[A comparative study of celiprolol and nicardipine in stable angina of effort]. / Efecto comparativo de celiprolol y nicardipina en angina de esfuerzo estable.

Seventeen patients with effort angina, a positive exercise test and at least one stenosed vessel in coronary angiography were studied. Following a crossover blind-design, each patient received at random either 400 mg/day oral celiprolol or 120 mg/day oral nicardipine. A treadmill exercise test and 24 hour Holter monitoring were accomplished at the end of each treatment period. Both drugs significantly prolonged exercise time and reduced maximum ST segment depression at similar stages of control testing. Nicardipine reduced resting diastolic blood pressure a mean of 18 mm Hg (p less than 0.005) and also systolic blood-pressure 11 mm Hg (p less than 0.005) while celiprolol only reduced systolic pressure 10 mm Hg (p less than 0.01). Resting heart-rate was lowered by celiprolol a mean of 9 beats/min (p less than 0.0001) while nicardipine slightly increased it. The double product at maximum effort decreased with celiprolol and increased with nicardipine. Six patients with 3 vessel disease continued having transient ischemic episodes during treatment with celiprolol and 5 had them with nicardipine. Both drugs were well tolerated by the patients. In conclusion celiprolol and nicardipine proved to be effective in the treatment of myocardial ischemia specially when coronary heart disease is not very advanced.

[Post-infarction recurrent myocardial ischemia. Characterization with Holter ECG and exercise test]. / Isquemia miocárdica recurrente postinfarto. Caracterización por ecg-holter y prueba de esfuerzo.

In order to characterize postinfarction ischemia, 68 patients were studied by 24 hours Holter-monitoring and exercise testing. Twenty-four (35%) patients in Holter-monitoring and 26 (38%) in exercise testing had transient ischemic episodes. A significant coefficient of agreement was found between both tests. Nineteen (79%) of the patients had only silent ischemic episodes in Holter monitoring, and 87% of all episodes were asymptomatic. Twenty-two (87%) of the patients during positive exercise testing had silent ischemia. Eleven (46%) patients had transient ischemia at low and also at high heart-rates. Ten (37%) patients had ischemic episodes at lower charges than 100 watts, and all of them had more than 60 min of total ischemic burden in Holter-monitoring. A significant correlation was found between total ischemic burden and maximum ST segment shifts. The number of ischemic episodes were significantly higher during morning hours. A significantly higher rate of ventricular extrasystoles was found in recurrent ischemic patients, however, no difference was found in complex arrhythmias. After 1 year follow-up, 3 residual ischemic patients have died. The morbidity-calculated relative-risk is 13.9 times higher in patients with recurrent ischemia.

Spontaneous variability and detection of repetitive extrasystoles during simulated acute antiarrhythmic testing.

In order to estimate the reduction in ventricular premature contractions (VPCs) due to spontaneous variability during simulated acute antiarrhythmic testing, and also to determine the detection capacity for repetitive VPCs during short periods of ECG monitoring usually employed as baseline recordings, 2 groups of patients were studied A reduction by more than 50% of the baseline VPC-rate can be expected to occur as a result of an antiarrhythmic intervention, while approximately 40% of the patients with repetitive high risk VPCs escape detection during short periods of control recordings. It is suggested to use a 24 to 47-hour ambulatory monitoring for the diagnosis and classification of VPCs, while acute antiarrhythmic testing should be employed for assessing individual efficacy and tolerance.