Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study addresses the effect of the three major classes of antianginal agents on asymptomatic myocardial ischemia in patients with chronic stable angina pectoris. The authors found that each class (given as monotherapy) resulted in a 50% reduction in asymptomatic ischemia (both in the number of episodes and the ST product). Dual therapy resulted in an overall four fold reduction compared to placebo. Therapy also resulted in a beneficial alteration in the frequency distribution of asymptomatic ischemia. Stratification into three age groups demonstrated an equal prevalence of asymptomatic ischemia in each. All ages had nearly equivalent reductions in asymptomatic ischemia by monotherapy and dual therapy, but the youngest age group seemingly responded better to monotherapy than did the oldest age group.
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PMID:The impact of antianginal drug therapy on asymptomatic myocardial ischemia. 277 92

In 47 patients with chronic stable angina and proven coronary artery disease, abrupt withdrawal of beta-adrenoceptor blocking agents either as monotherapy or in combination with calcium antagonists (group 1, n = 25) was compared with abrupt withdrawal of calcium antagonist monotherapy (group 2, n = 22) as regards the occurrence of cardiac events and total ischemic activity detected by ambulatory monitoring. Reinstitution of medical therapy was required in 6 patients (4 in group 1 and 2 in group 2). Ambulatory monitoring was initiated for 36 hours on 3 occasions: before withdrawal, and again 2 and 5 days after withdrawal. The first 2 monitorings were performed in the hospital and the last during daily activity. In group 1, the frequency of total ischemia increased by 64 and 148% from monitoring occasions 1 to 2 and 1 to 3, respectively (p less than 0.01), and silent ischemia increased by 100 and 129%, respectively (p less than 0.01). However, no significant change in transient myocardial ischemia was noted in group 2. Heart rate at onset of ischemia increased significantly in group 1 (p less than 0.01), in contrast to group 2 which had significant increases only in out-of-hospital values (p less than 0.05). These results indicate that a rebound increase in ischemic activity (mainly silent) occurs after abrupt withdrawal of beta-receptor blockade in patients with chronic stable angina. This increase in ischemic activity may be caused by increased myocardial oxygen demand.
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PMID:Transient myocardial ischemia after abrupt withdrawal of antianginal therapy in chronic stable angina. 289 81

Nicorandil therapy was compared with placebo therapy in 11 patients with chronic stable angina pectoris. A computer-assisted treadmill exercise test was performed after administration of either 10 or 30 mg of nicorandil. Analysis of variance showed a significant difference among placebo and nicorandil treatments (p less than 0.01). Ten milligrams of nicorandil prolonged time to onset of ischemia 36% (p less than 0.05) but increased the exercise duration only 15%. Thirty milligrams of nicorandil prolonged time to onset of ischemia 82% (p less than 0.01) and exercise duration 45% (p less than 0.01). Both time to onset of ischemia and exercise duration increased progressively from the 10-mg to the 30-mg dose (p less than 0.05). Heart rate at rest was significantly higher and systolic pressure at rest significantly lower with 30 mg of nicorandil than with placebo. After administration of 30 mg of nicorandil there was a significant reduction in ST depression associated with a slight decrease in the double product at the end of Bruce stage 2 exercise. The peak double product was greater after administration of 30 mg of nicorandil than after placebo, indicating an increased myocardial oxygen supply to the ischemic area. The plasma concentration of nicorandil averaged 78 +/- 83 ng/ml with the 10 mg and 313 +/- 142 ng/ml with 30 mg. There was an increase in exercise duration of more than 1 minute in 8 of 9 patients who had plasma nicorandil concentrations greater than 100 ng/ml.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparative efficacy of high-dose versus low-dose nicorandil therapy for chronic stable angina pectoris. 294 20

The safety and efficiency of the administration of diltiazem was evaluated in 10 patients with class II-III chronic stable angina. All the patients had ischemic heart disease documented by coronary angiography and/or an abnormal exercise test. A dose related improvement in both frequency of angina and exercise capacity were obtained by diltiazem administered in increased doses using a single blind protocol. The weekly frequency of angina was reduced from 7.5 +/- 9.8 with placebo to 3.8 +/- 5.5, 1.1 +/- (p less than 0.05) and 0.7 +/- 0.9 (p less than 0.01) with doses of 120, 240 and 360 mg/day respectively. The exercise duration on treadmill was significantly increased from 8.5 +/- 3.6 to 10.6 +/- 3.7 min (p less than 0.05) with the 360 mg/day dose. The mean exercise time required to develop 1 mm ST depression was 6.1 +/- 3 min on placebo and was significantly delayed to 9.0 +/- 3.8 min (p less than 0.05) with the 240 mg/day dose and to 10.7 +/- 4.0 min with 360 mg (p less than 0.01). In a double blind randomized crossover phase, the time to the onset of ischemia during exercise was increased from 8.5 +/- 3.8 min with placebo to 11.05 +/- 2.8 min with 360 mg/day of diltiazem (p less than 0.01). Diltiazem in doses ranging from 120 to 360 mg/day is an effective antianginal agent with no significant adverse effects.
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PMID:[Diltiazem in chronic stable angina]. 294 27

The efficacy of PY 108-068 (75 and 150 mg/day), a new dihydropyridine calcium antagonist, was compared with placebo for treatment of chronic stable angina. Twelve patients were studied in a placebo-controlled, double-blind, randomized, crossover trial of 2 weeks each. Antianginal efficacy was assessed by the number of episodes of angina and nitroglycerin tablets consumed during each 2-week period, as well as the number of episodes of ischemia during 48-hour ambulatory monitoring and the area and severity of ST-segment depression during 16-point precordial exercise mapping. Nitroglycerin consumption (mean +/- standard error of the mean) decreased from 6.1 +/- 2.9 with placebo to 1.8 +/- 1.5 with 75 mg/day of PY 108-068 (p less than or equal to 0.03) and to 3.6 +/- 2.3 with 150 mg/day of PY 108-068 (p less than or equal to 0.01 vs placebo, difference not significant vs 75 mg/day of PY 108-068), whereas episodes of angina were reduced significantly only by the high dose (p less than or equal to 0.03) (11.1 +/- 3.9 with placebo, 6.3 +/- 2.4 with 75 mg/day of PY 108-068 and 8.1 +/- 3.4 with 150 mg/day of PY 108-068). The low dose alone significantly reduced ST-segment depression during exercise testing (p less than or equal to 0.03) (29.6 +/- 3.6 with placebo, 23.1 +/- 5.6 with 75 mg/day of PY 108-068 and 24.4 +/- 5.0 with 150 mg/day of PY 108-068), whereas neither dose significantly altered the number of episodes of ischemia during ambulatory monitoring.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Usefulness of PY 108-068, a new calcium channel blocker, for angina pectoris. 307 40

The effects of nifedipine (60 to 90 mg/day) and propranolol (240 mg/day) on symptoms, angina threshold and cardiac function were compared in a placebo-controlled, double-blind, crossover study. Five-week treatment periods with nifedipine and propranolol were compared with 2 weeks of placebo treatment in 21 men with chronic stable angina pectoris, 13 of whom had symptoms both at rest and on exertion. Compared with placebo, New York Heart Association functional class improved in patients equally with nifedipine (p = 0.001) and propranolol (p = 0.006). Frequency of chest pain decreased with nifedipine (p = 0.001) and propranolol (p = 0.01), and nitroglycerin consumption similarly decreased with both treatments. Nifedipine significantly delayed the onset of chest pain (p = 0.01) and 1 mm of ST-segment depression (p = 0.002) during bicycle exercise; smaller increases with propranolol were not statistically significant. A preferential clinical response to nifedipine (9 patients) or propranolol (6 patients) was unrelated to the presence or absence of pain at rest or to any baseline hemodynamic finding. Nifedipine and propranolol were equally effective in relieving exertional ischemia as shown by improvements in ejection fraction at identical workloads, from 0.48 +/- 0.11 to 0.58 +/- 0.12 (p less than 0.001) and 0.56 +/- 0.14 (p less than 0.001), respectively. Exercise wall motion, assessed by a semiquantitative wall motion score, also improved with both drugs. Propranolol treatment decreased exercise cardiac output by 14% (p = 0.01) through its effect on heart rate. In contrast, nifedipine treatment had no effect on cardiac output.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparison of nifedipine alone with propranolol alone for stable angina pectoris including hemodynamics at rest and during exercise. 308 64

Recent evidence suggests that traditional approaches to the use of nitroglycerin (NTG) in patients with chronic stable angina should be reconsidered. Studies of the time to onset of hemodynamic effects of sublingual NTG suggest that the first detectable effect, on left ventricular end-diastolic pressure, occurs at a mean of 90 seconds after administration. By timing the duration of exertional angina after formal exercise testing, one can show that, on average, chest pain is gone within 2 minutes. Thus, in many patients, it is unlikely that sublingual NTG can further shorten episodes of exertional angina. The value of sublingual NTG is greater when patients exercise beyond the onset of pain, when patients have more protracted episodes of exertional pain and when there is a need to resume immediately the activity that brought on the angina. With respect to angina prophylaxis, the pioneering studies of Parker and co-workers have now been amply confirmed. Continuous nitrate administration by oral, transdermal or intravenous routes results in substantial, albeit incomplete, tolerance. Tolerance occurs even when high plasma concentrations are achieved and persist over time. Tolerance can eliminate responsiveness to sublingual NTG. Preliminary evidence suggests that tolerance to the antianginal effects of NTG at maximal exercise may be more marked than tolerance to the effects of NTG on silent ischemia at submaximal activity levels. The significance of this dissociation in time course and its implications are unclear at this time. Three potential strategies exist for avoiding NTG tolerance in patients with chronic stable angina. Administration of a thiol donor has been shown to reverse some hemodynamic manifestations of tolerance.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Nitroglycerin in chronic stable angina pectoris. 312 May 61

ST-segment analysis on 24-hour Holter ECG was performed in 64 patients with angiographically proven coronary artery disease, a positive exercise test and chronic stable angina. During 125 days of recording, 494 episodes of transient ST-segment depression were observed, at an average of 4.0 +/- 3.7 episodes (1-13 episodes, median: 3 episodes) per day. The duration of ST depression per episode was 13.2 +/- 14.4 min (1-90 min; median: 8 min). No episodes of ST-elevation were observed. Only 27 (5.5%) ischemic episodes occurred during the night, between midnight and 6:00 a.m., but they were frequently observed during the morning hours between 7:00 and 12:00 a.m. Nearly all episodes of ischemia were preceded by an increase in heart rate. However, heart rate at the onset of significant ST-segment depression was significantly lower during Holter monitoring than during exercise test (p less than 0.001); this indicates that factors additional to the increase in myocardial demand might be relevant for transient myocardial ischemia during daily life. 382 of the 494 episodes (77.3%) of ischemia were asymptomatic; heart rate at the onset of ST-segment depression was similar in symptomatic and asymptomatic episodes; however, in asymptomatic episodes, maximal heart rate was significantly lower (p less than 0.001) and the duration of the episodes significantly longer (p less than 0.001). The percentage of asymptomatic episodes was very high in patients with one-vessel disease, whereas the duration and amount of ST-segment depression, as well as heart rate, at the onset of ischemia, were not dependent on the extent of coronary artery disease.
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PMID:[ST segment analysis in 24-hour long-term ECG in patients with stable angina pectoris and angiographically detected coronary sclerosis]. 312 29

Fifteen patients aged 55 +/- 6 years (mean +/- SD) with mild, chronic stable angina were evaluated after 2 weeks of sublingual nitroglycerin therapy (control) and also after 12 weeks of treatment with either propranolol, up to 320 mg per day, or nifedipine, up to 120 mg per day, in order to measure signs of ischemia and the response of symptoms to therapy. Compared with the control period, there was a decrease in average daily episodes of angina from 1.0 +/- 0.8 to 0.5 +/- 0.4 with treatment (p = 0.10). There was a significant decrease of greater than or equal to 1.0 mm ST segment depression (both symptomatic and asymptomatic), from 6.1 +/- 6.5 to 1.5 +/- 2.4 episodes per 24 hours, p less than 0.001, and of asymptomatic episodes of ST segment depression, from 3.5 +/- 3.9 to 1.0 +/- 2.1 episodes per 24 hours, p = 0.03. The number of patients who had any episodes of greater than or equal to 1.0 mm ST segment depression on their 24-hour ECG decreased from 14 to 6 (93% to 40% of patients, p = 0.005) with treatment, and the number of patients with any episodes of ST segment depression without symptoms decreased from 11 to 5 (73% to 33% of patients, p = 0.07). There was an insignificant increase in treadmill time from 333 +/- 134 to 380 +/- 156 seconds, and an insignificant decrease in maximum double-product from 16,631 +/- 3,599 to 14,922 +/- 4,086; the number of patients with angina at maximum exercise decreased from 13 to 10 (87% to 67%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effect of pharmacologic therapy on angina frequency, ST segment depression during ambulatory ECG monitoring, and treadmill performance in patients with chronic stable mild angina. 312 46

In a randomized double-blind study, treatment with either metoprolol, nifedipine, or their combination was compared for effects on ischemic variables and heart rate obtained during ambulatory monitoring in 42 patients with chronic stable angina. All patients had severe chronic stable angina of at least 6 months' duration despite medical treatment, and exhibited coronary artery stenosis of 75% in one or more coronary arteries. Metoprolol reduced the frequency of total (p less than 0.01) and asymptomatic ischemic episodes (p less than 0.05), the duration of ischemia (p less than 0.05), and the ischemic burden (p less than 0.05), which contrasted to the lack of any similar significant effect during nifedipine monotherapy. During combination therapy, there was a tendency to further improvement, which did not reach statistical significance compared with metoprolol monotherapy. Heart rate at the onset of ischemia was reduced by metoprolol therapy (p less than 0.01), indicating that metoprolol acts by reducing myocardial oxygen demand even during ischemic episodes observed in daily life, where impairments of myocardial oxygen supply are suspected. No change in heart rate at the onset of ischemia could be detected during nifedipine monotherapy. It is concluded that metoprolol monotherapy, as well as its combination with nifedipine, effectively reduces total ischemic activity compared with placebo and nifedipine monotherapy. Control of ischemic activity in chronic stable angina may have prognostic implications.
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PMID:Randomized double-blind comparison of metoprolol, nifedipine, and their combination in chronic stable angina: effects on total ischemic activity and heart rate at onset of ischemia. 317 96


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