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)

Increasing longevity makes the consideration of coronary bypass common in elderly patients. Seventy-five patients 70 years of age or older undergoing coronary artery bypass grafting (CABG) for angina pectoris were compared to a control group of 75 patients under 70 years of age. The groups were matched for male:female ratio (46:29), previous infarction (28/75), unstable angina (27/75), and the requirement for preoperative intra-aortic balloon pumping (7/75). Patients under 70 years of age had an average preoperative New York Heart Association (NYHA) class of 3.0 +/- 0.6 (SEM) and an average left ventricular end-diastolic pressure of 15.5 +/- 0.8 mm Hg, compared to 3.3 +/- 0.6 and 12.9 +/- 1.1 mm Hg, respectively, for the older group. Average grafts per patient were 2.7 +/- 0.8 in the younger group and 2.8 +/- 0.1 in the older group. Overall operative mortality for patients under 70 was 4% (3/75) versus 12% (9/75) (p = 0.06) for patients 70 and older. The incidence of chronic stable angina was 2% (1/48) versus 6% (3/48) (p = 0.30). Perioperative infarctions occurred in 7% of those under 70 and 5% of those 70 or older (p = 0.54). Those under 70 averaged 13.8 +/- 0.6 postoperative hospital days versus 18.4 +/- 1.2 hospital days for the older group (p less than 0.05). Follow-up ranged from 2 to 94 months, averaging 22 months for patients under 70 and 24 months for those 70 or older. Late cardiac mortality rates were 4% (3/70) in the younger patients and 3% (2/66) in the older patients (p = 0.53). Current NYHA class was 1.3 +/- 0.7 for those under 70, with 9% reporting angina, and 1.4 +/- 0.7 for those who were 70 or older, with 6% reporting angina. CABG can be performed with acceptable risk in older patients and leads to encouraging symptomatic improvement and late survival.
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PMID:Isolated coronary artery bypass grafting in patients seventy years of age and older: early and late results. 698 Mar 29

The effect of nifedipine on exercise tolerance was studied in 30 patients with stable angina and positive graded exercise testing. Treadmill exercise testing was performed on each of five consecutive days. Placebo or nifedipine, 10 mg sublingually, was given 30 minutes before exercise on the third day. The following day the intervention was reversed in a double-blind manner. Angina was abolished by nifedipine but not by placebo in 12 patients (40 percent). The time to onset of angina in the remaining patients increased from 4.1 +/- 0.4 (SEM) to 6.7 +/- 0.6 min (p less than .001). Time to ST depression greater than or equal to 2 mm increased from 4.0 +/- 0.3 to 5.4 +/- 0.5 min, while duration of exercise increased from 6.3 +/- 0.3 to 8.2 +/- 0.4 min (p less than .001). The maximum heart rate was 145 +/- 3.3 with nifedipine and 122 +/- 3.8 min-1 with placebo (p less than .01). Resting systolic blood pressure decreased 30 min after nifedipine administration from 131 +/- 3.4 to 106 +/- 2.9 mm Hg (p less than .01). Maximal systolic blood pressure during exercise was lower with nifedipine (127 +/- 4.8 mm Hg) than with placebo (155 +/- 5.6 mm Hg, p less than .01). We conclude that nifedipine significantly improves the exercise tolerance of patients with stable angina pectoris by decreasing peripheral vascular resistance and myocardial oxygen demand.
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PMID:Effect of a calcium inhibitor, nifedipine, on exercise tolerance in patients with angina pectoris: a double-blind study. 700 84

Acebutolol, a relatively cardioselective beta-adrenergic blocking drug, was administered to 20 men with coronary artery disease and angina. A three month double-blind cross-over (placebo and acebutolol) design was used following a 12-week placebo phase and a six-week dose-titration phase. During the cross-over phase, acebutolol (400 mg in 19 men and 300 mg in one, orally three times per day) increased the duration of treadmill exercise (placebo, 6.8 +/- 0.5) min [average +/- SEM]; acebutolol, 8.1 +/- 0.6 min; P less than 0.05) and decreased the frequency of ST segment depression during exercise (placebo, 12 or 20 men; acebutolol, 6 of 20 men). The heart rate x systolic blood pressure product (x 10(-2)) was decreased both at rest (placebo, 105.0 +/- 4.0; acebutolol, 84.0 +/- 3.0; P less than 0.01) and during exercise (placebo, 199.0 +/- 10.0; acebutolol, 144.0 +/- 8.0; P less than 0.01). Acebutolol treatment decreased the frequency of angina (diary cards) (placebo, 9.0 +/- 2.4 episodes per week; acebutolol, 6.4 +/- 2.2 episodes per week; P less than 0.05) and decreased the consumption of nitroglycerin (placebo, 9.0 +/- 4.4 tablets per week; acebutolol, 7.4 +/- 4.0 tablets per week; P less than 0.05). Results suggest that acebutolol increases exercise performance and decreases the occurrence of angina in men with coronary disease.
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PMID:Favorable effects of acebutolol on exercise performance and angina in men with coronary artery disease. 704 8

A new calcium channel blocker, niludipine, was administered intravenously to nine patients with coronary artery disease in order to investigate its effects on left ventricular systolic and diastolic function, coronary sinus blood flow, and myocardial lactate metabolism. Coronary sinus pacing was performed in all patients and produced angina in six patients. Niludipine increased the resting heart rate from 75+/-3 beats/min (mean+/-SEM) to 82+/-3 (NS) and decreased the left ventricular systolic pressure from 155+/-4.7 mm Hg to 134+/-2.8 (p less than 0.05). Coronary sinus blood flow increased by 9%(NS). During pacing after niludipine, clinical improvement occurred in the six patients who had initially experienced angina. The extent of ischemic ST segment depression was decreased (-1.56+/-0.27 mm to -0.78+/-0.38, p less than 0.02) and myocardial lactate metabolism was improved. When pacing was terminated, niludipine suppressed the elevation of left ventricular end-diastolic pressure compared to pretreatment values (16.2+/-2.5 mm Hg vs 8.5+/-0.9, p less than 0.05) and decreased the left ventricular time constant T(26.4+/-3.6 msec to 20.2+/-2.4 p less than 0.05). The results suggest that niludipine appears to be beneficial in reducing systolic and diastolic work of the left ventricle during pacing induced angina without a significant change in total coronary sinus blood flow. Niludipine appears to have less of a hypotensive and reflex tachycardic effect than nifedipine.
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PMID:Effects of new calcium channel blocker of niludipine on the coronary hemodynamics, diastolic properties, and metabolic responses to tachycardia stress in patients with coronary disease. 712 62

To test the hypothesis that patients at risk of future cardiac events can be identified by sub-maximal exercise testing with radionuclide ventriculography (RVG), 61 patients were studied a mean of 19 +/- 1.0 days (+/- SEM) after acute myocardial infarction (MI). RVGs were used to measure left ventricular ejection fraction (LVEF), wall motion score (WMS), end-diastolic volume (EDV) and end-systolic volume (ESV), and the ratio of systolic blood pressure to ESV (P/V index) at rest and during submaximal exercise. Frank lead ECGs were analyzed for ST-segment change and arrhythmias. These patients were followed for a mean of 9.6 months (60 for 6 months or more and one for 3 months) to determine the incidence of cardiac death, recurrent MI, unstable or medically refractory angina, persistent congestive heart failure (CHF) or limiting angina; these problems were considered to be important cardiac events. At the 6-month follow-up, 37 patients had important complications: four patients died, five had MI, seven had unstable or medically refractory angina, 11 had persistent CHF and 10 had severe limiting angina. The sensitivity and specificity of RVG in predicting the important postinfarct complications listed above were 95% and 96% for failure to increase LVEF by at least 5 units, 95% and 96% for an increase in ESV of more than 5%, 97% and 88% for failure of the P/V index to increase by more than 35%, and 81% and 88%, respectively, for a decrease in WMS. The sensitivity and specificity of the ECG in predicting important complications were 54% and 58%, respectively. The rest and submaximal exercise RVG variables, the ECG, a history of MI, the location of the infarction, Killip class III, age, sex, and maximal work load performed were analyzed statistically to determine the best predictors of prognosis. The change with exercise in LVEF, ESV and the P/V index were most significant variables in predicting prognosis during the 6-month follow-up period. When patients with subsequent cardiac events were separated into those with death, recurrent MI and unstable or medically refractory angina as major cardiac events, and patients with persistent CHF and limiting angina as less important ("minor") cardiac events, only the peak submaximal exercise LVEF and history of MI were significant in distinguishing these groups. In patients without important cardiac events during the 3- and 6-month follow-up, 70% and 88%, respectively, no abnormality in the responses of LVEF, ESV, or P/V index to submaximal exercise. These results suggest that submaximal exercise testing with RVG is a highly sensitive means of classifying patients at the time of hospital discharge after MI according to the likelihood of having cardiac events during the ensuing 6 months.
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PMID:The prognostic value of submaximal exercise testing with radionuclide ventriculography before hospital discharge in patients with recent myocardial infarction. 726 Dec 86

Although the relationship between blood pressure and cardiac performance has been widely recognized, there are few published clinical observations concerning the effect of blood pressure control on cardiac function. We evaluated the effect of prazosin, an antihypertensive agent which also improves hemodynamic measurements in normotensive patients with heart failure, in 16 patients with moderate hypertension and reduced ejection fractions. Therapy with digoxin and diuretics was continued throughout the study, but other antihypertensive agents were withdrawn at least one week prior to the initiation of the study. Measurements of ejection fraction, cardiothoracic ratio and the duration of maximal treadmill exercise were made before and after two months of antihypertensive therapy with prazosin. On prazosin, blood pressure fell from a mean of 169/103 to 141/84. Excellent control was achieved in 13/16 patients and significant reductions were noted in the remaining three. Concomitantly, ejection fraction rose from .38 +/- .02 (SEM) to .43 +/- .03 (P less than .02), cardiothoracic ratio decreased from .55 +/- .02 to .53 +/- .02 (P less than .05) and exercise capacity increased from 9.2 +/- 0.9 to 11.9 +/- 1.1 minutes (P less than .005). Prazosin was well tolerated except in one patient who experienced worsening angina. These findings emphasize the importance of rigorous blood pressure control in hypertensive patients with left ventricular dysfunction and indicate that prazosin is effective in this setting.
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PMID:Antihypertensive therapy with prazosin in patients with left ventricular dysfunction. Improvement in cardiac performance and exercise tolerance. 730 90

Pentane and isoprene concentrations were analyzed in single end-expiratory breath samples using gas chromatography. Breath analysis was performed in 15 patients with acute myocardial infarction, 15 patients with stable angina, and 15 healthy control subjects. The two patient groups were well matched for age, sex, smoking habits, hypertension and serum cholesterol levels. There was no significant difference in breath pentane concentration in the acute myocardial infarction group (0.29 +/- 0.03 nmol/l) (mean +/- SEM) compared to the group with stable angina (0.31 +/- 0.03 nmol/l) or the control group (0.36 +/- 0.04 nmol/l). However, breath isoprene concentration was higher (p < 0.01) in the acute myocardial infarction group (11.4 +/- 1.2 nmol/l), compared to both the stable angina group (7.7 +/- 0.5 nmol/l) and the control group (7.1 +/- 1.0 nmol/l). There was no difference in either the pentane or isoprene concentrations between the control group and the group with stable angina. Since pentane is thought to be an index of lipid peroxidation, the results do not support the presence of enhanced lipid peroxidation in acute myocardial infarction in the absence of thrombolytic therapy or primary angioplasty. The mechanism responsible for isoprene elevation in acute myocardial infarction is unknown.
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PMID:Expired hydrocarbons in patients with acute myocardial infarction. 758 9

Acute systemic and, possibly, coronary vasoconstriction may limit the usefulness of i.v. beta-blockade for the management of hypertension in ischemic patients. The acute hemodynamic and neurohumoral profile of i.v. dilevalol (50 mg/5 min), a nonselective beta-antagonist and selective partial beta 2-agonist, was evaluated for 1 h in nine patients with stable angina, significant (> 50%) coronary artery disease, and mild hypertension. Immediately after administration, arterial pressures fell significantly by 13% and remained lowered for the entire study period. Concomitantly, heart rate slowed from 76 +/- 2 (mean +/- SEM; control) to 67 +/- 2 beats/min (60 min postadministration, p < 0.05), and cardiac index and stroke work decreased significantly by 15 and 21%, respectively. Isovolumetric contractility indices (measured at fixed heart rates) fell progressively by 9-12%, whereas relaxation (Tau1 and Tau2) slowed by 10% (all p < 0.05 vs. control). Consequently, left ventricular end-diastolic and right atrial pressures increased significantly from 17 +/- 3 and 9 +/- 1.2 mm Hg at baseline to 21 +/- 2.5 and 12 +/- 2.1 mm Hg, respectively. Dilevalol did not affect systemic or coronary resistance. However, coronary flow decreased by 24% (p < 0.05 vs. control), accompanied by significant reductions in myocardial oxygen demand and consumption of 23 and 14%, respectively. Levels of circulating norepinephrine and dopamine increased by 35 and 71%, whereas those of renin and angiotensin II decreased by 26 and 33%, respectively (all p < 0.05 vs. control). Adverse side effects did not occur. None of the patients became ischemic. Thus, at the dose level used, dilevalol has predominant beta-blocking effects.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Acute hemodynamic and neurohumoral profile of dilevalol in hypertensive patients with ischemic heart disease. 769 77

Thirty elderly (mean +/- SEM: 73.8 +/- 2.1 y) nondiabetic, moderately obese (body mass index = 28.3 +/- 0.6 kg/m2) patients with stable effort angina underwent an oral-glucose-tolerance test and a euglycemic hyperinsulinemic glucose clamp before and after vitamin E supplementation (900 mg/d for 4 mo). The study was of a randomized, placebo-controlled, double-blind, and crossover design. Anthropometric indexes were stable throughout the study. Despite similar fasting and 2-h plasma glucose concentrations, vitamin E administration (compared with placebo) lowered fasting (88 +/- 14 and 68 +/- 9 pmol/L, P < 0.02) and 2-h (348 +/- 43 and 263 +/- 28 pmol/L, P < 0.05) plasma insulin concentrations, plasma triglyceride concentrations (1.34 +/- 0.06 and 1.07 +/- 0.03 mmol/L, P < 0.05), and the ratio of plasma LDL to HDL cholesterol (7.64 +/- 0.31 and 5.52 +/- 0.38, P < 0.02). Vitamin E administration was associated with higher nonoxidative glucose metabolism (18.1 +/- 0.5 and 10.6 +/- 0.7 mumol.kg lean body mass-1.min-1, P < 0.03) than was placebo administration during the euglycemic glucose clamp. We conclude that chronic intake of pharmacological doses of vitamin E might be useful in the therapy of elderly insulin-resistant patients with coronary heart disease.
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PMID:Chronic intake of pharmacological doses of vitamin E might be useful in the therapy of elderly patients with coronary heart disease. 770 30

The 3-month efficacy and safety of a once-daily controlled formulation of diltiazem (180 to 360 mg/day) were assessed in a study of 54 patients with angina pectoris. This multicenter study was a nonrandomized, placebo run-in, open-label, 3-month trial followed by a 1-week, double-blind, randomized period during which most patients (89%) received placebo. There were only minimal changes in the time to termination (mean change +/- SEM -5.8 +/- 9.6 seconds), time to onset of angina (10.5 +/- 12.2 seconds), and the time to 1 mm ST-segment depression (2.9 +/- 12.5 seconds) from the end of the titration phase to the end of the open-label study. There were, however, statistically significant differences between the end of the 3-month treatment phase and the end of the 1-week randomized placebo phase for those 3 efficacy parameters (-37.3 +/- 11.2, -58.6 +/- 13.6, and -45.6 +/- 16.4 seconds, respectively). Diltiazem significantly decreased the frequency of anginal attacks and nitroglycerin use at the end of the 3-month treatment phase compared with results at the end of the randomized double-blind placebo phase. No new or unusual adverse events were reported during treatment. The present results suggest that there is no loss of efficacy of once-a-day diltiazem when administered for a long period to patients with chronic stable angina pectoris.
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PMID:Three-month efficacy and safety of once-daily diltiazem in chronic stable angina pectoris. 771 May 63


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