chest pain patients were more likely to skip breakfast and showed a trend to eat fast. These findings suggest that including assessment of activity levels, fatiguability, eating behavior, neurotic traits and coronary-prone attitudes at time of coronary arteriography can have some limited value for patients with chest pain who may seek cardiac treatment but could benefit from alternative approaches.
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PMID:Chest pain and behavior in suspected coronary artery disease. 334 20

Sixty-five patients with ST elevation were retrospectively studied in order to evaluate the clinical significance and underlying mechanisms of ST-segment elevation during exercise. Of these, 50 patients had previous myocardial infarction (Group I) and 15 patients did not (Group II). Exercise thallium-201 imaging was performed on 30 patients, resting gated blood pool imaging was performed on 33 patients, and 23 underwent cardiac catheterization for clinical indications. When the two groups were compared, patients in Group I had more frequent multivessel disease (9/13 vs. 3/10, p less than 0.05), anterior infarctions (33/50 vs. 4/10, p less than 0.02), while Group II patients had more frequent single-vessel disease (7/10 vs. 4/13, p less than 0.05). For Group I patients, the most common reason for termination of exercise was fatigue and/or dyspnea (35/50 vs. 0/15, p less than 0.05), with an irreversible defect noted in both stress and delayed views on thallium imaging (20/24 vs. 1/6, p less than 0.05). In Group II, the most common reason for termination was angina (15/15 vs. 2/50, p less than 0.001), with reversible thallium defects noted more frequently (4/6 vs. 3/24, p less than 0.01). Thus, we conclude that in patients with Q waves, left ventricular dysfunction rather than ischemia is the mechanism for ST elevation. In these patients angina is rare, but fatigue, dyspnea, multivessel disease, and fixed thallium defects are common. In patients with non-Q-wave exertional ST elevation, ischemia is the rule, manifested by frequent chest pain and reversible thallium defects.
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PMID:The role of ischemia and ventricular asynergy in the genesis of exercise-induced ST elevation. 335 73

Seventeen post-myocardial infarction patients experiencing angina on effort performed 6 different exercise tests until they reached symptom-limited maximal level, 3 after placebo and 3 after oral administration of 10 mg of the Calcium antagonist, nifedipine, in a randomized, double blind, cross-over controlled study. Four of the tests were conventional bicycle and treadmill tests with stepwise increasing load. In 2 of the tests an isometric exercise of carrying a weight averaging 6 kg and corresponding to about 30% of maximal grip strength was added to the treadmill walking. When the exercise was stopped because of moderately severe angina, the product of heart rate and systolic blood pressure did not show any statistically significant difference between the tests. However, in the treadmill plus isometric test the work time was shorter and the slope of the treadmill was less than in the treadmill test. The difference was caused partly by non-cardiac factors, namely fatigue of the hand muscles. In routine exercise tests of coronary patients the addition of an isometric to a dynamic load did not give substantially more information than dynamic exercise alone. Nifedipine caused a modest increase of exercise tolerance in all tests, the increase being greatest in the treadmill plus isometric test. The increase in exercise tolerance was seen also in patients receiving beta-blocking agent.
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PMID:Assessment of exercise tolerance of cardiac patients by bicycle, treadmill and treadmill plus isometric exercise with and without nifedipine. 344 98


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