Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Eighty patients undergoing abdominal surgery were studied to evaluate ECG changes in perioperative period and also identify the factors influencing the incidence and the severity of postoperative ventricular arrhythmia. Holter ECG was recorded with CM5 and NASA leads from the night before operation to the night of the 2nd postoperative day. Tachycardia (greater than or equal to 100 beats.min-1) was found in 46.3% of the patients preoperatively and in 55% postoperatively. Bradycardia (less than or equal to 50 beats.min-1) was found in 30% of the patients mostly in the night prior to the operation, while only 1 patient (1.3%) demonstrated bradycardia postoperatively. SVPCs were observed in high incidence ranging from 75% preoperatively to 85% postoperatively. Two patients had paroxysmal supraventricular tachycardia postoperatively. VPCs were observed in 42.5% of the patients preoperatively and in 53.8% postoperatively. Warning arrhythmias which were ranked as more dangerous than Lown 2 were observed in 15% of the patients preoperatively, in 11.3% intraoperatively and in 23.8% postoperatively. Serious arrhythmias which needed immediate treatment were found in 6.3% of the patients preoperatively, in 10% intraoperatively and in 11.3% postoperatively. ST depression was recorded in 11 patients at CM5 and 2 patients at NASA leads. Chi-square and Hayashi's multidimensional quantification analyses were applied to determine the relationship between postoperative VPCs and pre- and intra-operative clinical factors. Factors such as age, type of surgery, intraoperative VPCs, ASA classification, ischemic changes in preoperative ECG, intraoperative blood loss, operation time, Goldman score, untreated hypertension as well as ischemic heart disease and abnormal findings of Master ECG were considered to be contributing to the high incidence and the severity of post-operative VPCs. When multidimensional quantification analysis is applied to the data, the occurrences of no VPCs, occasional VPCs, warning VPCs and serious VPCs could be predicted in postoperative patients.
 ...
PMID:[Holter electrocardiographic findings in surgical patients during the perioperative period]. 156 May 81

In 1988 the fourth Joint National Committee (JNC IV) issued new guidelines for the detection, evaluation, and treatment of hypertension. Pharmacologic along with nonpharmacologic therapy is indicated for hypertensive patients whose diastolic blood pressures average greater than or equal to 95 mmHg over a period of time and for patients who have a diastolic blood pressure of 90 mmHg to 94 mmHg with evidence of target organ disease and/or other major risk factors. In the absence of target organ disease and/or other major risk factors, a trial of nonpharmacologic treatment is recommended for patients with a diastolic blood pressure of 90 mmHg to 94 mmHg. The JNC IV report recommends initiating pharmacologic treatment with any one of the following classes of drugs: diuretics, beta blockers, calcium channel blockers, or ACE inhibitors. In general, diuretics and calcium channel blockers are especially indicated for elderly and black patients and beta blockers and ACE inhibitors for young and white patients, but there are many exceptions. In selecting the appropriate step-one agent for a given patient, the therapeutic "two-for-one" concept is emphasized whereby one antihypertensive drug may also be beneficial for a coexisting condition. Examples are: diuretics or ACE inhibitors in congestive heart failure; calcium channel blocking drugs or beta blockers in angina pectoris or paroxysmal supraventricular tachycardia; and beta blockers for migraine headache or senile tremor.
 ...
PMID:Mild hypertension: critical analysis of different therapeutic approaches. 266 23

Isolation, purification and determination of the amino acid sequences of biologically active peptides were performed in 1983-84 by several groups. By that time the existence of such a humoral diuretic/natriuretic factor had been proposed for many years. The main, and perhaps the only, circulating form of atrial natriuretic peptide (ANP) is a 28 amino acid peptide structure with a disulphide bridge. This peptide is distributed mainly peripherally in the right and left cardiac atria. Smaller amounts are found in neonatal cardiac ventricles as well as in autonomic ganglia. In the central nervous system, high concentrations are found in hypothalamus, while lower concentrations are found in midbrain and brain stem regions. The amino acid sequence of ANP in the brain may be shorter than the form originating from cardiac atria. A 1 126 amino acid prohormone is present in granulae of atrial myocytes. After atrial distention the circulating 28 amino acid form is cleaved off. The main actions of this hormone include a diuretic/natriuretic effect, relaxation of vascular smooth muscle, and inhibition of basal or stimulated aldosterone secretion from the adrenal cortex. In the central nervous system, ANP has antidipsogenic actions, decreases salt appetite and lowers blood pressure. ANP may be of pathophysiological importance in several cardiovascular disorders such as congestive heart failure, paroxysmal supraventricular tachycardia and possibly also arterial hypertension. ANP seems to be a circulating hormone as well as putative neurotransmitter with important regulatory actions on salt and water homeostasis as well as blood pressure regulation.
 ...
PMID:ANP--a cardiac hormone and a putative central neurotransmitter. 295 8

Calcium antagonists have recently emerged as a class of drugs for the treatment of angina, hypertension and certain cardiac arrhythmias. Verapamil is the prototype calcium antagonist and has the most clearly defined antiarrhythmic properties. Other agents in the class include D-600 (gallopamil), tiapamil, nifedipine, and diltiazem. The antiarrhythmic effects of these compounds can be correlated with their electrophysiological properties which may differ significantly among different compounds and also between isolated tissues in intact animals and man. As a class they do not increase the effective refractory period of the atria, ventricle, His-Purkinje fibres or the accessory pathways in the heart. The dominant effect is slowing of conduction in the AV node with the prolongation of the AV nodal refractory period. The most marked changes are produced by verapamil, the least with nifedipine which is devoid of antiarrhythmic actions. Verapamil and its congeners as well as diltiazem terminate paroxysmal supraventricular tachycardia and slow the ventricular response in atrial flutter and fibrillation. They are also of prophylactic value in preventing recurrences of paroxysmal supraventricular tachycardia and controlling the ventricular response in atrial flutter and fibrillation during long term oral therapy. Their value in ventricular arrhythmias is uncertain but they are unlikely to be effective except in those complicating coronary artery spasms. The relative merits and potencies of various calcium antagonists in different arrhythmias need further studies.
 ...
PMID:Calcium antagonists. Clinical use in the treatment of arrhythmias. 633 97

The pharmacokinetics, clinical efficacy, and adverse effects of three calcium-channel blocking agents--verapamil, nifedipine, and diltiazem--are reviewed. Verapamil, nifedipine, and diltiazem are absorbed well after oral dosing, but absolute bioavailability of each is reduced substantially by a first-pass effect. Each drug is metabolized extensively (verapamil and diltiazem to moderately active metabolites) by the liver. A substantial percentage of each drug is bound to plasma proteins, but the binding is of clinical importance only for nifedipine (92--98% protein bound). Intravenous verapamil has become the agent of first choice for treatment of acute paroxysmal supraventricular tachycardia (PSVT); use of chronic oral verapamil therapy for prophylaxis remains controversial. Verapamil and diltiazem have been evaluated with mixed results for atrial flutter and fibrillation. For treatment of myocardial ischemia, calcium-channel blockers may be of some value (possibly in combination with nitrates of B blockers). All three agents have been studied in patients with exertional angina with good results. Calcium-channel blockers appear to be equal with nitrates for treatment of variant angina. Patients with hypertropic cardiomyopathy have been treated with verapamil and nifedipine with promising results. Nifedipine has been effective for treatment of essential hypertension. Adverse effects of calcium-channel blockers have been relatively minor or infrequent. Diltiazem overall has the best side-effect profile, with adverse effects causing discontinuation of therapy in about 2--10% of patients; verapamil in intermediate (8--10%) and nifedipine the worst (17%) in this respect. The most common side effects generally are fatigue, headache, dizziness, skin rash, and peripheral edema. While they generally should be reserved for patients in whom more conventional therapy has failed (except those with PSVT), calcium-channel blockers appear to have a valid role as reserve agents for exertional and variant angina, cardiomyopathy, and hypertension.
 ...
PMID:Update on calcium-channel blocking agents. 635 66

ACEIs, angiotensin II receptor antagonists, and calcium antagonists are effective and well-tolerated antihypertensive agents but, except in special situations, should be considered alternative drugs for first line therapy until randomized trials show that they are at least as effective as diuretics and beta-blockers in preventing cardiovascular morbidity and mortality for a broad spectrum of hypertensive patients. ACEIs are particularly indicated for managing patients with congestive heart failure due to systolic dysfunction and patients with diabetic nephropathy, especially in Type I diabetes. Theoretically, the AII receptor antagonists will be equally effective for these indications, and randomized trials are now underway to demonstrate this. Special indications for calcium antagonists in the management of hypertension include angina pectoris, and for the non-dihydropyridine calcium antagonists, paroxysmal supraventricular tachycardia, and atrial fibrillation with rapid ventricular rate. Isolated systolic hypertension in the elderly is a special indication for long-acting dihydropyridine calcium antagonists, although diuretics are preferred. Calcium antagonists have been particularly effective in managing hypertension induced by cyclosporine. They are contraindicated in CHF due to systolic dysfunction and in the management of acute myocardial infarction. The long-term cardioprotective effect of calcium antagonists after a myocardial infarction has been demonstrated only for verapamil and diltiazem in patients with no evidence of LV dysfunction during their infarction. Calcium antagonists should be prescribed for this purpose only when beta-blockers are poorly-tolerated or contraindicated.
 ...
PMID:Antihypertensive therapy. Angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, and calcium antagonists. 935 1

ESWL has proved to be a safe and effective method in the treatment of urinary tract calculosis. The method is hardly invasive when compared to all other methods known so far, except for the treatment of calculosis with a selective pharmacotherapy. Moreover, the method is contactless, extracorporeal, mostly necessitating no anaesthesia and spasmoanalgesic therapy, except in the very small number of patients. The importance of the problem of urinary tract calculosis is enormous. Calculosis affects children, and particularly adults, predominantly psychically and physically active individuals in the most productive phase of their lives as well as elderly population. All this makes considerable its adverse effects on health, producing great interest of specialists for this disease. However, the incidence of the disease requires much better surveillance of the patients, since the preventive measures must be undertaken in time as they are of utmost importance. The treatment of urinary tract calculosis has brought great improvements enabling resolution of all types of concrements, irrespectively of their size and chemical composition, in absence of surgical incisions and anaesthesia, except for the small number of patients. Therefore, ESWL therapy has been most advantageous in different types of lithotriptors, particularly lithotriptors of the second generation, such as lithostar lithotripter. Renal calculi are the most convenient for this therapeutical procedure. Ever since its introduction into the clinical practice, the method has become the first therapeutical choice in the treatment of urinary tract calculosis. The indications for this type of therapy are enlarger and now they include all types of urinary tract calculi. Hospitalization and convalescence periods following ESWL are reduced when compared to nephrolithotomy, pyelotomy or ureterolithotomy. The study included a series of 2034 patients treated by this method. Our results revealed a low morbidity rate. Transitory haematuria occurred in almost all patients. Significant fall in haemoglobin levels was extremely rare, occurring only in four of patients with prolonged haematuria resolved following blood transfusion. In 321 patients enormous "Steinstrasse" was evidenced. In 54 patients percutaneous nephrostoma was created. Ureteroscopical removal of the stone was attempted in 14 patients; however, the success was moderate. Urosepsis developed in 29 patients. In 107 patients of the series, heart-related problems were recorded during and immediately after ESWL treatment. Paroxysmal supraventricular tachycardia was recorded in 20 patients. Arterial hypertension was evidenced in 63 patients, although they had previous history of hypotension. Skin lesions were found in 1004 patients, and none of them necessitated the therapy. It may be concluded that ESWL is the optimal method in the treatment of urinary tract calculosis; it is free of risk of development of predicted and unpredicted complications, which are now readily resolved failing to induce higher mortality rates among the patients treated by this method. The patients with cardiac problems should be previously well compensated, and after achievement of satisfactory compensation (sinus rhythm of the heart, etc.), the patients may be subjected to the treatment. This therapeutical postulate also applies to patients with coagulation disorders, when they are first subjected to an intensive treatment; after the satisfactory condition is accomplished they can undergo the treatment without any risk of haemorrhage or similar complications. Silica ureteral probes protect the kidney from complications following ESWL. Morbidity induced by ureteral obstruction is minimized, particularly if calculi of greater size than 2.5 cm are treated. Careful assessment is mandatory in patients at high risk, as well as appropriate preoperative conselling with relevant specialists. (ABSTRACT TRUNCATED)
 ...
PMID:[Extracorporeal shock wave lithotripsy: prophylaxis, complications and therapy]. 948 May 68

A 55-year-old Japanese man was hospitalized for palpitations and severe chest oppression one hour after he ingested about 1500 ml of beer and sildenafil (Viagra) 50 mg. At 43 years of age, he had been diagnosed with intermittent WPW syndrome following a paroxysmal supraventricular tachycardia (PSVT) attack. He took a 1 mg tablet of doxazosin daily for mild hypertension. On admission, his blood pressure was 90/54 mmHg and his heart beat was weak and irregular with a rate of about 220/min. Since atrial fibrillation (Af) was diagnosed on an electrocardiogram (minimum RR interval; 0.22 seconds), direct current shock was performed with 100 joules and 150 joules but conversion to sinus rhythm failed. Sinus rhythm returned spontaneously from Af four hours after taking sildenafil. Since blood pressure was 50/17 mmHg despite the return to sinus rhythm, blood pressure was maintained by dopamine for twelve hours after sinus rhythm returned. The patient underwent catheter ablation for curative therapy and thereafter has not had any further episodes of tachycardia.
 ...
PMID:Atrial fibrillation and continuous hypotension induced by sildenafil in an intermittent WPW syndrome patient. 1073 66

OBJECTIVE: To investigate the correlation between RFCA catheter cumulative energy and autonomic nerve injury. METHODS: Forty-one patients with paroxysmal supraventricular tachycardia were enrolled, Patients were excluded if they had Diabetes, Hypertension, Congestive Heart Failure or other organic heart disease. HRV and biochemical markers were measured before and after the RFCA. RESULTS: Compared with pre-ablation values,there was significantly decrease in post-ablation low frequency (LF) and high frequency (HF). This was noted in both the septal group (AVNRT and septal pathway) and free wall group (free wall accessory pathway).Post-procedure,the sensitivity of cardiac troponin I(cTnI) for myocardial injury detection was 58.3%, AST was 41.7%. This was significantly higher than other markers(CK:4.2%, CK-MB:10.4%, LDH:20.8%). The post-ablation sensitivity of cTnI was 54.2%, 6.3% and 52.1%at 1 hour, 12 hours, and 24 hours respectively. A significant correlation between cumulative energy and delta HF(r=0.688,P=0.01) or delta LF (r=0.462, P<0.05).was noted in free wall group.(delta HF=pre-ablation HF-post-ablation HF/pre-ablation HF x 100%). There was no significant correlation between biochemical markers and either delta HF or delta LF. CONCLUSION: RFCA induced injury on cardiac autonomic nerves related to both cumulative energy and ablation site,but not size of myocardial injury as determined by cTnI measurement. cTnI is an excellent biochemical marker of myocardial injury.
 ...
PMID:[Radiofrequency catheter ablation autonomic nerve injury] 1259 13

To investigate the feasibility and safety of the transesophageal atrial pacing stress test combined with echocardiography (TAPSE) 1,727 TAPSE tests were performed on 1,641 patients consecutively referred to our echocardiographic laboratory for nonexercise stress testing (1,319 men; mean age 60 +/- 9 years; 34% of whom were outpatients). Wall motion abnormalities were present at baseline echocardiography in 975 cases (56%). TAPSE was feasible in 1,648 cases (95.4%). It was not feasible in 79 patients due to failure of positioning the transnasal catheter (n=11), the patient's intolerance of esophageal stimulation (n=24), failure to obtain any or stable atrial capture (n=36), or because the echocardiogram could not be evaluated at the peak of the test (n=8). TAPSE was diagnostic in 1,584 cases (96% of the feasible tests, 92% of all attempts). TAPSE was nondiagnostic in 64 cases (4% of the feasible tests) due to second-degree atrioventricular type I block resistance to atropine administration with failure to achieve 85% of the age-predicted maximum heart rate (n=59) or due to side effects, such as arrhythmias (n=3) or hypertension (n=2), which required premature interruption of the test. There were no major complications (death, myocardial infarction, or life-threatening arrhythmias). There were 28 instances of minor complications that comprised transient arrhythmias, including atrial fibrillation (n=8), paroxysmal supraventricular tachycardia (n=6), automatic atrial tachycardia (n=1), sinus arrest (n=1), atrioventricular junctional rhythm (n=2), ectopic atrial rhythm (n=2), nonsustained ventricular tachycardia (maximum 6 beats, n=3), hypotension (n=1), and hypertension (n=4) leading to interruption of the test. Only 5 complications hampered a diagnostic result, whereas 18 occurred during or after a positive test and 5 during a negative, but diagnostic, test. Thus, TAPSE is a highly feasible and very safe stress test. It gives high percentage of diagnostic tests and may represent a valid alternative to pharmacologic stressors.
 ...
PMID:Feasibility and safety of transeophageal atrial pacing stress echocardiography in patients with known or suspected coronary artery disease. 1467 70


1 2 Next >>