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Ten patients with typical angina pectoris and without hypertension, congestive heart failure or other disease were treated with alternating four-week courses of metoprolol (alpha beta1 cardioselective beta-blocking agent), propranolol and placebo. Midway through each four-week period, drug dosage was doubled; thus, regimes were metoprolol, 150 and 300 mg/day, propranolol, 120 and 240 mg per day and placebo, 3 and 6 tablets per day. Serum concentrations of metoprolol increased with increasing dosage in a proportion very similar to that seen with propranolol. Statistically significant reductions in angina frequency/nitroglycerin consumption, and statistically significant increases in total work performed on a bicycle ergometer, were found with both active compounds when compared with placebo. No significant differences were noted between the two active compounds. Though most patients showed greatest improvement on the higher of the two drug dosages, three patients with metoprolol and two with propranolol responded best on the lower dose regime. Both compounds reduced heart rate at rest and during exercise. Neither reduced arterial pressure at rest, but both reduced arterial pressure during exercise. It is concluded that metoprolol is as effective as propranolol in the reduction of angina attacks and improvement in exercise tolerance during chronic therapy in patients with uncomplicated angina pectoris. It is now appropriate to study the effects of metoprolol in patients with coronary artery disease in whom the harmful effects of non-selective beta-blockade heretofore have precluded optimal therapy with beta-blocking drugs.
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PMID:Assessment of metoprolol, a cardioselective beta-blocking agent, during chronic therapy in patients with angina pectoris. 79 74

Angina pectoris is a subjective symptom recognized primarily by a careful history. It must be differentiated from nonatherosclerotic chest pain. Arteriography should be performed when the diagnosis is in doubt or when the stable from becomes unstable. Management must include: attention to risk factors; awareness of precipitating factors; treatment of other illnesses such as hypertension and diabetes, and the use of drugs: nitroglycerin and, for long-term therapy, propranolol. If this regimen fails, patients should be considered for surgery.
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PMID:The medical treatment of angina pectoris. 81 84

Major risk factors for coronary heart disease include hypertension, high serum cholesterol and triglyceride levels, and cigarette smoking. Minor risk factors include glucose intolerance, electrocardiographic changes, and personality type. Often the initial manifestation is angina pectoris. To prevent coronary heart disease, physicians need to know the answers to the following questions: (1) In which person will coronary heart disease develop, and when? (2) What is the cause? (3) What major and minor causative factors can be modified? (4) How can these modifications be achieved in a free-living, working, well population? (5) What is the earliest manifestation of coronary atherosclerosis? (6) What special diagnostic procedures are useful in coronary heart disease? These subjects are examined briefly.
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PMID:Coronary risk factors and anginal pain patterns. 84 Jul 97

The ovarian function of 14 women, aged 23-40, with ischemic heart disease was examined. 4 of the patients had myocardial infarction (3 of which were transmural), 5 had unstable angina, and 5 had angina pectoris. All of the patients had a normal menstrual cycle and none used hormonal oral contraceptives. Cytohormonal examination was undertaken: assessment of the karyopyknotic and estrogenic index after 3-day intervals through the course of the cycle, the values of which were compared with ormal values. These data were combined with an analysis of risk factors in the patients' medical histories. 2 of the patients were found to be smokers, 4 were obese, 6 suffered from hypertension, and 6 from hypercholesterolemia. 1 showed a reduced tolerance to carbohydrates. 3 patients showed no risk factors. Hypoestrinism was recorded 9 times. In 3 of these cases the estrogenic indices were within physiological limits and 2 of them could not be evaluated. In all 3 patients in which no risk factor could be found hypoestrinism was found. It is strongly suspected that this ovarian hypofunction could play a role in the development of these heart diseases.
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PMID:[Ichaemic heart disease of young women and their ovarian function (author's transl)]. 85 Jul 70

Left ventricular function was assessed by measuring sytolic time intervals in insulin-requiring diabetics with and without significant microangiopathy. The results were compared with those in normal controls. Significant microangiopathy was defined as proteinuria over 3 g/24 h or proliferative retinopathy. Left ventricular function was also assessed one and a half years later by echocardiography in four patients with microangiopathy. Patients with angina, previous myocardial infarction, hypertension, and alcoholism were excluded. All had normal electrocardiograms and chest radiographs. Diabetics with microangiopathy had impaired left ventricular function, whereas those with uncomplicated diabetes had normal function. This finding supports the existence of a specific diabetic cardiomyopathy due to microangiopathy rather than the metabolic defect. The association of microangiopathy and impaired left ventricular function may explain the high immediate mortality and the high incidence of cardiogenic shock and congestive heart failure after myocardial infarction in diabetics.
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PMID:Diabetic cardiomyopathy: the preclinical phase. 86 81

Stress testing is by no means perfect as far diagnosing coronary artery disease, but at this time it is the single best noninvasive method for establishing the presence of ischemic heart disease. From the data shown here, one can see that it adds some important prognostic features as well. The American Heart Association has published a "Coronary Risk Handbook" which can be used to predict the likelihood of a future coronary event by means of accepted risk factors such as hypertension, cholesterol level, and smoking. If we include a positive stress test as a risk factor and compare it to the others, it is clear that a positive stress test has a much higher correlation with future coronary events than any of the other risk factors alone or in combination (Figure 12). Physicians should pay close attention to all of the mentioned factors while carrying out a stress test rather than just looking for ST depression alone. The occurrence of anginal pain, the time of onset, the degree of ST depression, and the patient's pulse and blood pressure response are all useful in assessing the degree of coronary involvement and in predicting an individual's chances of suffering some form of coronary event.
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PMID:Stress testing in the prognosis and management of ischemic heart disease. 86 78

498 diabetics were discovered in a survey of ischaemic heart disease in 10,059 men aged 40 years and over in Israel. -The diabetics were divided into previously known and newly diagnosed. -During a 5 year follow-up period, the incidence rates of fatal and non-fatal myocardial infarction and the incidence of intermittent claudication were considerably greater in both groups of diabetics than in non-diabetics. The frequency of hypertension and left ventricular hypertrophy was about the same in both groups, and in non-diabetics. -However, the pattern of increased morbidity for angina pectoris and the increased rate of sudden death is seen only in the previously diagnosed diabetics. Different pathological mechanisms might be responsible for angina pectoris and sudden death, as compared to myocardial infarction and these might be related in diabetics to the duration and severity of the disease.
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PMID:Differences in cardiovascular morbidity and mortality between previously known and newly diagnosed adult diabetics. 87 90

Fifty patients who suffered from an acute myocardial infarction at age 40 or below and underwent coronary arteriography, were studied from 8 to 184 months after the infarction (mean follow-up 56 months). Hyperlipidaemia (60%) and cigarette-smoking (82%) were the most common risk factors, while hypertension and diabetes mellitus were found in 10% of all patients. Thirty-seven patients had two or more risk factors. Preinfarction angina was present in 7 subjects. Death rate was 14% within five years and was related to the severity of symptoms. Out of the patients with normal coronary arteriogram (6 patients) or with a single vessel disease 21 were free of angina and 30 did not suffer a reinfarction. Out of 17 patients with two or more coronary vessel disease, angina was present in 14 and reinfarction was seen in 5.
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PMID:[Myocardial infarction in the young: evolution and clinico-coronarographic correlation (author's transl)]. 87 96

Haemodynamic tests were performed at rest and during exercise in 41 patients with arterial hypertension and early impairment of left-ventricular function, before and after administration of a single dose of 0.6 mg beta-methyl-digoxin. After clinical, ECG and coronary-angiographic studies, the patients were assigned to two groups. Group I: 17 patients with transmural infarcts in the chronic stage or with angina. Cardiac output was within normal limits at rest and on exercise and was not significantly altered by administration of beta-methyl-digoxin. There was no significant fall during exercise of the abnormally elevated pulmonary "wedge" pressure or of other pressures in the lesser circulation after digitalis. Group II: 24 patients without signs of coronary heart disease. They, too, had a normal cardiac output at rest and on exercise, not significantly changed by digitalisation with beta-methyl-digoxin. But pulmonary "wedge" pressure and right-atrial mean pressure were significantly reduced during exercise. Before beta-methyl-digoxin the mean "wedge" pressure rose on exercise to an average of 27.3 +/- 5.4 mm Hg, but after beta-methyl-digoxin to only 21.7 +/- 5.1 mm Hg (P less than 0.001). The mean right atrial pressure changed similar. These results indicate that acute digitalisation at the stated dosage in general has an effect on abnormal myocardial function only if there is no additional coronary heart disease.
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PMID:[Early digitalisation of patients with arterial hypertension (author's transl)]. 88 Sep 3

The life-span of methionie-Se75-labelled thrombocytes was studied in 46 patients with ischaemic heart disease and in 5 control individuals. In ischaemic heart disease patients the platelets life-span comprised 6.6+/-0.14 days, this period being smaller in patients over 60 years of age and in males, in contrast to younger patients and females. The presence of arterial hypertension and excessive body weight did not affect the life-span of the thrombocytes. Smoking, hypercholesterolemia and hypertriglyceridemia caused a statistically significant reduction of the circulation time of labelled thrombocytes. In patients with frequent attacks of angina pectoris and with postinfarction cardiosclerosis the life time of the platelets was shorter then in patients with painless forms of the disease and in those free of myocardial infarction. In Type II hyperlipoproteidemia the circulation period of labelled platelets comprised 6.3+/-0.16 days; in Type IV -- 6.7+/-0.29 days and in normolipemia -- 7.4+/-0.30 days. A distinct inverse correlation was established between the blood plasma cholesterol and thriglycerids level and the thrombocytes life-span. It was concluded that the reduction of the life-span of thrombocytes is attributed to the consumption of platelets by the processes of atherogenesis and chronic intravascular thrombus formation.
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PMID:[Types of hyperlipoproteinemia and thrombocyte survival in ischemic heart disease]. 88 45


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