Acute and sustained antianginal effects of nitroglycerin patches: objective evaluation with training-effect-eliminated exercise performance index.

A randomized within-patient double-blind acute and sustained study was performed to compare transdermal nitroglycerin (NTG) patches (5 and 10 mg) and matching placebo in 10 patients with chronic stable angina pectoris confirmed on exercise thallium scintigraphy or coronary angiography, or both. Patients performed treadmill tests 2 and 24 hours after application of patches on the first and last days of each of the 3 treatment periods. Effects caused by sequence of treatments and training with serial testing were prominent so the changes in the well-known parameters did not favor either of the active doses over placebo. Quantification of training effects and its subtraction from performance index disclosed that 10 mg of transdermal NTG caused significant increase in performance in both the acute and sustained stages of therapy in comparison to pretreatment performance. This was not observed with 5 mg and placebo treatments. To our knowledge, this is the first trial to study the efficacy of transdermal NTG with a more objective parameter that permitted elimination of training effects of serial exercise testing.

A case of ventricular tachycardia refractory to medical treatment related to a cystic mass in left ventricle--a case report.

This is a case report of a twenty-two-year-old woman who had attacks of ventricular tachycardia that could be prevented by the use of various antiarrhythmic drugs for three months. Electrophysiologic study showed that the mechanism of the tachycardia was "reentry." In cardiac catheterization a non-contractile mass having calcification was seen on the apical portion of the left ventricle. Angiographically, the mass resembled a diverticulum. Recurrence of attacks was terminated by resection of this mass, which had a cystic appearance.

Long-term prognosis after a first myocardial infarction in Turkey: determinants of mortality and reinfarction.

Long-term prognosis of a first myocardial infarction and factors associated with late cardiac mortality and reinfarction were studied in 718 survivors. Patients have been followed up for 1-10 years (mean 57.6 +/- 39.6 months). None of the patients underwent coronary bypass surgery in the follow-up period. Cumulative mortality rates were 8.6% in the first year, 17.9% in 3 years, 26.4% in 5 years and 36.5% in 10 years. The type and site of myocardial infarction (Q-wave versus non-Q-wave and anterior versus infero-posterior) were found to have no independent prognostic importance. The cardiac mortality was best predicted by the occurrence of congestive heart failure in the coronary care unit. Other determinants of late outcome were the presence of ventricular arrhythmias, left bundle branch block, and the occurrence of stable or unstable angina pectoris or reinfarction during the follow-up period. Usage of antiplatelet or anticoagulant drugs was not found to affect mortality. Reinfarction rates were 4, 9.9, 15.5 and 28% in 1, 3, 5 and 10 years, respectively, and no relation was found between the type and location of myocardial infarction and reinfarction rate. Reinfarction was higher in patients receiving anticoagulants and in patients with postmyocardial infarction angina. Our findings suggest that the prognosis of patients with a first acute myocardial infarction in Turkey is not different from that in Western populations and factors influencing prognosis are similar to those previously reported.