Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a study of low-dose oral contraceptives, it was found that the low dosage caused insignificant effects on glucose and lipid metabolism. 57 women of good health were studied and divided into 3 groups determined by the preparation given: monophasic desogestrel, monophasic cyproterone acetate, and triphasic gestodene. There was no family history of diabetes mellitus nor was there hyperlipoproteinemia in any of the women. Among the 3 groups, there were negligible differences concerning glucose and insulin levels and lipid profiles. This held true at both the beginning and concluding stages of the study. In all of the women, the insulin area/glucose area ratio was unaffected. Lipid metabolism and hyperglycemia have been linked to heart disease, and other reports have shown glucose and lipid abnormalities produced in women taking the 2 most popular progestins, norgestrel and norethindrone. Thus, the minor effects on carbohydrate and lipid metabolism found in these tests are significant.
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PMID:Metabolic effects of three new low-dose pills: a six-month experience. 252 17

The anti-anginal effect of the ACE inhibitor enalapril, at a dosage of 5 mg twice a day, was tested in a randomised, placebo-controlled double-blind trial on 12 normotensive patients with proven coronary-heart disease. There was a reduction of exercise-induced ST depression by 22% already after the first dose of 5 mg. After 15 days of treatment the ST depression had decreased by 35% (P less than 0.05).
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PMID:[Anti-ischemia effect of enalapril in coronary heart disease. A randomized placebo-controlled double-blind study]. 283 91

Plasma levels of atrial natriuretic peptide (ANP) were measured in patients with organic heart disease undergoing diagnostic cardiac catheterization. Independent of nature and duration of the disease (valvular heart disease, congestive cardiomyopathy) plasma ANP levels were closely related to the severity of cardiac failure. Furthermore, plasma ANP levels were found to be negatively correlated with the cardiac index and to be positively correlated with right and/or left atrial and with pulmonary artery pressures. During physical exercise (bicycle ergometer) a marked increase of plasma ANP levels was observed, which was closely related to increments in mean pulmonary artery pressure. This rise in plasma ANP levels during physical exercise was not attenuated in patients with already elevated resting plasma concentrations of ANP. In patients with congestive cardiomyopathy, afterload-reduction by ACE-inhibition resulted in changes of central hemodynamics, which were closely reflected by venous concentrations of ANP. The measurement of plasma ANP levels may serve as an indicator of the severity of cardiac failure. Plasma concentrations of ANP, however, are neither helpful in establishing the etiology of the underlying heart disease nor in differentiating left and right heart failure. However, in cases of already established organic heart disease plasma ANP levels may be used as a marker for assessing the efficacy of the therapeutic regimen.
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PMID:[Does the measurement of plasma ANP have a diagnostic or prognostic value in patients with organic heart disease?]. 297 Jan 74

A differential therapy of congestive heart failure requires the identification of the different stages of myocardial damage consequent to the underlying heart disease and the individual adaptive response to it. Because of their different load dependence, it is important to recognize the independent contribution of systolic and diastolic dysfunction in congestive heart failure. The vertical displacement of the diastolic pressure-volume loop is associated with a reduced therapeutic range. Reducing preload may limit the degree of diastolic filling necessary to fill a noncompliant heart and limit active myocardial stretch. The final outcome of any disorder is either to comprise cardiac filling, emptying, or both. When the end-stage is reached, only modification of excessive neurohormonal responses to heart failure remains. Efforts are necessary to avoid substances able to support the maladaptation. The rational use of vasodilator therapy in congestive heart failure is based on the concept that peripheral circulatory mechanisms overshoot, and may thereby act to exacerbate the heart failure. As important as it is to modify late neurohormonal responses, it is even more important to intervene at an earlier stage to reduce the degree of irreversible myocardial damage. Further studies have to prove the potential benefits of ACE-inhibitors in patients with mild heart failure in order to prevent or delay the progress of the disease.
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PMID:[Cardiac and extracardiac parameters as principles in differential therapeutic considerations for decreasing pre- and afterload]. 306 43

Ventricular tachyarrhythmias and severe bradycardia, flecainide acetate's most serious side effects, occur in patients with chronic heart disease or in healthy persons after frank overdose. Toxic effects appear to correlate closely with drug levels in plasma. The surface electrocardiogram can indicate toxicity by demonstrating this drug's electrophysiologic potency to depress all major cardiac conduction pathways with marked prolongation of the PR and QRS intervals. We report the clinical course of a young, healthy person who developed polymorphous ventricular tachycardia after taking a 3800-mg dose of flecainide acetate. Sinus rhythm was restored without pacing or cardioversion after infusion of a beta-sympathomimetic agent, physostigmine, and a sodium load. The initial flecainide serum levels were five times greater than the usual upper therapeutic level. Electrocardiography showed that the lengthened electrocardiographic time intervals decreased in correlation with falling drug levels. Flecainide-associated life-threatening arrhythmias and available therapeutic interventions are discussed.
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PMID:Life-threatening flecainide toxicity. A pharmacodynamic approach. 310 47

Thirty-nine patients with symptomatic ectopic atrial tachycardia (9 paroxysmal, of which 5 were incessant) and atrial fibrillation (AF) (25 paroxysmal, 5 chronic) were treated with oral flecainide acetate (100 to 400 mg/day). Thirty-two patients had organic heart disease (16 coronary artery disease, 6 valvular, 10 cardiomyopathy, 7 primary electrical abnormality). Previous antiarrhythmic trials consisted of 0 to 5 drugs (mean 2.2). Of 39 patients with atrial tachycardia or AF, a complete response (no recurrent symptomatic atrial arrhythmia) was achieved in 22 (56%), a partial response (more than 95% reduction in arrhythmia occurrence) in 3 (8%) and no response in 14 (36%). Left atrial size, ejection fraction, underlying heart disease, duration of symptoms before treatment and drug levels were not useful for predicting clinical response. Therefore, during the follow-up period of 5.4 +/- 6.7 months (range 4 weeks to 2.5 years), flecainide had a complete or partial effect in 25 patients (64%). Complete or partial responses were noted in 8 of 9 patients (90%) with ectopic atrial tachycardia and 17 of 30 (57%) with AF. In 14 patients with concurrent ventricular arrhythmias, a significant reduction in episodes of nonsustained ventricular tachycardia was also achieved. Treatment was discontinued in 8 patients (20%) because of cardiac adverse reactions, including pulmonary edema and ventricular or atrial proarrhythmic response. Thus, oral flecainide acetate is effective therapy for some patients with ectopic atrial tachycardia or AF.
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PMID:Efficacy and safety of flecainide acetate for atrial tachycardia or fibrillation. 310 29

Noninvasive quantification of regional myocardial metabolism would be highly desirable to evaluate pathogenetic mechanisms of heart disease and their response to therapy. It was previously demonstrated that the metabolism of radiolabeled acetate, a readily utilized myocardial substrate predominantly metabolized to carbon dioxide (CO2) by way of the tricarboxylic acid cycle, provides a good index of oxidative metabolism in isolated perfused rabbit hearts because of tight coupling between the tricarboxylic acid cycle and oxidative phosphorylation. In the present study, in a prelude to human studies, the relation between myocardial clearance of carbon-11 (11C)-labeled acetate and myocardial oxygen consumption was characterized in eight intact dogs using positron emission tomography. Anesthetized dogs were studied during baseline conditions and again during either high or low work states induced pharmacologically. High myocardial extraction and rapid blood clearance of tracer yielded myocardial images of excellent quality. The turnover (clearance) of 11C radioactivity from the myocardium was biexponential with the mean half-time of the dominant rapid phase averaging 5.4 +/- 2.2, 2.8 +/- 1.3 and 11.1 +/- 1.3 min in control, high and low work load studies, respectively. No significant difference was found between the rate of clearance of 11C radioactivity from the myocardium measured noninvasively with positron emission tomography and the myocardial efflux of 11CO2 measured directly from the coronary sinus. The rate of clearance of the 11C radioactivity from the heart correlated closely with myocardial oxygen consumption (r = 0.90, p less than 0.001) as well as with the rate-pressure product (r = 0.95, p less than 0.001). Hence, the rate of oxidation of 11C-acetate can be determined noninvasively with positron emission tomography, providing a quantitative index of oxidative metabolism under diverse conditions.
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PMID:Noninvasive assessment of canine myocardial oxidative metabolism with carbon-11 acetate and positron emission tomography. 326 28

Antiarrhythmic therapy is known to be associated with a significant risk of adverse cardiac reactions, including a proarrhythmic response. This study assessed in 1,330 patients followed up for 292 +/- 393 days the predictive value for cardiovascular safety of a system by which patients were classified according to ventricular arrhythmias on entry, presence or absence of organic heart disease and drug dose for flecainide acetate. Baseline arrhythmia subgroups included patients with premature ventricular complexes only, nonsustained ventricular tachycardia, and sustained ventricular tachycardia. Proarrhythmic events occurred in 6.8% of patients overall and were serious in 2.3% and lethal in 1.0%. However, proarrhythmia was highly dependent on arrhythmia class on entry: serious nonlethal proarrhythmic events occurred in 6.6% of patients with sustained ventricular tachycardia, only 0.9% with nonsustained ventricular tachycardia and 0% with premature ventricular complexes (p less than 0.01). Proarrhythmic death occurred in 3.1% of patients with sustained ventricular tachycardia, 0.2% with nonsustained ventricular tachycardia and 0% with premature ventricular complexes only (p less than 0.01). Proarrhythmia was also influenced by the presence of structural heart disease: serious nonlethal proarrhythmia occurred in 2.6% of patients with versus 0.4% of those without organic heart disease, and death occurred in 1.2 versus 0%, respectively. These adverse events were also dependent on dosing regimen. Flecainide caused premature discontinuation due to new or worsened heart failure in 1.4% of patients, all with underlying organic heart disease; however, heart failure was not clearly related to dose or type of arrhythmia. Symptomatic conduction disturbances occurred in 2.2%, and were predicted by preexistent sinus node disease but not by other baseline features.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Classification by type of ventricular arrhythmia predicts frequency of adverse cardiac events from flecainide. 374 6

Thirty-two patients received flecainide acetate for nonsustained ventricular tachycardia after having had unsuccessful treatment with a mean of four antiarrhythmic drugs. The mean left ventricular ejection fraction was 41% in 27. Thirty-one patients had organic heart disease, and 22 patients had arrhythmia-related symptoms. Total suppression of ventricular tachycardia occurred in 22 patients. Thirty patients were discharged from the hospital receiving flecainide at a mean (+/- SD) dosage of 315 +/- 76 mg/d and 26 of these patients attained a mean trough plasma drug level of 567 +/- 254 ng/mL. One patient had proarrhythmia and 3 had worsening of heart failure. Twenty-two patients remained in the trial for a mean follow-up of 13 +/- 7 months. Five patients died (1 suddenly) during the follow-up period. Our data indicate that flecainide suppresses refractory nonsustained ventricular tachycardia in 69% of patients who have organic heart disease. Serious adverse effects were minimized by initiation of treatment in the hospital and careful surveillance of electrocardiograms and plasma drug levels.
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PMID:Flecainide in the treatment of nonsustained ventricular tachycardia. 375 54

Understanding the precise nature of the links among styles of behavior, emotional expression, and the development of heart disease is a major challenge in psychology and health. In the present research, 60 men at high risk for coronary heart disease were examined in terms of their expressive style, their specific nonverbal cues, their personality, and their health. As assessed by the self-report Jenkins Activity Survey (JAS; Jenkins, Zyzanski, & Rosenman, 1979), half the men were Type A and half were Type B. To provide a more refined grouping, the men were further classified on the basis of scores on the Affective Communication Test (ACT; H. S. Friedman, Prince, Riggio, & DiMatteo, 1980), a self-report measure of nonverbal expressiveness. In the framework of theory and research on nonverbal expressive style, videotapes of the men were extensively rated and coded in terms of their judged appearance, the actual audio and video nonverbal cues emitted, and the words said (transcript). Two groups of Type A individuals were found--one that was repressed, tense, and illness-prone, but another that was healthy, talkative, in control, and charismatic. Furthermore, in addition to the expected healthy Type B men, a subgroup of Type B men was found who were submissive, repressed, tense, have an external locus of control, and may be illness-prone. A refined conception of the Type A behavior pattern is deemed necessary in light of these findings. Implications for improving the validity of the Type A construct and understanding the link between psychosocial factors and disease are discussed.
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PMID:Type A behavior, nonverbal expressive style, and health. 399 91


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