[Isradipine versus diltiazem in the treatment of stable effort angina pectoris: ergometric evaluation in a crossover double-blind study]. / Isradipina versus diltiazem nella terapia della angina stabile da sforzo: valutazione ergometrica in crossover doppio cieco.

OBJECTIVES: To evaluate the effects of isradipine (ISR) and diltiazem (DIL) on exercise tolerance and ischemic ST depression in patients with stable effort angina. METHODS: Fourteen out-patients, 9 males and 5 females, aged 46-65 years (mean +/- SD = 57 +/- 8), with ischemic heart disease and reproducible ST-segment depression on two consecutive exercise stress tests in baseline conditions, underwent a study consisting of 4 periods: 1 and 3 placebo, 2 and 4 at random ISR (5 mg b.i.d.) and DIL (120 mg b.i.d.). At the end of each period a multistage treadmill exercise stress test (Bruce protocol) was performed. RESULTS: Both drugs significantly (p < 0.001) increased ischemia time (IT) (0.1 mV ST depression) as compared to placebo, from 438 +/- 132 s. to 620 +/- 164 s. (ISR) and 583 +/- 147 s. (DIL) without statistical difference between two drugs (p = 0.2), and significantly reduced (p < 0.002) the maximal ST depression, from -0.20 +/- 0.11 mV to -0.07 +/- 0.07 mV (ISR) and -0.09 +/- 0.11 mV (DIL). At the IT, systolic blood pressure increased (p = 0.02), from 180 +/- 19 mm Hg to 187 +/- 15 mm Hg (ISR) and 191 +/- 15 mm Hg (DIL); similarly, heart rate increased from 133 +/- 24 bpm to 144 +/- 18 bpm (ISR: p = 0.002) and 140 +/- 17 bpm (DIL: p = NS). CONCLUSIONS: ISR and DIL, at the above dosage have showed an important and significant anti-ischemic effect (IT = +41.5% during ISR and +33.1% during DIL).

[Supraventricular tachycardia in children]. / Le tachicardie sopraventricolari nell'infanzia.

Supraventricular tachycardia is one of the most frequent arrhythmias in childhood. It may accompany congenital heart disease. W.P. W. syndrome, or a normal state of health. A re-entry circuit is the most commonly observed electrophysiological mechanism. Persistence is followed by decompensation. Drug management is based on digitalis, ATP, amiodarone, and verapamil. Atrial and ventricular pacing and surgery are alternatives when other means fail. Persistent tachycardia (i.e. its presence over long periods) is much less frequent that the paroxysmal form, and its aetiology is generally unknown. Even here, the clinical picture is substantially related to decompensation. Digitalis + amiodarone is the best treatment, though the arrhythmia may resolve spontaneously.