Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0432222 (SEM)
 47,337 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The short-term effect of oral nifedipine on effort tolerance was tested in 10 patients with effort angina pectoris and a positive effort test (GXT). The patients had four symptom-limited GXTs, using the Bruce protocol, on each day of the study at 0800, 1000, 1400, and 1800 hours. They received four doses of 10 mg oral nifedipine on one day and four doses of placebo on the other, each dose given half an hour prior to each GXT. Values with nifedipine were compared to values with placebo at the same time during each day. Nifedipine improved effort tolerance by 0.5 +/- 0.6 min (p = NS) on the first GXT (mean +/- SEM), by 1.2 +/- 0.6 min (p = NS) on the second GXT, by 1.0 +/- 0.3 min (p less than 0.01) on third GXT, and by 1.3 +/- 0.3 min (p less than 0.01) on the fourth GXT. Improvement of effort tolerance was associated with a fall in resting blood pressure and less ST depression; these changes were statistically significant only on the fourth GXT, which may indicate a cumulative effect of subsequent doses of nifedipine.
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PMID:Short-term effect of nifedipine on effort tolerance in patients with angina pectoris. 394 42

Two-dimensional echocardiography (2DE) was performed in 47 consecutive survivors (mean age 47 years) of a first myocardial infarction (MI), to assess its value in predicting major cardiac complications (MCC) during the posthospital phase. 2DE was undertaken 1 day before hospital discharge (mean 15 days). A wall motion score was derived by analyzing endocardial motion in 11 left ventricular segments. During a mean 17-month follow-up, 17 patients had MCC: eight (47%) had significant angina; two (12%) reinfarcted, and seven (41%) died. Wall motion scores of patients with MCC (9.2 +/- 0.9) (+/- SEM) were significantly higher compared to those without MCC (3.7 +/- 0.4 (p less than 0.005). A wall motion score greater than or equal to 8 was present in 82% (14 of 17) of patients with MCC compared to 7% (2 of 30) who remained asymptomatic. Patients who died had significantly higher wall motion scores compared to those who survived (11.3 +/- 0.9 vs 4.7 +/- 0.5) (p less than 0.005). Stepwise logistic regression and discriminant analysis, by means of age, infarct site, maximal Killip class, cardiac enzymes, and wall motion score, identified wall motion score and Killip class as the most significant predictors of MCC. Thus predischarge 2DE is capable of identifying high-risk patients prone to developing MCC after a first MI.
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PMID:The role of prehospital discharge two-dimensional echocardiography in determining the prognosis of survivors of first myocardial infarction. 397 72

PY-108-068 (PY) has calcium antagonist and coronary dilatory activity in animals, suggesting that it may be useful for the treatment of angina pectoris. We have studied its effects in 19 patients with stable exertional angina. After a 2-week single-blind placebo run-in phase, patients were randomised double-blind to either 75 mg or 150 mg of the drug (in three divided doses) daily for 2 weeks, crossing over to the alternate dose for a further 2 weeks. Maximal treadmill tests with computer-assisted electrocardiographic analysis were used to evaluate efficacy. The mean +/- SEM exercise time to onset of angina increased from 6.1 +/- 0.5 min on placebo to 9.3 +/- 0.8 min on PY 75 mg (P less than 0.001) and to 9.2 +/- 0.8 min on PY 150 mg (P less than 0.001) vs placebo; NS vs 75 mg). The time to development of 1 mm ST-segment depression in lead CC5 also increased from 5.0 +/- 0.7 min on placebo to 6.4 +/- 0.9 min on PY 75 mg (P less than 0.01) and to 7.0 +/- 0.8 min on PY 150 mg (P less than 0.01 vs placebo; NS vs 75 mg). Unlike other calcium antagonists, treatment with PY-108-068 did not significantly alter the resting or maximal heart rates or the heart rate gain during exercise. Resting blood pressure was reduced at the higher dose level but peak blood pressure during exercise and peak double product were unaltered by PY-108-068 treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Objective evaluation of PY-108-068, a new calcium channel inhibitor for the treatment of chronic stable angina pectoris. 405 38

Oxyhemoglobin dissociation (OHD) curves were performed on whole blood (WB) from 20 patients with anginal pain, normal hemodynamics, and normal coronary arteries, as demonstrated by selective coronary cinearteriography. OHD curves in 19 of 20 patients, from zero to full saturation, were nearly identical to those in normal control subjects with values for P(50) (Po(2) at 50% saturation and pH 7.4) of 26.7+/-1.5 (mean+/-SD of the mean) torr (mm Hg) and red blood cell (RBC) levels of 2,3-diphosphoglyceric acid (2, 3-DPG) of 0.72+/-0.10 (mean+/-SD of the mean) M/M hemoglobin (Hb). Normal values for nonsmoking adults were: P(50), 26.6+/-1.4 (mean+/-SD of the mean) torr: and RBC 2,3-DPG, 0.81+/-0.09 (mean+/-SD of the mean) M/M Hb. Mean levels of carbon monoxide were normal at 0.14+/-0.01 (mean+/-SEM) ml/100 ml WB in 10 patients who were nonsmokers and 0.45+/-0.15 (mean+/-SEM) ml/100 ml WB in 10 smokers. In one patient, a heavy smoker with markedly elevated blood carbon monoxide levels, an abnormal leftward shift of the OHD curve was observed. This was corrected after discontinuation of smoking. In utilizing these methods, we could not detect consistent abnormalities of Hb affinity for oxygen at rest in the patients studied, which suggests that a defect in oxygen transport at rest is an unlikely explanation for the symptoms of chest pain in patients with the anginal syndrome and normal coronary arteriograms.
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PMID:Hemoglobin affinity for oxygen in the anginal syndrome with normal coronary arteriograms. 484 50

The efficacy of verapamil (360 mg daily) in the treatment of patients with chronic stable angina pectoris was compared with placebo. 28 patients were studied in a placebo-controlled double-blind crossover trial of 2 weeks each and afterwards on long-term verapamil. Exercise tests were performed at the end f the placebo period, and after 2 weeks and 4 weeks on verapamil. On placebo, angina developed in all 28 patients during treadmill tests; the mean exercise time was 6.6 min (SEM +/- 0.5 min). The mean exercise time increased to 9.2 (+/- 0.8) min at 2 weeks, and 11.2 (+/- 0.8) min at 4 weeks on verapamil. In 15 and 20 patients out of the 28 angina did not develop during treadmill exercise at 2 and 4 weeks respectively. Trinitrin consumption also decreased. There was a significant improvement in ST-segment changes. Constipation (in 7 patients) and reversible PR-interval prolongation (in 2 patients) were the only side effects. No patient had clinical signs of heart-failure. Thus verapamil (360 mg daily) may be useful in the management of chronic stable angina.
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PMID:Verapamil in chronic stable angina. A controlled study with computerized multistage treadmill exercise. 610 8

Propranolol (240 mg daily) and verapamil (360 mg daily) were objectively compared for their respective efficacy in the treatment of chronic stable angina pectoris. Twenty-two patients were studied in a randomized placebo controlled, double-blind crossover trial with 4 weeks on each active drug treatment. Multistage treadmill exercise with computer-assisted ECG analysis was performed after 2 weeks on placebo and at the end of each 4-week active drug treatment. The mean exercise time to produce angina was 5.5 minutes (SEM +/- 0.4 minutes) on placebo and this increased to 7.8 (+/- 0.5) minutes on propranolol and 9.1 (+/- 0.5) minutes on verapamil. The improvement in exercise time of verapamil over propranolol was statistically significant (p less than 0.01). Ten patients became free of angina with verapamil and four with propranolol. Resting and maximal exercise heart rates were significantly reduced by propranolol; verapamil did not reduce the maximal heart rate but reduced the resting heart rate slightly. However, the heart rate increase per minute of exercise was significantly diminished (p less than 0.001). ST segment changes showed improvement with both drugs despite marked differences in heart rate profile. The overall efficacy of the slow calcium channel blocker, verapamil, compares favorably with that of a standard beta-adrenoreceptor blocking drug (propranolol), thus providing a new perspective in the management of angina pectoris. These two classes of drugs seem to act by different mechanisms and it is suggested that if patients are resistant or intolerant to one of these drugs, the other can be used to yield a beneficial response.
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PMID:Double-blind randomized crossover trial of verapamil and propranolol in chronic stable angina. 635 43

The nuclear probe was used for measuring left ventricular function in 11 normal subjects and the results compared with those using a digital gammacamera. The probe was then used to measure left ventricular function in patients with coronary artery disease during dynamic exercise and stress atrial pacing. The ability of the probe to detect changes induced by glyceryl trinitrate was also evaluated in separate parallel studies. In the 11 normal subjects there was a good correlation between the left ventricular ejection fraction measured by the gammacamera and the nuclear probe both at rest and during exercise. Exercise increased this value by at least 5% in all normal subjects during measurements with both the gammacamera and the nuclear probe. The mean (SD) difference was -0.3% (2.60) at rest and 2.3% (5.02) at peak exercise. Both exercise and pacing produced angina in the patient group and the mean (SEM) value fell from 52% (3.5) to 28% (2.6) and from 46% (5.1) to 34% (3.2) respectively. Glyceryl trinitrate prolonged the exercise and pacing times, and the corresponding falls in ejection fraction were significantly reduced. The non-imaging nuclear probe is a cheap and portable instrument capable of assessing left ventricular function in patients with cardiac disease. It is designed for high count rate acquisition over a short period of time and can thus provide both beat to beat and summated left ventricular time activity curves suitable for quantitative analysis. It therefore has important advantages in the clinical setting and during controlled interventions compared with the gammacameras.
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PMID:Assessment of left ventricular function in coronary artery disease with the nuclear probe during intervention studies. 643 46

Exercise testing is widely used for the diagnosis of ischaemic heart disease and for the evaluation of antianginal drugs. To assess reproducibility, analysis was carried out on 128 paired graded exercise tests from 103 patients performed at the same time of day and under identical conditions. Six different parameters were evaluated and compared between the basal test (no treatment) and the placebo test. During the basal period the mean (+/- SEM) exercise time to the development of angina was 6.0 (+/- 0.2) min and the 1 mm ST depression time was 4.1 (+/- 0.2) min. After 2 weeks of placebo the exercise time was 6.1 (+/- 0.2) min (P = NS) and the 1 mm ST depression time was 4.2 (+/- 0.2) min (P = NS). There was no significant difference between the resting or maximum heart rate on either test and the maximum ST segment depression (leads CM5 and CC5) was unaltered. In a second group of 17 patients where the basal tests were performed in the afternoon and the placebo tests in the morning, heart rate and ST segment were found to be reproducible but there was a significant difference in exercise time: 5.7 (+/- 0.7) min for the basal test and 8.3 (+/- 0.5) min for the placebo test (P less than 0.001); and of the 1 mm ST depression time: 2.7 (+/- 0.4) min for the basal test, and 5.4 (+/- 0.5) min for the placebo test (P less than 0.001). We conclude that exercise tests done under standardised conditions in the morning are highly reproducible in patients with chronic stable angina and therefore provide a valuable test for the evaluation of antianginal drugs.
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PMID:Reproducibility of multistage graded exercise testing in patients with chronic stable angina. 646 1

Responses of heart rate and blood pressure to transient myocardial ischemia were analyzed in patients with variant angina. Heart rate changes during ST segment elevation were examined by means of a Holter ECG monitoring system. All 27 ST segment elevations from 10 patients with anterior ischemia were accompanied by an increase in heart rate by 12 +/- 2 bpm (mean +/- SEM, p less than 0.001) at peak ST segment elevation. With inferior ischemia in nine patients, heart rate decreased significantly by 4 +/- 1 bpm (n = 28, p less than 0.001). However, 9 of these 28 ST segment elevations showed a biphasic response of heart rate, that is, an initial increase and subsequent decrease. Such heart rate changes were not different between ST segment elevations with and without chest pain. With chest pain systolic blood pressure rose in anterior ischemia by 42 +/- 5 mm Hg (n = 10, p less than 0.001) but fell in inferior ischemia by 22 +/- 8 mm Hg (n = 7, p less than 0.05). We conclude that a different cardiovascular reflex occurs in response to inferior versus anterior ischemia and it is independent of chest pain.
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PMID:Reflex heart rate and blood pressure changes during ST segment elevation in patients with variant angina. 649 87

Myocardial lactate metabolism was studied in 20 patients with coronary heart disease during and immediately after slight angina pectoris induced by atrial pacing. Myocardial lactate extraction ratio (MLE) decreased from 0.27 +/- 0.03 (SEM) before angina to 0.01 +/- 0.06 during angina, and further to -0.32 +/- 0.11 at 15 sec after pacing. Lactate production was found to occur in eight patients during pacing and 13 patients after pacing. Cardiac venous flow was measured by thermodilution in eight of these patients. 'Net ischaemic lactate efflux' increased by 23 +/- 4 mumol/min 15 sec after pacing, whereas 'lactate uptake in non-ischaemic regions' diminished by 11 +/- 2 mumol/min. Lactate production 15 min after pacing was revealed in all patients with subtotal stenosis of the left anterior descending coronary artery (LAD), whereas it was less frequently observed in patients with occluded LAD and collaterals to the post-stenotic area. Increased washout of metabolites from the ischaemic myocardium during the early recovery period is the main reason for the rather high sensitivity of ischaemia detection by this procedure. This permits shorter pacing periods and less pain than in earlier studies. Both MLE and electrocardiographic changes were equally reproducible after 20 and 45 min recovery period.
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PMID:Myocardial lactate metabolism during pacing induced angina pectoris. 662 63


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