Captopril - an oral angiotensin-converting enzyme inhibitor in CHF.
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Captopril↗
Biomedical subjects
K Chatterjee
Publications and source records attributed to K Chatterjee.
Long-term vasodilator therapy for heart failure: clinical response and its relationship to hemodynamic measurements.
To assess the clinical efficacy of chronic vasodilator therapy for refractory congestive heart failure, the long-term follow-up (mean 13 months, range 3-30 months) was evaluated in 56 patients treated with hydralazine, usually in combination with nitrates. In the first 6 months, 73% improved subjectively and 59% improved by one or two New York Heart Association classifications; early improvement was usually sustained. Mortality was high, 22% at 6 months and 37% at 12 months, but was significantly lower in patients who had a clinical response to vasodilators (21% in responders vs 55% in nonresponders at 1 year). The only clinical indicator that differentiated responders from nonresponders was the presence or absence of symptomatic progression before initiation of vasodilator therapy. Pulmonary artery pressure, pulmonary capillary wedge (PCW) pressure and stroke work index (SWI) before and during vasodilator therapy correlated with clinical response and survival. Fifteen of 20 patients with PCW < 20 mm Hg and SWI greater than or equal to 30 g-m/m2 improved and survived, compared with two of 19 with PCS greater than or equal to 20 mm Hg and SWI < 30 g-m/m2. Patients who did not have acute hemodynamic improvement generally did not improve clinically, but neither the percentage change nor the absolute change in any hemodynamic variable predicted outcome in the remaining patients. The findings of this study indicate that vasodilators produce clinical improvement in many patients with refractory heart failure and that hemodynamic measurements are helpful in predicting the outcome of therapy.
Blood Pressure↗
Studies on membrane ATPase activity and lipid level in vibrio el tor under normal and nitrofurantoin resistant conditions.
Nitrofurantoin resistance brought about decreased level of membrane bound ATPase activity in Vibrio el tor as compared to the normal strain while phospholipid as well as total lipid levels in the membrane fraction was increased. Mg++ was found to be the mose effective co-factor for ATPase. At higher concentrations of sodium and potassium ions, ATPase of normal and nitrofurantoin resistant Vibrio el tor responded quite differently. A soluble ATPase extract having low phospholipid content was found to be activated by the phospholipid extracts of Vibrio el tor, phosphatidyl ethanolamine, and also by phosphatidyl choline which is not a constituent of the membrane preparation of Vibrio el tor strains.
Adenosine Triphosphatases↗
Halothane and morphine-nitrous oxide anesthesia in patients undergoing coronary artery bypass operation. Patterns of intraoperative ischemia.
To examine whether the hemodynamic responses to halothane or morphine-nitrous oxide anesthesia produce different patterns of myocardial ischemia in patients undergoing myocardial revascularization, we studied 26 patients anesthetized with nitrous oxide (50%) and either halothane (0.2% to 1.0% end-tidal concentration) or morphine (2 mg/kg, given intravenously). We measured systemic and coronary hemodynamics and took blood samples to measure blood gases, oxygen content, and lactate and norepinephrine concentrations. Systemic blood pressure, rate-pressure produce, systemic vascular resistance, cardiac output, and stroke work were elevated following sternotomy in patients anesthetized with morphine, whereas halothane obtunded these hemodynamic responses to surgical stress. Intraoperative myocardial ischemia occurred in both patient groups. Ten of 14 patients receiving halothane and eight of 12 receiving morphine had at least one episode of either ST-segment depression or myocardial lactate production. The difference between these groups was not statistically significant. Only patients anesthetized with morphine had a significantly elevated rate-pressure product when ischemia occurred. In this selected series of patients subjected to myocardial revascularization, two sustained a myocardial infarction and four died in the postoperative period. The incidence of these and other indices of postoperative morbidity was not related to choice of primary anesthetic and did not differ between the patients who sustained ischemia and those who did not.
Anesthesia, General↗
Unstable rest angina. Coronary anatomy and evaluation of medical therapy.
The results of beta blockers and nitrates therapy were evaluated in 100 consecutive patients with unstable angina (72 with previous stable angina, 28 with recent onset angina), 89 patients had also a history of effort angina and 11 patients had only rest angina. In 92 of 100 patients selective coronary arteriography revealed fixed obstructive coronary artery disease in 86 patients and coronary artery spasm with normal coronary arteries in 6 patients. In 58 of 100 patients beta blockers and nitrates effectively controlled angina, and immediate coronary artery bypass graft surgery was avoided. In 42 patients early and in 22 patients late surgery were needed. 29 patients remained stable on long term beta blockers and nitrates therapy. Thus, despite the possibility of increased coronary vasomotor tone as the mechanism of rest angina, beta blockers and nitrates remain effective immediate medical therapy.
Angina Pectoris↗
Studies on the protective effects of L-ascorbic acid in chronic chlordane toxicity.
The influence of extraneous supplementation of L-ascorbic acid in chronic chlordane toxicity has been studied in rats. Oral administration of chlordane brings about a marked growth retardative effect, stimulates vitamin C synthesis in the system, elevates the vitamin C status of the liver and kidney tissues and also the urinary excretion. It inhibits the activities of acid and alkaline phosphatases, SDH and Mg2+-ATPase of both hepatic and renal tissues. The activities of serum and mitochondrial GOT, serum alkaline phosphatase, and glucose-6-phosphatase of both hepatic and renal tissues are markedly stimulated. The normal histological patterns of both liver and kidney tissues are grossly altered under chlordane toxicity condition. There occurs marked increase in the hepatic lipid composition. Supplementation of L-ascorbic acid in high doses to the chlordane treated rats can effectively counteract some of these alterations in respect of enzyme activities, morphological characteristics and of hepatic lipid composition.
Animals↗
Biochemical studies on molybdenum toxicity in rats: effects of high protein feeding.
Chronic oral administration of ammonium molybdate in rats markedly retarded the growth rate of rats and high protein diet could partially reverse this condition. The activities of several enzymes viz. acid phosphatase, alkaline phosphatase, glucose-6-phosphatase, succinic dehydrogenase, glutamate oxaloacetate transaminase, inorganic pyrophosphatase and acetylcholinesterase in different tissues and serum levels of luteinizing hormone, follicle stimulating hormone, prolactin and cortisol are altered due to the toxicity conditions and high protein diet fed group of animals showed almost normal values in respect of a few of these parameters. Normal histological pattern of both liver and kidney tissues were altered under molybdenum toxicity condition. Significant increase of basophilic substances are observed in the cytoplasm of the liver cells of the toxic group of animals which is counteracted by feeding high protein diet.
Animals↗
Pericardial effusion associated with minoxidil therapy.
Pericardial effusions are occasionally observed in patients treated with the new oral vasodilator, minoxidil. Almost all of these cases are related to severe renal or congestive heart failure, but very rarely can be observed in patients without an identifiable cause. Such a case is reported herein, in which extensive investigation failed to reveal the cause. On further observation, the effusion subsided despite continuation of minoxidil therapy. Review of the literature suggests that pericardial effusion is uncommonly observed in patients treated with minoxidil unless accompanied by renal or cardiac failure, and that discontinuation of minoxidil therapy is not always indicated.
Furosemide↗
Long-term digitalis therapy improves left ventricular function in heart failure.
To clarify the controversy regarding the benefits of long-term oral digoxin in the treatment of heart failure, we evaluated hemodynamics at rest and during exercise in nine patients in sinus rhythm with symptomatic heart failure. Patients were studied during long-term digoxin therapy, after withdrawal of the drug, and six hours after readministration. Upon withdrawal of digoxin, pulmonary capillary-wedge pressure increased from 21 +/- 8 to 29 +/- 10 mm Hg, and cardiac index decreased from 2.4 +/- 0.7 to 2.1 +/- 0.6 liters per minute per square meter of body-surface area, suggesting a deterioration in left ventricular function. In addition, heart rate tended to increase and stroke-work index, stroke-volume index, and radioangiographic ejection fraction decreased. Acute readministration restored the hemodynamic values to those observed during long-term digoxin therapy. The improvement in hemodynamics during long-term digoxin administration was also observed during exercise. This improvement demonstrated the value of long-term oral digoxin therapy in congestive heart failure.
Administration, Oral↗
Hemodynamic effects of nitrates in chronic heart failure and myocardial infarction.
The peripheral venodilation, principal effect of NTG and nitrates may cause a significant reduction in pulmonary venous pressure and, therefore, improve the symptoms of pulmonary venous congestion. Hemodynamic effects o high doses of oral isosorbide dinitrate in patients with chronic heart failure (N - 13). (Formula: see text). The other mechanism by which nitrates can potentially improve cardiac performance in patients with heart failure due to obstructive coronary artery disease is by relieving myocardial ischemia which tends to improve global myocardial function. Nitroglycerin or nitrates improve systolic motion of the ischemic but viable myocardial segments improved segmental wall motion consequent on relief of regional myocardial ischemia is probably related to a decrease in the determinants in oxygen demand rather than an increase in regional myocardial blood flow. An increase in collateral blood flow, however, may be contributory. Effects of nitrates on coronary dynamics and myocardial metabolism. (Formula: see text). These findings suggest with nitrates cardiac performance improves with decreased metabolic cost.
Chronic Disease↗
Altered prazosin pharmacokinetics in congestive heart failure.
The pharmacokinetics of prazosin (Minipress) were studied in nine patients with NYHA Class 3 or 4 congestive heart failure and in five healthy controls. After a single 5 mg oral dose, plasma concentrations of prazosin, as reflected in the area under the plasma concentration-time curve (AUC) and prazosin plasma half-life, were approximately double in the patients in comparison to the control group. Reduction in hepatic blood flow, altered gastrointestinal absorption of the drug or diminished intrinsic hepatic metabolic activity in the patient group may have contributed to the observed changes in prazosin disposition. The finding of higher prazosin plasma concentrations in patients with refractory heart failure demonstrates the need for close monitoring of these individuals following administration of the drug in the treatment of chronic congestive heart failure.
Adult↗
Estimation of pulmonary artery wedge pressure from chest radiograph in patients with chronic congestive cardiomyopathy and ischaemic cardiomyopathy.
In order to define the relation between chest x-ray findings and the level of pulmonary artery wedge pressure in patients with chronic congestive cardiomyopathy, 82 patients had chest radiographs before undergoing 92 haemodynamic studies. The studies were divided into three groups according to the level of pulmonary artery wedge pressure (PAWP) (group 1: less than 15 mmHg, group 2: 15 to 24 mmHg, group 3: greater than or equal to 25 mmHg. Venous distribution, interstitial oedema, pleural effusions, left atrial enlargement, and right ventricular enlargement each occurred in less than 10 per cent of group 1 studies. Radiological abnormalities generally distinguished group 1 from group 2, but none except cardiothoracic ratio distinguished group 2 from group 3. Cardiothoracic ratio correlated best with pulmonary artery wedge pressure (r = 0.70). Alveolar oedema was uncommon when PAWP greater than or equal to 25 mmHg, occurring in 32 per cent of group 3 studies. Stepwise multiple linear regression analysis showed that cardiothoracic ratio, alveolar oedema, interstitial oedema, and left atrial size each contributed independently to the prediction of PAWP. The regression analysis improved the accuracy of the estimation of PAWP from the findings noted on standard chest radiographs.
Aged↗
Vasodilator therapy for chronic heart failure.
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Captopril↗
Metabolic assessment of exercise in chronic heart failure patients treated with short-term vasodilators.
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Adult↗
Influence of left ventricular dimensions on endocardial and epicardial QRS amplitude and ST-segment elevations during acute myocardial ischemia.
The influence of acute myocardial ischemia and changes in ventricular dimensions on endocardial and epicardial electrograms were evaluated in 17 anesthetized open-chest dogs before and after left ventricular volume expansion and before and after coronary artery ligation. In eight dogs, regional myocardial blood flow was determined by the labeled microsphere technique. Endocardial QRS (endo-QRS) amplitude in ischemic and nonischemic zones, and epicardial QRS (epi-QRS) in nonischemic zones maintained a negative linear relation with left ventricular end-diastolic dimension before and after coronary artery ligation, although acute ischemia decreased endo-QRS independently. Epi-QRS amplitude in the ischemic zone decreased after coronary artery ligation but changed inconsistently during volume expansion. Ischemia-induced epicardial ST-segment elevation decreased during volume expansion and was associated with improved epicardial blood flow. Changes in epi-QRS in ischemic zones, however, were not related to epicardial blood flow during volume expansion. These findings indicate the potential problems of using changes in QRS amplitude for determining the extent of myocardial ischemic injury.
Acute Disease↗
Detection of patent coronary bypass grafts by computed tomography. A preliminary report.
Twenty-three coronary bypass graft patients were evaluated by a contrast-enhanced computed tomography (CT) technique to determine graft patency. Four to six 4.8-second sequenced scans with a 1-second interscan interval were obtained in each patient during the hand injection of 25-30 ml of contrast medium in a peripheral vein. Patency of grafts was determined by a characteristic contrast enhancement. The CT technique correlated with angiographic assessment of graft patency in 59 of 62 grafts (95%). We conclude that this relatively noninvasive technique shows promise as a method for determining coronary bypass graft patency.
Adult↗
Immediate and sustained hemodynamic and clinical improvement in chronic heart failure by an oral angiotensin-converting enzyme inhibitor.
The hemodynamic effects of an oral angiotensin-converting enzyme inhibitor, captopril, were evaluated in 10 symptomatic patients with chronic congestive heart failure. In all patients there was a significant increase in cardiac output (average 28%), stroke volume (49%), and stroke work index (26%), along with a decrease in pulmonary capillary wedge pressure (48%), indicating improved left ventricular function. Modest decreases in heart rate and arterial pressure were also observed. In seven patients maintained on captopril therapy, repeat hemodynamic studies at 2 months revealed sustained effects. These beneficial hemodynamic effects were accompanied by clinical improvement and improved exercise tolerance during maintenance therapy. These findings suggest that captopril may be a useful therapeutic adjunct for the long-term management of patients with chronic congestive heart failure.
Administration, Oral↗
Oral hydralazine in chronic heart failure: sustained beneficial hemodynamic effects.
Hemodynamic effects of oral hydralazine (200 to 400 mg/d) were evaluated in 11 patients with chronic heart failure after short-term (24 hours) and long-term (average, 8.3 months) therapy. In seven of 11 patients, hemodynamic changes were evaluated after withdrawal of hydralazine. During early study, cardiac index, stroke volume index, and stroke work index increased by an average of 56%, 59%, and 68%, respectively, and systemic vascular resistance decreased by 39%. During late study, cardiac index (+65%), stroke volume index (+88%), and stroke work index (+98%) remained higher and systemic vascular resistance (-41%) lower than control values. Withdrawal of hydralazine caused a decrease in cardiac index, stroke volume index, and stroke work index and an increase in systemic vascular resistance. Heart rate and arterial, pulmonary capillary wedge, and right atrial pressures did not change significantly. These findings suggest that oral hydralazine produces sustained beneficial hemodynamic effects in patients with chronic heart failure.
Administration, Oral↗