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Biomedical subjects

C E Handler

Publications and source records attributed to C E Handler.

At least 37 records · Page 2Linked to original sources
PubMed1988

Comparison of isradipine and nifedipine in chronic stable angina.

Isradipine, a new dihydropyridine calcium antagonist, was compared to nifedipine in the treatment of 11 male patients with angina and coronary artery disease in a randomised, double-blind cross-over study. Patients received 5 mg nifedipine three times a day rising to 20 mg three times a day in three dosage increments over six weeks or 2.5 mg isradipine three times a day rising to 7.5 mg three times a day in three dosage increments over six weeks, and then received the alternate preparation. There were no significant differences between the drugs in terms of the frequency and severity of angina attacks or the consumption of glyceryl trinitrate. The increases in systolic blood pressure and the double product during exercise were significantly less with isradipine than with nifedipine. There was a similar trend in heart rates. There was no difference between the treatments in respect of exercise induced ST-segment depression or diastolic blood pressure. We conclude that isradipine and nifedipine have similar anti-anginal effects and that isradipine may be a useful new anti-anginal agent.

Aged↗
PubMed1988

Effects of coronary artery surgery on left ventricular performance, segmental wall movement, and exertional ischaemia.

The effects of coronary artery surgery on left ventricular performance were assessed serially by echocardiography and treadmill exercise testing in 54 patients. Patients were assessed one day before operation and again before patients left hospital (mean 10 days after operation) and one month and six months after operation. At the predischarge assessment, 41 (77%) patients showed new abnormalities of left ventricular segmental wall movement, chiefly anteroseptal hypokinesia with hyperkinesia of the posterolateral segment. Although there were no significant changes in anteroseptal wall thickening after operation, there was a significant increase in posterior wall thickening at all postoperative assessments. The frequency of this abnormality decreased progressively after operation; it persisted in 19 (35%) patients at six months. Left ventricular fractional shortening decreased after operation and at one month was significantly less than before operation. There were no significant changes in left ventricular diastolic diameter during the study. Haemodynamic function during exercise, the duration of exercise, and features of reversible myocardial ischaemia all improved progressively and significantly after coronary artery surgery. Abnormalities in left ventricular segmental wall movement and thickening commonly develop early after coronary artery surgery but tend to resolve by six months and do not seem to impair left ventricular contractility at rest or exercise performance and haemodynamic function. Recognition of these echocardiographic changes may be clinically important in the assessment of patients after cardiac surgery.

Adult↗
PubMed1987

Use of an exercise QRS score and radionuclide left ventricular ejection fraction in assessing prognosis after myocardial infarction.

We have compared the prognostic value of a predischarge post-infarction QRS score derived at rest and at submaximal exercise with ejection fraction measured by gated radionuclide left ventriculography in 65 patients. Seventeen patients died or had heart failure (group 1) and 48 were well or had angina (group 2) six months after infarction. The mean QRS score derived from the resting electrocardiogram for group 1 was significantly greater than that for group 2 (P less than 0.01) but the QRS scores at peak exercise did not differ significantly between the two groups. The mean ejection fraction for group 2 was significantly greater than that for group 1 (P less than 0.001). Both the rest and peak exercise QRS scores correlated weakly but significantly with ejection fraction (P less than 0.001). The QRS score at rest had a greater sensitivity and specificity in predicting cardiac death and heart failure than the QRS score at peak exercise. A sensitivity of 88% was achieved with a resting ejection fraction less than 50% and a resting QRS score greater than 4. At these values the specificities were 58% and 63% respectively. Combining the blood pressure response to exercise with the QRS score and ejection fraction improved the sensitivity of both with no loss of specificity. Therefore, the resting QRS score is comparable to ejection fraction as a predictor of serious cardiac events after infarction and the sensitivity of both may be improved by including an assessment of the blood pressure response to exercise. Because a 12-lead electrocardiogram is cheap and widely available, this QRS score may be used in risk stratification after infarction.

Adult↗
PubMed1985

Effects of oral prajmaline bitartrate on exercise test responses in patients with coronary artery disease.

The safety, tolerability and haemodynamic effects of oral prajmaline bitartrate were assessed in a double-blind, randomized, placebo-controlled, crossover trial in 21 patients with stable angina pectoris and coronary artery disease. No serious side-effects occurred. Prajmaline bitartrate produced no statistically significant changes in resting heart rate or systolic blood pressure or in work capacity on the treadmill, or in heart rate or systolic blood pressure at maximum exercise compared to placebo values. No new arrhythmias or conduction abnormalities were produced in any patient. We conclude that oral prajmaline bitartrate is well tolerated and can be given safely to patients with coronary artery disease without producing deleterious haemodynamic effects or changes in exercise capacity.

Administration, Oral↗
PubMed1985

Stress testing predischarge and six weeks after myocardial infarction to compare submaximal and maximal exercise predischarge and to assess the reproducibility of induced abnormalities.

Submaximal and maximal treadmill exercise tests were performed predischarge in 64 patients after acute myocardial infarction to assess the relative yield of residual ischaemic abnormalities. The reproducibility of individual abnormalities resulting from maximal stress tests performed predischarge and 6 weeks after infarction was also assessed in 55 of these patients. Compared with predischarge submaximal exercise testing, a maximal exercise test identified a significantly greater number of patients with residual myocardial ischaemia (26 vs. 15, P less than 0.05) and this was associated with a significantly longer average maximal exercise duration (P less than 0.001), and a higher rate-pressure product (P less than 0.001). Among the 55 patients who had maximal stress tests both predischarge and 6 weeks after infarction, there was a significant lack of reproducibility in the occurrence of exercise induced angina (P less than 0.01) and an abnormal blood pressure response (P less than 0.02). In contrast, exercise induced ST segment depression and elevation and ventricular arrhythmias were relatively reproducible. More patients had an ischaemic test result (ST depression or angina) at the later test compared to the predischarge test (33 vs. 25 patients) but this increase was not statistically significant. There were, however, significant increases at the later test in mean maximal exercise duration (P less than 0.001). mean maximal heart rate (P less than 0.001) and heart rate-systolic blood pressure double product (P less than 0.001). The majority of patients who had a cardiac event in the period between the two tests had a predischarge test abnormality. We conclude that a significantly greater number of patients with residual reversible myocardial ischaemia after infarction will be identified by symptom limited exercise testing compared with a submaximal predischarge test. Because ST depression and elevation appear reproducible, patients who develop these abnormalities during a predischarge test do not, for prognostic reasons, need retesting 6 weeks after infarction. Exercise induced angina pectoris and an abnormal blood pressure response, however, are highly variable and in these patients a repeat test may be useful.

Adult↗
PubMed1985

Double-blind randomised crossover trial comparing isosorbide dinitrate cream and oral sustained-release tablets in patients with angina pectoris.

Percutaneous isosorbide dinitrate cream and sustained-release tablets were compared in a double-blind randomised crossover trial in 28 patients with coronary artery disease and chronic stable angina pectoris. Twenty-two patients completed the trial. Both preparations significantly increased the mean exercise time to the onset of angina (P less than 0.001) and to termination of exercise (P less than 0.001) compared to the pre-treatment period. There were no significant differences between the cream and tablets with respect to frequency of anginal attacks, glyceryl trinitrate consumption, heart rate and ST segment depression at the onset of angina, ST segment depression at maximal exercise and the double product of heart rate and systolic blood pressure at maximal exercise. Equal numbers of patients expressed preference for cream and tablets. We conclude that in this group of patients isosorbide dinitrate sustained-release tablets have no clinical advantage over isosorbide dinitrate cream which, may, therefore, be of particular value for those patients with angina pectoris who dislike taking tablets or who prefer this form of nitrate preparation.

Administration, Oral↗
PubMed1985

Diurnal variation in symptom-limited exercise test responses six weeks after myocardial infarction.

Diurnal variation of exercise test responses occurring during symptom-limited treadmill exercise testing was investigated in 45 patients six weeks after myocardial infarction. Each patient was exercised using a Naughton protocol before 8 a.m. and after 6 p.m. on the same day. No complications arose. There was no significant diurnal variation of any of the analysed exercise induced ischaemic abnormalities (angina pectoris or ST segment shift) or of the mean maximal exercise durations and achieved workloads. Mean maximal heart rates and heart rate-systolic blood pressure double products were similar in both tests. ST segment depression occurred in 21 patients and was totally consistent in both tests. An abnormal blood pressure response occurred in 14 patients in the morning test and in 18 patients in the evening test but this discordance did not reach statistical significance. Similarly there was no significant diurnal variation in exercise induced ventricular arrhythmias, although only three of the 11 patients in whom they occurred had this abnormality on both tests. We conclude that in this group of patients, no significant diurnal variation was observed in either exercise induced ischaemic abnormalities or in exercise haemodynamics during symptom-limited exercise tests performed six weeks after myocardial infarction. These data increase the confidence in clinical management decisions based on the results of this test.

Adult↗
PubMed1985

Submaximal predischarge exercise testing after myocardial infarction: prognostic value and limitations.

The prognostic value of abnormalities resulting from predischarge submaximal treadmill exercise testing was evaluated in 222 patients after myocardial infarction. The presence of the following variables--ST segment depression and elevation, an abnormal blood pressure response, limited exercise duration, angina pectoris, ventricular arrhythmias--were predictive of subsequent cardiac events (P less than 0.001) among the 154 patients with one or more of these abnormalities. When the presence or absence of specific variables was assessed, only an abnormal blood pressure response, limited exercise duration (P less than 0.001), and ST segment elevation and shift (P less than 0.05), were significantly associated with cardiac death. Exercise-induced angina was predictive only of the development of subsequent angina (P less than 0.05), and ST depression was associated only with future coronary surgery (P less than 0.01). Ventricular arrhythmias had no independent prognostic value. Markers of left ventricular dysfunction elicited by submaximal exercise testing are therefore valuable in identifying patients at high risk of death after infarction. Hallmarks of residual reversible myocardial ischaemia are of limited prognostic importance. The test result may be useful in selecting patients for coronary angiography.

Adrenergic beta-Antagonists↗
PubMed1985

Mitral valve prolapse, aortic compliance, and skin collagen in joint hypermobility syndrome.

Mitral valve prolapse was sought clinically and with phonocardiography and M mode and sector echocardiography in 15 women aged 22-57 years with joint hypermobility syndrome. The type III:III + I collagen ratio was measured in skin biopsy specimens and was found to be raised in seven of 10 patients sampled. Thirteen patients had increased aortic wall compliance measured by the continuous wave Doppler ultrasound technique. Ten (67%) patients had mitral valve prolapse shown by auscultatory signs or echocardiography or both--a prevalence at least three times greater than that in the general adult population. It is concluded that if the abnormality of collagen biosynthesis found in skin biopsy samples in these patients is also present in their mitral valve tissue this may predispose them to prolapse of the valve.

Adult↗
PubMed1985

Cardiogenic shock.

Explore the source record for details and available documents.

Digitalis Glycosides↗
PubMed1985

Gated thallium tomography--potential for improved accuracy in the detection of coronary artery disease.

Gated thallium-201 myocardial tomography incorporating perfusion profile analysis was used alone, to assess left ventricular wall perfusion and left ventricular wall movement together in 29 consecutive patients, without prior infarction, who presented with chest pain. All patients had had coronary and left ventricular angiography. The proportion of false positive perfusion defects was reduced when an analysis of corresponding wall movement was made. This combined technique resulted in an improved specificity compared with standard 201Tl myocardial tomography. This approach shows the functional effect of reversible ischaemia on regional myocardial contractility and would appear to be particularly useful in the assessment of patients who present with atypical chest pain.

Adult↗
PubMed1984

DHM 32-550 in patients with angina and normal coronary arteries: dose/response relationship.

This is the first report of the use of DHM 32-550 a dehydrogenated peptide ergot alkaloid with both alpha and beta adrenoceptor blocking activity, in patients with angina-like chest pain. Five patients were studied to assess a dose/response relationship. No deleterious effects on blood pressure occurred at either rest or on effort. The frequency of angina attacks and the number of glyceryl trinitrate tablets needed per week was appreciably reduced during treatment with both 'high' and 'low' dosages of the agent compared with placebo. The duration of treadmill exercise was appreciably prolonged. Within the limitations of this small, open pilot study, it appears that oral DHM 32-550 could be used safely in patients with chest pain due to cardiomyopathy or to coronary spasm.

Aged↗
PubMed1984

Safety, tolerability and efficacy of PN 200-110, a new calcium antagonist in patients with angina and coronary heart disease.

The safety, tolerability and efficacy of PN 200-110, a new calcium antagonist with minimal negative inotropic effects, were studied in twelve patients with stable angina pectoris and coronary artery disease. The study design was single-blind and placebo-controlled and increasing doses of the drug were used on consecutive days to investigate a dose response relationship. Eleven patients completed the trial. Response to the drug was evaluated using symptom limited cycle ergometric exercise. PN 200-110 in all three tested doses of 2.5 mg, 5.0 mg and 10.0 mg significantly increased the resting heart rate (p less than 0.02) and the exercise time to the onset of angina pectoris (p less than 0.02). Doses above 2.5 mg did not appear to improve the exercise parameters evaluated. Four patients had side effects probably due to PN 200-110 but these were mild and included dizziness, headache and flushing. There were no abnormal results from haematological and biochemical screening or from urine testing. We conclude that PN 220-110 can be given safely to patients with coronary artery disease without producing deleterious effects on blood pressure either at rest or during exercise.

Angina Pectoris↗
PubMed1984

A comparison of the Naughton and modified Bruce treadmill exercise protocols in their ability to detect ischaemic abnormalities six weeks after myocardial infarction.

Symptom-limited Naughton and modified Bruce treadmill exercise protocols were compared in 20 patients to assess their ability in detecting additional ischaemic abnormalities six weeks after myocardial infarction. Eleven patients had a result indicating reversible myocardial ischaemia on both tests while the other nine had no ischaemic abnormality during either of the two protocols. The only significant difference between the two protocols was the longer exercise duration resulting from the Naughton protocol (17.3 +/- 5.0 vs. 14.8 +/- 2.8 mins, P less than 0.01). The mean maximum heart rates, rate-pressure products and achieved workloads did not differ significantly. We conclude that even though the Naughton protocol resulted in a significantly longer mean maximum exercise duration, the protocols were equally effective in detecting additional ischaemic abnormalities six weeks after myocardial infarction.

Aged↗
PubMed1984

Diurnal variation and reproducibility of predischarge submaximal exercise testing after myocardial infarction.

Diurnal variation and reproducibility of abnormalities occurring during predischarge postinfarction treadmill exercise testing were investigated in 41 patients. Each patient was exercised using a limited Naughton protocol before 0800 and after 1800 h on two consecutive days. No complications arose. Individual ischaemic abnormalities were poorly reproducible in any patient. No abnormality and no patient showed significant diurnal variation. When the presence of any one of three ischaemic abnormalities (ST segment depression or elevation and angina) was analysed the reproducibility of an ischaemic result in the two morning and the two evening tests was 72% and 95% respectively with no significant difference between the two. The reproducibility of an ischaemic result in all four tests was 66%. The reproducibility of the test for either the presence or absence of an ischaemic result was 71%. No training effect could be shown either for the group as a whole or for any individual patient. There were no appreciable differences in either the heart rates or systolic blood pressures during exercise among those patients with non-reproducible ischaemic test results. Thus it is concluded that an assessment of any one of three ischaemic abnormalities improves the reproducibility of the result of submaximal exercise testing after infarction. Mechanisms other than increased myocardial oxygen consumption related to increased heart rate and systolic blood pressure at submaximal exercise tolerance are needed to explain non-reproducible ischaemic test results.

Adult↗
PubMed1983

Radiculomyelopathy associated with herpes simplex genitalis treated with adenosine arabinoside.

A case of herpes simplex genitalis producing radiculomyelopathy with urinary retention is reported. The patient was treated with adenosine arabinoside intravenously and made a complete recovery over 4 weeks. Although herpes simplex genitalis is common, neurological sequelae, particularly cord involvement, are distinctly rare. It should, nevertheless, be considered in the differential diagnosis of urinary retention, with or without long-tract signs, in young patients.

Adult↗