[Clinical features and therapy of persistent ductus arteriosus in adults].
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Adolescent↗
Biomedical subjects
W D Bussmann
Publications and source records attributed to W D Bussmann.
[Therapy with nitrates in the post-infarct phase].
The beneficial effects of nitrates in patients with angina pectoris and acute myocardial infarction have positively influenced the prognosis of the treated patients. Studies of Jugdutt pointed out that there is a better prognosis also in the postinfarction period. Especially left ventricular over dilatation, which follows larger infarct, can be prevented by a consistent nitrate therapy.
Hemodynamics↗
[Captopril in acute myocardial infarct: its effect on infarct size and arrhythmias].
The effect of captopril on infarct size and arrhythmias was determined in a prospective, randomized, placebo-controlled double-blind study of 46 patients (9 women, 37 men; mean age 61 [38-86] years). Within 2-18 hours of entry into the study these patients received either a slow intravenous bolus injection of 2.5 or 5.0 mg captopril followed by a continuous infusion of 1.5-2.0 mg/h for a period of 48 hours (n = 22), or of a placebo by the same mode of administration (n = 24). The two groups were comparable as to age, infarct site and time of intervention. All patients, except one in each group, also received nitroglycerin (1.2-6.0 mg/h intravenously). QRS complexes were measured to provide a necrosis index. Q-wave amplitudes decreased under captopril (-0.08 +/- 0.04 mV) while increasing under placebo (+0.15 +/- 0.04 mV; P less than 0.05). The number of ventricular extrasystoles in the first 24 hours after onset of treatment or on placebo was 25/h and 9/h, respectively (P less than 0.02). Ventricular fibrillation occurred in 7 patients of the placebo group, in none of the captopril group. Creatine-kinase infarct weight was 59 and 45 gram-equivalents, respectively (placebo vs treated group: not significant). The mean arterial blood pressure fell by 14 mm Hg during the first hour in the captopril group, but by only 3 mm Hg on placebo (P less than 0.01). These results indicate that captopril has a favourable influence on infarct size and electrical stability which is additional to that provided by standard nitroglycerin treatment.
Adult↗
[The angiotensin-converting enzyme inhibitor in the treatment of angina pectoris].
The effect of the angiotensin-converting enzyme (ACE) inhibitor quinapril on myocardial ischaemia was tested in a randomized double-blind cross-over study of 16 men (mean age 62 [44-75] years) with angiographically demonstrated coronary heart disease, exercise-induced ST-segment depression and stable angina. Exercise ECGs were recorded before and 4 hours after a single dose of 10 mg quinapril and after a 14-day course of 10 mg quinapril twice daily. The single dose decreased the average ST-segment depression from 1.12 mV (placebo) to 0.74 mV (P less than 0.05); after 14 days on quinapril the ST-segment depression decreased from 0.91 mV (placebo) to 0.72 mV (P less than 0.05). While heart rate remained unchanged the average resting arterial blood pressure fell from 136/80 to 120/74 mmHg (P less than 0.05) after a single dose and from 141/83 to 127/78 mmHg (P less than 0.05) after 14 days on the drug. These data indicate that ACE inhibitors should be considered as a means of treating coronary heart disease and angina.
Administration, Oral↗
Comparison of nitroglycerin with nifedipine in patients with hypertensive crisis or severe hypertension.
To determine whether nitroglycerin is as effective as nifedipine in lowering the blood pressure in severe hypertension and hypertensive crisis, two groups of 20 patients received in random sequence either 1.2 mg nitroglycerin sublingually or a 10-mg nifedipine capsule, which was chewed and swallowed. The blood pressure fell after 5 min in the nitroglycerin group from 211/122 mmHg to 171/95 mmHg and after nifedipine from 210/118 to 185/102 mmHg. The greater effect of nitroglycerin may result from faster absorption through the oral mucosa than through the small intestinal mucosa where nifedipine is primarily absorbed. After 15-20 min a satisfactory reduction in blood pressure was reached in both groups: 157/91 and 158/92 mmHg, respectively. After 30 min the heart rate in the nitroglycerin group had decreased from 83 to 80/min, but in the nifedipine group it had increased from 84 to 90/min. The reduction in blood pressure persisted up to 6 h. No significant differences in side effects were determined. Since a hypertensive crisis is usually accompanied by left ventricular failure, pulmonary edema, angina pectoris, or infarction, nitroglycerin has been definitively shown positively to influence these conditions, and preference should be given to nitroglycerin in the treatment of hypertensive crises.
Acute Disease↗
First dose hypotension with enalapril and prazosin in congestive heart failure.
Since the introduction of angiotensin converting enzyme inhibitors into the adjunctive treatment of patients with congestive heart failure, cases of severe hypotension, especially on the first day of treatment, have occasionally been reported. To assess the safety of the angiotensin converting enzyme inhibitor enalapril a multicenter, open, randomized, prazosin-controlled trial was designed comparing the incidence and severity of symptomatic hypotension on the first day of treatment. Trial medication was 2.5 mg enalapril or 0.5 mg prazosin. Subjects were 1210 inpatients with New York Heart Association functional class (I)/II and III who were not adequately compensated with digitalis and/or diuretics. In the group receiving enalapril, 3 patients (0.5%) experienced severe hypotension on day 1 and 28 patients (4.7%) moderate hypotension. In those given prazosin, 15 patients (2.6%) experienced severe hypotension and 60 patients (10.3%) moderate hypotension. The difference is statistically significant (P less than or equal to 0.000012). All patients recovered. It was concluded that treatment of patients suffering from congestive heart failure New York Heart Association functional class (I)/II or III with enalapril is comparably well tolerated.
Aged↗
Nitrate therapy in heart failure.
Nitrates are drugs of first choice in patients with acute heart failure. Acute pulmonary edema can be successfully treated with single or repeated doses of sublingual nitroglycerin. In cases of prolonged acute heart failure, e.g. in the setting of acute myocardial infarction, nitroglycerin or isosorbide dinitrate can be given by the intravenous route for up to 24 h. Patients with acute myocardial infarction usually benefit from nitrate therapy if filling pressures are high and/or left ventricular function is compromised. Nitrate therapy can be considered safe if arterial blood pressure is maintained above 95 mm Hg. With these precautions nitrates can reduce infarct size and the incidence of complications as well as improve long-term prognosis. In the chronic treatment concern has risen with regard to possible nitrate tolerance. Thus, therapy schedules allowing for nitrate-poor phases are generally recommended. Therapy schedules with constant-rate delivery of drugs achieved with patches or intravenous administration of nitrates should be used with caution.
Administration, Cutaneous↗
[Drug treatment of myocardial ischemia].
Nitrates are the basic medication of patients suffering from coronary heart disease. Frequently they are combined with calcium-antagonists or beta-receptor-blocking agents. The dose of 20 mg non-retarded dinitrates or mononitrates three times a day have the same effect as retarded nitrates once a day but of a higher dose (60-120 mg). The meaning of this drug has increased because of new results on the mechanism of action: nitric oxide is able to substitute the missing EDRF in the injured intima and leads to dilatation of the stenosis. This mechanism is the basis for the antianginal effect. Already minimal doses (0.025 mg nitroglycerine i.v. 1.25 mg isosorbide dinitrate oral) are effective independent of the dilatation of peripheral venous and arterial vessels. The antiaggregatory effect decrease thrombus formation in patients with unstable angina and the risk of infarction and produce a kind of rinsing effect in the stenosis. The size of infarction becomes smaller, the expansion of the ventricle is less and the prognosis improved. Concerning the calcium-antagonists dihydropiridine-preparations, verapamil and diltiazem have to be separated. Arterial vasodilatation of nifedipine may increase heart rate during exercise and rarely coronary steel phaenonemen. In contrast verapamil (3 x 120 mg) and gallopamil (3 x 50 mg) have strong antianginal effects and reduce the ischemic reaction during exercise about 50%. Heart rate is reduced during physical exercise, similar to the beta-receptor-blocking agents. AV-blocks are rare. Obstipation is more frequent with verapamil than with gallopamil. Verapamil decreases the infarct size and improves the prognosis after infarction in patients without left ventricular failure.(ABSTRACT TRUNCATED AT 250 WORDS)
Adrenergic beta-Antagonists↗
[Trans-femoral ductus Botalli occlusion in patients over 60 years of age].
A persistent ductus arteriosus was occluded with an ivalon-plug introduced through the femoral artery in 14 patients over 60 years old (61 to 70 years). Two patients had previous surgery. The maximum left-to-right shunt was 53%, the maximum pulmonary artery pressure 54/24 mm Hg. In all patients ductus occlusion was successful and permanent. Bleeding at the puncture site in two patients could be stopped by manual compression. During a follow-up period of up to 5 years there were no instances of recanalization.
Aged↗
[Acute effect of enoximone and captopril in patients with heart failure].
UNLABELLED: The acute effects of enoximone (E) and captopril (C) were compared in a single-blind, randomized, cross-over trial in 10 patients (P) (nine with dilative cardiomyopathy, one with coronary heart disease) with heart failure (NYHA Class III: 6P and Class IV:4P). Cardiac index (Cl, 1/min.nm(-2), mean pulmonary artery pressure (PAM, mmHg), and pulmonary capillary wedge pressure (PC, mmHg) were measured at baseline and 15, 30, and 60 min after 0.1 mg/kg C and 0.75 mg/kg E, respectively, followed by measurements at 15, 30, 60, 180, and 300 min after 0.2 mg/kg C and 1,5 mg/kg E, respectively. RESULTS: Cl was unchanged 60 min after 0.1 mg/kg C, increased 60 min after 0.2 mg/kg C by 7.7% from 2.1 +/- 0.5 to 2.4 +/- 0.5 (p = 0,001), and was unchanged after 5 h. Cl increased 60 min after 0.75 mg/kg E by 32.5% from 2.1 +/- 0.5 to 2.9 +/- 0.4 (p = 0.001), 60 min after 1,5 mg/kg E by 59% to 3.3 +/- 0.6 (p = 0,001), and after 5 h by 19% to 2.5 +/- 0.4 (p = 0.01). PAM was unchanged 60 min after 0.1 mg/kg C, decreased 60 min after 0.2 mg/kg C by 10% from 35.7 +/- 11 to 31.7 +/- 10, and was unchanged after 5 h. PAM decreased 60 min after 0.75 mg/kg E by 13% from 35 +/- 9 to 31 +/- 10 (p = 0.01), 60 min after 1.5 mg/kg E by 19% from 35 +/- 9 to 27 +/- 9 (p = 0.001), and was unchanged after 5 h. PC decreased 60 min after 0.1 mg/kg C by 23% from 24 +/- 8 to 19 +/- 9 (p = 0.05) and was unchanged 60 min und 5 h after 0.2 mg/kg C. PC decreased 60 min after 0.75 mg/kg E by 35% from 25 +/- 6 to 17 +/- 8 (p = 0,01) and 60 min after 1.5 mg/kg E by 47% to 14 +/- 8 (p = 0,001) and was unchanged after 5 h. CONCLUSION: The clinical trial showed that in P with chronic heart failure (NYHA III and IV) the acute increase of Cl and decrease of PC is higher after E than after C. The improvement of hemodynamics lasts longer after i.v. E than i.v.C.
Adult↗
Design and analysis of the HYPREN-trial: safety of enalapril and prazosin in the initial treatment phase of patients with congestive heart failure.
Since the introduction of angiotensin converting enzyme (ACE) inhibitors into the adjunctive treatment of patients with congestive heart failure, cases of severe hypotension, especially on the first day of treatment, have occasionally been reported. To assess the safety of the ACE inhibitor enalapril a multicenter, randomized, prazosin-controlled trial was designed that compared the incidence and severity of symptomatic hypotension on the first day of treatment. Trial medication was 2.5 mg enalapril or 0.5 prazosin. Subjects were 1210 inpatients with New York Heart Association (NYHA) functional class II and III. Patients who received enalapril experienced clinically and statistically significantly less symptomatic hypotension (5.2%) than the patients who received prazosin (12.9%). All patients recovered. It was concluded that treatment with enalapril was well tolerated and it is, therefore, unreasonable to restrict the initiation of treatment with enalapril to inpatients.
Aged↗
[Report of the Study Group "Vasodilators" at the Fall Meeting of the German Society of Cardiovascular Research, 4 October 1990. "Vasodilatory mechanisms of the endothelium"].
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Cardiology↗
Nitrate patches: duration of action and loss of efficacy. Reflections on the nitrates' mode of action.
Nitroglycerin patches deliver 0.003 mg nitroglycerin per minute through the skin. This small dose led to an antianginal effect in the short term and when applied with a nitrate pause at night also during sustained use. Minimal doses of i.v. nitroglycerin (0.025 mg) do have antianginal activity. This dose has no effect on pre- and afterload, but increases the diameter at the point of the stenosis. These findings are in accordance with newly won insights into the mode of action of nitrate in coronary heart disease. In the area of the stenosis EDRF cannot be produced by the intima because of damage resulting from arteriosclerotic plaques. EDRF is identical with NO. Thus, the administration of low doses of nitrates that act by means of the NO radical can increase the diameter in the stenosis, since the physiological dilator (EDRF) is no longer present. The increased flow caused by dilatation is the main factor in the antianginal activity of nitrates.
Administration, Cutaneous↗
Experimental balloon valvuloplasty of fibrotic and calcific mitral valves.
This study evaluated the mechanism of valvular area expansion during single- and double-balloon valvuloplasty in fibrotic and calcific mitral valves. Special interest was focused on the morphological features of the valves treated. Mitral valves that appeared unsuitable for commissurotomy were excised in toto at the time of mitral valve replacement in 15 patients. The excised valves were mounted in a fluid-filled chamber with a window for photographic evaluation. The chamber was perfused continuously to ensure maximal valvular opening. The valve was photographed, and the orifice area was measured before and after balloon expansion. In addition, the specimens were examined macroscopically and radiographically with regard to calcium content and degree and localization of fibrosis. These data were correlated with splitting of commissures and with rupture of leaflets. Nine valves were fibrotic, and six were calcific. Dilatation was performed first with a single-balloon catheter (diameter, 2 cm) and then with a double-balloon catheter (diameter, 2 and 1.5 cm). After dilatation with one balloon, the average mitral valve area increased from 0.79 to 1.09 cm2, and with two balloons, average area increased to 1.59 cm2. The single-balloon technique caused commissural splitting in nine valves, stretching in three, partial leaflet rupture in one, and no change in two. After the double-balloon technique, commissural splitting occurred in 12 valves and three leaflets were ruptured where severe fibrosis and calcification were mainly located within the commissures. As a rule, after dilatation with the single-balloon technique, the remaining stenosis was still severe, and after dilatation with the double-balloon technique, the remaining stenosis was moderate.(ABSTRACT TRUNCATED AT 250 WORDS)
Calcinosis↗
[Effect of verapamil on rate of restenosis following transluminal angioplasty of renal artery stenoses].
This prospective double-blind randomized study examined the effect of verapamil on restenosis after angioplasty of renal artery stenoses. 31 patients received placebo or 120 mg verapamil two or three times daily until the appointed day of the control angiography after 3 months. All patients received 1.5 g aspirin per day. In the control group (13 stenoses, 12 patients) the degree of stenoses increased from 35 +/- 15% immediately after PTA to 41 +/- 21% at repeat angiography 3 months after PTA, in the verapamil group (20 stenoses, 14 patients) from 35 +/- 16% to 43 +/- 22% (ns). Stenoses recurred in 23% of the stenoses in the placebo group and in 20% of the stenoses in the verapamil group (ns). 5 patients, who interrupted the therapy, were excluded from the evaluation. In the conclusion, verapamil does not decrease the incidence of restenosis after PTA of renal artery stenoses during concurrent therapy with aspirin.
Adult↗
[Nitrate plaster: duration of effect--loss of effect. Deliberations on the mechanism of activity of nitrate].
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Coronary Artery Disease↗
[Aortic aneurysm after dilatation of aortic isthmus stenosis].
An aneurysm in the region of the dilatation occurred in two of 23 patients (a 17-year-old boy and a 29-year-old woman) three and one years, respectively, after balloon dilatation for coarctation of the (thoracic) aorta. The aneurysm in the boy was small (18 mm diameter) and he was symptom-free so that no operation is as yet indicated. But the woman had progressively increasing backache after physical exertion and the aneurysm was 4 cm in diameter. Therefore, the aneurysm and coarcted segment were resected and a Dacron prosthesis interposed. As the ultimate value and risk of balloon dilatation of coarctation of the aorta cannot as yet be definitively judged, all patients should be carefully and repeatedly examined over a longer period.
Adolescent↗
[Basic therapy of chronic heart failure with digitalis or diuretics?].
Sixteen patients in heart failure and sinus rhythm were, after a four-week treatment-free period, randomly assigned to receive, for four to six weeks, either a diuretic combination (hydrochlorothiazide + triamterene) or a digitalis glycoside. Subsequently the treatment was exchanged between the two groups. Without treatment nine patients were in stage II (New York Heart Association classification), seven in stage III. Pulmonary wedge pressure at rest was 27 +/- 14, on exercise 32 +/- 8 mm Hg, cardiac output 5.3 +/- 1.0 at rest and 7.8 +/- 2.3 l/min on exercise. Digitalis glycosides improved symptoms by one stage in three of 16 patients. All objective measures showed slight but not significant improvement. Diuretic treatment improved symptoms in five patients, while heart size and echocardiographically measured ventricular volume decreased slightly. Cardiac output decreased at rest, but not significantly, and on exercise not at all. Pulmonary arterial pressure (21 +/- 9 mm Hg), pulmonary wedge pressure (13 +/- 7 mm Hg) and pulmonary artery pressure on exercise (39 +/- 11 mm Hg) were significantly lower on diuretics than without treatment. The results support the primary use of diuretics in the treatment of chronic heart failure.
Aged↗