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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The influences of glyceryl trinitrate, isosorbide dinitrate and sodium nitroprusside intravenously on haemodynamics, coronary circulation and myocardial oxygen consumption were investigated in closed chest dogs (n = 8). In an attempt to simulate heart failure the dogs received blood transfusion (15 ml/kg) in the presence of halothane-induced myocardial depression. All three nitrates reduced the loads for the left ventricle. With isosorbide dinitrate and sodium nitroprusside the preload and pulmonary pressure decreased to a greater extent than with glyceryl trinitrate. The haemodynamic results suggest that sodium nitroprusside is the favourable nitrate in left ventricular failure because it produces a balanced reduction in the ratio of pre- and afterload. Four micrograms/kg X min sodium nitroprusside induced marked coronary dilatation; glyceryl trinitrate had only a slight coronary vasodilating effect. With isosorbide dinitrate the myocardial blood flow remained well adapted to oxygen demand, the coronary vascular resistance did not change. Sodium nitroprusside produced a significant change of the transmural myocardial blood distribution-expressed as the epi/endocardial blood flow ratio. The ratio was increased by sodium nitroprusside, much more than by glyceryl trinitrate or isosorbide dinitrate.
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PMID:The effects of glyceryl trinitrate, isosorbide dinitrate and sodium nitroprusside on haemodynamics, coronary blood flow and myocardial oxygen consumption - an experimental study. 640 78

In the face of the recent introduction of beta-blockers and calcium inhibitors, the author examines the role of Amiodarone, Perhexiline and Molsidomine in the treatment of angina pectoris. Amiodarone, introduced in 1967, remains a very useful anti-anginal drug. The beta and alpha-sympathetic inhibition it produces, makes it effective in effort and resting angina. It is particularly useful in anginal patients with arrhythmias as it has a potent anti-arrhythmic effect at all levels. It can be used in patients with bronchial asthma, in elderly patients and in cardiac failure. However, it may give risk to hypo or hyperthyroidism and so, should not be used in patients with a history or thyroid disorders. Perhexiline has been used in France since 1973 and is a second-line drug to be used in cases of intolerance or contraindications to other anti-anginal drugs. It is effective but may cause severe, undesirable hepatic and neurological complications. These side effects are however rare at low doses. Molsidomine, a more recent molecule, has an action similar to that of the nitrate derivatives: it mainly reduces left ventricular preload. It has a slower onset of action than the classical nitrate derivatives but its duration of action seems to be longer; Molsidomine and betablockade can be a useful therapeutic association.
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PMID:[The classic anti-anginal agents and molsidomine]. 640 52

The hemodynamic and hormonal responses to nitroglycerin administered transdermally in a gel-like matrix were evaluated in nine patients with severe congestive heart failure and in nine normal subjects. In normal subjects, peripheral vasodilation was accompanied by reflex sympathetic stimulation as reflected by an increase in heart rate and plasma norepinephrine. In patients with heart failure, nitroglycerin produced sustained hemodynamic effects that began 30 minutes after the application and fully persisted for at least 6 hours. A significant decrease in right and left ventricular filling pressures was associated with an increase in stroke index and a significant decrease in forearm and pulmonary vascular resistances. There was no change in heart rate and systemic arterial pressure or in plasma norepinephrine or plasma renin activity. After 24 hours, pressures had partially returned to control levels, but mean pulmonary artery pressure was still significantly lower than in the control period. After removal of the nitroglycerin, each patient exhibited a decrease in cardiac index and an increase, above the control values, in pulmonary and systemic arterial pressures and pulmonary, systemic and forearm vascular resistances. This transient rebound appeared to be unrelated to stimulation of the sympathetic or renin-angiotensin systems. Thus, transdermal absorption of this new form of nitroglycerin appears to provide a nitrate vascular effect that is sustained for 24 hours, but an endogenous vasoconstrictor effect may influence the hemodynamic response over the first 24 hours.
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PMID:Hemodynamic and hormonal response to transdermal nitroglycerin in normal subjects and in patients with congestive heart failure. 641 42

Hemodynamic effects of vasodilator agents (molsidomine, nitroglycerin, isosorbide dinitrate or prostaglandin I2) were studied in 53 patients with acute myocardial infarction. In 20 of these patients, effect on cardiac metabolism were also studied. Patients were divided into four groups according to the Forrester subset and hemodynamic effects of these agents were evaluated by the cardiac index (CI)-preload (PAEDP) relationship. In patients of Forrester subset II and IV, vasodilators were capable of producing a considerable reduction in preload without a significant decrease in cardiac output. However, in patients of Forrester subset IV, five of six patients had only a minimal improvement in cardiac performance with vasodilator therapy because of a severe pump failure. In these patients, a combination therapy with dopamine was necessary to maintain the cardiac output. In patients with Forrester subset III, vasodilator therapy decreased cardiac index and preload was also reduced. Thus, for these patients vasodilators could not be indicated but volume infusion may be indicated. In patients with Forrester subset I, although vasodilator therapy decreased cardiac output, coronary sinus flow and myocardial oxygen consumption were also decreased, indicating that the vasodilator therapy is also beneficial for patients even without heart failure because of the protective effect of unloading on ischemic myocardium. Three nitrate agents, i.e., molsidomine, nitroglycerin and isosorbide dinitrate, demonstrated the similar effect on hemodynamics; mean blood pressure and PAEDP decreased by 7-10% and 20-29%, respectively, while systemic vascular resistance was not significantly decreased. In contrast to nitrates, PGI2 decreased mean blood pressure and systemic vascular resistance significantly, whereas a decrease in PAEDP was minimal.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Hemodynamic and metabolic effects of vasodilator therapy for heart failure in acute myocardial infarction. 642 27

Eighty patients admitted to hospital between 1975 and 1980 for "non-transmural" myocardial infarction (72 men, 8 women, mean age 56 +/- 9 years) were studied. The diagnosis was based on a severe attack of pain of over 30 minutes duration, increased serum cardiac enzyme levels (CKMB greater than 24 U; SGOT greater than 60 U), pyrexia and signs of inflammation. The patients were divided into two groups according to their ECG changes: Group A: "rudimentary" infarction with prolonged T wave inversion from V1 to V5, narrow transient Q waves and reduction of R wave amplitude in the corresponding leads; Group B: persistant prolonged, intercritical ST depression greater than 2.5 mm (subendocardial infarct). All patients underwent selective coronary angiography and left ventriculography in the RAO projection within 15 days of admission. The angiographic data (coronary score, ejection fraction, alinetic perimeter) were compared to those of 2 randomly chosen control groups: Group C: 30 inferior wall infarcts with coronary angiography and regularly followed-up; Group D: 30 transmural anterior infarcts with coronary angiography, regularly followed-up. Four factors were analysed during follow-up: the incidence of death after discharge from hospital, transmural infarction, unstable angina and cardiac failure. All patients were treated medically (nitrate derivatives, betablockers, calcium antagonists). Sixteen patients in Group A (p less than 0,025) were operated and excluded from the prognostic study. The angiographic data showed a high incidence of isolated, severe LAD disease in Group A (59.2% of cases) and that multivessel disease was commoner in Group B (78.4%). A collateral circulation revascularising the LAD was observed in 42% of patients in Group A. (ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[So-called rudimentary or nontransmural myocardial infarction. Coronary lesions, course and prognosis]. 643 44

The efficacy of three long-acting, orally administered nitrate derivatives was assessed in 10 patients with chronic heart failure. The compounds were: isosorbide dinitrate (ID) 5 mg, nitroglycerin microcapsules (NGMC) 7.5 mg and pentaerythritol tetranitrate (PETN) 160 mg. Pulmonary blood pressures were measured at regular intervals until the 6th hour following oral administration of all three compounds successively to 7 patients and of two compounds (ID and NGMC) to 3 patients. In addition, a hemodynamic study was performed in 3 of these patients while under placebo. The results showed a significant decrease in pulmonary artery diastolic pressure with all three compounds. The effects appeared after 30 minutes with ID and NGMC and after 1 hour with PETN. They lasted 1 hour with ID and 3 to 4 hours with NGMC and PETN. Maximal effect occured at 1 hour with ID (-28%; p < 0.001), at 1.5 hour with NGMC (-18%; p (< 0.01) and at 3 hours with PETN (-21%; p <0.01).
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PMID:[Comparative study of three oral nitrate derivatives. A hemodynamic assessment in 10 patients with chronic heart failure (author's transl)]. 677 96

Tolerance and cross-tolerance to nitrates has been known since 1900 but the actual clinical importance of this phenomenon is unclear. Vasodilator treatment of congestive heart failure has provided an important new role for long-acting nitrates. The advent of high-dose nitrate regimens for both angina and heart failure raises the possibility that nitrate tolerance could be a potential detriment to therapy. A number of older studies have documented the development of tolerance and cross-tolerance to blood pressure and heart rate responses to nitrates as well as the rapid onset of tolerance to nitrate headaches in subjects given nitrates on a regular basis. Animal experiments also confirm the ready appearance of nitrate tachyphylaxis. Needleman has proposed a cellular mechanism for nitrate tolerance based on a chemical alteration of nitrate receptors in the vascular wall. In spite of these studies, there is considerable evidence that clinically relevant tolerance to nitrates is rare. Several recent investigations designed to look at this problem using high-dose isosorbide dinitrate (ISD) failed to demonstrate tachyphylaxis to the anti-anginal or hemodynamic effect of ISD. However, very recent work in patients with angina suggests that tolerance to high dose ISD does occur and may reduce the duration of action of long-acting nitrates. Overall, the bulk of current evidence does not support tolerance to be a major problem in nitrate treatment of cardiac diseases, although attenuated vasodilator responses may occur after several weeks of nitrate therapy.
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PMID:Nitrate tolerance and dependence. A critical assessment. 677 5

Although nitrates produce marked decreases in ventricular filling pressures in patients with severe heart failure, their therapeutic value has long been believed to be limited because they were thought to exert minimal arterial dilating effects. Recently, however, new conceptual approaches to vasodilator drugs have been developed that have challenged this traditional view. These new perspectives indicate that nitrates exert dilator actions on both the arterial and venous circulations, and reduce both preload and afterload; such balanced circulatory responses are particularly evident when large doses of these drugs are used. Cardiac output increases markedly with nitrates in patients with a greatly increased systemic vascular resistance before treatment or with significant mitral regurgitation. The major reason for the limited increases in cardiac output noted in previous studies is the inclusion of patients with heart failure whose pretreatment values for cardiac output were within normal limits; in these persons nitrates markedly activate neurohumoral vasoconstrictor mechanisms that counteract the arterial dilating actions of these drugs. Long-term nitrate therapy attenuates exercise-induced increases in pulmonary venous pressures, which permit patients to undergo repeated submaximal exercise with fewer symptoms; this improves physical conditioning and exercise capacity, even in the absence of drug-related changes in cardiac output. The long-term hemodynamic and clinical benefits of nitrates in heart failure have been confirmed by two independent randomized double-blind placebo-controlled clinical trials.
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PMID:New perspectives on therapeutic application of nitrates as vasodilator agents for severe chronic heart failure. 685 73

In a double-blind cross-over study with 9 patients suffering from ischemic cardiomyopathy with cardiac failure, the effect of 3 different drug preparations on pulmonary artery pressure (PA-pressure) was studied. Iso-Ameritrat is a new drug-combination consisting of a sweet-tasting wrap containing 2.5 mg Isosorbide Dinitrate (ISDN) and of a bitter-tasting core containing 10 mg Pentaerythritol Tetranitrate (PETN) and 200 mg Meprobamate. A statistically significant decrease of PA-pressure values could be observed already 3 minutes after administration of Iso-Ameritrat. Within the next minutes this decrease even augmented and lasted over the whole period of measurement (30 minutes). After administration of the second drug preparation (Ameritrat), containing 10 mg PETN and 200 mg Meprobamate in the core, but not any nitrate in the wrap a slight but also statistically significant decrease of PA-pressure values could be documented. Therefore a sublingual resorption of PETN can be assumed. The precise beginning of the effect of PETN couldn't be assured, but it must be within 5 minutes. A thir preparation, containing only 200 mg Meprobamate in the bitter tasting core caused no significant decrease of PA-pressure values.
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PMID:[Pulmonary artery pressure measurement for assessment of bioavailability of isosorbide dinitrate and pentaerythritol tetranitrate (author's transl)]. 699 69

The results of this study with 102 patients, suffering from cardiac insufficiency and coronary heart disease are that a fixed combination of digoxin with nitrate-compositions is not convenient. In 45 cases the digoxin dose had to be altered, partly even several times, whilst only in 23 patients an alteration of the dosage of the nitrate compositions had to be done, independently from the digoxin dose.
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PMID:[Do fixed combinations of digoxin and nitrates have a therapeutic advantage?]. 721 39


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