Prevalence and severity of anxiety, depression and Type A behaviors in angina pectoris.

The role of psychological factors in coronary heart disease was examined by administering the Bech Rating Scale (BRS) of mood disorders and the Jenkins Activity Survey (JAS) for Type A behavior patterns (TABP) to a consecutive sample of angina patients (N = 94), to a consecutive sample of noncardiac patients (N = 47), and to a random sample of adults from the general population (N = 217). Anxiety and depression were both more frequent and more severe in angina patients than in noncardiac patients or in the general population. There was a tendency for certain components of TABP (i.e. speed, impatience, hard-driving and competitive disposition) to be elevated in angina patients, but a similar trend was noted in noncardiac patients. Although no consistent relations were observed between negative emotions and TABP scores in angina patients, their anxiety and depression scores were reliably related to their use of nitroglycerin. The findings concur with previous studies concerning the presence of anxiety and depression in patients with angina pectoris and indicate that such negative emotions are not closely related to Type A personality trails.

Coronary-prone behavior may be declining in Danish men and women.

Four hundred males and four hundred females were randomly selected from the Danish population and received the Jenkins Activity Survey (JAS) on two occasions, once in 1988 and again in 1992. The JAS was rated by the standard procedure, providing a measure of the degree of time urgency and ambitiousness (Factor A), speed and impatience (Factor S), hard-driving and competitiveness (Factor H) and job involvement (Factor J) shown by the subjects. The scores obtained for all four factors tended to be lower in 1992 than in 1988, and the differences were significant for Factor H. In addition, gender differences were observed for Factors A, S and J, with higher scores being obtained by males than by females. Age-related differences were observed for Factors A and J. The findings indicate that Type A behaviors have declined during the past four years in the Danish adult population and that different strategies may be required for encouraging health behaviors in men and women.

[Sex differences among Danish physicians of type A personality]. / Kønsforskelle i type A adfaerd hos danske laeger.

The Jenkins Activity Survey was used for measuring four components of coronary-prone behaviors (i.e. Factors A, S, H, and J) in a large random sample of male and female physicians as well as in a large random sample of males and females in the general public. As expected, males in the general public tended to score higher than females in terms of coronary-prone behavior. In contrast, female physicians scored higher than male physicians on several components of coronary-prone behavior related to career goals, ambitiousness, job involvement, and time urgency. The findings suggest that female physicians in Denmark may be influenced by factors that make them particularly prone to the development and/or expression of coronary-prone behaviors.

Female physicians outscore male physicians and the general public on Type A scales in Denmark.

The Jenkins Activity Survey was used to measure four components of coronary-prone behaviors in large random samples of Danish male and female physicians and of men and women in the general public. As expected, men in the general public tended to score higher than women in terms of coronary-prone behavior. In contrast, female physicians scored higher than male physicians on several components of coronary-prone behavior related to career goals, ambitiousness, job involvement, and time urgency. The findings suggest that female physicians in Denmark may be influenced by psychosocial factors that make them particularly prone to develop and/or express coronary-prone behaviors.

Normal values for Type A behaviour patterns in Danish men and women and in potential high-risk groups.

The Jenkins Activity Survey (JAS) was administered to a normal population of randomly selected Danish adults, to patients consulting a cardiologist, and to physicians in order to compare those groups in terms of their coronary-prone (Type A) behaviour patterns. The standard procedure of rating the JAS was used in order to obtain scores for each of the four subscales: Type A (time urgency and ambitiousness), Factor S (speed and impatience) Factor H (hard-driving and competitive) and Factor J (job involvement). Gender differences were observed in the normal population for each of the four subscale scores, and age-related differences were obtained for Factor J. Elevated scores for Factor S were obtained by physicians and by people in the population who had a cardiovascular disorder. Physicians had also elevated scores for Factor J, whereas their Factor H scores tended to be reduced. No reliable differences in JAS subscale scores were observed between four groups of heart patients (i.e. angina pectoris, arterial hypertension, atrial fibrillation and atherosclerosis), although there was a tendency for Factor J to be elevated in atherosclerosis. The findings provide normal values for JAS scores in Danish men and women, and suggest that some facets of coronary-prone behaviour may be enhanced in Danish high-risk groups.

Digoxin and xamoterol in patients with moderate chronic heart failure. A double-blind, randomized, controlled study.

Xamoterol is a partial beta 1 adrenoceptor agonist with positive inotropic properties. Treatment with xamoterol and digoxin was compared in 19 patients with cardiac failure (NYHA class II-III). The study consisted of a short-term and a long-term phase. The former was a randomized, double-blind, crossover study with 6-week treatment periods. In the 15 patients who completed this phase, there was no significant difference between exercise duration on digoxin and on xamoterol. Exercise duration increased on digoxin by 27% and on xamoterol by 17% relative to baseline. Comparing digoxin and xamoterol, maximum exercise heart rate (p less than 0.001), blood pressure (p less than 0.01), and the pressure-rate product during maximum exercise were significantly lower on xamoterol treatment. The systolic time interval was shorter on digoxin than on xamoterol (p less than 0.001). No changes occurred in the echocardiographic parameters. After the short-term study, 13 patients were followed 3-6 months on the drug to which they had responded best (digoxin 7, xamoterol 6). The results of the short-term study were maintained during this period. In conclusion, we found that xamoterol may be an alternative to digoxin in patients with mild to moderate heart failure.

The antihypertensive effect of pinacidil versus prazosin in mild to moderate hypertensive patients seen in general practice.

The antihypertensive effect of a new vasodilating drug, pinacidil, was compared with prazosin in a randomized, open study in general practice including 131 patients with a sitting diastolic blood pressure (DBP) between 100-115 mmHg. At inclusion 108 patients were untreated and the remaining patients were on treatment with thiazide diuretics and/or beta-blockers. The aim was to reduce the sitting DBP to less than or equal to 95 mmHg, which was achieved in 85% of the patients treated with pinacidil and in 77% of the patients treated with prazosin (NS). In the responding patients the reductions were (mean +/- SD) 16 +/- 7 mmHg (p less than 0.001) and 13 +/- 6 mmHg (p less than 0.001) in the pinacidil group (n = 60) and the prazosin group (n = 46), respectively (p less than 0.10). During 5 months of maintenance therapy no statistically significant differences in blood pressures between the two treatment groups were present. Side-effects were typical of vasodilator therapy, i.e. headache, dizziness, tachycardia and edema, leading to discontinuation of therapy in 10 patients in each treatment group. Heart rate (HR) was increased with pinacidil and unchanged with prazosin. Edema was frequently seen with pinacidil and dizziness with prazosin. Because of edema a thiazide diuretic was given to nine patients in the pinacidil group and two patients in the prazosin group. No clinically significant changes in ECG and biochemical variables were observed. In conclusion, the study has demonstrated that pinacidil is as effective an antihypertensive agent as prazosin. Pinacidil may be used as monotherapy. However, the study suggests that pinacidil should be used as add-on therapy to thiazide diuretics.

Intraventricular trifascicular block verified by His bundle electrocardiography.

A patient with the combination of right bundle branch block and intermittent left anterior and left posterior hemiblock is presented. His bundle recordings proved that this type of intraventricular conduction defect appeared when the two left fascicles were damaged partially, and to a varying degree. The recordings also revealed a Grade 2 A-V block distal to the A-V node. The mechanism is discussed.