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

The study was undertaken to investigate the acute haemodynamic effects of bunitrolol (0-2-hydroxy-3-(tert.butylamino)-propoxy)-bity. Right and left heart catheterization was performed in eleven patients with documented coronary artery disease. After bunitrolol (10 mg i.v.), there was a statistically significant decrease in left ventricular and aortic systolic pressures left ventricular end-diastolic pressure, aortic diastolic and mean pressures, pressure-rate product and compliance index (delta P/delta V). Left ventricular dp/dt, left ventricular dp/dt over isovolumic pressure, systemic resistance and heart rate tended to decrease, stroke volume and left ventricular stroke work index tended to increase, without statistical significance. Cardiac index showed individual variations, the mean values for the group being unchanged. Correlation of left ventricular end-diastolic pressure and left ventricular stroke work index showed a shift toward improved ventricular function curve in most cases, deterioration in no instance. Supine exercise was performed in ten patients. Angina occurred in nine patients; in five only before and in four before and after beta-blockade. Post-drug exercise heart rate, pressure-rate product and left ventricular end-diastolic pressure were significantly lower, the latter also in the four patients who still presented exercise angina. It is concluded that certain beta-blockers can improve cardiac performance at rest and during exercise in patients with coronary artery disease. This is explainable on the basis of a more favourable balance between oxygen supply and demand, together with a less marked negative inotropic effect due to the partial agonist activity of the agent used in the study.
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PMID:Evidence for improved cardiac performance after beta-blockade in patients with coronary artery disease. 1 74

1. 2-Ethyl-3-(4-gamma-di-n-butylaminopropoxy-benzoyl)-indolizine hydrochloride (L 9394) induced in the ananesthetized dog a marked and long-lasting decrease in heart rate together with a transient reduction in blood pressure. 2. L 9394 decreased Robinson's index, an effect which suggests that the substance reduces the oxygen requirements of the heart. 3. L 9394 markedly increased coronary arterial blood flow. 4. L 9394 is endowed with non-competitive antiadrenergic properties. 5. L 9394 did not impair cardiac function since cardiac output and stroke volume increased appreciably during the initial phase of action and did not fall below the control values at any time thereafter. 6. The overall haemodynamic properties of L 9394, which were similar to those of amiodarone, are considered to be potentially valuable for the long-term treatment of angina pectoris.
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PMID:Amiodarone-like haemodynamic and non-competitive antiadrenergic properties of a benzoyl-indolizine. 2 Jan 16

1. A study was conducted amongst 1247 treated hypertensive patients to determine the predictive power of untreated baseline and achieved treated blood pressures in the development of the complications of hypertension. In addition the relative importance of systolic and diastolic pressures was calculated. 2. Statistical analysis was done by calculating univariate differences in blood pressure between cases with and without complications. The higher the univariate distance, the greater the predictive power. 3. Blood pressures achieved during treatment were more important than baseline pressures for predicting stroke in both men and women, confirming the benefits of antihypertensive therapy in preventing strokes. 4. There was some evidence of prevention of myocardial infarction in men and of angina in women as a result of therapy. 5. There was no evidence to suggest that any one group of drugs, including beta-adrenoreceptor-blocking drugs and thiazides, conferred any extra benefit in preventing coronary heart disease. 6. The systolic blood pressures achieved during treatment predicted stroke better than diastolic pressure, but no consistent trends were found for coronary heart disease.
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PMID:Relation between prognosis and the blood pressure before and during treatment of hypertensive patients. 3 9

The study includes 50 patients with severe, stable angina who have undergone the saphenous vein bypass operation. Patients were evaluated preoperatively and postoperatively with regard to exercise tolerance, incidence of stress-induced agina, ST-segment changes of ischemia, and ventricular function as indicated by stroke work index (LVSWI) and ejection fraction. Comparisons were made between patients with complete revascularization (CR) and patients with postoperative residual ischemia (RI). Results revealed that exercise duration improved significantly in both the CR and RI groups. In the CR group, angina and ischemic ST changes were completely eliminated. In the RI group, there was a 25 percent incidence of stress angina and a 50 percent incidence of ischemic ST-segment changes. In neither group was the ejection fraction significantly different from preoperative values. LVSWI decreased significantly in both groups postoperatively.
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PMID:Evaluation of saphenous vein bypass surgery with multistage treadmill test and ventricular function studies. 30 89

The significant risk of fatal myocardial infarction after carotid endarterectomy in patients with coronary disease long has been recognized. In 1,546 consecutive carotid endarterectomies performed in 1,238 patients over the last 10 years, angina pectoris was present in 17% (212/1,238) of patients; a further 32% (396/1,238) of patients were asymptomatic, but had a history of myocardial infarction. The perioperative mortality (30 day) in the 1,306 consecutive endarterectomies in 1,026 patients without symptomatic coronary artery disease was 1.5% (15/1,026 patients). Of the 212 patients with symptoms, 85 carotid endarterectomies were performed in 77 patients without prior coronary bypass operation with an operative mortality of 18.2% (14/77 patients). The remaining 135 patients had 155 carotid endarterectomies but were treated by either prior coronary artery bypass (84 patients) or simultaneous carotid endarterectomy and coronary artery bypass (51 patients) with an operative mortality of 3% (4/135 patients). The greatly improved survival in those patients with symptomatic coronary disease who had a coronary artery bypass prior to or at the same time as carotid endarterectomy, and the absence of permanent neurological deficit in the 51 of these 135 patients who had simultaneous carotid endarterectomy and coronary artery bypass suggests that significantly improved survival can be achieved after carotid endarterectomy in these high risk patients by the use of simultaneous coronary artery bypass surgery.
Stroke
PMID:Improved results of carotid endarterectomy in patients with symptomatic coronary disease: an analysis of 1,546 consecutive carotid operations. 31 51

Three patients with angina pectoris were studied before and after aortocoronary bypass surgery. Angiographic studies were performed with and without atrial pacing. Preoperative atrial pacing in all three patients resulted in angina and/or ST segment changes accompanied by regional left ventricular contractile abnormalities, decreased ejection fraction, as well as decreased left ventricular end-diastolic and stroke volumes. After surgery with all grafts patent, atrial pacing at similar heart rates did not produce an ischemic response. Left ventricular contractile pattern remained normal, and there was no change in ejection fraction though end-diastolic and stroke volumes decreased. These studies demonstrate that aortocoronary bypass surgery can abolish both the ischemic response and left ventricular dysfunction that accompany atrial pacing.
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PMID:Atrial pacing induced left ventricular dysfunction: reversibility after aortocoronary bypass surgery. 31 53

The haemodynamic effects of atenolol, a new cardioselective beta-blocking agent, have been studied at rest in 8 patients with coronary artery disease. The drug was administered intravenously in cumulative doses of 0.03, 0.06, and 0.12 mg/kg body weight. A significant decrease in heart rate was associated with a fall in cardiac output. However, this cardiac output fall was not entiely rate dependent, since stroke volume fell significantly both during spontaneous sinus rhythm and when heart rate was maintained constant by atrial pacing. A dose related and significant reduction occurred in left ventricular dP/dt max without significant change in left ventricular filling pressure or mean aortic pressure. Total peripheral resistance at rest rose after atenolol. The haemodynamic findings more closely resemble those which follow intravenous propranolol than those after intravenous practolol in a similar group of patients. These actions of atenolol suggest that it may be a useful agent in the treatment of patients with angina pectoris.
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PMID:Haemodynamic effects of atenolol in patients with coronary artery disease. 34 28

Arteriosclerotic heart disease is a major cause of death in insulin-requiring juvenile diabetic patients treated for end-stage renal disease. Eleven consecutive diabetic patients without clinical evidence of coronary artery disease underwent complete cardiac evaluations, including coronary arteriography, as part of transplant recipient work-ups. Seven were women and four were men; their mean age was 32 (21 to 50 years). Angiographically, every patient had multifocal atherosclerotic coronary disease. Four of seven patients tested had positive-stress electrocardiograms. In this group of patients followed for a mean of 19.8 months, eight died. Of these deaths, six were due to coronary heart disease and another due to a stroke. In two patients who became clinically symptomatic, serial angiograms revealed progressive disease of the coronary circulation; in one case, despite normal renal allograft function and serum lipid levels. The mode of end-stage renal disease treatment, serum lipids or blood pressure control could not be linked to mortality. It is concluded that arteriosclerotic heart disease is common in diabetic patients with end-stage renal disease even when angina is absent. The natural history in this high risk population is an important consideration in the selection of patients for end-stage renal disease treatment.
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PMID:Natural history of asymptomatic coronary arteriographic lesions in diabetic patients with end-stage renal disease. 36 Aug 37

A feasibility trial to investigate the practicality of determining the advantages and disadvantages of prompt pharmacologic treatment for mild hypertension was jointly funded by the Veterans Administration and the National Heart, Lung and Blood Institute. Its clinical phase has been completed, and it demonstrated 1. that the required relatively young asymptomatic population could be enrolled in the study and 2. that it could be persuaded to adhere to the protocol for 2 years; however, it was evident that intensive efforts would be required in both areas. The feasibility trial screened almost 120,000 potential subjects over a period of 16 months to randomize about 1,000 subjects at four clinical centers. These men and women were 21 to 50 years old, had diastolic pressures from 85 to 105 mm Hg as outpatients, and had no evidence of cardiovascular renal abnormalities. They were randomized in double-blind fashion into active drug therapy and placebo groups. Stepped care therapy involved 50 mg chlorthalidone (Step 1), 100 mg chlorthalidone (Step 2) and 100 chlorthalidone plus 0.25 mg reserpine (Step 3). Death, myocardial infarction, stroke, angina pectoris, and congestive heart failure were the "major" morbid events that were looked for; also recorded were "minor" morbid events consisting primarily of electrocardiographic arrhythmias. The development of significant hypertension was considered a treatment failure. Side effects were carefully tabulated in both active drug and placebo groups. The study revealed an average drop in diastolic pressure of almost 12 mm Hg for active drug group and less than half of that for the placebo group; once established 6 months after randomization, the new pressure levels persisted almost without change throughout the study. Although the feasibility trial was not designed to answer the primary question regarding the benefits of treatment, the events were tabulated for each group. A total of 12 placebo-treated subjects developed significant hypertension and were put on active drug. There was not a significant difference between the two groups in the incidence of "major" morbid events; a total of eight active and five placebo patients developed myocardial infarction or died suddenly. There, however, was an excess of arrhythmias among the active drug subjects (17 in the active group versus 8 in the placebo group on the basis of preliminary data). Finally, there were twice as many side effects and 20 times as many chemical abnormalities among the active as among the placebo subjects. A protocol for a full scale study of the benefits of pharmacologic therapy in mild hypertensives has been prepared and is ready for implementation as needed; it involves relatively minor modifications of the protocol tested in the feasibility trial.
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PMID:Evaluation of drug treatment in mild hypertension: VA-NHLBI feasibility trial. Plan and preliminary results of a two-year feasibility trial for a multicenter intervention study to evaluate the benefits versus the disadvantages of treating mild hypertension. Prepared for the Veterans Administration-National Heart, Lung, and Blood Institute Study Group for Evaluating Treatment in Mild Hypertension. 36 Sep 21

The method of radionuclide cardangiography (RNCA) has become a well-established method amongst non-invasive assessments in coronary heart disease (CHD). By means of RNCA the most important parameters of left ventricular function, viz. ejection fraction (EF) and wall motion (WM), can be determined very exactly. The first bolus pass method (FBP), which allows satisfactory separation between right and left heart, enables the additional determination of EF distribution, stroke volume (SV) and SV distribution. This method requires the technical necessity of a multicrystal gamma camera. Special nuclear medicine characteristics have been worked out for different groups of CHD. EF and WM show typical signs of angina pectoris, caused by exercise correlating with reduced perfusion in the referring section of WM. While these changes may be reversible after nitrate administration, pathological myocardial function caused by acute myocardial infarction (AMI) or manifest heart failure is not reversed by nitroglycerine. Typical findings were seen in the course of AMI: initial decrease in global EF and diffuse (multilocated) asynergies in the left ventricular wall; in the second week possible start of recovery, including regression of dyskinesia to akinesia at the end of hospitalization. Especially in the early phase of AMI it was demonstrated that FBP--as a non-invasive technique--gives high information quality which is unequalled by other comparable methods. Therefore, the described method of FBP should be classified as very useful and effective in clinical cardiology.
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PMID:[Radionuclide cardangiography as non-invasive assessment in coronary heart disease (author's transl)]. 39 49


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