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PubMed1989

[Long-term therapy following myocardial infarct with isosorbide dinitrate in a low and high dose].

The favorable response to nitrates in the case of coronary heart diseases is based on both reduction in left ventricular pre- and afterload and improvement in coronary flow. These effects were studied in the setting of a long-term ISDN therapy with reference to the prognosis of patients after myocardial infarction. Following acute treatment in the respective hospitals, 608 patients with myocardial infarctions were allocated to two double-blind treatment groups with different ISDN dosage levels (group 1 = 5 x 2.5 mg i.d.; group 2 = 5 x 40 mg i.d.) and followed up over a period of 2 years. No differences were found with regard to the end points sudden cardiac death, reinfraction, and indication for revascularization. There was, however, a more frequent additional administration of calciumantagonists to patients of the low-dose group (p less than 0.05), a more frequent drop-out due to the lack of beneficial therapeutic results, and a more exceptional drop-out due to side effects in patients treated with low doses of ISDN (n.s.). The absence of any significant difference with regard to the end points might be attributed to; 1) a loss of potency of high-dose ISDN and simultaneous ineffectiveness of low-dose ISDN; 2) an efficacy of low doses; 3) an absence of actual influence on the target parameters, and 4) an inadequate follow-up time period.

Coronary Circulation↗
PubMed1989

[High-dose single administration of isosorbide dinitrate: effect on diurnal distribution of transitory myocardial ischemia in patients with stable angina pectoris].

We studied the effect of a monotherapy of isosorbiddinitrate on symptomatic and asymptomatic ischemic episodes in 15 ambulatory patients with chronic stable angina pectoris, positive exercise test, and coronary stenosis greater than 70%. Transient ST-segment depression (greater than 0.1 mV for at least 1 min) was documented by 48-h Holter monitoring during a control period without anti-ischemic therapy and at the end of 14 days of treatment with 120 mg o.d. isosorbiddinitrate slow-release. In the control period, 68 asymptomatic and 28 symptomatic ischemic episodes were detected; most of the episodes occurred in the morning between 6.00h and 12.00h (41 episodes) and in the afternoon between 12.00h and 18.00h (36 episodes). Under anti-ischemic therapy the number of episodes and the total duration of ischemia was reduced by 46% and 53%, respectively (p less than 0.01). The anti-ischemic effect was most evident during the morning and the afternoon; the ischemic episodes during the evening and the night were not significantly diminished. It is concluded that in patients with stable angina pectoris a single high-dose of isosorbiddinitrate significantly reduces the number and duration of transient ischemic episodes during daily life.

Aged↗
PubMed1989

[Hemodynamic effect of subchronic therapy with 120 mg isosorbide dinitrate in a slow release form in minimal to moderate post-infarct heart failure].

In 16 patients (12 male, 4 female; age 48-73 years, mean = 62.2 years) with left heart failure NYHA Class II-III after myocardial infarction hemodynamic measurements by Swan-Ganz-Catheterization were performed before and after a 3-week therapy with a single dose of 120 mg ISDN in slow-release form. No patient received vasodilators and surgical revascularization was not indicated. Hemodynamics were measured before, 2 and 10 h after ISDN at rest and during exercise. Both before (rest/exercise: LVFP = 18.9 +/- 8.1 +/- 8.1/31.2 +/- 10.5 mmHg) and after 3 weeks (20.6 +/- 8.9/33.1 +/- 14.4 mmHg) ISDN significantly reduced LVFP 2 h (12.1 +/- 5.9/19.0 +/- 10.1 and 11.7 +/- 5.8/20.5 +/- 10.4 after 3 weeks) and 10 h (12.2 +/- 4.6/23.5 +/- 11.0 and 13.0 +/- 3.8/25.8 +/- 11.7 mmHg after 3 weeks) after application. No significant changes of heart rate were observed. In a subgroup of patients hemodynamic control after a 1-year treatment with 120 mg ISDN revealed a sustained reduction of LVFP at rest and during exercise. There is no significant evidence for the development of nitrate tolerance using this treatment regimen in chronic left heart failure.

Aged↗
PubMed1989

[Combination therapy with slow release isosorbide nitrate and diltiazem in silent myocardial ischemia].

In 11 patients (2 female, 9 male) suffering from angiographically proven CHD (age 45-60 years; 54.3 years on an average) the efficacy of a once-daily oral medication with 120 mg ISDN/50 mg ISMN and diltiazem (D) each in a long-acting preparation was examined in a placebo-controlled study. Each period lasted for 3 days; 2 capsules were given at 0700 a.m. one capsule at 5 p.m. Long-term ECG-recordings for 24 hrs (Tracker recorder, Pathfinder III) were performed twice under placebo and once during the third day of ISDN or ISMN, ISDN/ISMN + D in the morning and JSDN or ISMN in the morning and D in the afternoon. The rate of ischemic events declined from 10.4 to 4.7, 3.3 and 2.2; the duration of ischemia in 24 hours declined from 128 min to 43 min, 44 min and 34 min. The product of ST-depression (mV) and time of duration (min) showed an equivalent course. A more than 80% reduction of ischemia (duration and frequency) was achieved by a combination therapy in 72% of the patients. Minimal increase of heart rate at the beginning of ST-depression increased significantly during all periods of therapy, maximal increase of heart rate at that time showed a decrease only during combination therapy with D, the mean value did not change significantly. The once-daily application of ISDN/ISMN (50 mg) in a long-acting preparation (120 mg) led to a significant reduction of silent myocardial ischemia. The efficacy of ISDN/ISMN can be improved by D (120 mg, long acting preparation) up to a greater than 80% reduction in frequency and duration of ischemic events.

Adult↗
PubMed1989

[Clinical effects of isosorbide dinitrate in the transdermal spray (TD Spray Iso Mack) form].

The authors report on their experience with the transdermal spray, TD spray Iso Mack. Using a graded ergometric test, the authors examined 11 patients with angina on exertion before and 60 minutes after administration of 60 mg of the effective substance by the transdermal route. The average threshold of ischaemia and work tolerance increased significantly and the ECG depression of segment S-T receded. In an open trial six patients were investigated with angina on exertion during three-week treatment with the spray--twice a day 60 mg by the transdermal route--as compared with standard treatment. The number of attacks and consumption of sublingual nitroglycerin decreased significantly. Five patients were subjected to haemodynamic examination before and repeatedly after application of 60 mg of the spray. A significant drop of the filling pressures occurred which persisted for 6 to 8 hours.

Administration, Cutaneous↗
PubMed1989

[Hemodynamic effect of isosorbide-5-mononitrate in acute cardiac insufficiency secondary to myocardial infarct].

The hemodynamic effects of IS-5-MN were studied in 18 patients with acute myocardial infarction (AMI) complicated with left ventricular failure. Before treatment, 13 patients were in Forrester's hemodynamic class II and 5 in class IV. Hemodynamic monitoring was performed for 3 days, and the following parameters were measured: heart rate (HR), blood pressures (BP), right atrial (RAP), pulmonary artery and pulmonary capillary (PCP) pressures, cardiac index (CI), systemic (SVR) and pulmonary (PVR) vascular resistances, and coronary perfusion pressure (CPP). Patients with clinical symptoms of acute pulmonary edema or systolic BP (BPs) less than 90 mmHg were not included. Twenty mg of 5-IS-MN per os were administered every 8 h. Hemodynamic measurements and IS-5-MN plasma levels were obtained in basal conditions and 1/2, 1, 2, 6 and 8 h after the first and seventh dose of IS-5-MN. A significant decrease of systolic and diastolic BPs, RAP, PCP, SVR and PVR was observed after 1/2 of IS-5-MN administration and was maintained through the study, while CI and CPP increased and HR remained unchanged. The hemodynamic effect was maintained after the seventh dose, with a further decrease of the following parameters: BP, RAC, PCP and PVR. However, 2 patients were withdrawn from the study due to severe symptoms of heart failure. One patient presented headache. IS-5-MN plasma levels were identified after 1/2 h, with a peak level after 1 h, and were similar after the seventh dose. A significant correlation was found between the IS-5-MN levels and the delta RAP and delta PCP after the seventh dose.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗