[Comparison of dynamic and isometric loading in echocardiographic examinations in patients with ischemic heart disease]. / Srovnání dynamické a izometrické záteze pri echokardiografickém vysetrení nemocných s ischemickou chorobou srdecní.

The objective of the work was to compare functional indicators of the left ventricle during isometric (HG) and dynamic (Ergo) echocardiographic load examinations in patients with different grades of ischaemic heart disease. In group A they compared results in 34 patients with affection of three coronary arteries and in group B 15 patients with 1-2 coronary arteries affected. They evaluated the systolic, diastolic blood pressure, heart rate (HR), the index of the diastolic end volume EDV/m2, the index of the systolic end volume ESV/m2, Limacher's index for evaluation of left ventricular motility and the left ventricular ejection fraction (EF) at rest and after both types of loads. The EDV/m2 index increased in group A by 5.2 ml during an isometric load and by 10.4 ml during a dynamic load, in group B it increased by 1.6 and 7.0 ml resp. The values of the ESV/m2 index increased in group A by 8.5 ml during the isometric load and by 14.0 ml during the dynamic load, in group B by 4.1 and 10.8 ml resp. EF values at rest were similar in both groups: group A: 51.4%, B: 51.5%. During the isometric load the EF declined to 45.3% in group A and to 47,1% in group B. During the dynamic load the EF declined to 42% in group A and 42.5 in group B. The dynamic load produces, as compared with the isometric one, a statistically more significant drop of Limacher's index and greater volumetric changes of the left ventricular cavity in the group with 1-2 affected coronary arteries, as compared with the isometric load. In patients with three affected coronary arteries the volumetric changes during an isometric load are comparable with changes after a dynamic load.

[Comparison of the effects of molsidomine retard and isosorbide dinitrate retard in patients with stable angina pectoris using an ergometry test]. / Srovnání úcinku retardovaného molsidominu a retardovaného isosorbiddinitrátu u nemocných se stabilní anginou pectoris pomocí ergometrického vysetrení.

In 24 men with angina after exertion the authors assessed, using ergometry, the action of molsidomine retard and isosorbide dinitrate retard after a single dose and after tree-week administration of the drug. The authors found that 8 mg of molsidomine retard in a single dose had a somewhat more potent effect than 40 mg isosorbide dinitrate retard. After prolonged administration the effect of both drugs on haemodynamics diminished and in molsidomine a significant decline of action was observed before development of a reduced S-T segment on the ECG. After three weeks' administration the effects of both drugs were comparable. After neither drug clinically significant tolerance developed when the drug was administered every 8 hours. In the conclusion the authors discuss possible mechanisms involved in development of tolerance.

[Multicenter study of isradipine in the treatment of hypertension]. / Multicentrická isradipinová studie lécby hypertenze (MIS).

MIS is a one-year Multicentre Isradipine Study of the treatment of essential hypertension, in which participated seven centres in Czechoslovakia. The study comprised 144 patients with mild or medium severe hypertension. Isradipine belongs into the group of dihydropyridine derivatives with a high specific and low non-specific affinity to dihydropyridine binding sites of the L-type of calcium channels. After a four-week placebo period isradipine treatment (2.5 mg (1/2 tablet twice a day/was started. This dose increased to 5 mg (1 tablet twice a day) unless normalization of the diastolic pressure was achieved by a smaller dose. Monotherapy with isradipine normalized the diastolic pressure (less than 90 mmHg) in 44% of the hypertonic patients. 56% hypertonics where monotherapy with isradipine did not reduce the diastolic pressure below 90 mmHg were treated by a combination of isradipine and bopindolol. This group of patients had a significantly higher systolic and diastolic pressure, a higher number of erythrocytes and thrombocytes at the onset of the investigation. Addition of bopindolol to isradipine proved very effective. At the end of the one-year study 87% of the patients had a normal diastolic pressure. Isradipine as monotherapy and combined with bopindolol did not influence the metabolic risk factors of IHD and drug tolerance was very good.

MIS (Multicentric Isradipine Study of antihypertensive therapy).

One-year open Multicentric Isradipine Study (MIS) performed in 7 centres in Czechoslovakia included 144 patients with mild and moderate hypertension. Isradipine was given at a dose of 2.5 mg daily. If normalization of diastolic blood pressure (BP) had not been reached, the dosage was increased to 5 mg. Monotherapy with isradipine normalized diastolic BP in 44% of patients. Isradipine (5 mg daily) was combined with bopindolol in patients in whom isradipine alone failed to normalize diastolic BP. These had higher mean systolic and diastolic BP, body weight, erythrocyte and platelet counts at the beginning of the study. The combination of isradipine with bopindolol normalized diastolic BP in 87% of the group at the end of 48 weeks' treatment. Tolerance was excellent in 82% of patients. Treatment was discontinued in 8% patients, undesirable effects being the reason in 2%, ineffective therapy in 2% and poor adherence to therapy in 4%. Isradipine in monotherapy or in combination with bopindolol did not exert an adverse effect on the metabolic risk factors of ischaemic heart disease (cholesterol, glycaemia).

[Isosorbide dinitrate tolerance in the treatment of patients with angina pectoris and the effect of addition of captopril on therapeutic results]. / Otázka tolerance pri lécbe nemocných s anginou pectoris isosorbiddinitrátem a vliv na výsledky této lécby po pridávání captoprilu.

The authors investigated in patients with stable angina the influence of a single dose and of long-term administration of isosorbide dinitrate alone and combined with captopril. Administration of 40 mg Iso-Mack ret. every 8 hours for four weeks did not lead to the development of tolerance. However, captopril added to isosorbide dinitrate tends to improve the investigated indicators after a single dose as well as after long-term treatment. It is probable that concurrent administration of the two drugs causes addition of their vasodilatating action and thus the vascular resistance declines, as well as the cardiac pre-load and after-load and the oxygen consumption of the heart muscle. The authors discuss possible mechanisms of the increased vasodilatation after addition of captopril.

Bopindolol: Czechoslovak experience with a new beta blocker in the treatment of hypertension.

Bopindolol is a nonselective beta blocker with mild intrinsic sympathomimetic activity. One of the drug's main benefits is its prolonged effect, lasting for 24 hours, which makes it possible to administer bopindolol in a single daily dose, a fact that may improve patient adherence to therapy. A double-blind study was performed in two centers, comparing bopindolol with metoprolol in 86 hypertensive patients. Baseline diastolic blood pressure (BP) was 100 to 120 mm Hg. The effects of bopindolol or metoprolol on BP and heart rate were similar: return to normal values was achieved in 70% of patients with either drug. A 6-month study at another center found that bopindolol did not affect the levels of total cholesterol, low-density and high-density lipoprotein cholesterol or triglycerides. Another 12-month study documented a decrease in total cholesterol, apolipoprotein (apo) A1 and apo B. The apo A/B ratio rose, thus improving the atherosclerotic index. No deterioration of glucose tolerance or immunoreactive insulin response to glucose was seen after 6 months of bopindolol administration. Bopindolol satisfactorily modifies not only resting but also exercise BP during isometric and isotonic load, thus reducing BP fluctuation during physical activities of the hypertensive patient. The drug exerts no effect on renal and liver function, electrolyte balance and hematologic parameters. Bopindolol is a very useful drug of first choice in mild and moderate hypertension. Bopindolol's main advantages include its prolonged action, good tolerance and a beneficial effect on risk factors of atherosclerosis (lipid and carbohydrate metabolism).

[Beta-blockers in the treatment of hypertension in elderly patients]. / Betablokátory v lécbe hypertenze starsích osob.

The authors investigated the effectiveness of treatment of hypertension by monotherapy with beta-blockers--bopindolol (a beta-blocker with a slightly expressed ISA) and metoprolol (cardioselective beta-blocker) in 86 subjects with mild and medium severe hypertension. The purpose of the work was to analyze the effectiveness of control of hypertension in relation to age and to compare groups of subjects under 40 years with patients above 60 years of age. Both investigated beta-blockers proved effective in 80% of subjects above 60 years in the control of hypertension; no serious side-effects were recorded.

[Intravenous streptokinase in the treatment of acute myocardial infarct]. / Nitrozilní streptokináza v lécbe cerstvého srdecního infarktu.

In 314 patients with a first myocardial infarction, admitted within four hours after development of symptoms, the authors used in addition to standard therapy heparin treatment in 205 and streptokinase treatment (1.5 mil. u. i.v. with subsequent i.v. heparin administration) in 109 patients. Thrombolytic treatment was more effective, it reduced the lethality by 55.7% and was associated with a lower incidence of complications during the first 30 days. The reduced lethality, however, did not reach statistical significance because of the small number of patients and the low mortality rate in both groups. The left ventricular ejection fraction was practically equal in both groups after six weeks. Undesirable effects of thrombolytic therapy were rare and did not seriously threaten the patients. Provided contraindications are carefully respected, this treatment is safe and its routine use in the treatment of new myocardial infarctions must be supported. Streptokinase remains the drug of choice because it is equally effective as other available fibrinolytics and is the cheapest one.

Hemodynamic effects of transdermal nitroglycerin patches in patients with acute myocardial infarction.

Transdermal nitroglycerin patches are used mainly in the therapy of angina pectoris. However, the magnitude and duration of their effects are still controversial. In this study, transdermal discs with nitroglycerin were given to 14 patients with acute myocardial infarction (AMI) and mild hemodynamic impairment. Seven patients received Nitroderm TTS, and seven patients Deponit 5 (in this case 2 patches), the nitroglycerin dose being 10 mg. Hemodynamic measurements were made 19-24 h after application of the patch and 1 h after its removal. Comparing with the values obtained 1 h after removal of the patch, 19-24 h after the application of the patch heart rate was significantly higher (90.2 +/- 3.8 vs. 85.6 +/- 4.0 min-1; p less than 0.01), mean right atrial pressure was significantly lower (10.8 +/- 1.0 vs. 12.7 +/- 1.3 mm Hg; p less than 0.01), and so were the pulmonary artery pressure: systolic (36.9 +/- 3.0 vs. 43.0 +/- 3.1 mm Hg; p less than 0.001), mean (26.8 +/- 2.1 vs. 31.4 +/- 2.0 mm Hg; p less than 0.001) and the capillary wedge pressure (19.2 +/- 1.8 vs. 23.0 +/- 1.9 mm Hg; p less than 0.01). These findings revealed that in patients with AMI hemodynamic effects persist for at least 19 h after single application of a nitroglycerin patch of 10 mg. The therapy is safe and the risk of side effects is small.

[Effectiveness of nifedipine, diltiazem and their combination in the treatment of chronic stable angina pectoris]. / Ucinnost nifedipinu, diltiazemu a jejich kombinace v lécbe chronické stabilní anginy pectoris.

In a double blind crossed ten-week study with a randomized beginning the authors compared in 25 patients with chronic stable angina pectoris (II-III according to NYHA classification) and with normal blood pressure the effect of placebo, nifedipine, diltiazem and in 16 of the patients (who completed treatment with the combined drugs) also a combination of nifedipine and diltiazem. Nifedipine, 60 mg per day, and diltiazem, 270 mg per day, improved significantly the total amount of performed work as compared with placebo, they delayed significantly the onset of stenocardias and reduced the ST depression in lead V5 during ergometry, they reduced significantly the rate of stenocardias per day as well as the nitroglycerin consumption. Diltiazem, as compared with nifedipine, increased significantly the total volume of performed work and delayed the development of stenocardias during ergometry, the symptomatic improvement of the patients being similar. A combination of 30 mg nifedipine per day with 180 mg diltiazem per day did not lead to improvement, as compared with a higher dose of diltiazem alone, as compared with a higher dose of diltiazem alone. A combination of 60 mg nifedipine per day with 270 mg diltiazem per day did not improve the exercise tolerance, as compared with diltiazem alone, however, it reduced significantly the rate of stenocardias. However, the combination of the latter amounts was tolerated without side-effects only by 13% of the patients (2 of 15 patients), 53% (8 of 15 patients) terminated treatment prematurely because of several side-effects.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effect of celiprolol on isoprenaline-induced myocardial necrosis]. / Ovlivnení izoprenalinových nekróz myokardu celiprololem.

The assessed elevated catecholamine levels in the organism during substantial physical or mental stress lead to changes in the heart rate and to intensification of contractions. The demands of the heart muscle as regards increased oxygen supplies and are not met. This may have serious consequences for the patient. The authors wanted to find out therefore whether the beta-blocker celiprolol will be able to reduce the negative effect of large amounts of catecholamine in the organism and thus play a part in the prevention of myocardial damage. When celiprolol was administered half an hour before isoprenaline, the extent of necrosis caused by catecholamine was reduced. When administered half an hour after isoprenaline administration, the marked protective effect was no longer observed. The necroses in the heart muscle were similar as in animals given catecholamine only.

[Captopril in the therapy of stable angina pectoris]. / Captopril v terapii stabilní anginy pectoris.

In 28 patients with chronic angina pectoris grade II-III (NYHA) the authors investigated the antianginous effect of captopril. All patients had a normal blood pressure and the diagnosis was confirmed by coronary angiography. The investigation was made in three sub-groups as a simple crossover experiment with a randomized onset. In 10 patients without dysfunction (group A) and eight with severe left ventricular dysfunction (group C) a short-term comparative study of captopril and placebo was made; 10 patients of group B took first for 7 days diltiazem, 3 X 60 mg, and then during subsequent weeks the action of diltiazem with placebo was compared and the action of diltiazem combined with captopril 3 X 25 mg per day. Captopril significantly reduced the blood pressure and Robinson's index at rest and during activity. It protracted significantly the time before the development of stenocardia in patients with left ventricular dysfunction and in the group treated with diltiazem where it reduced even further the incidence of stenocardias. ACE inhibitors may apparently enhance the effectiveness of diltiazem in normotensive patients with angina pectoris and it may be assumed that it will have an even more potent effect in concurrent hypertension or left ventricular dysfunction.

[Comparison of the effects of depot isosorbide dinitrate (Isoket Retard 120) and diltiazem in patients with exertional angina pectoris]. / Srovnání úcinku depotního isosorbiddinitrátu (Isoket retard 120) a diltiazemu u nemocných s námahovou anginou pectoris.

In a simple blind crossover 7-week study with a randomized beginning the authors compared in 13 patients with stable angina pectoris after exercise the action of diltiazem (Blocalcin 60, Lachema) and isosorbidedi nitrate (Isoket retard 120, Schwarz). Both drugs improved significantly, as compared with placebo, the tolerance of the load, reduced the frequency of stenocardias per 24 hours, diltiazem also the nitroglycerin consumption per 24 hours. Diltiazem reduced significantly, as compared with isosorbidedi nitrate, the pulse rate at rest, it reduced significantly Robinson's index and the diastolic pressure at rest. In none of the other investigated parameters there was a significant difference between the two drugs and both are valuable in the treatment of angina after exercise. Diltiazem was well tolerated by the patients, while headache was a frequent side-effect of isosorbide dinitrate.

[The effect of molsidomine on bicycle ergometry in patients with stable angina pectoris]. / Vliv molsidominu na prubeh bicyklové ergometrie u nemocných se stabilní anginou pectoris.

The authors investigated the effect of a single dose of 4 mg molsidomine on the course of bicycle ergometry. This effect was compared with that of 120 mg isosorbide dinitrate retard and with placebo. Isosorbide dinitrate in this large dose significantly protracted the period before angina pectoris developed after exercise, it significantly reduced the duration of stenocardias, significantly increased the total work output, significantly prolonged the period before a reduction of the ST segment occurred on the ECG and significantly reduced the values of reduction of the ST segments. Moisidomine in medium doses significantly protracted the period before angina pectoris developed after exercise and significantly increased the total work output. After comparison of the described results with those of investigations where smaller doses of isosorbide dinitrate were used, the authors assume that after increasing the dose of molsidomine its effect will be comparable with large nitrate doses.

[Comparison of the effects of diltiazem and isradipine in patients with chronic stable angina pectoris]. / Srovnání úcinku diltiazemu a isradipinu u nemocných s chronickou stabilní anginou pectoris.

In 21 patients with chronic stable angina pectoris stage II-III according to NYHA, by means of bicycle ergometry antianginous and antiischaemic effects of short-term dilthiazem administration (Blocalcin 60, Lachema) were compared with isradipine (Lomir, Sandoz). Dilthiazem was administered in three doses à 90 mg by mouth (midday, evening and subsequent morning), isradipine in a similar way but in three doses à 5 mg. Both preparations reduced, as compared with placebo, significantly the systolic and diastolic blood pressure at rest and the diastolic pressure during a load, dilthiazem also the systolic pressure during a load. Both drugs raised also significantly the total amount of work performed during an ergometric examination, dilthiazem moreover delayed significantly the onset of stenocardia and significantly reduced the ST depression in lead V5 during the maximal load achieved with all administered drugs. A significant increase of the heart rate at rest and in particular of the heart rate during an equal maximal load after isradipine or after placebo, but in particular after dilthiazem, led in comparison with dilthiazem to a significant rise of Robinson's index during the same maximum load and was obviously the cause of its lower anti-anginous and antiischaemic effectiveness. Tachycardia at rest and after a load following isradipine administration led in four patients to a deteriorated load tolerance, as compared with placebo, in another patient tachycardia caused stenocardia at rest with ST depressions on the electrocardiographic tracing. Based on the assembled results, it seems better and safer to use in the treatment of chronic stable angina pectoris dilthiazem rather than isradipine.

[The effect of temporary cardiac stimulation on the course of acute myocardial infarct]. / Vliv docasné kardiostimulace na prubeh cerstvého srdecního infarktu.

The authors analyzed retrospectively the course of acute myocardial infarction in 165 patients, who needed temporary pacing. Medicamentous influencing with Atropine was not very effective and isoprenaline influencing with atropine was not very effective and isoprenaline was used only to brigade the time before the electrode was introduced. From the whole group, 36 patients were selected who had been admitted to the coronary unit within 4 hours after the development of pain. The authors investigated the development and regression of impaired conduction and investigated whether early admission, early diagnosis of bradyarrhythmia and early introduction of temporary pacing affect the patients' prognosis. In the group of patients admitted within 4 hours pacing was needed on admission by 25% of the patients and in the group admitted later by 75.9%. In the majority of early admissions the authors investigated the development of disorders in the course of the first 24 hours. Early admission did not affect the mortality which is high and differs by the site of the infarction. In infarctions of the lower wall 27.3% of the early admissions died and 32.1% of those admitted after the 4th hour. In infarctions of the anterior wall in the group admitted within four hours 57.1% died and in the group admitted after 4 hours 67.3%. The high mortality is associated with the site but in particular with the extent of the necrotic focus.

[Does coronary pathomorphology affect the anti-anginal and anti-ischemic effects of diltiazem in patients with chronic stable angina pectoris?]. / Ovlivnuje koronární patomorfologie antianginózní a antiischemický úcinek diltiazemu u nemocných s chronickou stabilní anginou pectoris?

The authors compared by means of bicycle ergometry the effect of a single dose of 90 mg diltiazem (Dilzem Gödecke Co.) and placebo in 31 patients with chronic stable angina pectoris grade II-III according to NYHA. These patients were divided into group A where the pathomorphology of the coronary circulation made the "steal phenomenon" possible and group B where there were no conditions for the "steal phenomenon". Diltiazem, as compared with placebo, increased significantly in both groups the total work output during ergometric examination, delayed significantly the onset of stenocardia and the time before the development of a 1 mm depression of the ST segment; in group A it significantly reduced the depression of the ST segment during the maximum equal load achieved with diltiazem and placebo; it significantly reduced the diastolic blood pressure at rest and during exercise, it significantly reduced the heart rate in group B during exercise. The differences in the action of diltiazem, as compared with placebo, between the two compared groups A and B were not significant in any of the investigated parameters. Administration of diltiazem had a very favourable anti-anginal and anti-ischaemic action in both groups of patients, regardless of the morphology of the coronary affection.

Bopindolol in the treatment of hypertension: a double blind study comparing bopindolol and metoprolol.

The article presents the experience gained with a new betablocker- bopindolol-in the treatment of hypertension. Using a three-month double blind study conducted in 2 centres, the antihypertensive effect of bopindolol and metoprolol was compared in a total of 86 patients. The incidence of undesirable effects was determined, and biochemical parameters before and after therapy were followed up. Both drugs were equally effective in controlling blood pressure. In 70% of patients with mild and moderate hypertension, diastolic pressure values less than 95 mmHg were obtained in monotherapy with a betablocker. The incidence of undesirable effects was low, the drug was tolerated well. Biochemical parameters did not change within the three months of study.