Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018681 (headache)
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Carvedilol competitively blocks beta 1, beta 2 and alpha 1 receptors. The drug lacks sympathomimetic activity and has vasodilating properties that are exerted primarily through alpha 1-blockade. Animal models indicate that carvedilol confers protection against myocardial necrosis, arrhythmia and cell damage caused by oxidising free radicals, and the drug has no adverse effects on plasma lipid profiles. Recent data have confirmed the antihypertensive efficacy of carvedilol in patients with mild to moderate essential hypertension. Carvedilol has similar efficacy to other beta-blocking agents, calcium antagonists, ACE inhibitors and hydrochlorothiazide. Carvedilol also improves exercise tolerance and ischaemic symptoms in patients with stable angina pectoris. Significant reductions in serious cardiac events after acute myocardial infarction and in frequency and severity of ischaemic events in patients with unstable angina have also been demonstrated. Interest in the use of carvedilol in patients with congestive heart failure (CHF) has culminated in the publication of a cumulative analysis of data from 1094 patients with mild to severe CHF who participated in the US Carvedilol Heart Failure Study Program (4 trials). After a median follow-up of 6.5 months, a significant overall reduction in mortality relative to placebo (3.2 vs 7.8%) was revealed in patients who had received carvedilol 6.25 to 50 mg twice daily (plus diuretics and ACE inhibitors). All-cause mortality, risk of hospitalisation for cardiovascular reasons and hospitalisation costs were also reduced significantly (by 65, 28% and 62%, respectively) in these trials. In addition, the Australia and New Zealand Heart Failure Research Collaborative Group showed a 26% reduction in the combined risk of death or hospitalisation with carvedilol 12.5 to 50 mg/day relative to placebo after a mean 19-month follow-up period in 415 patients with CHF (relative risk 0.74). Adverse events with carvedilol appear to be less frequent than with other beta-blocking agents, are dosage-related and are usually seen early in therapy. Events most commonly reported are related to the vasodilating (postural hypotension, dizziness and headaches) and the beta-blocking (dyspnoea, bronchospasm, bradycardia, malaise and asthenia) properties of the drug. Carvedilol appears to date to have little effect on the incidence of worsening heart failure. Concomitant administration of carvedilol with some medications requires monitoring. Carvedilol is therefore likely to have a beneficial role in the management of controlled CHF, but further clinical studies are required to show the place of beta-adrenoceptor blocking therapy in general in this indication, and the position of carvedilol relative to other similar agents. Carvedilol is also confirmed as effective in the management of mild to moderate hypertension and ischaemic heart disease.
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PMID:Carvedilol. A reappraisal of its pharmacological properties and therapeutic use in cardiovascular disorders. 921 Oct 87

A 68-year-old man with coronary artery disease was admitted for chest pain and ventricular tachycardia. After electric cardioversion, therapeutic heparinization was started for myocardial ischemia and nontransmural infarction. On day 3, headache and fever developed, followed by an altered sensorium and hyponatremia. Infectious etiology for the fever was excluded, and results of computed tomography of the brain were normal. Later magnetic resonance imaging (Day 10) demonstrated a pituitary macroadenoma with hemorrhage. Treatment for panhypopituitarism with stress-dose steroids stabilized the patient, and the fever and hyponatremia resolved. Transsphenoidal resection of the pituitary adenoma was performed without incident. This is the first reported case of pituitary apoplexy after heparin anticoagulation for acute myocardial infarction, although chronic anticoagulation in other settings has been reported as a precipitant of apoplexy. The uncommon presentation of a "central" fever and confusion in a patient with previously undiagnosed adenoma posed a diagnostic challenge. Subtle presentations of panhypopituitarism, knowledge of which should lead to suspicion and early diagnosis of pituitary apoplexy, will prevent anticoagulant-induced central nervous system catastrophes and potential fatalities.
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PMID:Heparin therapy for myocardial infarction: an unusual trigger for pituitary apoplexy. 936 41

During the years 1986 to 1990, an increasing number of cases of acute carbon monoxide (CO) poisoning were encountered in the Emergency Department Hacettepe University Hospital in Ankara, Turkey. Between January 1 and March 31, 1991, all the patients presenting with complaints compatible with CO poisoning were evaluated; the diagnosis was confirmed in 55 of the 5795 people who attended the Emergency Department during this period. In all cases the source of CO intoxication was determined. Among these patients, nausea or vomiting and headaches were the most common complaints (occurring in 100% and 85%, respectively). At least transient impairment of alertness was observed in 29% of cases. The carboxyhaemoglobin levels ranged from 3.80 to 48.1% (median 14.2%). Two comatose patients who developed a non-cardiogenic pulmonary oedema required mechanical ventilation. One of them was discharged from the hospital with mild cerebral disability. Another patient developed an acute myocardial infarction. In all the cases in this series, the source of CO poisoning was identified as improper combustion of recently marketed steam coal in inadequately ventilated bucket stoves.
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PMID:Carbon monoxide poisoning related to the use of steam coal in poorly ventilated bucket stoves. 942 89

Nitrates, which have been used for more than a century, are the second oldest drug (after digitalis alkaloids) in the cardiological pharmacological arsenal. However, several facets of their mode of use still remain controversial. Their vasodilator and arteriolodilator action (especially in coronary vessels) and their platelet aggregation inhibitory effect make them useful drugs, particularly in all clinical forms of ischaemic heart disease (unstable or stable angina and acute myocardial infarction), for the prevention or treatment of ischaemic episodes (silent or not) and also in heart failure where nitrates are useful not only as symptomatic treatment (alone or associated with diuretics), but also in view of their positive effect on survival (associated with hydralazine: V-Heft I trial). At the present time, nitrates can be administered via the sublingual, oral, intravenous of transdermal routes in the form of nitroglycerin and isosorbide dinitrate or mononitrate (short-acting and sustained-effect forms). Their rare contraindications concern patients suffering from severe hypotension (< 70 mmHg), severe anaemia, glaucoma or intracranial hypertension. The most serious adverse effects are pulsatile headache (which usually disappear after several days), postural hypotension (possibly causing fainting), facial erythema, vertigo, palpitations or nausea and vomiting. Most of these adverse effects can be controlled by dosage adaptation and it is rarely necessary to stop treatment. However, the major problem raised by the use of nitrates concerns the development of a tolerance. The pathophysiology of this multifactorial phenomenon is still unclear. The protagonist role played by loss of SH groups or activation of humoral feedback mechanisms, with an increase of circulating catecholamine levels, activation of the R-A-A system and increased plasma volume, has been postulated. This complication can be avoided by prescribing intermittent treatment, with a drug-free interval of 10-12 hours per day. A single dose of a sustained-release preparation (60 mg of isosorbide dinitrate or 40 to 60 mg of isosorbide mononitrate), or 2 or 3 doses of a short-acting preparation (20-40 mg of isosorbide mononitrate) can be prescribed via the oral route. When the transdermal route is used, the patch should be left in place for 12 hours. Treatment should be started at low doses, which are then gradually increased. The free period is usually at night, which can be covered, when necessary, by other antiischaemic drugs (for example, beta-blockers and/or calcium channel blockers), already usually used in combination with nitrates. This interruption is not accompanied by a rebound phenomenon. It must be remembered that nitrates potentiate the action of other vasodilators and calcium channel blockers and that, in some patients, intravenous nitroglycerin reduces the anticoagulant effect of heparin, while indomethacin can inhibit their vasodilator effect. Nitrates are therefore in very good health despite their advanced age and, when used correctly, they continue to be very useful in the pharmacological treatment of cardiovascular diseases.
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PMID:[Principles and rules of the use of nitrates]. 945 73

Previous studies of specialist care have shown that the onset of acute myocardial infarction occurs most frequently on Mondays; however, the septadian pattern in the reasons for referrals from primary care to secondary care has not been examined previously. We examined daily variations in rates of referral from primary to secondary care in central and northern Finland, using International Classification of Primary Care codes, during two weeks (30 November to 6 December 1992, and 28 November to 4 December 1994) before and after the introduction of a reform in the system of financing health care. Monday peaks were observed in the occurrence of angina pectoris, fractures of the tibia/fibula, lumbar disc lesions, and infections of the eye. Tuesday peaks were found in the occurrence of headache. Two peaks (on Tuesday and Thursday) were observed for patients with suspected appendicitis. Many problems of primary health care leading to referral to secondary care are not random events but occur in a weekly pattern. Further investigation is needed within these subgroups of patients to identify the causes of this variation.
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PMID:They call it stormy Monday--reasons for referral from primary to secondary care according to the days of the week. 1081 61

Nicorandil is a drug with both nitrate-like and ATP-sensitive potassium-channel (K+ ATP) activating properties. By virtue of this dual mechanism of action, the drug acts as a balanced coronary and peripheral vasodilator and reduces both preload and afterload. The K+ ATP channel has been shown to be involved in the phenomenon of myocardial preconditioning, and studies in animal models of ischaemia-reperfusion-induced myocardial stunning or infarction indicate that nicorandil has cardio-protective effects. Studies in patients undergoing percutaneous transluminal coronary angioplasty (PTCA) have shown that the administration of nicorandil reduces ST-segment elevation during ischaemia. Nicorandil significantly improved the results of exercise tolerance tests versus baseline in patients with stable effort angina pectoris in early noncomparative trials. The drug also improved the results of exercise tolerance tests relative to placebo in early randomised, double-blind, placebo-controlled trials. In randomised, double-blind comparative studies in patients with angina pectoris, nicorandil has demonstrated equivalent efficacy, as measured by exercise tolerance testing, to isosorbide di- and mononitrate, metoprolol, propranolol, atenolol, diltiazem, amlodipine and nifedipine. The effects of nicorandil on various aspects of myocardial recovery from ischaemic damage caused by acute myocardial infarction have been investigated in the short term. Regional left ventricular (LV) wall motion, a marker of myocardial function, was significantly improved in nicorandil recipients relative to control. The main adverse event associated with nicorandil as treatment for angina pectoris is headache. This can be minimised by commencing nicorandil at a low dose in patients prone to headache. There have been infrequent case reports of mouth ulcers in patients receiving nicorandil; causality has not been conclusively established, but product prescribing information indicates that an alternative treatment should be considered if persistent aphthous or severe mouth ulceration occurs. Thus, nicorandil remains a useful background therapy for patients with angina pectoris. The drug has also demonstrated potential cardioprotective effects when used as part of an intervention strategy directly after acute myocardial infarction in high-risk patients. Further large scale longer term studies of nicorandil in this latter indication are awaited with interest.
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PMID:Nicorandil. An updated review of its use in ischaemic heart disease with emphasis on its cardioprotective effects. 1108 2

Myocardial infarction presenting solely as an acute, severe headache is underdiagnosed in elderly patients. In patients over 80 years of age, myocardial infarction presents more commonly with atypical symptoms than with chest pain. The authors describe two patients who presented with headache as the only symptom of an acute myocardial infarction. The authors recommend that acute myocardial infarction be considered in the differential diagnosis of acute, severe headache in elderly patients.
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PMID:Headache as the sole presentation of acute myocardial infarction in two elderly patients. 1125 57

Erectile dysfunction (ED) in men is amenable to correction with Viagra in a majority of patients. The accumulated experience of prescribing Viagra across the broad continuum of men suffering from ED is sufficient for a meaningful assessment of the safety of Viagra in clinical practice. The use of Viagra necessitates caution in cardiac failure and when used within six months of acute myocardial infarction and stroke. It is inadvisable in patients with unstable angina pectoris. The co-administration of Viagra with organic nitrates, for example, glyceryl trinitrate or isosorbide dinitrate, is unsafe. The relative contraindications to Viagra in cardiovascular disease are uncontrolled hypertension and impaired cardiac reserve. With respect to interactions with other drugs, the potential influence on the metabolism of Viagra by medications that affect the cytochrome-P-450 system does not translate into clinical effects. The vasodilatory properties of sildenafil citrate are largely responsible for unwanted effects. The most common side effects are headache, flushing (due to vasodilation), and dyspepsia (due to relaxation of the smooth muscle of the gastroesophageal sphincter with reflux). In the recommended single-dose range (25-100 mg), the use of Viagra for erectile dysfunction, in the absence of contraindications, is extremely safe provided the drug is taken under proper conditions.
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PMID:The clinical safety of viagra. 1207 89

This open-labeled single-blinded study was performed to evaluate the efficacy and tolerability of telmisartan in the treatment of mild to moderate essential hypertension. Each patient was assigned to take a placebo for 4 weeks followed by once daily-titrated telmisartan (40-80 mg) for 8 weeks. "Office BP" and "24-hour ambulatory BP" measurements (24-h ABPM) were recorded as scheduled. Thirty-one patients (10 males: 21 females) with a mean age of 48.1 years were enrolled. The final SBP/DBP reductions of 14.6 +/- 14.2/9.9 +/- 6.2 mm Hg were obtained. Full response defined as office DBP reduction of > or = 10 mm Hg from baseline and/or DBP < 90 mm Hg was achieved in 73.3 per cent of cases. Excluding 5 cases of white coat HT diagnosed by 24-h ABPM, full response rate (DBP reduction of > or = 10 mm Hg from baseline and/or < 85 mm Hg) was 76 per cent. Trough to peak ratio and smoothness index for SBP/DBP were highly acceptable (0.75/0.76 and 0.97/1.01, respectively). There were 4 cases of adverse events (2 cases of dizziness, 1 case of headache, and 1 case of acute myocardial infarction).
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PMID:The efficacy and tolerability of an angiotensin II receptor blocker, telmisartan, in Thai patients with mild to moderate essential hypertension. 1245 74

The authors report the case of a 60-year-old man admitted for uncomplicated acute myocardial infarction. The history of persistent fronto-occipital headaches and palpation of bilateral tortuous temporal arteries with a decreased pulse suggested the diagnosis of temporal arteritis, particularly in the presence of marked laboratory signs of inflammation and the coronary angiograph findings. The diagnosis was confirmed by temporal artery biopsy. Treatment consisted of corticosteroid therapy, with a satisfactory outcome at three months. The diagnosis of temporal arteritis should be systematically suggested in patients over the age of 50 years, presenting with a marked inflammatory syndrome and recent-onset arterial disease. Similarly, any form of arterial disease occurring during treated temporal arteritis should initially be considered to be a secondary site of the arteritis, requiring intensification of corticosteroid therapy.
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PMID:[Horton's disease presenting as a myocardial infarction]. 1255 52


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