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Biomedical subjects

D Bracchetti

Publications and source records attributed to D Bracchetti.

At least 37 records · Page 2Linked to original sources
PubMed1989

[Gallopamil in stable effort angina. Effects of 2 different dosages].

The effects of gallopamil, a calcium channel blocker methoxy derivative of verapamil, recently introduced into clinical use in Germany, were evaluated in 20 patients with stable exertional angina. Two different dosages of the drug were used: 25 mg tid and 50 mg tid. It was observed that both dosages improved exercise tolerance (355 +/- 95 sec after placebo; 462 +/- 78 sec, p less than 0.01 and 511 +/- 97 sec, p less than 0.01 after the two doses) while the time taken to produce ischemia (-1 mm ST depression) was significantly prolonged only by the higher dose of the drug (204 +/- 101 sec after placebo; 324 +/- 135 sec after gallopamil 150 mg, p less than 0.05). Both dosages of gallopamil caused a significant reduction in the double product in the first phases of the exercise (double product 3 degrees min of exercise x 10(2): 173 +/- 140 after placebo; 153 +/- 34, p less than 0.05 and 145 +/- 30, p less than 0.05 after the two doses), while they did not affect this parameter at the end of the exercise. Our data seem to confirm that gallopamil works through a lowered myocardial metabolic demand as a consequence of the reduction of the afterload. Both dosages of the drug decreased the number of episodes of angina, but the higher dose was more effective. The drug is safe and well tolerated. All patients completed the study. Furthermore, no particular haemodynamic problems were observed.

Adult↗
PubMed1989

[Paroxysmal tachycardia with long QRS (left branch block type) in a female patient with accessory nodo-ventricular pathway. Role of the anomalous pathway in the electrogenesis of the arrhythmia].

The authors report a case of paroxysmal tachycardia with widened QRS (left bundle branch block morphology), where the electrophysiologic investigation shows an accessory nodo-ventricular pathway and suggests its involvement, as descendent (anterograde) pathway in a circular movement, the ascendant (retrograde) limb of which is the nodo-hisian pathway.

Adult↗
PubMed1988

Combination of positive inotropic and vasodilating substances in congestive heart failure.

Therapy combining vasodilators and inotropic agents is considered to be one of the most powerful means of improving cardiac function in patients with congestive heart failure (CHF). The vasodilators enhance the effectiveness of inotropic agents by providing a reduction in preload and/or afterload. Inotropic drugs with different mechanisms of action, such as digitalis glycosides, ephedrine, dopamine, dobutamine, ibopamine, terbutaline, salbutamol, pirbuterol, prenalterol, amrinone, and milrinone, have been tested in combination with vasodilators with a predominant effect on preload (nitrates, molsidomine), with a predominant effect on afterload (hydralazine, nifedipine), or with a balanced action on both arterial and venous beds (nitroprusside, prazosin, captopril), showing positive results. The problem of the combination of digitalis glycosides and vasodilators with different sites of action has been considered by our group. In 42 patients with CHF, digoxin (DIG, 0.01 mg/kg intravenously) was tested in combination with molsidomine (MLS, 4 mg sublingually) (12 patients), a nitrate-like agent with a predominant vasodilating action on the capacitance vessels, nifedipine (NFP, 10 mg sublingually) (22 patients), a Ca2+ antagonist drug with a predominant action on the resistance vessels, and captopril (CPT, 25 mg orally) (8 patients), an ACE inhibitor with a balanced effect on both preload and afterload. The combination DIG plus MLS caused a reduction in left ventricular filling pressure (LVFP) greater than that achieved with either agent alone. The hemodynamic improvement was obtained without side effects, in spite of the striking fall in preload. We stress that this investigation was performed on patients with CHF following acute myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiotonic Agents↗
PubMed1986

Antihypertensive treatment with metoprolol or hydrochlorothiazide in patients aged 60 to 75 years. Report from a double-blind international multicenter study.

In a randomized double-blind study (N = 562), a traditional treatment schedule, starting antihypertensive treatment in elderly hypertensive patients (60 to 75 years old) with 25 mg of hydrochlorothiazide once daily and doubling the dose if a satisfactory response was not achieved, was compared with antihypertensive treatment of 100 mg of metoprolol once daily, adding 12.5 mg of hydrochlorothiazide for patients whose response was not satisfactorialy achieved with metoprolol alone. Systolic and diastolic blood pressure was significantly reduced with both regimens. The frequency rates of responders (diastolic blood pressure, less than or equal to 95 mm Hg) in the metoprolol group and the hydrochlorothiazide group were 50% and 47% after four weeks and 65% and 61% after eight weeks, respectively. There were no significant differences in total symptom score or single symptoms between the regimens, but significantly more patients had hypokalemia and hyperuricemia with the hydrochlorothiazide regimen. Thus, we conclude that beginning antihypertensive treatment with 100 mg of metoprolol once daily and adding a small dose of hydrochlorothiazide (12.5 mg) in patients whose response is not satisfactory with metoprolol alone appears to be effective and safe in elderly hypertensive patients.

Aged↗
PubMed1986

[Plasma levels of anti-arrhythmic drugs and clinical effectiveness in the treatment of ventricular arrhythmias].

In spite of the ratio between plasmatic concentration and antiarrhythmic effects of a drug many factors can be influenced by many factors, the plasma level monitoring plays an important clinical role. The efficacy of the antiarrhythmic therapy should be evaluated not only by means of ECG-Holter monitoring and/or electrophysiological study but also by the means of determination of plasmatic and tissular concentration of a drug and metabolites. This latter is indispensable in the evaluation of new antiarrhythmic drugs and of a dose/effect relationship during acute and chronic therapy.

Anti-Arrhythmia Agents↗
PubMed1985

Comparison of propafenone and disopyramide for treatment of chronic ventricular arrhythmias: placebo-controlled, double-blind, randomized crossover study.

In a double blind, placebo-controlled study, the efficacy of propafenone, a new antiarrhythmic drug was compared to that of disopyramide. Sixteen patients with frequent and complex premature ventricular contractions (PVCs) were studied by serial 24-hour ambulatory monitoring, while they were receiving propafenone, 300 mg, and disopyramide, 200 mg, both every 8 hours. A reduction in the mean frequency of PVCs per hour, in comparison to the placebo period, from 574 +/- 535 to 100 +/- 130, was observed after propafenone (p less than 0.005) and from 629 +/- 455 to 231 +/- 280 after disopyramide (p less than 0.008). A greater than 70% reduction in PVCs in comparison to placebo was observed in 11 of 14 after propafenone and 9 of 15 after disopyramide (NS). A greater than or equal to 90% reduction in PVCs was observed in 9 of 16 with propafenone and in 4 of 15 with disopyramide (p less than 0.05). The suppression of complex PVCs (repetitive, polymorphic, or more than 5/min with bigeminism) was observed in 11 of 14 after propafenone and in 9 of 14 after disopyramide. The abolition of nonsustained ventricular tachycardia was observed in 6 of 6 and 3 of 5, respectively, after propafenone and disopyramide (p less than 0.05). A lower incidence of side effects, 4 of 16 vs 8 of 16, was observed during propafenone than during disopyramide treatment. We conclude that propafenone, in a dose of 900 mg daily, is more effective than disopyramide, in a dose of 600 mg daily, in the treatment of frequent and complex PVCs and nonsustained ventricular tachycardias. Propafenone also showed a lower incidence of side effects.

Adult↗
PubMed1985

Hemodynamic effects of molsidomine in patients with heart failure following acute myocardial infarction.

The short-term hemodynamic effects of molsidomine (4 mg sublingually) were evaluated in 13 patients with congestive heart failure following acute myocardial infarction. Right heart catheterization was performed by means of a Swan-Ganz thermodilution catheter. Hemodynamic measurements were made 30, 60, 120, and 180 minutes after the administration of the drug. Molsidomine significantly reduced systolic blood pressure from 121.5 +/- 3.3 (mean +/- SEM) to 111.1 +/- 2.9 mm Hg (p less than 0.001) after 60 minutes, mean right atrial pressure from 6.1 +/- 1 to 2.6 +/- 0.6 mm Hg (p less than 0.0001), mean pulmonary arterial pressure from 29.8 +/- 1.9 to 20.1 +/- 1.3 mm Hg (p less than 0.0001), and left ventricular filling pressure from 20.3 +/- 0.6 to 12.2 +/- 0.7 mm Hg (p less than 0.0001). No significant change occurred in heart rate, diastolic and mean blood pressure, cardiac index, stroke volume index, left ventricular stroke work index, systemic vascular resistance, and pulmonary vascular resistance. No side effects were seen after the administration of molsidomine.

Aged↗
PubMed1984

Propafenone for refractory ventricular arrhythmias: correlation with drug plasma levels during long-term treatment.

The efficacy of propafenone, a new antiarrhythmic drug, was studied in 21 patients with ventricular arrhythmias refractory to previous antiarrhythmic medications. Group A included 10 patients with chronic ventricular premature complexes (VPCs), 6 of whom had nonsustained ventricular tachycardia (VT) and 4 of whom had recurrent, sustained VT; all received propafenone, 900 mg/day. Group B included 11 patients, all with chronic VPCs, 9 of whom had nonsustained VT and 5 of whom had sustained VT; all received propafenone, 450 mg/day. Drug efficacy was evaluated as a 70% or greater reduction in VPC frequency with complex VPC abolition in ambulatory monitoring and suppression of nonsustained VT and sustained VT during a follow-up period up to 154 +/- 58 days in group A and 96 +/- 42 days in group B. Drug plasma levels were measured during chronic therapy in pharmacologic steady state. In group A, propafenone reduced the frequency of chronic VPCs in 9 patients and abolished nonsustained VT in 4 of 6 and sustained VT in 3 of 4; in group B, propafenone reduced the frequency of chronic VPCs in 6 patients and abolished nonsustained VT in 6 of 9 and sustained VT in 3 of 5. Two patients with recurrences of sustained VT in this group were later successfully treated with propafenone, 900 mg/day; overall, 8 of 9 patients with recurrences of sustained VT were successfully treated with 900 mg/day.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗