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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The role of temporary percutaneous endocardial pacing has been examined in a retrospective analysis of all paced patients admitted to one coronary care unit over a 6 year period. The majority of 162 cases (84.6%) were paced for complete heart block complicating acute myocardial infarction. These patients had a higher incidence of previous hypertension, myocardial infarction and diabetes, compared to matched controls (P less than 0.05, less than 0.02 and less than 0.001, respectively). Admission blood glucose levels were also higher (P less than 0.05). The in-hospital mortality was high (46.7%), especially for those with anterior myocardial infarction (74.5%). Twenty-five (15.4%) patients without recent myocardial infarction were paced for symptomatic brady-dysrhythmias, usually due to chronic complete heart block (Lenegre's disease) or sick sinus syndrome. Most later required permanent pacing. Complications of temporary pacing were more frequent in those who died, the most common being dysrhythmias during pacemaker insertion. Review of our cases suggests that whilst facilities for temporary pacing were extremely valuable, many cases treated were not haemodynamically compromised and probably did not require pacing. Guidelines should be established on coronary care units to prevent the unnecessary morbidity, mortality and expense of the procedure.
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PMID:Temporary transvenous cardiac pacing: 6 years experience in one coronary care unit. 259 96

The role of retrograde coronary sinus perfusion in the preservation of ischemic myocardium is controversial. We evaluated the use of combined antegrade and retrograde cardioplegia in 59 patients undergoing coronary artery bypass surgery. Nineteen patients were administered antegrade cardioplegia, whereas 40 patients were administered antegrade plus retrograde cardioplegia. Hemodynamic data were obtained before the onset of cardiopulmonary bypass and at 1, 2, 4, 8, 16, and 24 hours after cessation of cardiopulmonary bypass. Myocardial function was assessed by measuring systemic blood pressure, heart rate, cardiac index, pulmonary artery pressure, and capillary wedge pressure. Both cohorts were similar in age, incidence of hypertension, diabetes, and previous myocardial infarction. No significant differences were noted in the need for postoperative inotropic support, the incidence of postoperative arrhythmias, myocardial infarction, heart block, or death. The two groups were similar with respect to cardiac index and systemic and pulmonary vascular resistance. However, the left ventricular stroke work index, when expressed as a function of its prebypass control value, was significantly improved (p less than 0.01) in the cohort administered combined cardioplegia. In the combined group recovery of left ventricular stroke work index occurred earlier and was more complete. These results suggest that the use of combined antegrade/retrograde cardioplegia is safe and may provide superior protection.
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PMID:Combined antegrade/retrograde cardioplegia for myocardial protection: a clinical trial. 268 23

The records of 483 patients admitted to the emergency room because of syncope were reviewed. Forty-one patients were found to have drug-related syncope. Thirty-nine experienced syncope related to drugs administered for cardiovascular disease. The most frequently associated diseases were anginal syndrome (22 patients), hypertension (13 patients), and a history of myocardial infarction (6 patients). Thirty-eight patients experienced symptomatic orthostatic hypotension following drug taking (nitrates in 19 patients, beta blockers in 10 patients, nifedipine in 3 patients, prazosin and quinidine in 2 patients each, methyldopa and verapamil in 1 patient each). One patient developed complete heart block as a result of digoxin intoxication. Two patients developed the characteristic picture of anaphylactic reaction (1 with ampicillin, 1 with dipyrone). During one-year follow-up, without the offending medications, no further syncopal episodes were reported by these patients. We conclude that drug-related syncope was more common among our patients with syncope than had been reported previously. It is suggested that drug-related syncope should be taken into consideration in any patient with syncope who is treated by any of the above-mentioned drugs.
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PMID:Drug-related syncope. 280 62

We have used a combination of a beta-blocker and verapamil to treat 42 consecutive patients with angina resistant to either agent alone. Patients with heart failure, heart block or uncontrolled hypertension were excluded. The mean duration of follow-up was 6.5 months. Thirty-six patients (81%) reported an improvement and the number of angina attacks was reduced from 17/week to 5/week. Side effects necessitated withdrawal of one or both drugs in 6 patients, 2 of whom developed bradyarrhythmias not solely related to drug treatment. The most common complication was mild left ventricular failure (6) treated by reducing or stopping the beta-blocker. The data suggest that the combination of verapamil and a beta-blocker may be used in a relatively unselected group of patients with difficult angina. However, as dosage adjustment and close observation may be necessary to minimise side effects, the use of this combination should be limited to hospital practice.
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PMID:Tolerability of combined treatment with verapamil and beta-blockers in angina resistant to monotherapy. 285 47

At present nitrates remain the initial treatment for relief or prevention of angina in patients with coronary artery disease. In cases where nitrates and beta blockers have been used and are ineffective for managing effort angina, calcium antagonists may be substituted or added to the beta-blocking treatment. When the predominant symptom is rest angina, and there is evidence suggesting coronary artery spasm, nitrates and a calcium antagonist can be effective therapy. In patients with heart block, bradyarrhythmias, heart failure, or hypertension nifedipine may be the drug of choice. In contrast verapamil merits choice when supraventricular tachycardia is present. Diltiazem appears intermediate between nifedipine and verapamil and may be particularly useful when hypotension or other side effects must be avoided.
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PMID:Calcium antagonists. 286 40

Adverse effects of beta-adrenergic receptor blocking drugs can be divided into two categories: 1) those that result from known pharmacological consequences of beta-adrenergic receptor blockade; and 2) other reactions that do not appear to result from beta-adrenergic receptor blockade. Adverse effects of the first type include bronchospasm, heart failure, prolonged hypoglycemia, bradycardia, heart block, intermittent claudication, and Raynaud's phenomenon. Neurological reactions include depression, fatigue, and nightmares. It is not yet proven whether the beta 1-selective adrenergic blockers or those with partial agonist activity reduce the overall frequency of adverse reactions seen with propranolol. Patient age does not appear, in itself, to be associated with more beta-blocker side effects. Side effects of the second category are rare. They include an unusual oculomucocutaneous reaction and the possibility of oncogenesis. There are also many drugs that interact with beta-blockers, which may increase toxicity. Finally, there are specific patient characteristics where one beta-blocker may be more effective and safer than another.
Hypertension 1988 Mar
PMID:Beta-adrenergic receptor blockers. Adverse effects and drug interactions. 289 72

PN 200-110 (isradipine) is a new dihydropyridine calcium antagonist with selective actions on the heart as well as the peripheral circulation. It selectively inhibits the sinus node but not atrioventricular conduction and its negative inotropic action is minimal, about 20 times weaker than its negative chronotropic effect. This in vitro pattern also expresses itself in vivo: partial suppression of the reflex tachycardia induced by its peripheral vasodilatation and no effect on the P-Q interval on the electrocardiogram even at large doses. The presence of first- or second-degree heart block should therefore not limit its use, whereas the sick sinus syndrome might. PN 200-110 does not decrease myocardial contractile force even in vagotomized animals with full beta blockade. PN 200-110 nevertheless lowers myocardial oxygen consumption mainly by its action on afterload. It should therefore be useful in angina pectoris. PN 200-110 is a powerful peripheral vasodilator. It preferentially dilates coronary, cerebral and skeletal muscle vasculature. Its long lasting (24 to 48 hours) antihypertensive action is not accompanied by tachycardia in spontaneously hypertensive rats and it enhances sodium and water excretion in normotensive rats. It should be useful in the treatment of hypertension, and, considering its pattern of cardiac actions, perhaps also as an after-load-reducing agent for the treatment of heart failure. Antiarteriosclerotic effects in conscious rabbits were found at reasonably small doses, suggesting that such effects might occur in man at therapeutic doses.
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PMID:Selective effects of PN 200-110 (isradipine) on the peripheral circulation and the heart. 294 86

Calcium channel blocking drugs are a chemically heterogenous group, so it might be expected that their effects on vascular smooth muscle, cardiac contractility, and conduction tissue may differ. However, the majority of adverse reactions are predictable from their pharmacological actions and may be conveniently grouped in the following categories: 1) vasodilatation, 2) negative inotropic effects, 3) conduction disturbances, 4) gastrointestinal effects, 5) metabolic effects, and 6) drug interactions. Vasodilatory symptoms, namely, dizziness, headaches, flushing sensation, and palpitation, are more likely with nifedipine. Peripheral edema is also common with nifedipine, but the mechanism is uncertain. For a given degree of vasodilation, the greatest negative inotropic effect is seen with verapamil first, diltiazem second, and nifedipine last. Calcium channel blocking drugs are contraindicated in hypertensive patients with second and third degree heart block, sick sinus syndrome, and severe heart failure. Verapamil and diltiazem have a significant effect on cardiac conduction, whereas nifedipine, in therapeutic doses, does not. Local gastrointestinal symptoms, such as nausea and constipation, are common with verapamil. None of the calcium channel blocking drugs have been reported to adversely affect lipid or protein metabolism. However, nifedipine, verapamil, and diltiazem in high doses may inhibit liberation of insulin. The significance of this finding needs to be explored further in hypertensive diabetics. Serum digoxin levels have been shown to increase after administration of verapamil and nifedipine, but there is no evidence that this change has any clinical relevance.(ABSTRACT TRUNCATED AT 250 WORDS)
Hypertension 1988 Mar
PMID:Side effects of calcium channel blockers. 328 Apr 92

Univentricular heart is a complex congenital anomaly with an extremely dismal prognosis. Left untreated the majority of patients will die in infancy. This poor outlook has prompted an aggressive surgical approach consisting of early palliation followed by eventual complete repair. The initial palliative efforts are aimed at providing adequate arterial oxygen saturation and normalizing pulmonary artery pressure. Infants with severe cyanosis due to diminished pulmonary blood flow are best treated with a systemic to pulmonary artery shunt. Those with excessive pulmonary flow and hypertension must be banded early to prevent pulmonary vascular occlusive disease. Most patients who are properly palliated will become acceptable candidates for an eventual corrective procedure. For the majority, this will be a direct atriopulmonary connection, known as the Fontan procedure. In this operation, systemic venous blood is routed directly to the pulmonary artery, excluding the ventricular mass. Although not corrective in the usual sense, this procedure provides normal arterial saturation without ventricular volume overload. A small group of patients with univentricular heart may best be treated by partitioning the ventricular chamber into 2 halves. Septation procedures, however, carry a high operative mortality and are likely to result in complete heart block. These surgical options, when properly selected and timed, have improved the outlook for many children with univentricular heart.
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PMID:Cardiac surgery for the adolescent with univentricular heart. 358 51

We present a case of a 79-year-old woman with periods of syncope, complete heart block (CHB), and ventricular standstill during periods of increased vagal tone following sublingual nifedipine for hypertension. The syncopal episodes were associated with periods of elevated vagal tone (micturition and vomiting) with one monitored episode showing a clear time course of emesis; CHB then ensued, progressing to ventricular standstill with loss of consciousness that resolved over several minutes. Although nifedipine is not thought to affect conduction at current clinical dosages, it seems likely that the additive effects of nifedipine and elevated vagal tone produced the observed conduction abnormalities. This is the first case report of nifedipine administration followed by syncope and conduction disturbances.
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PMID:Syncope and conduction disturbances following sublingual nifedipine for hypertension. 403 65


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