Alberto N. Goldbarg

Therapy of Angina Pectoris with Propranolol and Long-Acting Nitrates

A double-blind study of the effects of isosorbide dinitrate, 10 mg given orally four times a day, propranolol, 40 mg four times a day, and the combination of these two drugs was performed on 21 patients with angina pectoris. Each patient received placebo, isosorbide, propranolol, and the combination of the two drugs for 1 month each in a random sequence over 4 months. The number of anginal pains and nitroglycerin tablets used were recorded, and a multistage treadmill ECG exercise test was performed after each treatment period.Frequency of anginal pains was reduced significantly with propranolol (7.0±2.5 pains/week) and the combination of propranolol and isosorbide dinitrate (9.9±2.9) as compared with placebo (21.0±6.4). Similarly, the number of nitroglycerin tablets was reduced with propranolol-containing regimens. Isosorbide was not significantly better than the placebo. Symptomatic improvement with propranolol could be related to a reduction in heart rate, and the product of heart rate and systolic blood pressure during exercise (P<0.001). The capacity of these patients to perform a multistage exercise test, however, was not improved significantly, and the ischemic ST-segment changes were not altered by the treatments. Thus, propranolol appeared to be effective on the symptoms of angina pectoris, but it did not significantly improve exercise performance, and it did not prevent the ischemic patterns in the exercise ECG in this group of patients. Isosorbide dinitrate, alone or in combination with propranolol, was ineffective in this study.

Efficacy of amiodarone during long-term treatment of potentially dangerous ventricular arrhythmias in patients with chronic stable ischemic heart disease☆

Amiodarone was administered orally to 30 patients with chronic stable coronary artery disease and severe ventricular arrhythmias. Control studies revealed frequent (more than 30/hr) ventricular premature beats (VPBs) (27 patients), bigeminy (21 patients), couples (29 patients), R-on-T phenomenon (14 patients), ventricular tachycardia (16 patients), and ventricular fibrillation (1 patient). Two 24-hour Holter recordings and stress tests were performed before treatment, and an average of 3.6 per patient were done during treatment. Amiodarone caused suppression of all ventricular arrhythmias in 13 (43%) of the 30 patients and suppression of all complex forms and greater than 90% reduction of VPB number in 14 patients (47%) during a follow-up of 12.4 months. The mean dose was 590 mg/day in the 27 responders and 300 mg/day in the three nonresponders. A similar antiarrhythmic response was observed during stress testing. One of the 30 patients died due to massive pulmonary embolism and no arrhythmias were detected. In addition, amiodarone suppressed the occurrence of anginal pain and effort-induced ST changes in 9 of 10 patients and in 11 of 13 patients, respectively. The rate-pressure product and peak heart rate were significantly reduced in all patients. Our results suggest that amiodarone may be ideally suited for treatment of ventricular arrhythmias and for possible prevention of sudden death in patients with ischemic heart disease.

Multistage electrocardiographic exercise tests. Principles and clinical applications.

Abstract Multistage electrocardiographic exercise testing and the physiologic basis for this form of cardiovascular stress are discussed. When performed in the proper manner, the technique is safe and is a sensitive measure of cardiovascular performance. In addition, it is useful in the serial evaluation of patients and in the assessment of the effects of drugs, therapeutic regimens and the results of surgical intervention. Its use in diagnosing latent coronary arterial disease in “healthy” individuals is still unknown based on the results of 140 normal subjects studied, in 14 percent of whom abnormal S-T segment changes developed. The test is “noninvasive” and therefore easily repeatable and is an invaluable aid in the management of patients with heart disease.

Results and correlations of multistage exercise tests in a group of clinically normal business executives

Abstract Multistage treadmill exercise tests were performed on 91 healthy business executives. Eleven of these subjects exhibited abnormal S-T-segment responses. Although no correlation was found between abnormal exercise responses and the coronary risk factors, the abnormal responders were older and had more abnormalities in the resting ECG. The predictive value of the maximal exercise test will be determined in the long-term follow-up of these individuals.