Comparison of the new beta-adrenoceptor antagonist, nadolol, and propranolol in the treatment of angina pectoris.

A randomized, double-blind study was carried out in 24 patients with stable angina pectoris to compare the efficacy of nadolol, a new beta-adrenoceptor antagonist, and propranolol. After a period on placebo, 14 patients received nadolol once daily and 10 patients propranolol 4-times daily over a 10-week dose-ranging period followed by a maintenance period of 4 weeks. Optimal daily dosage for nadolol was 100 mg, and 112 mg for propranolol. Parameters used for evaluation of therapeutic effects included the number of anginal attacks, number of nitroglycerine tablets needed, time before onset of chest pain during exercise test, exercise time, and overall clinical impression of response. The results indicated that nadolol given once daily was equally as effective as propranolol 4-times daily in treating angina pectoris.

Relationship between P wave form and left atrial pressure and volume in mitral valve disease.

The P wave of the ECG, recorded with both conventional and special techniques, was compared with left atrial (LA) pressure and volume in 22 patients with mitral valve disease. The patients were also compared with 2 groups of normal subjects as to the P wave, recorded with the special technique. Changes in the P wave, such as increased duration, increased bipeak interval or P terminal force were significantly more common in the patients than in normal subjects. Among the patients, no significant correlations were found between degree of LA pressure elevation, LA enlargement and P wave changes. It is concluded that for the diagnosis of increased LA load it is more useful to study the terminal vector of the P wave than signs of increased atrial asynchrony. Recordings with high amplification and paper speed as in the present special technique are of advantage for such measurements. However, the special leads by themselves were not ideal for study of an increased terminal vector directed to the left and backwards.

Mode of spontaneous onset and termination of supraventricular tachyarrhythmias.

ECG tracings from 16 patients with spontaneous onset and/or termination of supraventricular tachyarrhythmias (SVTA) were studied. Of these recordings, 13 were made with a special technique which gives a high resolution of the atrial waves. At the onset of SVTA, the first atrial wave invariably had an aberrant configuration. The coupling index (coupling interval (P-1P) preceding cycle length) was 0.05 or less in 9 of 16 cases but more than 0.60 in 4 cases. In the 5 cases of onset of atrial fibrillation, the intervals between the first few atrial waves corresponded to a frequency of 300-350 per minute. Acceleration of the atrial activity occurred within the first 30 seconds. At the termination of SVTA, no successive modification of the atrial activity was found. The termination often did not occur at or shortly after a QRS complex. It is concluded that a premature atrial beat--even a single one--with a short coupling interval may well intiate a circus-movement SVTA, while an ectopic atrial beat with a long coupling interval apparently must be followed by repeated rapid discharges from the ectopic focus in order for SVTA to ensue. The functional conditions of the atria may then determine which kind of SVTA eventually results.

Atrial activity during exercise in patients with atrial flutter or atrial fibrillation.

The atrial activity was studied at rest and during exercise in 6 patients with atrial flutter and in 7 patients with atrial fibrillation. In the latter, a special recording technique was used which permitted identification of the f-waves. No increase in the frequency of the atrial waves was found. Thus the increase of the ventricular rate during work in patients with atrial flutter or atrial fibrillation seems to be caused by a change in the atrio-ventricular conduction.

Effect of intravenous infusion of propantheline bromide on gastric secretion.

The effect of 2 hours' intravenous infusion (7.5 mg/h) of propantheline bromide (Ercotina, Erco Läkemedel AB) on basal or pentagastrin-stimulated gastric secretion was studied in 7 healthy subjects and in 11 patients with acute duodenal ulcer. A moderate to marked decrease in acid secretion rate and acid output was found both in subjects and patients during the infusion period. The acidity decreased in most of the subjects but did not change much in the patients. Two other dose rates (3.75 and 15 mg/h) were studied in a few subjects and patients. The lowest dose rate gave as good an inhibition of the gastric secretion as the higher ones. No troublesome side effects were noticed. It was concluded that a dose rate of around 5-10 mg/h may be suitable for prolonged i.v. infusion, for example as trial therapy in patients with upper gastro-intestinal bleeding.

Electrocardiographic changes during the first few seconds after cardioversion of atrial fibrillation and flutter.

Electrocardiograms were registered with a special technique during attempts at cardioversion in 22 patients with atrial fibrillation or flutter. The registrations permitted analysis of the electrocardiogram 0.1-0.5 s after the electrical discharge. Mean values indicate that there is no compensatory pause after the d.c. shock. After 29 of the 42 synchronized d.c. shocks the first QRS complex was aberrant.

Prevalence of ECG findings in 18-19 year old Swedish men.

2268 consecutive men, 18-19 years of age, were examined at an enlistment centre regarding their health, some anthropometric variables and electrocardiogram. ECG items according to the modified Minnesota code [1] were found in 230 subjects (10%). Most common ECG findings were T wave abnormalities (2.2%). Heart rate was higher in the groups with QRS axis deviation, T wave items, sinus tachycardia and supraventricular ectopic beats. Systolic and/or diastolic blood pressure was increased in the groups with T wave items, sinus tachycardia and ventricular ectopic beats. A dysfunction of the autonomic tone can often be suspected as a cause of the abnormality, especially in the groups with tachycardia, T wave changes, AV block grade I and AV junctional rhythm. An ECG recording during orthostasis was considered to be of value to clarify the nature of the ECG abnormality.

Atrioventricular and intraventricular conduction in familial amyloidosis with polyneuropathy.

Atrioventricular and/or intraventricular conduction disturbances were found in 48 (67%) out of 71 patients with familial amyloidosis with polyneuropathy. Low voltage, often described in various forms of heart amyloidosis, was seen in one patient only. Myocardial infarction patterns, also often reported in heart amyloidosis, were not present in our patients. The prevalence of conduction disturbances increased with the duration of the disease. In 28 out of 47 patients from whom more than one ECG recording was available, a progression of conduction disturbances could be seen. Ten patients developed high-degree conduction disturbances and required permanent pacemaker treatment.

Serum lipoproteins, apolipoproteins and intravenous fat tolerance in young athletes.

Serum lipoproteins, apolipoproteins and intravenous fat tolerance were studied in 22 male athletes and compared with healthy age and weight-height matched controls. All of the subjects were non-smokers. Athletes had lower serum, very low density lipoprotein (VLDL) and low density lipoprotein (LDL) triglycerides, lower serum VLDL and LDL cholesterol and an increase in apolipoprotein A I. High density lipoprotein (HDL) cholesterol was similar in both groups. The clearance of i.v. injected triglyceride emulsion was faster in athletes. This suggests that the lower serum and VLDL triglycerides in athletes are at least in part due to a more rapid triglyceride clearance.

Poland and US collaborative study on cardiovascular epidemiology. II. Correlates of lipids and lipoproteins in men and women aged 35-64 years from selected Polish rural, Polish urban, and US samples.

Three diverse samples of men and women aged 35-64 years living in urban Poland, rural Poland, and the United States, are described and subsequently analyzed by multiple regression methods. Total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, and the natural logarithm (ln) of triglycerides are treated separately as dependent variables, with several demographic, behavioral, and biologic factors as independent variables. In the analyses of total cholesterol, systolic blood pressure was statistically significant in men and women in all three samples, while Quetelet index, cigarette smoking, age, ethanol consumption, and education were significant in at least one of the samples. In the LDL cholesterol analyses, Quetelet index and cigarette smoking were the predominant variables; in the HDL cholesterol analyses, Quetelet index, cigarette smoking, ethanol consumption, and age were key variables; and in the ln triglycerides analyses, Quetelet index, cigarette smoking, education, and systolic blood pressure were significant.

Poland and US collaborative study on cardiovascular epidemiology. III. Correlates of systolic and diastolic blood pressure in men and women aged 35-64 years from selected Polish rural, Polish urban, and US samples.

Three diverse samples of men and women aged 35-64 years living in urban Poland, rural Poland, and the United States are described and subsequently analyzed using systolic blood pressure and diastolic blood pressure separately as dependent variables in multiple regression. Several demographic, behavioral, and biologic factors are included in the models as independent variables. Heart rate, Quetelet index, high density lipoprotein cholesterol, and the natural logarithm of triglycerides were statistically significant in accounting for variation in systolic pressure in men in all three samples, whereas only heart rate and Quetelet index were significant in women in all samples. In the analysis of diastolic pressure, Quetelet index, heart rate, and ethanol consumption were statistically significant in men in all three samples, while only Quetelet index and heart rate were significant in women in all samples.