Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0151744 (myocardial ischemia)
 31,282 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

ICI 141,292 is a new beta 1-adrenoceptor blocking drug. The beta 1-adrenoceptor antagonistic effect of ICI 141,292 was examined in a double-blind, randomised crossover study in eight healthy young volunteers and compared with atenolol. Three doses of ICI 141,292 (1, 2 and 4 mg) and atenolol 5 mg were administered intravenously. The attenuation in exercise induced tachycardia varied between 16.0 and 21.2% (P less than 0.01). A significant reduction in blood pressure could be demonstrated following all three doses of ICI 141,292 and atenolol during exercise. At rest in the sitting position HR decreased approximately 8% following all three doses of ICI 141,292 and 14.9% after atenolol 5 mg. No changes in blood pressure were observed under resting conditions after any of the drugs. In six patients with ischaemic heart disease the intrinsic sympathomimetic activity following intravenous administration of four sequential doses (0.5, 0.5, 1.0 and 2.0 mg) of ICI 141,292 was examined. HR decreased 7% (P less than 0.05) following ICI 141,292 1 mg with no further decrease following the succeeding doses. Cardiac output decreased 5.2% (P less than 0.05) following a cumulative dose of 4 mg. No significant changes were observed in mean arterial blood pressure, stroke volume or total peripheral resistance whereas an increase in supine resting mean pulmonary arterial pressure of 3.4 mm Hg (P less than 0.05) could be demonstrated. ICI 141,292 seems to be a potent (at least five times as potent as atenolol) beta 1-adrenoceptor blocking agent possessing moderate intrinsic sympathomimetic activity.
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PMID:Immediate haemodynamic effects of a novel partial agonist, beta 1-adrenoceptor blocking drug ICI 141,292 after intravenous administration to healthy young volunteers and patients with ischaemic heart disease. 288 Jun 3

The choice of therapy in chronic ischemic heart disease depends on identifying the underlying mechanism. Ambulatory monitoring provides a means of identifying those patients in whom increased myocardial oxygen demand is the most important mechanism and who will respond to a beta blocker. In contrast, those patients with coronary spasm are best treated with a calcium antagonist. The history of angina pectoris and the time of onset may, in itself, be misleading. Detailed ambulatory monitoring studies show that nocturnal angina is frequently due to increased myocardial oxygen demand and in such circumstances should be treated by careful control of the heart rate using a beta blocker without intrinsic sympathomimetic activity. Other factors that will influence the choice of medical therapy must be considered. Smoking is particularly important because it not only acts detrimentally in terms of increased myocardial oxygen demand, but may also interfere with the metabolism of those antianginal agents that are metabolized in the liver. The importance of silent myocardial ischemia has been emphasized recently, and studies using ambulatory pulmonary artery monitoring have shown that silent ischemic episodes have the same significance in terms of hemodynamic effects as painful ischemic episodes. The therapeutic and prognostic implications of these findings need to be explored.
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PMID:Choice of therapy in chronic ischemic heart disease. 288 99

Esmolol (Brevibloc) is a potent, titratable, cardioselective beta-blocker with a short elimination half-life (t1/2 = 9.2 min) and no intrinsic sympathomimetic activity. It was designed for use in critically ill patients who would benefit from the short duration of beta-adrenergic blockade. Esmolol's short duration of action allows for rapid onset and control of hemodynamic effects. Its safety and efficacy has been demonstrated in patients with acute myocardial ischemia. This review provides a brief summary of the pharmacology of esmolol, as well as experimental and clinical evidence on the use of esmolol in acute myocardial ischemia.
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PMID:Esmolol: a short-acting titratable beta-blocker in acute myocardial ischemia. 290 Aug 18

Clinically significant differences between various beta-adrenoceptor blocking drugs exist. Patients with ischaemic heart disease and exertional angina pectoris benefit from all types of beta-blockers. Drugs with intrinsic sympathomimetic action (ISA) given intravenously may be safer in some patients with acute myocardial infarction than those drugs without ISA. In cardiac patients at rest they may have a vasodilator action and cause less myocardial depression than beta-blockers without ISA. When, however, the cardiac sympathetic tone is high pindolol and other beta-blockers with ISA act as any other beta-blockers, producing haemodynamic impairment. Studies have shown that beta-blockers with ISA confer less benefit in secondary prevention after myocardial infarction and they are not suitable for the treatment of obstructive cardiomyopathy. Non-selective beta-blockers may be advantageous in hypokalaemic arrhythmias. Beta 1-blockers may be preferred for patients with bronchoconstriction, diabetes, peripheral vascular disease and, theoretically to some extent in theory also in patients with hypertension. The extent and nature of side effects may also influence the selection of the most suitable beta-blocker in cardiovascular therapy.
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PMID:Differences in betablocking drugs in cardiovascular therapy. 290 77

Ritodrine hydrochloride, a beta-sympathomimetic treatment for premature labor, has been associated with the development of pulmonary edema, various metabolic derangements, myocardial ischemia, and infarction. We present the first reported case of absolute neutropenia after prolonged intravenous administration of ritodrine with rapid, spontaneous reversal once the medication was discontinued.
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PMID:Ritodrine-induced neutropenia. 396 86

Widespread use of beta 2-sympathomimetic therapy for premature labor has resulted in a diverse number of serious maternal complications, ie, pulmonary edema, myocardial ischemia, etc. However, to the authors' knowledge, there has been only one previous report of mild maternal liver impairment associated with this therapy. Recently, a patient developed marked elevation of liver enzymes (serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase) during therapy with terbutaline sulfate for premature labor.
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PMID:Maternal liver impairment associated with prolonged high-dose administration of terbutaline for premature labor. 402 9

Although right ventricular function may be examined by following the passage (first pass) of a bolus of radionuclide through the right heart before it reaches the left heart, the counts detected with conventional gamma cameras in such a short time interval are low; moreover, repeated determinations would result in an unacceptable radiation burden to the patient. We have modified the gated equilibrium blood pool method to allow repeated assessment of the right ventricular ejection fraction (RVEF) and have compared the results with the first-pass method in 43 patients. Good agreement was obtained between the two methods (r = 0.91, p less than 0.001). The mean difference between the two methods was 0.04 with an intra-observer variation for the equilibrium studies of 0.03 and an inter-observer difference of 0.04. The mean difference in RVEF for seven patients studied on two separate occasions 30 minutes apart was only 0.02. In four patients the mean RVEF measured at rest was 0.44 +/- 0.05 (SEM) and after exercise it was 0.48 +/- 0.06. After infusion of isoprenaline at 1 microgram/min the mean rose to 0.64 +/- 0.04 (p less than 0.02) and after infusion of a new beta 1-sympathomimetic agent, prenalterol, at doses of 1 and 2 mg it was 0.56 +/- 0.02 (p less than 0.02) and 0.59 +/- 0.03 (p less than 0.01) respectively, where the significance levels are relative to the resting values. In nine patients with good ventricular function the vasodilator nifedipine caused right and left ventricular ejection fractions to increase by the same amount; while in six patients with severe impairment of left ventricular function due to ischaemic heart disease the RVEF increased from 0.58 +/- 0.03 to 0.73 +/- 0.03 (p less than 0.01) after 2 mg of prenalterol, but the left ventricular ejection fraction increased only from 0.22 +/- 0.04 to 0.26 +/- 0.04. We conclude that repeated estimation of right ventricular performance is possible by equilibrium radionuclide ventriculography.
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PMID:Can right ventricular performance be assessed by equilibrium radionuclide ventriculography? 613 86

Beta blockade is the cornerstone of the therapy for ischemic heart disease and is increasingly used as first-line therapy for hypertension. Three chief properties that distinguish among different beta blockers are cardioselectivity, intrinsic sympathomimetic activity (ISA) and pharmacokinetic differences. Cardioselectivity appears to confer some advantages, although there is a potential and serious danger in giving any beta blocker to patients with asthma, heart failure or active peripheral disease. The degree of ISA in different beta blockers may vary. This property may diminish the degree of cardiac depression caused by beta blockade, influencing the response to exercise, but on the other hand, it may make the beta blocker less beneficial in minimizing the effects of myocardial ischemia. Beta blockers also differ in duration of action, vasodilating capacity and effect on renal blood flow. Several mechanisms may be involved in the antihypertensive effects of beta antagonists. In elderly hypertensive patients, beta blockade should be given cautiously, especially if combined with a diuretic, and pharmacokinetic differences in this age group must be considered.
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PMID:Basis for cardiovascular therapy with beta-blocking agents. 613 10

It was the purpose of the present study to assess the hemodynamic effects of adrenergic beta-receptor blocking drugs possessing intrinsic sympathomimetic activity (ISA) and/or beta 1 selectivity, both at rest and during exercise. The hemodynamic effects of seven different beta-blockers (propranolol, atenolol, acebutolol, ICI 72,222, ICI 89,406, and pindolol) were studied at rest in patients with ischemic heart disease. Heart rate (HR), cardiac output (CO), arterial blood pressure (BP), and pulmonary artery pressure (PP) were determined. At rest, it was possible to subdivide the various beta-blockers into three main groups according to the degree of ISA. One group without ISA, including propranolol and atenolol, reduced CO by 25% and HR by 15%. A second group with moderate ISA, represented by practolol, acebutolol and ICI 72,222, reduced CO only by 15% and HR by 10%. A third group with pronounced ISA, represented by pindolol and ICI 89,406, did not change CO and HR significantly. All three groups consisted of drugs both with and without beta 1 selectivity. During exercise, pindolol and propranolol reduced CO, HR, and BP to the same extent. In conclusion, the central hemodynamic response to beta-blockers at rest is determined by the degree of ISA, whereas beta 1 selectivity does not modify the central hemodynamic response to beta-blockade. However, the hemodynamic differences between adrenergic beta-blocking drugs with and without ISA disappear in situations with increased sympathetic drive, such as exercise.
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PMID:Central hemodynamics of beta-adrenoceptor blocking drugs: beta 1 selectivity versus intrinsic sympathomimetic activity. 618 16

Sympathomimetic amines are useful in the treatment of patients with ischemic heart disease complicated by heart failure and shock. These agents influence the cardiovascular system by action on alpha-adrenergic, beta-adrenergic, and dopamine receptors. Recent evidence has demonstrated the existence of subtypes of the classic adrenergic and dopamine receptors that mediate distinct physiologic effects. The relative actions of sympathomimetic amines on these receptors differ substantially, resulting in considerable variation in their cardiac and peripheral vascular effects. Two classes of sympathomimetic amines are being intensively investigated at present: (1) compounds acting predominantly on beta 1-adrenergic receptors (i.e., they increase cardiac contractile force with little or no peripheral vascular effects) and (2) compounds acting on both beta 1-adrenergic and dopamine receptors. Orally active compounds of these two classes have been synthesized recently and are now under study for the treatment of patients with heart failure. Results of preliminary studies with such components are briefly reviewed.
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PMID:Sympathomimetic amines: potential clinical applications in ischemic heart disease. 627 12


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