Search

The study was designed to examine the safety and efficacy of acute interventional use of captopril on left ventricular volumes, ventricular arrhythmias and neurohormones during thrombolysis in patients with a first anterior myocardial infarction, within 6 h of onset of symptoms. Left ventricular dysfunction and prognosis after myocardial infarction can be improved by angiotensin converting enzyme inhibition started after the ischaemic phase. Experimental evidence suggests that intervention during thrombolysis may lead to even further benefit. In a randomized, double-blind placebo-controlled trial, 298 patients with a first anterior myocardial infarction, eligible for thrombolytic therapy were treated with captopril 6.25 mg or placebo, started immediately upon streptokinase infusion and titrated to 2.5 mg t.i.d.. The efficacy of captopril by an intention-to-treat-analysis to reduce left ventricular volumes, ventricular arrhythmias, neurohumoral activation and enzymatic infarct size was measured. During dose titration, mean blood pressure and heart rate were similar in both groups. However, hypotension after the first dose was reported in 18 patients on placebo and 31 patients on captopril (P<0.05). At discharge, 80% of patients were on study medication. Left ventricular volumes were significantly increased in both groups at 3 months, but they tended to be lower in the captopril group; however, the differences were not statistically significant. The incidence of accelerated idioventricular rhythm and non-sustained ventricular tachycardia in captopril patients was lower than in placebo patients (P<0.05), parallelled by transiently lower norepinephrine levels (P<0.05) upon thrombolysis. In addition, enzymatic infarct size was smaller in captopril patients, especially in larger infarcts (P<0.05), and a 34% (95% confidence interval; 0–56%) lower incidence of heart failure during 3 months follow-up was reported in the captopril group. Captopril is well tolerated, although hypotension after the first dose was more common than in patients on placebo. In agreement with experimental studies, captopril reduces repetitive ventricular arrhythmias and catecholamine levels in the acute thrombolytic phase of myocardial infarction. Although left ventricular volumes were not significantly smaller in captopril patients, in the chronic phase, these patients showed a reduced incidence of heart failure. This study was carried out under auspices of the Interuniversity Institute of the Netherlands (ICIN) and the Working Group of Cardiovascular Research the Netherlands (WCN). Financial support was received from Bristol-Myers Squibb, Pharmaceutical Research Institute, Princeton, N.J., U.S.A. [ABSTRACT FROM PUBLISHER]

A retrospective study on 126 patients with pericardial effusion showed cardiac tamponade to be present in 39 patients and absent in 87. We evaluated the distribution of the pericardial effusion as well as the effect of hydrodynamic compression on the different heart chambers. Small to large volumes of pericardial fluid were found in both groups of patients. Abnormal wall movements were only present if pericardial effusion was adjacent. Hydrodynamic compression signs consisted of abnormal wall movements of both atria at enddiastole continuing into systole, and of the right ventricle in early- and mid-diastole. Most of the patients with cardiac tamponade showed an abnormal motion pattern of both right atrium and ventricle (13 patients) or of the right atrial wall alone (12 patients). Abnormal motion of the right ventricle alone was seen in 6 patients, of both atria and right ventricle in 4 and of the left atrium alone in 1 patient. False-negative diagnoses of cardiac tamponade occurred in 3 of the 39 patients and false-positives in 2 of the 87 (sensitivity 92%, specificity 98%). Measurements of the duration of the inversion of both atria increased the specificity of these abnormal wall movements to 100%. Echocardiography can help to identify those patients who are clinically at risk and need pericardial drainage. [ABSTRACT FROM PUBLISHER]

We report a case of infective endocarditis (IE) caused by an unusual micro-organism in a previously healthy young man. Our patient presented with meningo-encephalitis and embolic signs due to IE caused by Neisseria sicca. Risk factors for IE due to Neisseria sicca, such as intravenous drug use and pre-existing heart disease were absent. The patient recovered well after mitral valve surgery and antimicrobial therapy. IE due to Neisseria spp. is associated with embolic manifestations and valve destruction. However, no deaths have been reported in patients who are treated with appropriate antimicrobial and surgical therapy.

Aims: Physical training is considered to be safe and beneficial as part of the treatment in heart failure patients. Prospective, sufficiently large studies are still needed to confirm this hypothesis., Methods: In a prospective study, 80 patients with chronic heart failure class II and III (age, 56.6+/-8.3 years; left ventricular ejection fraction, 26.5+/-9.6%) were randomized to an endurance training group or to a control group with continuation of optimal pharmacological treatment., Results: No training-related adverse event was reported, implying that the training programme was safe for these groups of chronic heart failure patients. Between-group comparison of changes revealed that training increased exercise time (from 608+/-35 to 738+/-40 s, P<0.0001), anaerobic threshold (from 10.5+/-0.4 to 11.8+/-0.3 ml x kg-1 min-1, P<0.05), and decreased the ventilatory equivalent for carbon dioxide at submaximal exercise level (from 2.8+/-0.1 to 2.7+/-0.1, P<0.05). Training did not increase peak oxygen consumption (15.2+/-0.5 to 16. 6+/-0.5 ml x kg-1 min-1, ns). An improvement in patients' assessment of quality of life was observed. There was a significant correlation between physiological and psychological improvements. Training was not effective in patients whose exercise test at entry had a duration of less than 7 min. None of the other baseline data could predict an effective training response., Conclusion: Physical training in chronic heart failure patients class II and III is safe and results in significant improvements in exercise time, anaerobic threshold, ventilatory equivalent for carbon dioxide at submaximal exercise level and quality of life., (Copyright 1999 The European Society of Cardiology.)

Cardiac L-carnitine content, essential for mitochondrial fatty acid transport and ATP-ADP exchange, decreases during ischemia. In animal models, administration of the natural derivative, L-propionylcarnitine, may reduce ischemia and improve cardiac function. To evaluate possible antiischemic effects of L-propionylcarnitine was compared with placebo in a randomized, double-blind, parallel design, in addition to preexisting therapy. Patients with > or = 2 anginal attacks per week and objective signs of ischemia with angina during bicycle exercise testing were included. After an initial 2-week, single-blind placebo phase, 37 patients received 500 mg L-propionylcarnitine tid, and 37 patients received placebo for 6 weeks. Both groups were comparable at baseline. Three patients discontinued the study while on placebo (two because of noncompliance, one because of palpitations) and one while on L-propionylcarnitine (noncompliance). Although heart rate, blood pressure at rest, and maximal exercise were not affected, L-propionylcarnitine increased the time to 0.1 mV ST-segment depression [44 +/- 3 vs. 8 +/- 2 seconds (mean +/- SEM) in the placebo group; p = 0.05], and exercise duration improved by 5% compared with placebo. Anginal attacks and the consumption of nitroglycerin were not affected in either group. Thus, following a 6 week treatment period, L-propionylcarnitine induced additional, albeit marginal, antiischemic effects in anginal patients who were still symptomatic despite maximal conventional antianginal therapy. It is questionable whether in these patients this form of metabolic treatment will achieve great benefit, although in some improvement can be expected.

Coronary artery disease is an increasingly common medical problem in the elderly, and relatively few studies investigating drug therapy focus on this population. To assess the efficacy and safety of the calcium channel blocker, felodipine, and isosorbide mononitrate (ISMN), as adjunct to optimal beta-blocker therapy in elderly patients, a placebo-controlled, double-blind study was conducted in 46 patients, aged between 65 and 80 years, with documented stress-induced angina pectoris and myocardial ischemia. With use of a latin-square design, with 3 periods of 4 weeks each, exercise testing was performed after each period. Felodipine, 5 mg once daily, significantly improved both time to ischemic threshold and pain threshold (p = 0.02 and p = 0.003, respectively, vs placebo), and tended to increase total exercise time (p = 0.06 vs placebo). In contrast, ISMN, 20 mg twice daily, did not significantly affect these parameters. Comparison of the 2 active treatment arms showed that, overall, felodipine was more effective than ISMN, with a statistically significant difference for time to ischemic threshold (p = 0.02). With regard to safety, felodipine was also better tolerated than ISMN, which led to more patients discontinuing study medication with ISMN (p < 0.05 between ISMN and felodipine). It is concluded that in elderly patients who are treated with optimal beta blockade, felodipine, but not ISMN, leads to an additional significant reduction in ischemic parameters during exercise.(ABSTRACT TRUNCATED AT 250 WORDS)