Paul Novack

Effects of Nitroglycerin on Hemodynamics During Rest and Exercise in Patients with Coronary Insufficiency

Twenty-three patients exhibiting coronary insufficiency on exercise have been studied at rest and at exercise prior to and following sublingual administration of nitroglycerin. The most consistent and marked effect of nitroglycerin was the reduction in pulmonary artery pressure, total pulmonary resistance, and right ventricular work at rest and during exercise. Our patients were grouped according to the degree of left ventricular failure as indicated by the abnormality of rise in pulmonary artery pressure during exercise. It became evident that nitroglycerin improved left ventricular function in terms of increased output and lessened pulmonary artery pressure in cases in which failure was most severe.

PHARMACODYNAMIC EFFECTS OF ALPHA-METHYL DOPA IN HYPERTENSIVE SUBJECTS.

Abstract The decarboxylase inhibitor, alpha-methyl dopa, is a potent antihypertensive agent. The hypotensive action of the drug appears to be due primarily to peripheral arteriolar relaxation. Its ability to reduce renal vascular resistance suggests its potential usefulness in the hypertensive patient with renal functional impairment.

CLINICAL CORRELATION OF CORONARY ARTERIOGRAPHY.

Abstract Selective coronary arteriography is a satisfactory technic in the study of the distribution and severity of atherosclerosis in patients with coronary heart disease. This investigation analyzes the placement and gradation of pathology in patients with angina pectoris whose resting electrocardiograms varied from normal patterns to tracings indicative of past transmural myocardial infarctions. Atherosclerosis was visualized as a diffuse process involving two or three main arteries even in those individuals who had the earliest clinical form of coronary heart disease, namely, angina pectoris and a normal resting electrocardiogram. The severity of the atherosclerotic process in terms of its stenosing effect on the vascular vessels increased materially as the electrocardiographic tracing deteriorated from normal to a pattern indicative of a past transmural myocardial infarction. Channels of anastomosis did not develop when atherosclerosis was diffuse but not occlusive. Particular attention is drawn to patients with angina pectoris and normal resting electrocardiograms who had in the past RS-T or T wave abnormalities or both. The occlusive disease in these patients was considerable and hardly compatible with the term “mild coronary.”

Pharmacodynamic effects and clinical use of alpha methyldopa in the treatment of essential hypertension

Abstract The availability of decarboxylase inhibitors provides a new biochemical means for controlling blood pressure in patients with diastolic hypertension. The decarboxylase inhibitor, alpha methyldopa, is a potent antihypertensive agent which produces a predominant orthostatic response. The hypotensive action of the drug appears due to peripheral arteriolar relaxation and accompanying reduction in cardiac output. Its ability to reduce renal vascular resistance suggests potential usefulness in the hypertensive patient with renal functional impairment as well.

Coronary arteriography: Correlation with electrocardiographic response to measured exercise

Abstract Measured exercise rarely produced specific S-T segment deviations when the coronaryarteries were free of discernible atherosclerosis, provided other conditions capable of interfering with the balance between coronary flow and the metabolic needs of the myocardium were not present. However, negative exercise electrocardiograms were also recorded in patients with angina pectoris and both nonobstructive and obstructive coronary atherosclerosis as visualized by arteriography. The incidence of negative responses was influenced by the inclusion of patients with past transmural infarctions. Abnormal exercise electrocardiograms were obtained mainly when patients with angina pectoris had demonstrable nonobstructive and obstructive coronary artery disease. However, specific S-T segment alterations were also encountered when the coronary arteriography was normal if a structural or functional defect was present capable of altering the balance between coronary flow and myocardial need.

Hemodynamic Effects of Pargyline in Hypertensive Patients

Pargyline exerts its antihypertensive effect via a predominant reduction in peripheral vascular resistance, whereas cardiac output is not altered significantly. The effect on renal blood flow is inconsistent, but a significant reduction in glomerular filtration rate does occur. Therefore the drug should be used with appropriate caution in patients with significant impairment of renal function. The hemodynamic response observed with pargyline is similar to that obtained with other MAO inhibitors.

RUPTURE OF A SINUS OF VALSALVA ANEURYSM.

Abstract Rupture of an aneurysm of the sinus of Valsalva into the right atrium followed by successful surgical repair is described. The clinical aspects of the case are emphasized, and the phonocardiographic and angiocardiographic findings are presented.

Selective Coronary Arteriography

In its evolution, coronary arteriography has passed through stages of initial exploratory opacifications in experimental animals, the development of various technics for coronary visualization, and their clinical trial to its present important position in the diagnosis and assessment of coronary artery disease. Interest in this procedure as a clinically useful tool is attested to by its inclusion in most current symposia concerned with overall considerations of coronary artery disease, and by the rapidly increasing number of medical centers applying coronary arteriography in clinical studies of this disorder. Historically, coronary arteriography dates from Rousthois (1) on angiocardiography in experimental animals, published in 1933, while Radner (2) in 1945 achieved the first opacification of coronary arteries in living man. A variety of technics for radiologic opacification of the coronary arteries has been studied and described (3–6), and the senior author has reviewed and discussed considerations of ...