Distinctive properties of perindopril among converting enzyme inhibitors in congestive heart failure.

Converting enzyme inhibitors constitute a major advance in the management of patients with congestive heart failure (CHF). Not only do they improve the hemodynamics of these patients, but they also prolong the survival. Certain patients with CHF, however, may not tolerate conventional converting enzyme inhibitors because of hypotension, renal dysfunction or other side effects.

Hydration of DOPC bilayers by differential scanning calorimetry.

The phase diagram of the unsaturated lipid dioleoylphosphatidylcholine (DOPC) in aqueous multibilayer dispersions has been constructed from a series of differential scanning calorimetry (DSC) thermograms over the temperature range from -40 to +10 degrees C, covering a range of hydration levels from the monohydrate to excess free water. Both the lipid chain melting transition and the ice melting point are found to be hydration dependent. From their respective variations it is found that the bilayer in the gel phase binds approximately 9 H2O per lipid, while the liquid-crystalline state has a saturation limit near 20 H2O.

Haemorrhagic pituitary tumours.

In a group of 69 patients with pituitary tumours, 12 were found to have evidence of intratumoral haemorrhage on MRI, characterized by high signal intensity on short TR/TE sequences. This was verified in all but 1 patient. The majority of the bleedings occurred in macroadenomas.

A role for band 4.2 in human erythrocyte band 3 mediated anion transport.

Human erythrocyte band 3 was purified essentially free of peripheral proteins, in particular band 4.2, using affinity chromatography. Band 3 protein was then reconstituted into liposomes of lipid type and ratio approximating that of erythrocyte membranes.

Holter monitor recording for the detection of myocardial ischemia: validation of a new recorder and chest lead positions.

Objective: To validate the Reynolds Tracker II Holter system using newly described lead positions during both upright treadmill exercise and in the recumbent position following exercise. The specific lead positions HL1 and HL2 were chosen to detect anterior and postero-inferior myocardial ischemia, respectively, without interfering with the surgical field in the hypothetical situation of open-heart surgery. Similar lead positions have previously been used to monitor myocardial ischemia during induction of anesthesia, but have never been validated by comparison with 12-lead modified electrocardiogram (ECG) recording.

Structural stability of the erythrocyte anion transporter, band 3, in native membranes and in detergent micelles.

The exothermic thermal denaturation transition of band 3, the anion transporter of the human erythrocyte membranes, has been studied by differential scanning calorimetry, in ghost membranes and in nonionic detergent micelles. In detergent micelles the transmembrane domain of band 3 gave an irreversible denaturation transition (C transition). However, no thermal transition was observed for the N-terminal cytoplasmic domain when band 3 was solubilised in detergent micelles.

Sudden death in congestive heart failure.

Despite significant advances in recent years in the diagnosis and treatment of congestive heart failure, sudden unexpected cardiac death is still considered a major epidemiologic problem among those patients. This article lists some of the predisposing factors to the development of cardiac arrhythmias and sudden death in patients with congestive heart failure. These include electrolyte or autonomic nervous system inbalance, the use of certain anti-arrhythmic drugs, or intermittent myocardial ischemia.

Regression of left ventricular hypertrophy in hypertension with indapamide.

In hypertensive patients, the development of left ventricular hypertrophy seems to increase the risk of cardiovascular death. Although some antihypertensive agents have been associated with regression in left ventricular hypertrophy, diuretics, the most widely used ones, have not. Indapamide is a new, nonthiazide diuretic and vasodilator.

[Ventricular arrhythmia in patients with hypertension and left ventricular hypertrophy].

Left ventricular hypertrophy is a problem in itself in patients with hypertension. Hypertensives with left ventricular hypertrophy have a higher incidence of ventricular arrhythmias and sudden death. This article reviews the epidemiological evidence in favour of this association.

Comparative hemodynamics of antiarrhythmic drugs.

It is important to consider the hemodynamic effects of antiarrhythmic drugs, because the majority of patients who require these drugs already have compromised cardiac function. The presently available antiarrhythmic agents vary in their potential for producing negative inotropic effects on the myocardium; they vary, as well, as to the mechanisms by which these effects are produced. The drugs in each of the Vaughan-Williams' classes are discussed in terms of the extent to which they affect cardiac output and the mechanisms by which they may depress cardiac function.

Efficacy and safety of intravenous diltiazem for treatment of atrial fibrillation and atrial flutter. The Diltiazem-Atrial Fibrillation/Flutter Study Group.

This study evaluates the effectiveness and safety of intravenous diltiazem for the treatment of atrial fibrillation and atrial flutter. A double-blind, parallel, randomized, placebo-controlled protocol was used, and 6 large, urban hospitals, both university-affiliated and private, participated. The study involved 113 patients with atrial fibrillation or flutter, a ventricular rate greater than or equal to 120 beats/min and systolic blood pressure greater than or equal to 90 mm Hg without severe heart failure.

The incidence of myocardial ischemia during anesthesia for coronary artery bypass surgery in patients receiving pancuronium or vecuronium.

This study was performed to compare the incidence of prebypass myocardial ischemia in patients receiving fentanyl and enflurane for anesthesia along with either pancuronium or vecuronium. Ninety-eight patients with normal left ventricular function were randomly allocated to receive either pancuronium 0.15 mg.

Hydrogen exchange from the transbilayer hydrophobic peptide of glycophorin reconstituted in lipid bilayers.

The hydrophobic transbilayer peptide of erythrocyte glycophorin has been purified following exchange of tritium into the backbone amides, and reconstituted in egg phosphatidylcholine micelles. Analysis of tritium exchange from the backbone amides of the membrane-reconstituted peptide shows that about two of the amides are virtually non-exchangeable, about 10 are slowed by factors of 10(7) relative to free amides in unstructured water soluble peptides and the remainder of the amides (about 20) have slowing factors of less than 1000. These classes of amides are proposed to reflect the stability of the peptide with respect to hydrogen bond breaking fluctuations and the accessibility of the amides to exchange catalysts in different regions of the bilayer.

The incidence of prebypass dysrhythmias in patients undergoing coronary artery surgery.

The incidence of dysrhythmias during the prebypass period of coronary artery surgery has not been accurately reported. Using Holter monitoring of the electrocardiogram, this study was undertaken to determine the incidence of dysrhythmias and ischemia and their relationship to specific events during the prebypass period. The role of preoperative calcium entry blockers (CEB), beta-adrenergic blockers (BB), or both on the incidence of dysrhythmias and ischemia was also studied.

Comparison of the effects of pindolol and propranolol on exercise performance in patients with angina pectoris.

The effects of pindolol (mean dose 17 +/- 8 mg/day), a beta-blocking drug with intrinsic sympathomimetic activity (ISA), and propranolol (130 +/- 40 mg/day) on exercise performance in 11 patients with stable angina pectoris were compared. Doses were titrated to symptoms. The design was a randomized, double-blind, crossover protocol with 8 weeks of treatment with each drug.

Combination of theophylline and salbutamol for arrhythmias in severe COPD.

We conducted a single-bind placebo controlled study using 24-hour continuous ambulatory electrocardiographic recordings. The arrhythmogenic potential of the combination of salbutamol and theophylline was investigated in 25 ambulatory subjects with severe chronic airflow obstruction (mean age 65 +/- 8 SD, mean FEV1 31 percent +/- 13 SD predicted). Asymptomatic arrhythmias were very prevalent in the study population: 76 percent of the patients had runs of supraventricular tachycardia while 24 percent had runs of ventricular tachycardia.

Hemodynamic variables and the incidence of prebypass ischemia during sufentanil/O2/pancuronium anesthesia in patients undergoing coronary artery surgery.

It has been suggested that sufentanil is a superior anesthetic to fentanyl for patients undergoing myocardial revascularization. This study was performed to determine the incidence of prebypass myocardial ischemia using sufentanil, 20 micrograms/kg for patients undergoing coronary artery bypass grafting (CABG). Twenty-seven patients with normal left ventricular function, scheduled for elective CABG, were studied.

Acute intravenous and long-term oral hemodynamic effects of encainide.

The short- and long-term hemodynamic effects of encainide, a new class IC antiarrhythmic agent, were studied in 25 patients (mean age 61 +/- 11) with complex symptomatic ventricular arrhythmia and left ventricular dysfunction. Ninety-two percent had previous myocardial infarction and 8% had dilated cardiomyopathy. Seventy-five percent had congestive heart failure, class III or IV, according to the New York Heart Association.

Drug interaction studies and encainide use in renal and hepatic impairment.

The effect of encainide administration on steady-state plasma digoxin levels was evaluated in 17 patients receiving stable doses of digoxin. A paired t test, comparing plasma digoxin levels (mean +/- standard error) before encainide therapy (1.05 +/- 0.

Mexiletine: long-term efficacy and hemodynamic actions in patients with ventricular arrhythmia.

Fifty-one patients with symptomatic ventricular tachycardia who failed control on current anti-arrhythmics were studied. Seventy-four percent had ischemic heart disease and 81% had congestive heart failure. Patients underwent serial 24 Holter recordings and radionuclide ventriculography before, during dose titration and during long-term mexiletine therapy.

Mexiletine kinetics in healthy subjects taking cimetidine.

Cimetidine, a commonly used H2-receptor antagonist, was found to interact adversely with many drugs, including class I antiarrhythmics such as lidocaine and quinidine. To test the effect of cimetidine on the kinetics of mexiletine, a class I antiarrhythmic similar to lidocaine, the absorption and disposition of mexiletine were followed in six healthy subjects before and after 1 week of cimetidine, 300 mg by mouth four times a day. Cimetidine did not alter the distribution and elimination of mexiletine, as shown by similar mean kinetics including total body clearance, AUC, and the elimination t1/2 before and after cimetidine treatment.

Usefulness and safety of cimetidine in patients receiving mexiletine for ventricular arrhythmia.

Cimetidine, a commonly used H2 receptor antagonist, was found to adversely interact with many drugs metabolized by the liver, including class I antiarrhythmic agents, lidocaine and quinidine. Mexiletine is a new class I antiarrhythmic agent similar to lidocaine which when used orally may have significant gastric side effects. Since some patients with peptic ulcer disease or gastric hyperacidity on mexiletine may benefit from the addition of cimetidine, it was important to rule out any significant adverse interaction between the two drugs in such patients.

Significance of exercise-induced ventricular arrhythmia in stable coronary artery disease: a coronary artery surgery study project.

This retrospective study examines the prognostic significance of exercise-induced ventricular arrhythmia in patients with stable coronary artery disease (CAD) who were included in the multicenter patient registry of the Coronary Artery Surgery Study. The population is composed of 1,486 patients selected from 1975 to 1979 and followed an average of 4.3 years.