Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The immediate haemodynamic effects of prenalterol and nitroglycerine were examined in 15 patients, with severe chronic heart failure. Prenalterol was given intravenously in increasing doses of 2, 4, and 8 mg. Cardiac index increased significantly by 16%, 24%, and 32%, respectively. Heart rate increased by 16%, 19%, and 24%. Stroke volume index, systemic artery pressure, pulmonary artery pressure, and right atrial pressure did not change. Prenalterol reduced systemic vascular resistance by 15%, 17%, and 24%, respectively. Forearm blood flow and forearm vascular resistance was unchanged. Cardiac index and heart rate were not changed by 0.5 mg nitroglycerine, administered sublingually. Systolic and diastolic blood pressure were on average reduced by 14% and 12%, respectively. Systolic and diastolic pulmonary artery pressure and right atrial pressure were similarly reduced by 17%, 31%, and 39%, respectively. Nitroglycerine lowered calculated systemic vascular resistance by 11%, whereas forearm blood flow and forearm vascular resistance was unchanged. The conclusion is that prenalterol acutely increased cardiac index and improved haemodynamics in 14 out of 15 patients, mainly due to an increased heart rate. Nitroglycerine did not change cardiac index in the same group of patients.
 ...
PMID:Prenalterol in severe congestive heart failure. I. The immediate haemodynamic effects as compared to nitroglycerine. 312 10

In an attempt to resolve some of the controversies concerning the dose requirements and duration of effects of transdermal nitroglycerin (NTG) in patients with heart failure (CHF), the short-term hemodynamic responses to transdermal NTG, in a 20 cm2 self-adhesive patch (10 mg/24 h), were evaluated in 10 patients with severe chronic CHF using a randomized, within-patient, double-blind, placebo-controlled cross-over trial. Serial hemodynamic measurements over 24 h revealed sustained effects that began 1 h after the application of nitroglycerin patch and fully persisted throughout the study. The peak effect occurred at 4 h with the pulmonary capillary wedge pressure decreasing from 33.7 +/- 8.4 to 21.4 +/- 9 mmHg (mean +/- SD) (p less than 0.05) and the cardiac index increasing from 2.5 +/- 0.6 to 3 +/- 0.6 l/min/m2 (p less than 0.01). Transdermal nitroglycerin also significantly reduced pulmonary arterial and right atrial pressures (from 43.5 +/- 9.5 to 31 +/- 11.4 and from 7.4 +/- 6.6 to 3.8 +/- 4.7 at peak effect, respectively) as well as pulmonary and systemic vascular resistances (from 10.7 +/- 6.6 to 6.5 +/- 3.2 and from 26.2 +/- 5.1 to 22.5 +/- 5.7, respectively). There was no change in heart rate or systemic arterial pressure. These beneficial hemodynamic responses persisted for 24 h. No rebound deterioration occurred upon withdrawal of the nitroglycerin. No significant hemodynamic changes occurred during placebo treatment period. Thus, low doses (10 mg/24 h) of transdermal nitroglycerin induce significant hemodynamic benefit that is sustained for 24 h in patients with heart failure.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Sustained beneficial hemodynamic effects of low transdermal nitroglycerin doses compared with placebo in patients with congestive heart failure. 312 12

The resting and exertional haemodynamic effects of acute and chronic discontinuous (one tablet every 6 h) treatment with 5 mg of buccal nitroglycerin (BN) have been assessed in nine postinfarction heart failure patients. At rest, pulmonary artery (PAP), pulmonary wedge (PWP), and right atrial pressures (RAP) were reduced by 42%, 55% and 77%, respectively, after the first dose and by 26%, 32% and 45%, respectively, after the chronic (three weeks) treatment with BN. During exercise, at the same workload, PAP, PWP and RAP were significantly reduced by 44%, 54% and 62%, respectively, after acute treatment and by 28%, 34% and 44%, respectively, after chronic treatment. The maximal workload (Kgm) increased by 179% and 166% and the exercise time increased by 78% and 71% after acute and chronic therapy, respectively. At the maximal workload, after acute BN, overall haemodynamics were better than in the basal state. PAP, PWP and RAP were still reduced by 19%, 31% and 31%, respectively, after acute treatment, while after chronic phase the results did not differ from control. The severity of cardiac failure, according to the Weber classification, was reduced by acute and chronic therapy. We can conclude that the buccal nitroglycerin showed clear efficacy in improving overall haemodynamic parameters both at rest and during exercise in post-myocardial infarction patients with heart failure. The discontinuous treatment maintained the effect of nitroglycerin without clear evidence of tolerance during chronic therapy.
 ...
PMID:Resting and exertional haemodynamic effects of buccal nitroglycerin: acute and chronic discontinuous treatment in post-myocardial infarction patients with heart failure. 313 10

The efficacy of transdermal nitroglycerin was investigated in 18 patients with moderate to severe congestive heart failure in a placebo-controlled, double-blind, crossover study. Treatment periods were of four weeks, following a one week dose titration period during which the maximum tolerated dose within the range of 5-15 mg was estimated. Therapeutic effects were evaluated by clinical examination (NYHA class), treadmill exercise, echocardiography and patient subjective scaling of general well being, cardiac symptoms and dyspnoea. Both patient and investigator analogue scaling of general well being showed improved scores indicating an improvement throughout the study. This tendency was even more marked when comparing inclusion values with those after each treatment period (P less than 0.05). However, when comparing values before with those after each treatment period, only the investigator scaling of heart failure level proved significantly higher after the placebo period (P less than 0.05). No other findings of significance were observed. We conclude that transdermal nitroglycerin given in the present doses over four weeks fails to improve the clinical situation in patients with moderate to severe congestive heart failure.
 ...
PMID:Efficacy and tolerability of transdermal nitroglycerin in heart failure. A noninvasive placebo controlled double-blind cross over study. 313 11

The effect of nitroglycerin and sodium nitroprusside on arterial and venous blood gases and acid-base state as well as central hemodynamic parameters were assessed in myocardial infarction patients using a micro-Astrup and a rheoplethysmograph. Blood oxygen flow and oxygen uptake were estimated. Nitroglycerin and sodium nitroprusside, administered to myocardial infarction patients showing no signs of heart failure, caused a significant reduction in arterial blood partial oxygen pressure (pO2), which, however, did not lead to a reduction of oxygen flow and tissue oxygen provision. In myocardial infarction patients with heart failure, nitroglycerin and sodium nitroprusside had a favorable effect on systemic oxygen regimen and central hemodynamics.
 ...
PMID:[Effect of peripheral vasodilators on the oxygen system of the body and central hemodynamics in patients with acute myocardial infarction]. 314 56

To evaluate how necessary and helpful invasive hemodynamic measurements after thoracic surgery are we studied 25 patients after pneumonectomies (n = 5), lobectomies and bilobectomies (n = 10), partial lobectomies (n = 6) and thoracotomies without lung resection (n = 4). Measurements were taken between half an hour and eighteen hours after closure of the rib cage using a preoperatively introduced Swan-Ganz-catheter. Pulmonary resistance was elevated in 12 out of 17 cases. 6 out of 25 patients had a mean pulmonary arterial pressure greater than 20 Torr. The cardiac index was below the lower limit of normal in 16 of 23 cases. 5 patients had an increased stroke work index. There was no correlation between the hemodynamic parameters and the type of surgery. In 7 patients the measurements indicated hypovolemia. Isolated right or left sided cardiac insufficiency was noted in one case each. Four patients received nitroglycerin intravenously resulting in a dose-dependent reduction in pulmonary arterial pressure, pulmonary resistance and heart work. Hemodynamic monitoring with a Swan-Ganz-catheter seems not to be necessary in every case. But it proved to be a safe method which can help in the management of high-risk patients.
 ...
PMID:[Hemodynamics in the early postoperative period after thoracotomy and lung resection]. 323 37

A study was made of the peculiarities of therapy of chronic heart failure (CHF) resulting from rheumatic heart disease under low-altitude (200 patients) and high-altitude (139 patients) conditions using strophanthin (76 patients), digoxin (76 patients), myofedrin (30 patients), nitroglycerin (43 patients), nitrong (35 patients), corvaton (46 patients), hydralazine (40 patients), nifedipine (52 patients), and verapamil (31 patients). It was shown that glycoside intoxication was twice as frequent in the patients with severe CHF under high-altitude conditions requiring the use of lower doses of cardiac glycosides and more thorough medical control. Better response to nitrates, corvaton, hydralazine, and nifedipine in multimodality treatment of CHF was found in mountain dwellers. Low clinical and hemodynamic results and frequent side effects of myofedrin and verapamil were established limiting their wide use in CHF patients living under high-altitude conditions.
 ...
PMID:[Characteristics of the pharmacotherapy of chronic heart failure under high-altitude conditions]. 336 71

Verapamil has been shown to be effective in reducing the frequency of episodes of ischemic pain in patients with unstable angina pectoris, and to be more effective than beta-adrenoceptor antagonists in such patients. However, in many patients ischemic symptoms persist despite verapamil therapy. In a group of 33 consecutive patients admitted to the Coronary Care Unit with unstable angina pectoris and treated with verapamil and nitroglycerin, we prospectively tested the hypothesis that plasma concentrations of verapamil were a direct determinant of resolution of ischemic symptoms over the initial 72-h period of admission. During this period, improvement or resolution of symptoms occurred in 23 of the 33 patients. With patients receiving 240 to 320 mg/day of verapamil, plasma verapamil concentrations varied between 8 and 487 ng/ml, rising significantly with increasing duration of therapy. Mean plasma verapamil concentrations were somewhat greater in patients who improved than in those with ongoing or worsening symptoms, but the differences were not statistically significant. Furthermore, no correlation was found between symptomatic status and plasma concentrations of norverapamil, the active metabolite of verapamil. In one patient cardiac failure worsened, possibly attributable to an elevated plasma verapamil concentration (336 ng/ml). We conclude that in this clinical setting there is little place for routine monitoring of plasma verapamil concentrations.
 ...
PMID:Verapamil in unstable angina pectoris: failure to demonstrate a relationship between efficacy and plasma levels. 337 79

We studied the acute effects of nisoldipine, a new second-generation calcium channel-blocking drug, on cardiac hemodynamics and left ventricular (LV) contractility in 10 patients with grade 2 to 4 cardiac failure. Pressures were measured from an arterial line and a flow-guided catheter in the pulmonary artery, cardiac output by thermodilution, and LV ejection fraction simultaneously by radionuclide ventriculography. Ventricular loading conditions were altered by sublingual nitroglycerin to facilitate construction of LV end-systolic pressure (radial stress)-volume and stress-shortening curves. Nisoldipine, given by continuous intravenous infusion (0.12 micrograms/kg/min), reduced mean arterial pressure (p = 0.001), systemic vascular resistance (p less than 0.05), and the double product, a measurement of myocardial oxygen demand (p less than 0.01). Cardiac index, stroke index, and LV ejection fraction increased in 8 of the 10 patients. LV contractility was initially greatly reduced and was unchanged or slightly decreased during the administration of nisoldipine. Emax, the slope of the end-systolic pressure-volume curve, was unaltered in half of the patients and decreased in the others (NS), whereas the end-systolic stress-shortening curve did not change. In summary, nisoldipine has a potentially useful acute hemodynamic profile in patients with cardiac failure; it increases forward blood flow in most patients, decreases the determinants of myocardial oxygen demand, and produces little measurable changes in the inotropic state of the left ventricle.
 ...
PMID:Effect of the second-generation calcium channel blocker nisoldipine on left ventricular contractility in cardiac failure. 337 41

Vasodilator therapy of heart failure has through the last 5-10 years become a well established treatment. Traditionally these drugs have been classified after their primary site of action on the vascular beds. Thus drugs primarily acting on the arteriolar bed are called afterload-reducing agents and are exemplified by hydralazine. Drugs primarily acting on the venous bed have been called preload-reducing reducing agents and the typical example is nitroglycerin. Other drugs, like prazosin, act on both the arteriolar and venous vascular beds. The classification is, however, not as sharp as originally believed since preload- and afterload-reducing activities mix with each other. Treatment with vasodilators for chronic heart failure has mainly been advocated in patients with valvular regurgitation, ischemic heart disease and various types of dilated cardiomyopathies. It seems appropriate today to put some questions concerning vasodilator therapy for heart failure. Among such questions are: When in the natural history of congestive heart failure should vasodilator therapy be commenced? How effective is long-term administration of vasodilating drugs? May vasodilator therapy decrease mortality in congestive heart failure? What about the efficacy of new vasodilating drugs compared to more traditional ones? In the review of vasodilating drugs besides ACE inhibitors, these questions will be addressed.
 ...
PMID:Aspects on "traditional" vasodilators in the treatment of chronic heart failure. 352 22


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>