Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0016382 (flushing)
 6,387 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In this report we present the history of a patient with symptomatic carcinoid syndrome. During flushing he suffered from variant angina. The observation of coronary spasm due to excess 5-hydroxytryptamine (5-HT) is discussed with regard to the discharge of 5-HT from clotting platelets in the coronary arteries.
Clin Cardiol 1984 Aug
PMID:Evidence for coronary spasm during flushing in the carcinoid syndrome. 646 96

The action of nifedipine tablets was examined in 17 patients with essential hypertension focusing particularly on the profile of blood pressure (BP) reduction over 24 hours resulting from both twice-daily and once-daily therapy (dose range 40 to 120 mg daily). This new formulation of nifedipine has a more prolonged and lower peak plasma level than an equivalent dose of nifedipine capsules. Our patients were fully ambulant and studied by continuous intraarterial recording techniques. BP responses during isometric and dynamic exercise testing were also observed. Within-patient comparisons of consecutive mean hourly systolic and diastolic BP showed a highly significant effect from twice-daily therapy (p less than 0.001) for nearly the entire day. Also, significantly lower BP was maintained during isometric and dynamic exercise. Mean hourly heart rates were not significantly altered. The profile of action of the single morning dose was initially similar, but its efficacy diminished from 6 P.M. to 8 A.M. on the following day. Side effects were not unduly troublesome and did not cause any patient withdrawals. Four patients developed mild ankle edema. Two others had facial flushing. Nifedipine given twice daily in tablet form, therefore, is an effective antihypertensive drug capable of lowering BP consistently over 24 hours in ambulant patients and during formal exercise testing. We suggest that this agent may be useful as initial therapy for systemic hypertension, although the tablets are not as yet widely available.
Am J Cardiol 1983 May 01
PMID:Nifedipine tablets for systemic hypertension: a study using continuous ambulatory intraarterial recording. 684 59

The cardiovascular actions of prostacyclin (PGI2) were investigated in a double-blind, randomised, balanced study. Six healthy volunteers received intravenous infusions of PGI2 in a range of doses up to 4 ng/kg per min, which is the lowest dose which consistently inhibits platelet aggregation. Measurements of systolic time intervals, peak normalised first derivative of the apexcardiogram, high-speed surface electrocardiogram and arterial blood pressure were made during each infusion. PGI2 caused dose-related decreases in diastolic blood pressure, preejection period and QS2 index, and an increase in heart rate. Systolic blood pressure, left ventricular ejection time index, the peak normalised first derivative of the apexcardiogram, and PR interval, QRS duration, QT index and T-wave amplitude were unchanged. Facial flushing was seen in all subjects at PGI2 4 ng/kg per min. These results suggest that PGI2 has an important arteriolar vasodilator action, but do not exclude a minor direct effect on contractility.
Eur J Cardiol 1980
PMID:Noninvasive assessment of the cardiovascular effects of prostacyclin (PGI2) in man. 700 63

The carcinoid syndrome is a rare clinical entity, the unique manifestations of which continue to excite the interest of physicians. Despite a common origin from neural crest tissue, the tumors are partially differentiated, as evidence by the different secretory products of foregut, midgut, and hindgut carcinoids. They also differ in their ability to metastasize, thus presenting an even more varied clinical picture. The prognosis of patients with carcinoid syndrome varies with the origin of the tumor and extent of metastases. The management of patients with carcinoid syndrome is difficult. Despite an understanding of the neurohormones that carcinoid tumors secrete, their various antagonists and inhibitors have been only partially successful in providing symptomatic relief. Carcinoid heart disease represents the most intriguing aspect of this syndrome. Although valvular dysfunction most often coexists with flushing and diarrhea, the findings of tricuspid regurgitation or stenosis occasionally provide the first clue to the presence of the disease. Despite intensive research, the definite etiology of these valvular lesions has not been established. A small group of patients has been managed by valve replacement. While surgical treatment has been successful in improving hemodynamics in most of these patients, it is expected to prolong life only in those without extensive liver metastases. In patients with extensive metastatic disease, one must carefully consider whether the risks and trauma of cardiac surgery for palliation are justified.
Curr Probl Cardiol 1982 Feb
PMID:Carcinoid heart disease: a clinical pathologic, and therapeutic update. 704 96

The acute hemodynamic effects of intravenous prostacyclin (PGI2), in doses of 22 +/- 11 ng/kg per min were studied in nine patients with severe congestive heart failure refractory to digitalis and diuretic drugs. After prostacyclin infusion, mean (+/- standard deviation) pulmonary capillary wedge pressure decreased from 21.0 +/- 7.9 to 15.0 +/- 6.6 mm Hg (p less than 0.001), mean arterial pressure from 98.9 +/- 12.8 to 76.2 +/- 7.0 mm Hg (p less than 0.001), systemic vascular resistance from 2,574 +/- 384 to 1,368 +/- 283 dynes s cm-5 (p less than 0.001), pulmonary vascular resistance from 1,008 +/- 451 to 443 +/- 135 dynes s cm-5 (p less than 0.001) and pulmonary arteriolar resistance from 330 +/- 111 to 189 +/- 73 dynes s cm-5 (p less than 0.001). Heart rate increased from 78 +/- 21 to 82 +/- 24 beats/min (p = not significant [NS]), cardiac index from 2.0 +/- 0.37 to 3.2 +/- 0.59 liters/min per m2 (p less than 0.001) and stroke index from 27.6 +/- 8.69 to 42.0 +/- 0.62 cc/m2 (p less than 0.001). With prostacyclin, moreover, coldness of the limbs and face disappeared, and patients felt warmth and mild flushing of the face. After prostacyclin, plasma norepinephrine levels, renin activity and aldosterone concentrations rose from 824 +/- 375 to 880 +/- 468 pg/ml (NS), 0.68 +/- 1.36 to 0.95 +/- 1.21 ng/ml per h (NS), and 6.64 +/- 2.50 to 6.38 +/- 2.88 ng/dl (NS), respectively, while plasma epinephrine increased from 140 +/- 80 to 250 +/- 154 pg/ml (p less than 0.025).
Am J Cardiol 1982 Aug
PMID:Prostacyclin therapy in patients with congestive heart failure. 704 86

The purpose of this study was to compare angiography and angioscopy for the detection of thrombus during coronary interventional procedures. The diagnosis of coronary thrombus has important clinical implications. Angioscopy can directly visualize the coronary luminal surface and may be more accurate than angiography in the diagnosis of thrombus. Angiography and angioscopy were sequentially performed in 75 patients undergoing a variety of interventional cardiology procedures during 117 distinct procedural time points. The angiographic presence of thrombus was defined as a noncalcified filling defect outlined on at least 3 sides by contrast media. The angioscopic presence of thrombus was defined as red material protruding into the lumen (intraluminal thrombus) or adherent to the luminal wall (mural thrombus) that persisted despite flushing. Thrombus was detected on 14 occasions (12.0%) by angiography compared with 48 (41.0%) by angioscopy (p < 0.05). In 4 of the 14 episodes (28.6%) of angiographic filling defects, angioscopy found no evidence of thrombus and provided an alternative explanation for the angiographic filling defect. When angioscopy was used as a reference standard, the sensitivity of thrombus detection by angiography was 20.8%, with a specificity of 94.2% and a predictive value of 71.4%. The sensitivity of angiography for the detection of intraluminal (protruding into the lumen) thrombus was 100% compared with only 10% for mural (adherent to the luminal wall) thrombus (p < 0.05). Angioscopy was significantly more accurate than angiography for detecting coronary thrombus and may be considered an improved reference standard for this diagnosis.
Am J Cardiol 1995 Jun 01
PMID:Angioscopic versus angiographic detection of thrombus during coronary interventional procedures. 776 89

Adenosine triphosphate (ATP) is an alternative to dipyridamole or adenosine in thallium-201 myocardial scintigraphy. However, the optimal dose of ATP has not been determined. A Doppler guide wire study showed the coronary flow velocity at a dose of 0.15 mg/kg of ATP was equal or higher than that at 0.14 mg/kg of adenosine or 0.56 mg/kg of dipyridamole. ATP was given intravenously to 67 patients with coronary artery disease at 0.15 mg/kg/min for 6 min. Thallium-201 was injected at 3 min, followed by immediate and delayed (3 hrs) tomographic imaging. There was no serious side effect during examination, although chest pain (26%), dyspnea (17%), and flushing (33%) were common. The sensitivity and specificity to detect coronary artery disease were 98 and 100%, respectively. The sensitivity to detect left anterior descending artery, left circumflex artery, and right coronary artery lesions was 94, 59 and 77%, respectively. ATP loading thallium-201 scintigraphy provides an accurate diagnosis of coronary artery disease. The optimal dose of ATP is 0.15 mg/kg/min for 6 min.
J Cardiol 1995 Jan
PMID:[Adenosine triphosphate loading thallium-201 myocardial scintigraphy: optimal dose and diagnostic accuracy]. 787 4

Right-sided valvular heart disease is a common complication of metastatic carcinoid tumors. On the contrary, left valve involvement is a rare finding. In our report we describe a patient in whom the subsequent involvement of right and left heart valves was documented by 2D and Doppler echocardiography. The patient was a 46-year-old woman who, in the last three years, complained of face flushing, postprandial diarrhea and shooting epigastric pain lasting for hours. She came at our observation for increasing dyspnoea, peripheral edemas and asthenia. 2D-echocardiography and Color Doppler revealed a severe tricuspid regurgitation and a turbulent blood flow across the pulmonary valve. An Angiographic examination confirmed the severe tricuspidal regurgitation and disclosed a mild pulmonary stenosis. These findings were associated with high 5 hydroxyndole acetic acid (5-HIAA) urinary excretion and the presence of a liver metastasizing ileal carcinoid tumor. Some months later, a new 2D echo-Doppler examination showed thickening and reduced motion of the posterior mitral leaflet, associated with regurgitation and an aortic insufficiency without evident structural valvular abnormalities. Even if carefully investigated no right-to-left shunt was found.
G Ital Cardiol 1994 Apr
PMID:[Left valvular involvement in carcinoid: description of a case]. 805 18

A double-blind, randomized study was undertaken to evaluate the efficacy and safety of fluvastatin as monotherapy and as combination therapy with niacin in the treatment of hypercholesterolemia refractory to diet. Seventy-four patients with plasma low-density lipoprotein cholesterol (LDL-C) levels > or = 160 mg/dL were treated with fluvastatin, 20 mg/d, or placebo for 6 weeks. Thereafter, immediate-release niacin, at a dosage titrated to a maximum of 3 g/d, was added to both regimens for another 9 weeks. All adverse events were monitored, with particular attention to the evaluation of liver and muscle enzymes. Initial analysis of the data shows that fluvastatin and its combination with niacin was well tolerated and was not associated with any serious adverse events. Small, transient, asymptomatic rises in aspartate aminotransferase (AST) occurred in 28.9% of fluvastatin-niacin treated patients compared to 8.3% in the niacin-placebo control arm (p < 0.05). These were considered clinically insignificant in that no transaminase elevations > 3 times the upper limit of normal occurred. No evidence of myopathy, creatine kinase levels exceeding 10 times the upper limit of normal, myositis, or rhabdomyolysis were demonstrated in this short-term trial. The majority of adverse events resulting in patient withdrawals were ascribed to niacin therapy and included cutaneous vasodilatation, flushing, itching, and rash. These preliminary results suggest that fluvastatin, both alone and combined with niacin, is an effective, safe, and well-tolerated treatment for hypercholesterolemia.
Am J Cardiol 1994 May 26
PMID:Combination therapy with fluvastatin and niacin in hypercholesterolemia: a preliminary report on safety. 819 20

The failure of patients to adhere adequately to prescribed medication and behavioral regimens is an important medical problem. Poor adherence is most common when the treatment regimen is preventive rather than curative, when patients are asymptomatic, and when the duration of treatment is long. For these reasons, adherence with dietary therapy for hypercholesterolemia is well recognized to be a significant clinical and research challenge. Medication adherence has been acknowledged to be a problem for those treatments with significant side effects, such as flushing and pruritus or the low palatability of bile acid sequestering agents. The availability of drugs that lack these effects has long been viewed as an important contribution to improving overall patient compliance. However, the literature on patient adherence with life-long treatment regimens that are simple and palatable (e.g., antihypertensives) suggests that while these improved treatments can enhance adherence, the overall rates of patient compliance still average only 50%. The fact that patients with heterozygous familial hypercholesterolemia are at high risk for early coronary artery disease and death if they fail to adhere to therapy is not sufficient to assure high rates of appropriate therapy over long periods of time, as demonstrated by the poor or erratic adherence commonly reported to treatments for other life-threatening diseases, such as advanced renal disease, hemophilia, and type I diabetes. The measurement of patient adherence to hypercholesterolemia therapy is often neglected in clinical practice and inadequate in hypercholesterolemia research.(ABSTRACT TRUNCATED AT 250 WORDS)
Am J Cardiol 1993 Sep 30
PMID:Measuring adherence with therapy for chronic diseases: implications for the treatment of heterozygous familial hypercholesterolemia. 821 1


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