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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Antiarrhythmic and hemodynamic effects of i.v. disopyramide phosphate (1.7 mg/kg b.wt. over 2 min) have been studied in nine patients, several in various degrees of cardiac decompensation, with sinus rhythm and persistent ventricular ectopic beats (VEBs). In one case with primary cardiomyopathy, with greater than 30 VEBs/min, disopyramide (DE) abolished the arrhythmia for 30 min, but precipitated brief dysponea. Other side-effects were tolerable and mainly attributable to anticholinergic effects of the drug. DE either abolished or significantly reduced the arrhythmia in all cases. For 30 min, only one patient showed VEBs, and in three patients no VEBs were seen for three hours. Changes in cardiac output and pulmonary artery (PAP) and central aortic pressures were measured in eight patients. Negative inotropic effects were indicated in seven by an increased diastolic PAP/stroke volume ratio and in seven by a decreased central aortic (dp/dt)max. Patients with high control values for diastolic PAP showed marked reductions in cardiac output, stroke volume and stroke work. In predicting myocardial depressant effects of DE, the control values for diastolic PAP seemed to be superior to central venous pressure, cardiac index and systolic time intervals. Mean arterial pressure measured 5 and 10 min after drug administration showed no significant change, indicating that vasoconstrictor reflexes were well preserved, and a pressure level significantly above the control value was reached from the 20th min. It is concluded that DE is potent in suppressing VEBs but exerts negative inotropic effects that may be of clinical importance. The optimal antiarrhythmic dose is probably lower than that used in the present study.
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PMID:Hemodynamic and electrocardiographic effects of disopyramide in patients with ventricular arrhythmia. 125 72

The goal of antihypertensive therapy is the reduction in morbidity and mortality associated with high blood pressure. Despite our ability to reduce blood pressure, "standard" antihypertensive therapy has not produced a general decrease in coronary heart disease. This failure might be related to the adverse metabolic consequences of diuretics and beta-adrenergic receptor-blocking agents used in most clinical trials. In the hypertensive patient population, however, the principal physiologic abnormality is increased systemic vascular resistance. This increase in vascular tone leads to compensatory changes in cardiac function that result in left ventricular hypertrophy and diastolic filling abnormalities. Diastolic ventricular dysfunction is present in approximately 50% of asymptomatic hypertensive patients and might be a precursor of the syndrome of congestive heart failure with normal systolic ventricular function. In view of the prevalence of diastolic filling abnormalities in the hypertensive patient population, one should consider the effect of an antihypertensive drug on left ventricular function. In a comparison of the angiotensin-converting enzyme (ACE) inhibitors, captopril, lisinopril, and fosinopril, only fosinopril increased stroke volume, peak ejection rate, and peak filling rate, and decreased time to peak ejection rate. These favorable inotropic and lusitropic responses to fosinopril may reflect an effect on the myocardial renin-angiotensin cascade which is dependent upon the unique chemical structure of the fosinopril molecule.
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PMID:Left ventricular hypertrophy and performance: therapeutic options among the angiotensin-converting enzyme inhibitors. 128 27

The role of impaired diastolic function in determining the pathophysiology of congestive cardiomyopathy was only recently appreciated. In the present study, echocardiography and Doppler cardiography were used to determine changes in cardiac size and transmitral filling dynamics over a 1-year period in patients with congestive cardiomyopathy and determine the effect of captopril on these changes. The study population consisted of 27 patients with congestive heart failure in spite of therapy with digitalis and diuretics (NYHA class 3.2). Fifteen patients were started on placebo and 12 on captopril. Noninvasive evaluation was performed at 6-month intervals. Left ventricular size and left ventricular ejection fraction did not change significantly in either group. Forward stroke volume improved significantly only in patients on captopril compared to placebo (p < 0.05). No significant changes in transmitral flow dynamics were observed in the placebo group whereas the captopril-treated group showed a decrease in the peak velocity, flow velocity integral and rate of rapid filling wave (E) and an increase in the peak, integral and rate of filling during atrial contraction (A). The E/A ratio did not change significantly over time in the placebo group, whereas a reduction in the ratio was noted in the captopril-treated patients. These changes are sustained over 1 year with concomitant improvement in stroke volume, exercise duration and functional class.
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PMID:Left ventricular filling dynamics by Doppler echocardiography in dilated cardiomyopathy: one-year follow-up in patients treated with captopril compared to placebo. 130 Dec 44

Coarctation can be recognized by physical examination alone early in a person's life, except in instances in which the obstruction is very mild. While some cases remain mild for a lifetime, others become progressively worse during adolescence or adulthood with typical manifestations of upper-extremity hypertension and imperceptible pulses in the lower extremities. It is especially urgent and sometimes difficult to recognize coarctation in infants with congestive cardiac failure just as it is to identify older children and adolescents with asymptomatic but severe systemic hypertension. There may be medical or legal implications in failing to do so.
Heart Dis Stroke
PMID:Coarctation of the aorta: difficulties in clinical recognition. 134 10

The haemodynamic effects of roxatidine were investigated in 12 patients with congestive heart failure (New York Heart Association class II) in a placebo-controlled, double-blind, randomized, cross-over study. Impedance and mechanocardiography were determined following successive 7-day treatment periods with placebo and roxatidine 150 mg once daily. Comparison with placebo values showed roxatidine to significantly increase the preejection period (109.7 +/- 2.7 ms versus 117.3 +/- 2.7 ms, 1.5 h after administration). Heart rate and blood pressure remained the same. In contrast to other, newer H2-receptor antagonists, which decrease stroke volume and/or cardiac output, roxatidine did not reduce these parameters but increased the preejection period and the ratio of the preejection period to the left ventricular ejection time, indicating a slight negative influence on cardiac performance.
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PMID:Haemodynamic effects of roxatidine, an H2-receptor antagonist. 135 Sep 35

The effects of acute and chronic ibopamine treatment on resting and exercise hemodynamics, exercise capacity and plasma catecholamines were evaluated in 25 patients with chronic heart failure, using a double-blind, parallel, placebo-controlled design. During 2 months of therapy with either placebo or ibopamine (100 mg, 3 times daily), 1 patient was withdrawn from each group for worsening heart failure, New York Heart Association functional class improved in 4 patients on ibopamine and in 1 on placebo, and furosemide dose could be decreased in 4 on ibopamine and in no patient on placebo. Acute ibopamine administration induced, in comparison with placebo, a significant increase of cardiac and stroke volume indexes both at rest and peak exercise, with a reduction of systemic vascular resistance. These hemodynamic changes were maintained also after chronic therapy, with no evidence of tolerance development. Exercise capacity (evaluated as peak exercise duration and oxygen consumption, and ventilatory threshold) did not significantly change. Resting and peak exercise norepinephrine plasma levels were significantly reduced after both acute and chronic ibopamine administration. Thus, the hemodynamic and neurohumoral effects of ibopamine make this drug potentially useful for the chronic treatment of congestive heart failure.
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PMID:Effects of acute and chronic ibopamine administration on resting and exercise hemodynamics, plasma catecholamines and functional capacity of patients with chronic congestive heart failure. 135 38

Research on antihypertensive drugs not only provides new information on presently used agents but also leads to the introduction of exciting new compounds. Several important clinical trials involving currently available drugs have been published recently. Angiotensin-converting enzyme inhibitors improved survival in patients with milder degrees of congestive heart failure, which indicates that they have become the cornerstone of treatment for this condition. Angiotensin-converting enzyme inhibitors delayed or prevented the development of diabetic proteinuria (> 200 micrograms/min) in a placebo-controlled randomized trial. Further, enalapril was more effective than metoprolol in reducing the rate of decline in renal function in patients with type I diabetes. Calcium channel blockers protected against acute renal failure in patients after renal transplantation in two separate studies. Calcium channel blockers were shown to promote natriuresis, with negative sodium balance the same as that associated with thiazide diuretics. The voltage-dependent calcium channel has been cloned, and the binding sites of the three classes of calcium channel blockers are now known. beta-Blockers and thiazide diuretics were the drug treatments in the Systolic Hypertension in the Elderly Program trial and in the Swedish Trial in Old Patients with Hypertension study (patients 65 to 85 years). In both investigations, stroke and cardiovascular events were significantly reduced by these conventional inexpensive agents. Clonidine was found to lower blood pressure primarily by its interaction with the imidazole receptor rather than the alpha 2 receptor. Elucidation of the imidazole receptor promises to shed light on physiologic mechanisms as well as lead to the introduction of new agents, such as moxonidine.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:New classes of antihypertensive drugs and new findings with established agents. 136 36

Untreated hypertension has a variety of serious consequences, such as stroke, congestive heart failure and coronary heart disease, the incidences of which escalate sharply in the presence of other risk factors. Traditional antihypertensive therapy has been associated with reductions in the frequency of strokes, congestive heart failure and kidney failure, but a corresponding decline in myocardial infarctions has not been observed. Deleterious changes in lipid metabolism that are induced by these agents may counteract the beneficial effects of blood pressure reduction. Calcium antagonists have been used successfully in the management of hypertension for more than a decade. To define the impact of the calcium antagonist verapamil on metabolic parameters, 45 hypertensive patients were treated with verapamil monotherapy and followed up for 4 to 8 years. After a mean treatment period of 5.3 years, total cholesterol and triglycerides were unchanged, whereas mean high density lipoprotein (HDL) cholesterol increased significantly, from 1.17 +/- 0.41 to 1.39 +/- 0.36 mmol/L (p less than 0.05). Other important biochemical parameters were unaffected by verapamil therapy. The primary target organs of hypertension are the arterial system and the myocardium. Accumulating literature now suggests that the calcium antagonists may represent an effective therapeutic approach to hypertension that controls both the pressure-related and atherosclerotic complications.
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PMID:Primary prevention potential of the calcium antagonists. Effects on blood pressure and lipid pattern. 137 85

The use of antihypertensive drug treatment has altered the natural history of hypertension. Whereas congestive heart failure, cerebral hemorrhage, and renal failure were the major complications of untreated severe hypertension, myocardial infarction and thrombotic stroke have emerged as major problems in treated hypertensive patients. None of the major therapeutic trials in hypertension have provided evidence that reducing blood pressure reduces the risk of atherosclerotic complications of hypertension. Hypertension certainly aggravates the severity of atheromatous lesions in experimental animals, and may do so in humans. However, atherosclerosis is more closely related to disturbances in lipoprotein metabolism than to other factors. The common finding that serum cholesterol is raised in hypertensive patients may be due to atherosclerosis being the primary lesion, and hypertension a secondary complication rather than hypertension being the primary lesion.
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PMID:Hypertension and vascular disease. 138 98

Atrial fibrillation is a common disorder and the incidence increases with each decade of life. Previously, rheumatic mitral valve disease has been the condition most highly associated with atrial fibrillation. However, with the decreasing incidence of rheumatic heart disease, other conditions have assumed greater importance and now congestive cardiac failure, coronary artery disease, and hypertension are the most commonly associated conditions. Nonrheumatic atrial fibrillation is associated with an approximately five-fold increase in the risk of ischemic stroke and a 5% to 7% yearly risk that increases with age. In addition, atrial fibrillation is associated with an increased incidence of silent cerebral infarction and increased mortality. However, whether atrial fibrillation is independently associated with the risk of stroke or is a marker of underlying cardiac disease is contentious. Until recently, the use of preventive therapy has been controversial. However, data from four recently published, prospective randomized studies clearly support the use of warfarin prophylaxis in nonrheumatic atrial fibrillation. Within the diverse group of patients with nonrheumatic atrial fibrillation there are high and low risk subgroups and identification of these may influence decisions regarding antithrombotic prophylaxis. With a few exceptions, however, this remains an area in which there are contradictory findings in the literature. The role of aspirin for prophylaxis in nonrheumatic atrial fibrillation remains unclear and further evaluation awaits the publication of ongoing studies.
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PMID:Atrial fibrillation: epidemiology and the risk and prevention of stroke. 138 92


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