Ergometric evaluation of the effects of captopril in hypertensive patients with stable angina

The antihypertensive and anti-ischaemic effects of methyldopa and captopril were compared in 12 hypertensive patients with coronary artery disease. The antihypertensive effect of alpha-methyldopa (A) and captopril (C) were significant and similar. On the other hand, while methyldopa did not increase the product of systolic pressure and heart rate and did decrease the effort-induced S-T segment depression, C increased the double product (DP) and decreased the ischaemic S-T changes. Captopril might be useful in the treatment of hypertensive patients with coronary artery disease.

Incidence of complex ventricular arrhythmias in asymptomatic patients with recent myocardial infarction

The incidence of ventricular extrasystoles (VES) was documented in 50 patients with recent uncomplicated myocardial infarction, with a 72-h two-channel ambulatory electrocardiogram. All patients were free of symptoms of arrhythmias; unstable angina pectoris and heart failure were absent. A total of 82% of the patients had VES: 23/50 patients had multiform or complex VES, 8/50 patients had ventricular tachycardia. VES were independent of heart rate and stable angina pectoris. Thus, frequent and complex VES are common in asymptomatic patients with uncomplicated recent myocardial infarction. Even in the absence of symptoms, ambulatory electrocardiography is useful. The prognostic significance of asymptomatic complex VES in these patients remains unsettled.

Antiarrhythmic use of cibenzoline, a new class 1 antiarrhythmic agent with class 3 and 4 properties, in patients with recurrent ventricular tachycardia

Cibenzoline is a new antiarrhythmic agent with class 1 properties, and additional class 3 and 4 effects. We treated 28 patients with drug-refractory and recurrent ventricular tachycardia with up to 700 mg/day cibenzoline for periods up to 5.5 months. Cibenzoline prevented the recurrence of ventricular tachycardia in five patients (18%). In three patients (11%) the arrhythmia may have been worsened, in 23 patients (82%) cibenzoline was ineffective. Cibenzoline increased the PR interval by 18% and the QRS duration by 33%; the effect on the QT was variable and the corrected QT interval did not change significantly. Side-effects were observed in 21% of patients. We conclude that cibenzoline does not appear to be superior to conventional class 1 antiarrhythmic agents and that it cannot be recommended for general use in patients with ventricular tachycardia. Additional pharmacokinetic and electrophysiologic studies are required before cibenzoline is used in outpatients with severe ventricular arrhythmias.

Vasodilator treatment for mild to moderate heart failure. Effect of Ro 12-4713, a minoxidil analogue

18 patients (14 men, 4 women) with a mean age of 64.3 years (range 41-75) and with chronic cardiac failure, NYHA functional class 1-2 (12 cases) or 2-3 (6 cases), insufficiently responsive to digitalis and diuretics, were treated for 4 weeks with Ro 12-4713, a minoxidil-like drug. The effects were assessed at rest and during maximal exercise, each patient was his own control. All patients completed the study. The treatment did not affect the body weight, the heart rate or the blood pressure, but it should be stressed that all patients were normotensive. The ejection fraction (by 99mTc pertechnetate scintigraphy) increased from 42.0 +/- 10.0 (resting means +/- SD) to 48.9 +/- 8.7%, and from 44.7 +/- 10.1 to 57.9 +/- 8.7% (end-exercise values), both changes being significant (p less than 0.0001). The ejection rate increased in a similar manner. The resting stroke volume increase from 53.5 +/- 13.6 to 60.2 +/- 16.5 ml (p less than 0.005), but the exercise stroke volume did not increase significantly. The cardiac output increased both at rest and during exercise, but the changes did not reach statistical significance. The end-diastolic volume decreased from 132.6 +/- 126.9 +/- 47.0 to 126.9 +/- 42.3 ml (resting values), and from 151.5 +/- 44.4 to 120.6 +/- 36.6 ml (exercise), the changes being significant (p less than 0.005). The physical work capacity increased, i.e. the duration of exercise increased from 7.8 +/- 3.2 to 9.9 +/- 1.9 min (p less than 0.05) and the 'quality of life' (symptoms related to heart failure) improved (fewer symptoms) in 14/18 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Tiapamil in the management of supraventricular arrhythmias occurring after acute myocardial infarction

18 patients with acute myocardial infarction and sustained supraventricular arrhythmias were treated with tiapamil, in a dose of 1 mg/kg i.v. The drug was effective, i.e., the heart rate was reduced to less than 90 beats/min in 9 of 10 patients with atrial fibrillation, in 3 of 4 patients with atrial flutter, and in 3 of 4 patients with atrial tachycardia. The peak effect was observed within 2-5 min. In cases with recurring tachyarrhythmias, tiapamil was also effective during successive administrations, the systolic blood pressure was reduced by 10-15%, but severe hypotension was not observed. In these patients, no major changes in atrioventricular or intraventricular conduction were observed. In the dose used, tiapamil was effective and well tolerated.