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Biomedical subjects

R K Mahapatra

Publications and source records attributed to R K Mahapatra.

18 recordsLinked to original sources
PubMed1987

Clinical experience with a transdermal nitroglycerin system.

Forty-seven patients with chronic stable angina pectoris entered a thirteen-week open-label study with a transdermal therapeutic system of nitroglycerin in order to evaluate its clinical efficacy, safety, and patient acceptance. In 19 patients, a beta-blocker and in 17 patients a calcium-channel blocker were continued throughout the study period without alteration of their doses. The study consisted of a two-week run-in period and an eleven-week active drug period. Acute titration was done with nitroglycerin patches on the basis of weekly patient diaries on frequency of angina and sublingual nitroglycerin consumption. Overall, reductions in frequency of angina and in nitroglycerin consumption were statistically significant (p less than 0.05). Adverse reactions were common but tolerable. The reported side effects were headache in 32, skin rash in 18, dizziness in 10, palpitation and itching in 9 each, nausea in 7, flushing in 3, and vomiting in 1 patient. In conclusion, the present study demonstrates that individual dose titration with nitroglycerin patches for obtaining significant antianginal effect is essential. The present therapeutic system is convenient to use and well tolerated and had acceptable side effects in our study population.

Administration, Cutaneous↗
PubMed1986

Efficacy and safety of oral tocainide in refractory ventricular arrhythmia: a preliminary report on an open label study.

The preliminary data on efficacy and safety of oral tocainide in refractory ventricular dysrhythmia in 8 patients is described. Two patients died; one within 15 days and the other after 1750 days of continuous tocainide therapy. The cause of death in both patients was unclear. During initial administration and acute titration, oral tocainide was extremely effective in lidocaine-sensitive ventricular dysrhythmia and in patients with Q-T prolongation syndrome. Four out of 8 patients received tocainide in presence of left ventricular dysfunction and 2 out of 4 such patients died suddenly. Minor central nervous system side effects were seen in 2 patients and dermatologic adverse reaction was seen in one patient only.

Aged↗
PubMed1986

Cardiovascular effects of polycyclic antidepressants.

Every day, thousands of people in the United States receive polycyclic antidepressants (PCAs) prescribed by their primary care physicians. We have examined the cardiovascular manifestations of polycyclic antidepressants in 14 patients with primary depression receiving various antidepressant drugs for a period of six months or more. None had suffered from any systemic illness. All 14 received a commonly prescribed PCA, such as doxepin, amitriptyline, imipramine, desipramine or amoxapine, in therapeutic doses. None developed any significant adverse reaction. Left ventricular function, as determined by M-mode echocardiogram, was within normal limit in all patients. A twenty-four-hour ambulatory electrocardiogram revealed rare supraventricular ectopic beats in 8 patients and ventricular ectopic activity (Lown grade 1) in 4 patients. In 1 patient, who received additional lithium carbonate for treatment of depression, both supraventricular and ventricular ectopic activity developed on rare occasions. In 4 of the 8 patients the plasma concentration of PCA was optimal or near optimal, and in 4 of the 8 patients it was subtherapeutic (even though these 4 patients had shown clinical improvement with continued polycyclic therapy). It appears from the present data that antidepressant therapy with PCAs prescribed in therapeutic doses was well tolerated, without any significant adverse cardiovascular reaction, in otherwise healthy young patients with primary depression.

Adult↗
PubMed1986

Acute titration and chronic follow-up with captopril in hypertension. A one-year safety profile on combination therapy with captopril and a diuretic.

The present study examines acute titration with captopril and chronic follow-up data on captopril and a diuretic in patients with all forms of hypertension. Captopril was initiated in those patients in whom previous antihypertensive agents either failed to control high blood pressure or produced adverse reactions. Acute titration was done in 88 patients in whom average diastolic blood pressure was equal to or more than 95 mm Hg. Initial titration dosage was decided on the basis of initial blood pressure recordings. During initial titration, 5 patients received 12.5 mg, 51 received 25 mg, 28 received 50 mg, and the remaining 4 received 100 mg of captopril. Post-captopril blood pressure data were normalized by using pre-captopril data as 100% for each patient. The blood pressure-lowering effect of captopril on both systolic and diastolic blood pressure in all 88 patients was statistically significant (p less than 0.05), within forty-five minutes of captopril administration irrespective of the doses. No adverse reactions were seen during the acute titration. After the initial titration, in all 88 patients a diuretic was added to obtain a synergistic effect. Eleven patients were dropped from the study, for they could not follow the requirements of the protocol. In 77 patients the data for a one-year safety profile with captopril and diuretic were available. There were no overall significant statistical changes in serial white blood cell count, serum potassium, and serum creatinine values in those 77 patients. In 31 patients the initial and maintenance dosage of captopril and the diuretic remained unaltered for one year. Post-captopril blood pressure and heart rate data were normalized, pre-captopril data being considered as 100% in those 31 patients. The blood pressure data following captopril and a diuretic therapy compared with the pre-captopril data were statistically significant (p less than 0.05) throughout the study period. However, no significant changes in heart rates were observed during the study period. In all other patients, diuretic therapy was continued throughout the study period. In 6 severely hypertensive patients, an additional beta-blocker was needed for further control of high blood pressure. In 3 severe hypertensives with renal failure, besides a diuretic and a beta-blocker, minoxidil was needed to normalize their high blood pressure. In 4 of 77 patients, verapamil was used for treatment of either vasospastic angina or paroxsysmal supraventricular arrhythmia.(ABSTRACT TRUNCATED AT 400 WORDS)

Adrenergic beta-Antagonists↗
PubMed1985

Myocarditis and hepatitis B virus.

Two patients with hepatitis B virus infection and myocarditis are reported. The implicated pathogenesis was an immune complex mechanism in one patient. Both patients presented with heart failure and arrhythmia which were controlled with conventional medical therapy. Echocardiography played an important role for early detection of left ventricular dysfunction. The efficacy and safety of corticosteroid therapy is still conjectural. Acute hepatitis B infection should be a differential diagnostic consideration in the etiology of acute myocarditis.

Adult↗
PubMed1984

Paroxysmal ventricular tachycardia associated with Bell's palsy in a teenager at late pregnancy.

Several attacks of ventricular tachycardia (VT) were observed in a fifteen-year-old girl at late pregnancy. Left sided Bell's Palsy was the accompanying presentation. The symptom started with a viral-like illness. The VT could be effectively controlled with IV Lidocaine therapy. Labor was induced and the delivery was uneventful. To the best of the authors' knowledge, this syndrome was not previously described.

Adolescent↗
PubMed1983

Low-dose captopril titration in patients with moderate-to-severe hypertension treated with diuretics.

To study the value of low-dose captopril (6.25 and 12.5 mg) and a diuretic combination, the blood pressure and heart rate of 17 patients with moderate-to-severe hypertension were monitored for 6 hours (hospital) or 3 hours (office) after the single low-dose or larger (25, 50, 100 and 150 mg) captopril dosage. All patients had preserved renal function and were taking an oral diuretic (hydrochlorothiazide or furosemide) for at least 4 weeks. The supine and upright acute blood pressure lowering with 6.25 mg was not different from the larger captopril doses; none produced persistent or profound hypotension. There was no deterioration of renal function, new or persistent increase in proteinuria, neutropenia or agranulocytosis acutely or during 17 +/- 2 weeks of follow-up. Low-dose captopril (6.25 or 12.5 mg three times daily) normalized the supine blood pressure of 35% of these patients acutely. We suggest that in hypertensive patients already taking a diuretic, a lower starting dose of captopril than the recommended 25 mg three times daily may be desirable.

Adult↗
PubMed1980

Stroke as a complication of mitral valve prolapse.

A patient with mitral valve prolapse had two minor strokes after she stopped taking oral anticoagulants. While routine oral anticoagulant therapy is not indicated for mitral valve prolapse, such therapy is strongly recommended when this condition is accompanied by stroke.

Adult↗
PubMed1980

Systemic thromboembolism in rheumatic heart disease.

The results of 62 autopsies of patients with rheumatic heart disease have been analyzed. The patients were 14-56 years old (mean 26 years). Thirteen patients had evidence of systemic thromboembolism (STE). All 13 patients had renal infarction, 2 had cerebral infarction, and 1 had a splenic infarction. Only 1 case with cerebral infarct was diagnosed clinically. Seven of 30 patients with atrial fibrillation had STE as did 6 of 32 patients with sinus rhythm. The type of valve involved and previous commissurotomy did not positively correlate with STE. It was observed that in this selected group of chronically ill patients who were autopsied, the elderly male patients with atrial fibrillation demonstrated increased incidence of STE.

Adolescent↗
PubMed1977

Metoprolol--a new cardioselective beta-adrenoceptor blocking agent for treatment of tachyarrhythmias.

The antiarrhythmic effect of the cardioselective beta-adrenoceptor blocking agent metoprolol, given intravenously, was studied in 44 patients with various tachyarrhythmias, including patients with congestive heart failure and signs of digitalis intoxication. All patients with atrial tachycardia (12 cases) reverted to normal sinus rhythm. In 3 out of 18 patients with atrial fibrillation, sinus rhythm was restored, and in the others there was a significant reduction in ventricular rate. In 6 of 10 patients with ventricular ectopic beats, and 1 of 2 patients with ventricular tachycardia, the ectopic rhythm was abolished. The drug was well tolerated, without any significant changes in blood pressure, even by patients with signs of digitalis intoxication and varying degrees of pulmonary or peripheral circulatory congestion. Metoprolol is of clinical value for treatment of tachyarrhythmias, especially those of supraventricular origin.

Adolescent↗