enalapril and Dyspnea

Although the angiotensin-converting enzyme inhibitor enalapril has recently been shown to reduce mortality and the need for hospitalization in patients with left ventricular dysfunction and congestive heart failure, this drug was found to have no significant impact on short-term mortality after acute myocardial infarction (AMI) in the CONSENSUS II trial. The effect of enalapril initiated early after AMI on clinical and echocardiographic determinants of left ventricular (LV) function was studied in a subset of patients from CONSENSUS II.. Symptoms and signs of heart failure were classified as NYHA and dyspnea classes. Echocardiography included LV end-systolic volumes (ESV) and end-diastolic volumes (EDV), as well as ejection fraction (EF), wall motion index (WMI), and mitral flow indices. In all, 428 patients were included and followed for an average of 5.1 months by serial examinations, starting 2-5 days after myocardial infarction (MI) and repeated after 1 month and at the completion of the study.. There was no beneficial effect of enalapril on clinically determined function. Changes (i.e., changes in NYHA class) in the functional status remained correlated with changes in echocardiographic determinants throughout the study in patients belonging to the placebo group: EDV index (r = 0.36, p = 0.002, ESV index (r = 0.49, p < 0.001), EF (r = -0.41, p < 0.001), and WMI (r = 0.29, p = 0.008). In a stepwise logistic regression model, the best baseline parameters to predict NYHA class at final visit in all patients were age (p = 0.014) and ESV index (p = 0.001).. Enalapril treatment for an average period of 5.1 months following MI resulted in no clinically significant beneficial effects on NYHA and dyspnea class. Changes in clinical function class were correlated with changes in echocardiographic determinants in placebo-treated patients, but not in patients given enalapril.

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Dyspnea; Echocardiography; Enalapril; Female; Humans; Logistic Models; Male; Middle Aged; Myocardial Infarction; Randomized Controlled Trials as Topic; Ventricular Function, Left

A multicenter, randomized, double-blind assessment of 130 patients with congestive heart failure (New York Heart Association functional classes II to IV) was undertaken to assess the therapeutic efficacy of lisinopril, an angiotensin-converting enzyme inhibitor. All the subjects received concurrent therapy with digoxin and diuretics. Assessments performed periodically over 12 weeks revealed that the active treatment was associated with significant improvements in treadmill exercise time, cardiothoracic ratio, ejection fraction, functional status and clinical signs and symptoms of heart failure. Lisinopril exhibited a mild first-dose effect on blood pressure that was not significantly different from that observed with placebo. The incidence of adverse experiences was not markedly different in the 2 study groups, with only mild hypotension and dizziness occurring more frequently in association with the active medication.

Topics: Angiotensin-Converting Enzyme Inhibitors; Blood Pressure; Cardiac Output; Clinical Trials as Topic; Double-Blind Method; Dyspnea; Enalapril; Exercise Test; Fatigue; Heart Failure; Humans; Lisinopril; Multicenter Studies as Topic; Placebos; Random Allocation; Time Factors

A 15-year-old, neutered male, domestic shorthair presented with dyspnea. Unclassified cardiomyopathy was diagnosed. Treatment resulted in a profound bradycardia, which was attributed to the administration of a beta-adrenergic blocker. The pathogenesis of unclassified cardiomyopathy is discussed and the side effects of beta-adrenergic blockers and angiotensin converting enzyme inhibitors are reviewed.

Topics: Adrenergic beta-Antagonists; Angiotensin-Converting Enzyme Inhibitors; Animals; Atenolol; Bradycardia; Cardiomyopathies; Cat Diseases; Cats; Dyspnea; Enalapril; Hypotension; Male

Topics: Aged; Airway Obstruction; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Diagnosis, Differential; Drug Combinations; Drug Hypersensitivity; Dyspnea; Enalapril; Heart Arrest; Humans; Hydrochlorothiazide; Male; Tongue Diseases

To present a case of respiratory depression following the administration of nebulised morphine.. A 74-yr-old, 51-kg woman with a history of hypertension controlled with 5 mg.day-1 enalapril and 50 mg.day-1 atenolol was admitted for evaluation of low back pain, loss of appetite, and weight loss. Investigation revealed advanced metastatic disease with a probable primary in the right lung. The patient's pain was well controlled with 10 mg continuous release morphine p.o. three times daily, and 10 mg immediate release morphine p.o. for breakthrough pain as required. During the two weeks following the commencement of this treatment she occasionally complained of shortness of breath. Examination revealed a fully conscious patient with slight dyspnoea and mild wheezing which responded to oxygen 30% and nebulised bronchodilators. An oncological consultation recommended 4 mg nebulised morphine and 4 mg dexamethasone in saline as treatment for the bouts of breathlessness. Approximately 15 min after the first administration of nebulised morphine the patient became markedly bradypneic (respiratory rate: 4-5 bpm), hypotensive (BP 70/40 mmHg), and responded only partially to command. The pupils were pinpoint. The trachea was immediately intubated and the lungs ventilated with oxygen 40% for four hours. Following this occurrence of respiratory depression nebulised morphine was discontinued and no further events occurred.. Patients receiving inhaled morphine should be closely monitored and resuscitation equipment should be readily available.

Topics: Acute Disease; Administration, Inhalation; Administration, Oral; Aged; Analgesics, Opioid; Angiotensin-Converting Enzyme Inhibitors; Anti-Inflammatory Agents; Antihypertensive Agents; Bone Neoplasms; Bronchodilator Agents; Dexamethasone; Dyspnea; Enalapril; Female; Glucocorticoids; Humans; Hypertension; Intubation, Intratracheal; Lung Neoplasms; Morphine; Nebulizers and Vaporizers; Oxygen Inhalation Therapy; Pain; Palliative Care; Respiration; Respiration, Artificial; Respiratory Insufficiency; Respiratory Sounds

An American Cocker Spaniel with low plasma taurine concentration (< 2 nmol/mL) was presented with dyspnoea associated with pulmonary oedema and a left ventricular shortening fraction of 9%. Emergency therapy with furosemide, dobutamine, nitroglycerine and oxygen supplementation led to a good response. Chronic therapy was started with enalapril, furosemide, digoxin and taurine. Improvement in all echocardiographic indices were noted over a 22 week follow-up, most notably an increase in left ventricular shortening fraction to 20%, a decrease of E-point septal separation from 14 mm to 7 mm and marked left ventricular remodelling. This degree of improvement in myocardial function may represent a direct link between dilated cardiomyopathy in the American Cocker Spaniel and plasma taurine deficiency. Alternatively, this response may reflect a breed-related cardiomyopathy with a natural history and therapeutic response not commonly seen in the more common large breed cardiomyopathy presentations.

Topics: Animals; Antihypertensive Agents; Breeding; Cardiomyopathy, Dilated; Cardiotonic Agents; Digoxin; Diuretics; Dobutamine; Dog Diseases; Dogs; Dyspnea; Echocardiography; Enalapril; Female; Furosemide; Heart; Heart Ventricles; Nitroglycerin; Pulmonary Edema; Taurine; Vasodilator Agents

To evaluate the occurrence of asthma and dyspnoea precipitated or worsened by angiotensin converting enzyme inhibitors.. Summary of reports of adverse respiratory reaction in relation to treatment with angiotensin converting enzyme inhibitors that were submitted to Swedish Adverse Drug Reactions Advisory Committee and to World Health Organisation's international drug information system until 1992. Sales of angiotensin converting enzyme inhibitors in Sweden were also summarised.. Patients receiving angiotensin converting enzyme inhibitors who reported adverse respiratory reactions.. Clinical characteristics of adverse reactions of asthma, bronchospasm, and dyspnoea.. In Sweden 424 adverse respiratory reactions were reported, of which most (374) were coughing. However, 36 patients had adverse drug reactions diagnosed as asthma, bronchospasm, or dyspnoea. In 33 of these cases the indication for treatment with angiotensin converting enzyme inhibitors was hypertension, in only three heart failure. The respiratory symptoms occurred in about half of the patients within the first two weeks of treatment, and about one third needed hospitalisation or drug treatment. Dyspnoea symptoms occurred in conjunction with other symptoms from the airways or skin in 23 out of the 36 cases. In the WHO database there were 318 reports of asthma or bronchospasm, 516 reports of dyspnoea, and 7260 reports of cough in relation to 11 different angiotensin converting enzyme inhibitors.. Symptoms of airway obstruction in relation to treatment with angiotensin converting enzyme inhibitors seem to be a rare but potentially serious reaction generally occurring within the first few weeks of treatment.

Topics: Adult; Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors; Asthma; Bronchial Spasm; Captopril; Cough; Dyspnea; Enalapril; Female; Humans; Lisinopril; Male; Middle Aged; Ramipril

A new clinical index of dyspnea and fatigue has been applied to rate the condition of patients with congestive heart failure. The index has 3 components, each rated on a scale from 0 to 4, for the magnitude of the task that evokes dyspnea or fatigue, the magnitude of the pace (or effort) with which the task is performed and the associated functional impairment in general activities. The ratings for each component are added to form an aggregated score, which can range from 0, for the worst condition, to 12, for the best. Because dyspnea and fatigue are prime symptoms and sources of clinical distress, the index helps reflect the quality of life in patients with congestive heart failure. In double-blind trials of therapy, changes in the index showed good correlations with patients' self-selected ratings of improvement. The posttherapeutic changes in the index ratings were significantly higher with a new active agent (lisinopril) than with placebo or another active agent (captopril).

Topics: Angiotensin-Converting Enzyme Inhibitors; Captopril; Double-Blind Method; Dyspnea; Enalapril; Fatigue; Heart Failure; Humans; Lisinopril; Quality of Life; Random Allocation

There are several reports of beneficial effects of ACE inhibitors in both primary and secondary pulmonary hypertension. However the effect of ACE inhibitors in mitral stenosis is not documented. The authors report three patients with severe mitral stenosis in whom surgery was delayed. They had initial symptomatic improvement with diuretics and sodium restriction, but had recurrence of their symptoms while on treatment. Enalapril not only relieved their symptoms in particular exertional dyspnoea and haemoptysis but prevented recurrence and improved their effort tolerance without causing excessive fall of blood pressure or impairment of renal function.

Topics: Adult; Dyspnea; Enalapril; Female; Hemoptysis; Humans; Middle Aged; Mitral Valve Stenosis