digoxin and Angina-Pectoris

Amlodipine, a dihydropyridine calcium antagonist, was synthesized in an attempt to develop a compound with a pharmacokinetic profile characteristic of this class, which would also have an increased oral bioavailability and extended clearance time. A single intravenous dose of 10 mg resulted in an absolute bioavailability of 64% and a calculated elimination half-life of 34 hours. The pharmacokinetic profile of oral doses showed similar changes. These results were significantly different from those seen with most other dihydropyridines (elimination half-life of 3 to 10 hours and absolute bioavailability of 10% to 30%) and nondihydropyridine calcium antagonists (elimination half-life 3 to 6 hours and low absolute bioavailability). With chronic oral dosing of amlodipine once daily for 14 days, support was provided for the linearity of amlodipine's pharmacokinetics and absence of such with chronic oral dosing with verapamil, diltiazem, and nifedipine. In the elderly population, elimination half-life of 5 mg oral doses is significantly prolonged (48 vs 35 hours; p less than 0.025) suggesting decreased oral clearance or increased bioavailability. Comparison of the pharmacokinetics of amlodipine in patients with chronic stable angina pectoris with the profile in healthy volunteers suggested that clearance is not altered in patients with chronic stable angina, steady state being reached 6 to 12 hours after administration of the drug. In patients with cirrhosis, elimination half-life is significantly prolonged (60 vs 34 hours; p less than 0.01) suggesting that there is a greater accumulation of amlodipine in patients with severe liver disease than in individuals with normal hepatic function.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Oral; Aging; Amlodipine; Angina Pectoris; Animals; Biological Availability; Calcium Channel Blockers; Cimetidine; Digoxin; Drug Interactions; Half-Life; Humans; Injections, Intravenous; Kidney Diseases; Liver Cirrhosis; Nifedipine

Topics: Angina Pectoris; Arrhythmias, Cardiac; Calcium Channel Blockers; Coronary Vasospasm; Digoxin; Diltiazem; Heart Block; Heart Diseases; Heart Rate; Humans; Hypertension; Nifedipine; Verapamil

Topics: Angina Pectoris; Arrhythmias, Cardiac; Biological Availability; Cardiac Glycosides; Central Nervous System Diseases; Digitoxin; Digoxin; Endocrine System Diseases; Gastrointestinal Diseases; Heart Failure; Humans; Hypersensitivity; Hypertension; Intestinal Absorption; Myocardial Infarction; Preoperative Care

We conducted a prospective, double-blind, placebo-controlled multicenter trial in order to evaluate the long-term effects of captopril (50 mg/day), digoxin (0.25 mg/day) and placebo on quality of life, cardiovascular events, clinical symptoms and exercise tolerance in patients with documented myocardial infarction, resulting in regional wall motion abnormalities, and with mild heart failure (NYHA class II to III without treatment) and exercise not limited by angina. 222 patients were studied, 63 were randomized to captopril, 66 to digoxin, 67 to placebo. Follow-up was conducted for two years. Base line characteristics in the three treatment groups were similar. After one year of therapy, digoxin had significantly improved general well-being (p < 0.01 vs captopril), symptom score (p < 0.05 vs captopril and placebo), and vitality (p < 0.05 vs captopril). Digoxin improved NYHA class in 45% as compared to placebo (28%, p < 0.05). Worsening of angina was more frequent with captopril as compared to digoxin (p < 0.05). However, cardiovascular events during follow-up were lower in the captopril group as compared to placebo and digoxin (p < 0.01 captopril vs placebo). No differences between groups were observed in baseline and follow-up exercise tolerance between the three groups. Dizziness during upright tilt and cough were more frequent with captopril as compared to digoxin or placebo. After two years of follow-up (captopril n = 32, digoxin n = 29, placebo n = 27) general well-being was improved with both digoxin and captopril (p < 0.004 and p < 0.03 vs placebo).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Angina Pectoris; Captopril; Coronary Disease; Digoxin; Double-Blind Method; Drug Therapy, Combination; Exercise Test; Female; Heart Failure; Hemodynamics; Humans; Male; Middle Aged; Myocardial Infarction; Nitroglycerin; Prospective Studies; Quality of Life; Survival Rate

The study was designed to evaluate the safety of ibopamine (3,4-diisobutyryl ester of N-methyldopamine. SB(-)-505. Inopamil; CAS 66195-31-1) for the chronic treatment of congestive heart failure. It was conducted as a comparative cohort survey, versus digitalis. A third cohort was made with patients who received both drugs in association. Any differences between cohorts at baseline were dealt with by identifying explanatory variables with linear discriminant analysis and by performing multivariate statistical analysis by Cox's proportional hazard model. During 16 months, 3.330 patients were enrolled and then followed-up for a median time of 1 year. Baseline characteristics are reported as well as follow-up results on mortality, disease progression, anginal episodes, arrhythmias, need for cointervention and other undesired on-therapy events. Results pointing to efficacy are consistent with the favourable results from controlled randomized double blind medium--long term clinical trials. In addition, data from the present study do indeed provide strong evidence on the safety of long-term treatment with ibopamine. At variance with inotropic agents ibopamine did not increase mortality. The results rather suggest that long-term treatment with ibopamine affords an increase in survival and a delay in the progression of the disease, without adverse effects on cardiac rhythm and myocardial oxygen balance, and with a general improvement in the patients' quality of life.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Angina Pectoris; Arrhythmias, Cardiac; Blood Pressure; Cardiotonic Agents; Deoxyepinephrine; Digoxin; Drug Prescriptions; Drug Therapy, Combination; Electrocardiography; Female; Heart Failure; Heart Rate; Humans; Male; Middle Aged; Product Surveillance, Postmarketing; Prognosis; Risk Factors

The appearance of impaired left ventricular diastolic function in chronic ischemic heart disease often precedes systolic dysfunction. Myocardial ischemia and increased calcium loading have been implicated in the genesis of increased left ventricular stiffness. We have assessed the effects of long-term therapy with different classes of calcium channel-blocking drugs on left ventricular peak filling rate in patients with chronic stable angina and congestive heart failure secondary to ischemic heart disease. Therapeutic effects of nicardipine (30 mg t.i.d.), nisoldipine (10 mg b.i.d.), and verapamil (120 mg t.i.d.) (4 weeks) have been assessed on radionuclide left ventricular diastolic filling parameters in patients with chronic stable angina using placebo-controlled studies. All three drugs significantly improved exercise capacity as compared with placebo. Verapamil produced significant improvements in peak filling rate (p less than 0.005), time to peak filling rate (p less than 0.01), and first one-third filling fraction (p less than 0.005), whereas nicardipine only improved peak filling rate (p less than 0.005); neither drug altered the mean ejection fraction (n = 20). Nisoldipine did not significantly alter diastolic filling parameters or ejection fraction (n = 10). Nisoldipine and digoxin were also assessed in congestive heart failure (New York Heart Association [NYHA] classes II and III) associated with ischemic heart disease (n = 26) (open parallel design). Neither produced significant alterations in peak filling rate and ejection fraction after 3 months of therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Angina Pectoris; Calcium Channel Blockers; Cardiac Output; Digoxin; Exercise Test; Heart Failure; Humans; Middle Aged; Myocardial Contraction; Radionuclide Ventriculography; Randomized Controlled Trials as Topic; Stroke Volume; Time Factors

The effect of the postoperative administration of digoxin to patients undergoing coronary artery bypass surgery on the incidence of supraventricular arrhythmias was studied. Patients were randomly assigned to a control group (n = 51) or digoxin group (n = 47) on a prospective basis. Patient characteristics were similar in both groups, and no patients were receiving digoxin therapy preoperatively or other antiarrhythmic medications. All patients had normal systolic ejection fractions, renal function, and hepatic function. Eight patients (16%) in the control group developed postoperative arrhythmias while seven patients (15%) in the digoxin group developed supraventricular arrhythmias. This difference was not significant. Two patients in the digoxin group developed digoxin-induced arrhythmias, and two other patients experienced digoxin-related nausea and vomiting, which were resolved with discontinuation of the drug. The postoperative administration of digoxin to patients undergoing coronary artery bypass surgery had no effect on the incidence of supraventricular arrhythmias. The prophylactic use of digoxin therapy in this patient population is not recommended unless there is a history of arrhythmias responsive to digoxin therapy.

Topics: Adult; Aged; Angina Pectoris; Arrhythmias, Cardiac; Coronary Artery Bypass; Digoxin; Female; Humans; Male; Middle Aged

The effect of nitroglycerin, digoxin and inderal on myocardial asynergy was studied in 108 patients with ischemic heart disease by means of echocardiography. The effect of nitroglycerin was studied in 32 patients; myocardial contractions were restored in the areas of asynergy in 15 patients, in 17 the character of myocardial asynergy did not change. The effect of digoxin was studied in 42 patients; intensification of myocardial contractions in the asynergic areas was noted in 18 patients in 16 the character of asynergy of the myocardium did not change, and in 8 paradoxical protrusion of the cardiac wall increased. Prescription of inderal for 34 patients did not lead to the development of additional areas of myocardial asynergy; proportionate decrease of the amplitude of the systolic myocardial movement in healthy areas and in areas with hypo-and dyskinesia was noted in such cases. The study showed changeability of the character of myocardial asynergy under the effect of the drugs investigated, which should be taken into account when these drugs are given to patients with ischemic heart disease.

Topics: Adult; Aged; Angina Pectoris; Clinical Trials as Topic; Coronary Disease; Digoxin; Drug Evaluation; Echocardiography; Female; Humans; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Nitroglycerin; Propranolol

The effects of oral propranolol and digoxin and digoxin alone and in combination on angina frequency, heart size, systolic time intervals and treadmill exercise tolerance, were assessed in 20 patients with coronary heart disease. Oral propranolol alone reduced the average frequency of angina pectoris from 16 to 7 attacks per week (P less than 0.02). However, the mean duration of exercise was not significantly improved because 8 patients with abnormal left ventricular function exhibited a decrease in exercise tolerance. Combined propranolol and digoxin improved exercise tolerance in these patients, and, consequently, mean exercise duration in all patients increased significantly from the control value of 390 +/- 42 to 458 +/- 46 s (P less than 0.01). Propranolol alone also resulted in a significant increase in left heart size from 46.5 +/- 1.3 to 47.7 +/- 1.5 mm/m2 (P less than 0.001), which was reversed by the addition of digoxin. Therefore, oral propranolol combined with digoxin is advantageous in patients with angina pectoris who have abnormal ventricular function or large hearts.

Topics: Administration, Oral; Adult; Aged; Angina Pectoris; Blood Pressure; Clinical Trials as Topic; Digoxin; Drug Therapy, Combination; Female; Heart; Heart Function Tests; Heart Rate; Humans; Male; Middle Aged; Physical Exertion; Placebos; Propranolol; Radiography

Topics: Administration, Oral; Adult; Angina Pectoris; Blood Pressure; Cardiac Volume; Clinical Trials as Topic; Digoxin; Exercise Test; Heart; Heart Rate; Humans; Male; Middle Aged; Nitroglycerin; Placebos; Thorax

Topics: Alprenolol; Angina Pectoris; Blood Pressure; Cardiac Output; Cardiac Volume; Digoxin; Electrocardiography; Exercise Test; Female; Heart Ventricles; Hemodynamics; Humans; Lanatosides; Male; Middle Aged; Physical Exertion; Placebos; Time Factors

Topics: Adrenergic beta-Antagonists; Adult; Aged; Angina Pectoris; Anticoagulants; Blood Pressure; Clinical Trials as Topic; Digoxin; Diuretics; Electrocardiography; Exercise Test; Heart Rate; Humans; Male; Middle Aged; Myocardium; Nitroglycerin; Oxygen Consumption; Physical Exertion; Placebos; Propranolol; Sympatholytics

Topics: Adult; Aged; Angina Pectoris; Blood Pressure; Clinical Trials as Topic; Coronary Disease; Digoxin; Electrocardiography; Female; Heart Rate; Humans; Hypertension; Hypnotics and Sedatives; Injections, Intravenous; Male; Middle Aged; Myocardial Infarction; Placebos; Respiration; Vasodilator Agents

Digoxin is a phyto-estrogen capable of inducing hormonal effects. Use has been associated with increased risk of breast cancer, an estrogen-sensitive malignancy. The incidence of corpus uteri (uterus) cancer is also strongly increased with exposure to estrogens. Therefore, we evaluated whether digoxin use might also increase its incidence. In all women in Denmark, we identified digoxin users from 1995 through 2008 using a nationwide pharmacy registry system. Cancer occurrence was obtained from Danish Cancer Registry. Relative risk was determined using incidence risk ratios (RR) and 95% confidence intervals (CIs) relative to non-users after adjustment for age- and calendar-time. For ovarian and cervical cancers, RRs in users and non-users were similarly evaluated, these cancers representing gynecological cancers with weak or no associations to estrogen exposure. Of 2.1 million women, 104,648 (4.9%) had digoxin exposure and 137,493 6.5% had exposure to angina drugs but not digoxin during the study period. For uterus cancer, the RR was increased in current digoxin users (1.48, 95% CI: 1.32-1.65; N = 350). Incidence was marginally increased in former users. For ovary and cervix cancers, RRs in current digoxin users were 1.06 (95% CI: 0.92-1.22; N = 207) and 1.00 (95% CI: 0.79-1.25; N = 81), respectively. We examined risks in women using angina drugs but not digoxin to determine whether being under cardiac care affected risk. Among women using angina drugs only, RRs for uterus, ovary or cervix cancers were not statistically significant. We conclude that women currently using digoxin, a phyto-estrogen, have an increased risk of developing uterus cancers.

Topics: Adult; Aged; Aged, 80 and over; Angina Pectoris; Denmark; Digoxin; Female; Humans; Middle Aged; Ovarian Neoplasms; Phytoestrogens; Risk Factors; Uterine Cervical Neoplasms; Young Adult

We assessed, in patients with a first hospitalization for heart failure (HF), the temporal relationship of the incidence of cardiovascular events, all-cause mortality, and cardiovascular drug treatment.. Data were obtained from the PHARMO Record Linkage System, a population-based registry of pharmacy records linked with hospital discharge records in The Netherlands. Patients were selected based on a first hospital discharge diagnosis of documented HF. Two time-periods were compared: 1998-2002 and 2003-07. In each time-period, we analysed all prescribed cardiovascular medications, all-cause mortality, and cardiovascular events (rehospitalization for HF and ischaemic events) within the first year after hospitalization, and the occurrence of ischaemic events separately (myocardial infarction and ischaemic stroke). Cox-regression analysis was performed to calculate hazard ratios (HR) with 95% confidence intervals (CI). We identified 8276 patients in 1998-2002 and 9548 patients from 2003-07. There was an increase in almost all cardiovascular medication prescriptions in the second period: in particular, beta-blocker prescriptions rose from 36% in 1998-2002 to 55% in 2003-07. In the first year after hospitalization, there was no difference in all-cause mortality or any cardiovascular event (HR 1.00, 95%CI: 0.95-1.05), as a composite endpoint or when analysed separately. The incidence of ischaemic events decreased from 2.7 to 1.9% in the first and second time-period, respectively (HR 0.74, 95%CI: 0.61-0.90).. Prescription of cardiovascular medications in patients with a first hospitalization for HF has increased in recent years, particularly for beta-blockers, and the incidence of ischaemic events may have decreased. There was no decrease in all-cause mortality or cardiovascular events.

Topics: Adrenergic beta-Antagonists; Aged; Aged, 80 and over; Angina Pectoris; Angiotensin-Converting Enzyme Inhibitors; Cardiotonic Agents; Digoxin; Diuretics; Female; Heart Failure; Hospitalization; Humans; Male; Myocardial Infarction; Myocardial Ischemia; Practice Patterns, Physicians'; Prognosis; Spironolactone; Stroke

The multidrug transporter, MDR1-mediated interaction of digoxin with antiarrhythmic or antianginal drugs was examined in vitro by using the MDR1-overexpressing LLC-GA5-COL150 cells, which were established by transfection with human MDR1 cDNA into porcine kidney epithelial LLC-PK(1) cells. Amiodarone, its active metabolite monodesethyl-amiodarone (DEA), and quinidine markedly inhibited the basal-to-apical transport (renal secretion) of [(3)H]digoxin and increased the apical-to-basal transport (reabsorption), but cibenzoline and lidocaine showed slight inhibition of the transport, and disopyramide and mexiletin had no such effects. The IC(50) values for amiodarone, DEA and quinidine on [(3)H]digoxin transport in LLC-GA5-COL150 cells were 5.48 microM, 1.27 microM and 9.52 microM, respectively. These were comparable to, or only several times the achievable concentration in clinical use, suggesting that MDR1 could be responsible for the drug interaction between digoxin and amiodarone found in clinical reports and that DEA contributes the elevation of digoxin serum concentration. Similarly, dipyridamole altered the transport, but isosorbide showed only slight modification of the transport. The IC(50) value for dipyridamole was 40.0 microM, also only several times the achievable concentration in clinical use, indicating a risk of interaction.

Topics: Amiodarone; Angina Pectoris; Animals; Anti-Arrhythmia Agents; ATP Binding Cassette Transporter, Subfamily B, Member 1; Biological Transport; Digoxin; Drug Interactions; Humans; LLC-PK1 Cells; Quinidine; Swine

Topics: Angina Pectoris; Angiotensin-Converting Enzyme Inhibitors; Arrhythmias, Cardiac; Cardiotonic Agents; Clinical Protocols; Digoxin; Heart Failure; Humans

Heart failure is today one of the most serious health problems of modern industrialized societies. The increase in the mean age of the population is an additional factor which favours a high incidence of episodes of heart failure. Age is also a relevant factor in mortality linked with heart failure. On this basis more emphasis has been given by researchers and physicians to improve a preventive and therapeutic approach to heart failure. For many years the pharmacological treatment of heart failure patients was based on the increase in inotropism through the digitalis and on the reduction in sodium-water retention through diuretics, while less importance was given to the improvement of the afterload. We have had knowledge of vasodilatory drugs in chronic heart failure for at least 20 years but only 10 years ago with the Vasodilator-Heart Failure Trial (V-HeFTI), it was proved that the combination of hydralazine and nitrates in addition to the conventional treatment, improved the survival of patients affected by moderate-severe heart failure. With the advent of the ACE-inhibitors, in the '80s, the first studies concerning the role of such drugs in heart failure were carried out. In the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS I) it was proved for the first time that an ACE-inhibitor (enalapril), added to the conventional heart failure therapy, improved the survival of patients with severe congestive heart failure (NYHA class IV). The result was so extraordinary that the study was interrupted for ethical reasons. However, it has raised a considerable interest in the study of the ACE-inhibitors in heart failure and now it has been proved that such drugs are a milestone in a correct pharmacological approach to heart failure.

Topics: Adult; Aged; Aged, 80 and over; Angina Pectoris; Angiotensin-Converting Enzyme Inhibitors; Clinical Trials as Topic; Clinical Trials, Phase I as Topic; Digoxin; Drug Therapy, Combination; Enalapril; Felodipine; Follow-Up Studies; Heart Failure; Humans; Middle Aged; Multicenter Studies as Topic; Myocardial Infarction; Randomized Controlled Trials as Topic; Time Factors; Vasodilator Agents; Ventricular Dysfunction

Three cases of diabetic myocardiopathy having history of diabetes, angina and left ventricular dysfunction of various degrees and confirmed by coronary angiography and endomyocardial biopsy were reported. Electrocardiography showed significant ST-T changes simulating coronary insufficiency but without definite localization. As to the treatment, nitrate preparations, inotropic agents such as strophanthin K, digoxin etc. were used to relieve the symptoms; insulin was also administered to control the blood glucose level. Diltiazem, a calcium blocker, is also of help in alleviating the symptoms. It is shown in the present study and in the literatures as well that diabetic myocardiopathy is a disease showing intramural microvascular endothelial proliferation and swelling as well as subendothelial accumulation of acid glycogen deposition cells. The transportation of intracellular calcium ions and the cellular metabolism are thus affected, so there are extensive ischemia, focal necrosis and fibrosis in the myocardium with resulting cardiac dysfunction. The authors are, therefore, of the opinion that diabetic myocardiopathy is a specific and separate clinical entity.

Topics: Aged; Angina Pectoris; Cardiomyopathies; Diabetes Complications; Digoxin; Female; Humans; Male; Middle Aged; Strophanthins; Ventricular Function, Left

Digoxin and sidnopharm were used in the treatment of 60 patients with initial stages of chronic circulatory insufficiency in IHD with a maintained sinus rhythm. It was established that sidnopharm in adequately selected doses possesses an essential antianginal effect with minor manifestations of side-effects, results in a favourable hemodynamic unloading of the heart and may be used in monotherapy of these patients.

Topics: Angina Pectoris; Chronic Disease; Digoxin; Drug Evaluation; Female; Heart Failure; Hemodynamics; Humans; Male; Middle Aged; Molsidomine; Physical Exertion; Vasodilator Agents

To determine the relative value of clinical findings, results of low-level treadmill electrocardiographic (ECG) exercise testing and left ventricular (LV) ejection fraction (EF) for predicting cardiac events in the year after an acute myocardial infarction (AMI), 72 patients who had had an uncomplicated AMI were studied with either radionuclide angiography or 2-dimensional echocardiography to assess LVEF and a low-level treadmill exercise test before hospital discharge. All patients were followed for 1 year. Nineteen patients (26%) had at least 1 cardiac event: coronary artery bypass grafting (11 patients), recurrent AMI (6 patients) or cardiac death (6 patients). Multiple logistic regression analysis revealed that total cardiac events were predicted by exercise ECG ST-segment depression or angina, prior AMI, ventricular ectopic activity during exercise and digoxin therapy (cumulative r = 0.58, p less than 0.001). Coronary artery bypass grafting was predicted by exercise ECG ST-segment depression or angina (r = 0.29, p = 0.01). Recurrent AMI was predicted by exercise ECG ST-segment depression or angina, prior AMI and ventricular ectopic activity during exercise (cumulative r = 0.49, p less than 0.001). Cardiac death was predicted by an LVEF of 40% or less (r = 0.38, p = 0.01). The presence of both an LVEF of 40% or less and ECG ST-segment depression on treadmill exercise testing defined a subgroup of patients with a high incidence of early cardiac death (33%).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adrenergic beta-Antagonists; Angina Pectoris; Coronary Artery Bypass; Digoxin; Exercise Test; Female; Heart; Heart Arrest; Humans; Male; Myocardial Infarction; Prognosis; Radionuclide Imaging; Stroke Volume

A submaximal treadmill exercise test performed before hospital discharge after an uncomplicated myocardial infarction is often utilized to estimate prognosis and guide management, but there is little experience with a maximal exercise test performed 6 months after infarction to identify prognosis later in the convalescent period. The performance characteristics during an exercise test 6 months after myocardial infarction were related to the development of death, recurrent nonfatal myocardial infarction and coronary artery bypass surgery in the subsequent 12 months (that is, 6 to 18 months after infarction) in 473 patients. Mortality was significantly greater in patients who exhibited any of the following: inability to perform the exercise test because of cardiac limitations, the development of ST segment elevation of 1 mm or greater during the exercise test, an inadequate blood pressure response during exercise, the development of any ventricular premature depolarizations during exercise or the recovery period and inability to exercise beyond stage I of the modified Bruce protocol. By utilizing a combination of four high risk prognostic features from the exercise test, it was possible to stratify patients in terms of risk of mortality, from 1% if none of these features were present to 17% if three or four were present. Recurrent nonfatal myocardial infarction was predicted by an inability to perform the exercise test because of cardiac limitations, but not by any characteristics of exercise test performance. Coronary artery bypass surgery was associated with the development of ST segment depression of 1 mm or greater during the exercise test. Although clinical evidence of angina and heart failure 6 months after infarction was predictive of subsequent mortality among all survivors, among the low risk group without severely limiting cardiac disease, the exercise test provided unique prognostic information not available from clinical assessment alone. Therefore, a maximal exercise test performed 6 months after myocardial infarction is a valuable, noninvasive tool to evaluate prognosis. It provides information that is independent of and additive to clinical evaluation performed at the same time.

Topics: Adrenergic beta-Antagonists; Adult; Aged; Angina Pectoris; Blood Pressure; Coronary Artery Bypass; Digoxin; Electrocardiography; Exercise Test; Female; Follow-Up Studies; Heart Failure; Humans; Male; Middle Aged; Myocardial Infarction; Prognosis; Random Allocation; Recurrence; Risk

The importance of cardiovascular system involvement in hyperthyroidism has been recognized for many years. In the middle-aged and elderly patient, often with mild but prolonged elevation of plasma thyroid hormones, symptoms and signs of heart failure and complicating atrial fibrillation may dominate the clinical picture and mask the more classical endocrine manifestations of the disease. Pitfalls in diagnosis and the importance of early recognition and treatment are discussed. Despite experimental evidence for a short-term inotropic action of thyroid hormone excess, clinical data support the existence of a reversible cardiomyopathy in hyperthyroidism with impaired contractile reserve. Enhanced myocardial performance at rest primarily reflects the peripheral actions of thyroid hormone excess. Most, if not all, of the cardiac abnormalities return to normal once a euthyroid state has been achieved, although atrial fibrillation may persist in a minority. Optimum treatment requires rapid and definitive antithyroid therapy, usually using a large dose of radio-iodine, and rapid control of heart failure. Systemic anticoagulation is indicated in the presence of atrial fibrillation and should be continued until sinus rhythm has been present for at least three months, either spontaneously or after cardioversion.

Topics: Adrenergic beta-Antagonists; Angina Pectoris; Arrhythmias, Cardiac; Atrial Fibrillation; Cardiomyopathies; Digoxin; Drug Therapy, Combination; Heart Diseases; Heart Rate; Hemodynamics; Humans; Hyperthyroidism; Myocardial Contraction; Myocardial Infarction; Sympathetic Nervous System; Thyroid Function Tests; Thyroid Hormones

The incidence, risk factors and long-term prognosis of complex ventricular arrhythmias after coronary artery bypass graft surgery are not known. Complex ventricular arrhythmias are defined as Lown grades 4a (couplets), 4b (ventricular tachycardia) and 5 (R on T phenomenon). Ninety-two patients with normal left ventricular function who underwent elective coronary artery bypass graft surgery were prospectively evaluated. Ventricular arrhythmias were documented by predischarge 24 hour ambulatory electrocardiographic monitoring; 43% of patients had no or simple ventricular arrhythmias (Lown grades 1 to 3) and 57% had complex ventricular arrhythmias. Risk factors analyzed included age, sex, diabetes, hypertension, smoking, preoperative digoxin or propranolol therapy, cardiopulmonary bypass time, aortic cross-clamp time, number of vessels bypassed, peak creatine kinase (CK) elevation and pericarditis. No risk factor identified patients at higher risk for complex ventricular arrhythmias. Patients were followed up for 6 to 24 months (mean 16). Patients with complex ventricular arrhythmias did not have a higher incidence of sudden death, cardiac death, syncope, angina, myocardial infarction or cerebrovascular accident. It was concluded that: Complex ventricular arrhythmias are common after coronary artery bypass graft surgery. None of the risk factors considered identify high risk patients. Complex ventricular arrhythmias after coronary artery bypass graft surgery do not indicate a poor prognosis in patients with normal left ventricular function.

Topics: Ambulatory Care; Angina Pectoris; Arrhythmias, Cardiac; Coronary Artery Bypass; Digoxin; Electrocardiography; Electrophysiology; Female; Follow-Up Studies; Heart Ventricles; Humans; Male; Middle Aged; Monitoring, Physiologic; Premedication; Prognosis; Propranolol; Prospective Studies; Random Allocation; Risk; Time Factors

Topics: Adrenergic beta-Antagonists; Angina Pectoris; Arrhythmias, Cardiac; Calcium Channel Blockers; Digoxin; Drug Interactions; Humans; Hypertension; Hypoglycemic Agents; Kinetics; Liver; Myocardial Infarction

Calcium antagonists, of which the best known are verapamil, nifedipine and diltiazem, are a powerful group of cardioactive agents with a clinical spectrum of indications rather similar to those of beta-adrenoceptor blockade, including angina of effort, angina at rest, hypertension and supraventricular tachycardias (nifedipine is ineffective for the latter). In angina caused by coronary spasm, calcium antagonists are preferred to beta-blockade. Calcium antagonists have a basically different mode of action from beta-adrenoceptor blockade, although both ultimately act on the free cytoplasmic calcium ion concentration. Critical differences between the calcium antagonists are dependent on the individual properties of the calcium antagonists concerned. Different binding sites on the sarcolemma have been identified for nifedipine-like agents and verapamil, but with a different interaction with the nifedipine site. None of these sites might be relevant to the binding of calcium antagonists to the tissue of their therapeutic site of action (arterial smooth muscle for all; atrioventricular node for verapamil and diltiazem). As a group, calcium antagonists cause vascular dilation and do not cause bronchial constriction, in contrast to the beta-adrenoceptor blocking agents. In many patients, these diverse properties allow safe combination of calcium antagonists and beta-adrenoceptor blockers if due care is observed, especially in the case of nifedipine. The clinical differences between the effects of various calcium antagonists reflect: (i) the greater vasodilator capacity of nifedipine, so that at a given concentration the afterload effect dominates over possible effects on the nodal or myocardial tissue; (ii) the greater inhibition of vagal tone by nifedipine than by verapamil or diltiazem; and (iii) the greater inhibition of the atrioventricular node by verapamil and diltiazem. In angina of effort, calcium antagonists are now becoming the agents of first choice in some centers. Experimental use of calcium antagonists include the possible prevention of ventricular fibrillation, the inhibition of ischemic injury, the prevention of catecholamine mediated injury to the myocardium and decreased arterial calcinosis.

Topics: Adrenergic beta-Antagonists; Angina Pectoris; Animals; Arrhythmias, Cardiac; Calcium; Calcium Channel Blockers; Catecholamines; Coronary Disease; Coronary Vasospasm; Coronary Vessels; Digoxin; Drug Interactions; Heart; Heart Failure; Humans; Hypertension; Myocardial Contraction; Myocardial Infarction; Myocardium; Prazosin; Sinoatrial Node; Structure-Activity Relationship; Ventricular Fibrillation

This review is an attempt to demonstrate the safety and usefulness of the simple maneuver of carotid sinus stimulation with selected subjects undergoing exercise tests. In a variety of circumstances the addition of CSP before or after treadmill walking can yield clinically relevant information relating to arrhythmias, conduction disturbances, symptoms, and pacemakers. Further applications and benefits of these combined procedures remain to be clarified and expanded for judicious application with attention to safeguards.

Topics: Angina Pectoris; Arrhythmias, Cardiac; Bundle-Branch Block; Cardiac Pacing, Artificial; Carotid Sinus; Digoxin; Electrocardiography; Exercise Test; Heart Rate; Humans; Physical Stimulation; Pressure; Propranolol

The prognostic importance of ventricular arrhythmias detected during 24 hour ambulatory monitoring was evaluated in 395 patients with and 260 patients without significant coronary artery disease. Ventricular arrhythmias were found to be strongly related to abnormal left ventricular function. A modification of the Lown grading system (ventricular arrhythmia score) was the most useful scheme for classifying ventricular arrhythmias according to prognostic importance. When only noninvasive characteristics were considered, the score contributed independent prognostic information, and the complexity of ventricular arrhythmias as measured by this score was inversely related to survival. However, when invasive measurements were included, the ventricular arrhythmia score did not contribute independent prognostic information. Furthermore, ejection fraction was more useful than the ventricular arrhythmia score in identifying patients at high risk of sudden death.

Topics: Adrenergic beta-Antagonists; Ambulatory Care; Angina Pectoris; Arrhythmias, Cardiac; Cardiac Catheterization; Cardiac Output; Coronary Disease; Death, Sudden; Digoxin; Electrocardiography; Female; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Prognosis

Topics: Angina Pectoris; Coronary Circulation; Coronary Disease; Digoxin; Hemodynamics; Humans; Middle Aged; Myocardial Infarction

Topics: Aged; Angina Pectoris; Diagnosis, Differential; Digoxin; Gynecomastia; Humans; Male; Middle Aged

Two hundred consecutive catheterized patients with unstable angina pectoris were reviewed to find clinical and noninvasive indicators of left main coronary artery disease (greater than or equal to 50% lesion). Thirty-five patients (17.5% of total) had left main coronary artery disease. There were no differences between patients with and without left main coronary artery disease in age, sex, results of resting electrocardiogram, congestive heart failure, dyspnea during pain, duration of longest pain, arrhythmias, response to medical therapy, or other risk factors. Crescendo angina pectoris (worsening of pre-existing angina), transient ST-segment depression with pain, simultaneous anterior and inferior ST changes during pain, and fluoroscopic calcification of the left main coronary artery were all significantly more common in patients with left main coronary artery disease. However, low sensitivity or low predictive value, or both, limit the usefulness of these clinical predictors. Left main coronary artery disease cannot be reliably predicted in patients with unstable angina pectoris before coronary arteriography.

Topics: Angina Pectoris; Angiography; Anticoagulants; Calcinosis; Cardiac Catheterization; Cardiomegaly; Collateral Circulation; Coronary Angiography; Coronary Circulation; Coronary Disease; Digoxin; Electrocardiography; Female; Heart Conduction System; Heart Failure; Humans; Male; Middle Aged; Nitrates; Propranolol; Risk

The hemodynamic effects of nitroglycerin and nifedipin and the application of both substances during a long term training program in patients with angina pectoris, myocardial infarction, and myocardial dysfunction (=48) were studied. Cardiac output, heart rate, and arterial blood pressure showed no significant changes after application of nitroglycerin and nifedipin. After nitroglycerin, however, there were significant drops of pulmonary arterial pressure and right atrial pressure during rest and exercise, whereas no changes were seen after nifedipin. With the application of nitroglycerin (but not with nifedipin) prior to the daily physical training program on a bicycle ergometer, all patients with angina pectoris and myocardial dysfunction showed an increasing training effect during the long term program and their angina pectoris improved.

Topics: Angina Pectoris; Blood Pressure; Cardiac Complexes, Premature; Cardiac Output; Digoxin; Exercise Therapy; Heart Rate; Humans; Myocardial Infarction; Nifedipine; Nitroglycerin; Pulse; Pyridines

Topics: Adult; Aged; Angina Pectoris; Coronary Disease; Digoxin; Electrocardiography; Female; Heart Failure; Heart Rate; Humans; Male; Middle Aged; Myocardial Contraction

Topics: Aged; Angina Pectoris; Blood Glucose; Cardiac Pacing, Artificial; Coronary Disease; Digoxin; Electrolytes; Fatty Acids, Nonesterified; Female; Glucose; Hemodynamics; Humans; Lactates; Male; Medigoxin; Middle Aged; Nitroglycerin; Pyruvates

Therapeutic doses of digitalis may give rise to depressions and abnormities of the ST segment. In coronary patients this is occasionally also associated with anginal complaints. In 7 patients the ST segment was investigated at rest and under increasing stress by atrial frequency without and with digitalis at increasing therapeutic dosage. In all patients a glycoside-induced, linearly intensifying depression of the ST segment was demonstrated as a regular and dose-dependent pattern the onset of which was already recognizable at an average effective level of 0,59 mg digoxin. The opinion is held that glycoside-induced ST depressions in the ECG are not in general of insignificant nature but may be the reflection of myocardial ischemia.

Topics: Aged; Angina Pectoris; Coronary Disease; Digoxin; Dose-Response Relationship, Drug; Electric Stimulation; Electrocardiography; Female; Heart; Heart Rate; Humans; Male; Middle Aged; Oxygen Consumption

Topics: Angina Pectoris; Anticoagulants; Clofibrate; Coronary Artery Bypass; Diazepam; Digoxin; Humans; Isosorbide Dinitrate; Nitroglycerin; Oxprenolol; Perhexiline; Prenylamine; Propranolol; Verapamil

Haemodynamic tests were performed at rest and during exercise in 41 patients with arterial hypertension and early impairment of left-ventricular function, before and after administration of a single dose of 0.6 mg beta-methyl-digoxin. After clinical, ECG and coronary-angiographic studies, the patients were assigned to two groups. Group I: 17 patients with transmural infarcts in the chronic stage or with angina. Cardiac output was within normal limits at rest and on exercise and was not significantly altered by administration of beta-methyl-digoxin. There was no significant fall during exercise of the abnormally elevated pulmonary "wedge" pressure or of other pressures in the lesser circulation after digitalis. Group II: 24 patients without signs of coronary heart disease. They, too, had a normal cardiac output at rest and on exercise, not significantly changed by digitalisation with beta-methyl-digoxin. But pulmonary "wedge" pressure and right-atrial mean pressure were significantly reduced during exercise. Before beta-methyl-digoxin the mean "wedge" pressure rose on exercise to an average of 27.3 +/- 5.4 mm Hg, but after beta-methyl-digoxin to only 21.7 +/- 5.1 mm Hg (P less than 0.001). The mean right atrial pressure changed similar. These results indicate that acute digitalisation at the stated dosage in general has an effect on abnormal myocardial function only if there is no additional coronary heart disease.

Topics: Adult; Angina Pectoris; Blood Pressure; Capillaries; Cardiac Output; Digoxin; Electrocardiography; Humans; Hypertension; Lung; Middle Aged; Myocardial Infarction; Physical Exertion; Time Factors

Topics: Angina Pectoris; Digoxin; Drug Therapy, Combination; Humans; Nitroglycerin; Propranolol

Topics: Angina Pectoris; Digoxin; Humans; Propranolol; Research Design

Topics: Angina Pectoris; Digoxin; Drug Administration Schedule; Humans; Propranolol

Topics: Angina Pectoris; Digoxin; Humans; Myocardial Infarction; Physical Exertion; Vectorcardiography

Topics: Angina Pectoris; Digoxin; Drug Therapy, Combination; Humans; Propranolol

Preliminary tests to determine whether there is an electromechanical link between the electrocardiogram and cardiac function have been done by means of echocardiography. Three different haemodynamic manipulations which alter cardiac function, viz. nitroglycerin, intravenous digoxin and exercise-induced angina, were used. The changes in the S-wave amplitude, in selected leads, appear to be directionally related to the changes in the left ventricular enddiastolic volume. It is thus suggested that the S-wave changes may be indicative of changes in cardiac function.

Topics: Angina Pectoris; Blood Pressure; Cardiac Volume; Digoxin; Echocardiography; Electrocardiography; Heart; Humans; Male; Middle Aged; Nitroglycerin; Physical Exertion

The effects of bypass graft surgery versus continued medical management in 40 patients with stable angina were evaluated at 2 years: 17 of 20 surgical patients (85%) and 18 of 20 medical patients (90%) were alive, and 5 of 20 surgical patients (25%) and 2 of 20 medical patients (10%) had developed myocardial infarction; 8 of 17 surgical patients (47%) and 4 of 18 medical patients (22%) had no angina, and 13 of 17 surgical patients (76%) and 9 of 18 medical patients (50%) had no angina or greater than 25% increase in exercise time until angina. No statistically significant differences were demonstrated between the medical and surgical groups for all variables submitted to statistical analysis.

Topics: Angina Pectoris; California; Coronary Artery Bypass; Digoxin; Follow-Up Studies; Humans; Male; Middle Aged; Myocardial Infarction; Physical Exertion; Saphenous Vein; Statistics as Topic; Time Factors; Transplantation, Autologous

Topics: Angina Pectoris; Depression, Chemical; Digitalis; Digoxin; Drug Synergism; Drug Therapy, Combination; Heart; Heart Rate; Humans; Phytotherapy; Plants, Medicinal; Plants, Toxic; Propranolol

Topics: Adult; Angina Pectoris; Coronary Disease; Digoxin; Drug Combinations; Female; Heart Failure; Humans; Male; Middle Aged; Myocardial Infarction; Prenylamine

Topics: Age Factors; Aged; Angina Pectoris; Blood Pressure; Chronic Disease; Coronary Disease; Digoxin; Drug Synergism; Drug Therapy, Combination; Electrocardiography; Female; Geriatrics; Heart Failure; Heart Rate; Humans; Male; Nitro Compounds; Pentaerythritol Tetranitrate

Topics: Adult; Angina Pectoris; Diabetes Mellitus; Digoxin; Electrocardiography; Female; Heart Conduction System; Heart Ventricles; Humans; Hypertension; Hypokalemia; Tachycardia

Topics: Angina Pectoris; Atrial Fibrillation; Bradycardia; Cardiac Catheterization; Diagnosis, Differential; Diagnostic Errors; Digoxin; Electrocardiography; Humans; Hyperthyroidism; Lidocaine; Male; Middle Aged; Myocardial Infarction; Procainamide; Tachycardia; Tachycardia, Paroxysmal; Thyroxine

Topics: Adult; Aged; Angina Pectoris; Arrhythmias, Cardiac; Blood Pressure; Cardiac Complexes, Premature; Coronary Disease; Digoxin; Geriatrics; Heart Diseases; Heart Failure; Humans; Hypertension; Middle Aged; Morpholines; Myocardial Infarction; Phenethylamines; Pulmonary Heart Disease; Pulse; Tachycardia

Topics: Acetanilides; Adrenergic beta-Antagonists; Aged; Amino Alcohols; Angina Pectoris; Arrhythmia, Sinus; Bundle-Branch Block; Diagnosis, Differential; Digoxin; Electric Countershock; Electrocardiography; Female; Humans; Lidocaine; Male; Middle Aged; Myocardial Infarction; Myxedema; Tachycardia; Thyroxine

Topics: Angina Pectoris; Coronary Disease; Digitalis Glycosides; Digoxin; Drug Synergism; Electrocardiography; Female; Humans; Male; Middle Aged; Pentaerythritol Tetranitrate

Topics: Angina Pectoris; Collateral Circulation; Coronary Disease; Digoxin; Humans; Male; Middle Aged; Myocardium; Oxygen; Time Factors

Topics: Angina Pectoris; Coronary Disease; Digoxin; Electrocardiography; Hydrochlorothiazide; Hypercholesterolemia; Hypertension; Metaraminol; Nitroglycerin; Shock; Shock, Cardiogenic; Vasopressins; Warfarin

Topics: Adenine Nucleotides; Angina Pectoris; Cardiovascular Agents; Digoxin; Heart Failure; Humans; Nucleosides