Long-term cardiac assessment in a sample of adolescent-onset anorexia nervosa.

BACKGROUND: High mortality rates have been reported in patients with anorexia nervosa, mainly due to cardiovascular alterations. The purpose of the present study was to assess cardiac structural and functional abnormalities some 20 years after initial treatment in a sample of adolescent-onset anorexia nervosa (A-AN) and to compare them with matched healthy controls (HC). METHODS: A sample of 29 women diagnosed and treated for AN during adolescence (A-AN) were assessed more than 20 years later. A complete cardiac evaluation was carried out including an electrocardiogram (ECG) and a standard 2D echocardiography. Thirty matched HC were also assessed. RESULTS: In the A-AN group, four subjects had a body mass index lower than 18.5 and met full DSM 5 criteria for AN at follow-up (Low-Weight group). They were compared with the rest of the sample (n = 25) who had normalized their weight (Normal-Weight group), though some still showed some eating disorder symptoms. Both groups were compared with the HC group. Subjects in the Low-Weight group presented statistically significant decreases in the left ventricular end-diastolic and left atrium dimensions and left ventricular mass in comparison with the Normal-Weight group and the HC. No other differences in cardiac parameters were found between groups. CONCLUSIONS: Echocardiographic and ECG parameters of adults who had presented A-AN twenty years earlier and currently maintained normal weight were similar to those of HC who had never been treated or diagnosed with AN. Adult subjects with A-AN who still had low weight in the long term present certain cardiac abnormalities similar to those seen in short-lasting disease. More studies are needed to confirm these results in a larger sample.

Anorexia nervosa is associated with multiple medical complications and high mortality, mainly due to cardiovascular complications. The main objective of the project was to study long-term cardiac abnormalities in a group of patients diagnosed with anorexia nervosa during adolescence. A sample of 29 patients, treated during adolescence for anorexia nervosa, were evaluated 20 years later. We did an echocardiogram and an electrocardiogram to all of them, and compared them with 30 healthy controls. Of the 29 patients with anorexia nervosa, 4 had low weight and 25 had normal weight. Patients who had normalized their weight did not present cardiac alterations and did not differ from the healthy controls. The 4 underweight patients did present cardiac abnormalities similar to those observed in short-term studies, such as decreased dimensions and mass of the left ventricle and the left atrium.

Systolic left atrial failure in elderly women with severe aortic stenosis: mitral and pulmonary vein Doppler analysis by transesophageal echocardiography.

We studied prospectively 35 elder women aged 65-82 years, with isolated severe symptomatic aortic stenosis, referred for aortic valve surgery. We assessed diastolic function by TEE before and after cardiac surgery, although follow-up data were collected in 26 patients. The examination was performed prior to surgery and 6 months after. The control group consisted of 32 patients referred for TEE. In the preoperative study, the velocities and integrals of the waves in the pulmonary vein flow were similar to the people of their same age, except the A-wave of atrial contraction and the integral of the systolic wave, which were significantly smaller (Control A-wave 26.1 +/- 5.1 vs preoperative A-wave 22.6 +/- 5.6, P = 0.009 and control double product A vel xA dur 2,748 +/- 835 vs preoperative 2,273 +/- 968, P = 0.03; systolic integral 14.6 +/- 3.8 vs 11.3 +/- 4, P = 0.0009). Six months after surgery, the PV flow was similar to the control group except for the wave of atrial contraction, which was significantly smaller but tended to normalization (postoperative A-wave 23.3 +/- 5, P = 0.04 vs control, and postoperative double product A vel x A dur 2460 +/- 893, P = 0.21 vs control). Mitral flow parameters did not change in the preoperative and postoperative period. Left ventricular mass index changed from 166 +/- 54 g/m(2) to 105 +/- 39 g/m(2) (P< 0.0001). The results of this study show that in elderly women with symptomatic severe AS, diastolic function does not change, left ventricular mass reduces, with improvement in symptoms, and the left atrium function, considered by pulmonary vein flow, is preoperative depressed and tends to mild recovery in the postoperative period, suggesting systolic LA failure.

Eficacia del tratamiento antihipertensivo sobre la presión de pulso: estudio PREDIVERA / Efficiency of antihypertensive therapy on pressure pulse: the PREDIVERA study

Introducción y objetivo. La presión del pulso (PP) es un excelente predictor de complicaciones cardiovasculares. La eficacia del tratamiento antihipertensivo sobre la PP está poco documentada. Los objetivos de este trabajo son: a) analizar el efecto de verapamilo-SR 240 mg/día (V) y, secuencialmente, de la combinación fija verapamilo 180 mg + trandolapril 2 mg (V/T) sobre la presión arterial (PA) y la PP en pacientes ancianos con hipertensión arterial (HTA) y PP elevada. b) Establecer factores predictores de la utilización de terapia combinada. Ámbito: Atención Primaria. Tipo de estudio: prospectivo, observacional y multicéntrico. Métodos. Hipertensos entre 60-80 años de edad, con HTA esencial (PA 140/90 mmHg) y PP 50 mmHg. Tratamiento inicial con V; si a las 4 semanas no hay respuesta o a las 8 semanas no se logra el control de la PA, V es sustituido por V/T. PA medida mediante esfigmomanómetros validados OMRON HEM-705 CP. Resultados. Finalizaron el estudio 343 pacientes; 189 (55 por ciento) con V y 154 (45 por ciento) precisaron V/T. Edad: 67,9 (5,4) años; mujeres: 210 (61,2 por ciento); fumadores: 60 (17,5 por ciento); diabetes: 47 (13,7 por ciento); hipercolesterolemia: 114 (33,2 por ciento). La PA sistólica (PAS) y PP basales fueron significativamente más elevadas en V/T respecto a V (p < 0,001). En el grupo tratado con V la PP pasó de 66,6 (10,1) mmHg a 53,9 (7,7) y la PA de 159,8 (10)/93,2 (8) a 133,9 (6)/80 (6,3) (p < 0,001). En los pacientes tratados con V/T, la PP se redujo de 70,6 (10,8) a 58,6 (10,6) y la PA de 167,04 (11,3)/96,4 (7,6) a 142,2 (11)/ 83,6 (7) mmHg (p < 0,001). Al cambiar a V/T la reducción adicional de PAS, PA diastólica (PAD) y PP fue significativa (p < 0,001). La regresión logística mostró que por cada 1 mmHg de incremento de la PAS y por cada mes de evolución de la HTA la odds ratio para utilizar la combinación V/T era de 1,0501 (IC: 1,0241,076; p < 0,001) y 1,0048 (IC: 1,0011-1,0085; p = 0,011), respectivamente. Conclusiones. En pacientes hipertensos con PP elevada iniciar el tratamiento con verapamilo-SR 240 mg/día es eficaz para el control de la PA y la reducción de la PP. Cuando se precisa terapia adicional, la asociación V/T muestra un efecto sinérgico. La antigüedad de la HTA y la PAS elevada predicen la necesidad de utilizar la combinación farmacológica (AU)

Evaluación de la eficacia de la combinación de verapamilo y trandolapril en ancianos hipertensos institucionalizados, insuficientemente controlados con monoterapia / Evaluation of the efficacy of the combination verapamil-trandolapril treatment in nursing home hypertensive elderly patients who are inadequately controlled with single drug therapy

INTRODUCCION Y OBJETIVO: La HTA en el anciano es un problema de salud relevante, y existe un escaso conocimiento de su prevalencia, así como un bajo grado de control de las cifras de PA. Hemos llevado a cabo un estudio en pacientes ancianos institucionalizados con un objetivo doble: evaluar la prevalencia de HTA esencial y su grado de control en ese medio, y evaluar la eficacia antihipertensiva de una asociación farmacológica de trandolapril y verapamilo en combinación fija en los pacientes no controlados en monoterapia. MATERIAL Y MÉTODOS: Se trata de un estudio abierto, prospectivo, en pacientes ancianos institucionalizados en residencias de Vizcaya y Cantabria, en dos fases: epidemiológica (escrutinio para detectar la población hipertensa) y de intervención (tratar a los hipertensos no controlados en monoterapia con la asociación fija trandolapril más verapamilo), durante seis meses. RESULTADOS: Estudio de prevalencia: de un total de 1.696 ancianos escrutados, 1.053 no recibían tratamiento. Existía HTA en el 31 por ciento (323 pacientes), mientras que en los hipertensos tratados, el 70 por ciento (453 pacientes) mostraban cifras de PA no controladas (prevalencia de un 56,9 por ciento). De los tratados y no controlados, el 81 por ciento recibía monoterapia para la HTA. La cifra global de prevalencia de HTA fue del 56,95 por ciento de la población estudiada. ESTUDIO DE INTERVENCION: En 257 ancianos no controlados con monoterapia, la administración de la asociación de trandolapril y verapamilo durante cuatro meses consiguió que el 45,2 por ciento de los pacientes mostraran cifras de PA controladas, porcentaje que ascendía al 78 por ciento si se definía como control adecuado de la PA cifras inferiores a 145/90 mm Hg. La presión del pulso descendió significativamente de 75 a 58 mm Hg. CONCLUSIONES: En una población anciana institucionalizada, con HTA mal controlada en monoterapia, el empleo de la asociación verapamilo y trandolapril ayuda a conseguir un control estricto en cerca de la mitad de los pacientes, o un control adecuado de la misma en un 78 por ciento de los mismos, disminuyendo la presión del pulso (AU)

Isquemia miocárdica en el paciente hipertenso: efecto del verapamilo / Myocardial ischemia in hypertensive patients: verapamilo effect

Introducción y objetivos. La hipertensión arterial es uno de los principales factores de riesgo para el desarrollo de aterosclerosis y es frecuente entre los pacientes que padecen cardiopatía isquémica. Para valorar el efecto del tratamiento farmacológico en sujetos hipertensos con isquemia miocárdica, hemos llevado a cabo un estudio en pacientes que recibieron 360 mg de verapamilo diariamente (180 mg/dos veces al día) y mononitrato de isosorbida cuando fue necesario para controlar la angina. Métodos: Estudio prospectivo, multicéntrico, de observación, abierto. 746 pacientes fueron evaluados mediante pruebas de esfuerzo y control de la presión arterial, durante los seis meses de duración del ensayo. Resultados: La presión arterial y la frecuencia cardiaca disminuyeron significativamente desde el primer mes de tratamiento. La clase funcional de angina mejoró al cabo de tres meses (p<0.001). El 84 por ciento de los pacientes pasaron a clase I, el 15,2 por ciento a clase II y el 1,2 por ciento permaneció en clase III. En las pruebas de esfuerzo, realizadas al inicio y al cabo de seis meses de tratamiento, se observaron mejorías relevantes en la isquemia miocárdica y en los parámetros de angina: la duración del ejercicio y el tiempo hasta la aparición de angina y/o isquemia se prolongaron significativamente. Al cabo de 30 días fue necesario añadir mononitrato de isosorbida en 141 pacientes. Conclusiones: En pacientes con hipertensión e isquemia miocárdica, el tratamiento con verapamilo, sólo o asociado a nitratos, controla la presión arterial y mejora las manifestaciones clínicas de cardiopatía isquémica, espontáneas o inducidas por el ejercicio (AU)

[The effect of trandolapril, in monotherapy and associated with verapamil, on arterial pressure, albuminuria, and metabolic control in hypertensive patients with type 2 diabetes and albuminuria]. / Efecto del trandolapril, en monoterapia y asociado con verapamil, sobre la presión arterial, albuminuria y control metabólico en pacientes hipertensos con diabetes tipo 2 y albuminuria.

The aim of this study was to analyse the effect of the ACE-1, Trandolapril, alone or with Verapamil on blood pressure, albuminuria and metabolic profile in type 2 diabetic patients with hypertension and albuminuria. It was an open multicenter, consecutive and prospective study conducted in 281 patients. There was a four-week wash-out period of antihypertensive drugs, after which we carried out a measurement over a 24-h period of the urinary excretion of albumina (UEA). Blood pressure was recorded after at least 5 minutes of rest in the sitting position at 1 to 3 minute intervals with a mercury sphygmomanometer in good condition. Average BP was obtained from three consecutive readings. Within treatment changes were analysed using descriptive statistics and t-tests on the change from baseline. Analysis of variance, chi-square and Mc Nemar tests were also used. If after 8 weeks of treatment with Trandolapril 2 mg o.q.d. the patients were non-responders (mean blood pressure reduction of 5 mmHg or less) or their blood pressure remained uncontrolled (blood pressure > or = 140/90 mmHg), Verapamil 180 mg o.q.d. was added. Two hundred and thirty patients completed the 12 weeks study. Population included 157 (55.9%) males with an average of 61.7 +/- 9.2 years. Baseline measurements were systolic 165.4 +/- 14.6 and diastolic 94.8 +/- 8.5 mmHg blood pressures, fasting glucose 162.7 +/- 43.9 mg/dL, glycosylated hemoglobin (HbAlc) 6.8 +/- 1.2%, and albuminuria 520.9 +/- 602 mg/day. UEA fell significantly (p < 0.001) after treatment to 177.9 +/- 24.3 mg/day (CI 95%, 129.9 to 225.8). The percent reduction reached 29.6%. Albuminuria was lower than 30 mg/day in 47 patients. Blood pressure was completely controlled in 125 (54%) patients. Glucemia fell significantly (p < 0.001) to 153.2 +/- 42.7 mg/dL, and the HbAlc to 6.5 +/- 1.3% (p = 0.012). In summary, in those diabetic type 2 patients with arterial hypertension and proteinuria, Trandolapril alone or associated with Verapamil significant lowered albuminuria and blood pressure facilitated the control or their metabolic profile.

Efecto del trandolapril sobre la presión arterial y la microalbuminuria en el paciente diabético: estudio galitran

Objetivo. Evaluar la respuesta de la albuminuria al tratamiento con trandolapril en los pacientes diabéticos, hipertensos o no, durante un año. Pacientes y métodos. Catorce centros de Asistencia Primaria incluyeron 131 pacientes diabéticos con microalbuminuria positiva, independientemente de sus cifras de presión arterial. Se cuantificaba la albuminuria en orina de 24 horas y se les administraba, en dosis crecientes de 2 a 4 mg, trandolapril, hasta lograr control de la presión arterial. Se evaluaba la respuesta de la proteinuria durante un período de seguimiento de doce meses. Aquellos pacientes con hipertensión arterial (HTA) no controlada recibían la asociación fija de trandolapril y verapamilo a dosis de 2/180 mg. Resultados. La presencia de albuminuria fue del 70 por ciento de los pacientes escrutados mediante tiras reactivas. Existía HTA en el 93 por ciento de los pacientes diabéticos. La albuminuria descendió significativamente desde 55,7 ñ 32 µg/min hasta 17,3 ñ 36 µg/min al cabo de un año de tratamiento (p < 0,001). Cuando se consideró la negativización de la proteinuria como un valor inferior a 20 µg/min, el porcentaje de pacientes pasó de un 23,3 por ciento inicial a un 83,7 por ciento al final del estudio. La presión arterial descendió significativamente, de 158,8 ñ 19/89,3 ñ 10 a 134,1 ñ 9/75,5 ñ 8 mmHg (p < 0,001). Considerando el objetivo de presión arterial por debajo de 130/85 mmHg, al cabo de un año se controló al 45,3 por ciento de los pacientes tratados. El control metabólico de la diabetes mejoró, pasando la glucemia de 177 ñ 51 mg/dl a 130 ñ 32 mg/dl (p < 0,001), y la hemoglobina glucosilada de 7,98 por ciento ñ 2,3 por ciento a 6,7 por ciento ñ 2,1 por ciento (p < 0,001). Conclusiones. La presencia de HTA es muy frecuente entre la población diabética con microalbuminuria. Las tiras reactivas pueden arrojar hasta un 30 por ciento de falsos positivos cuando se determina posteriormente la albuminuria en orina de 24 horas. El tratamiento con trandolapril controla la presión arterial en el diabético hipertenso, disminuye sustancialmente la microalbuminuria y ayuda a mejorar el control metabólico de la diabetes en estos pacientes al cabo de un año de tratamiento (AU)

Löffler's syndrome: pulmonary vein and transmitral doppler flow analysis by transesophageal echocardiography-report of a case.

Löffler's syndrome is defined by prolonged and profound eosinophilia and restrictive cardiomyopathy. Doppler echocardiography is useful in both the diagnosis and management of this entity. On the other hand, diastolic dysfunction is assessed better by transesophageal echocardiography than by transthoracic echocardiography, mainly in the analysis of pulmonary vein Doppler flow. We describe a patient with Löffler's syndrome, whose pulmonary vein flow, obtained by transesophageal echocardiography, was helpful for better management of the disease.

Effect of verapamil on home self-measurement of blood pressure and heart rate by hypertensive patients. Verapamil-Frequency Research Group.

BACKGROUND: Achievement of a controlled blood pressure and improvement of cardiovascular risk profile are the mainstays of therapy for hypertension. OBJECTIVE: To assess the responses of heart rate and blood pressure in hypertensive patients to 240 mg/day sustained release verapamil. METHODS: We assessed the effect of 240 mg/day sustained released verapamil on blood pressure and heart rate, measured in the office and at home, in 1395 hypertensive outpatients with mild-to-moderate hypertension, who were using an Omron HEM 705 CP automatic device for self-measurement. The period of observation was 3 months. RESULTS: Blood pressure decreased both in the medical office and at the patient's home, the measurements obtained at home being lower than those found in the office. Heart rate decreased in a significant and particular way. The decrease was greatest among those patients with histories of myocardial infarction and among relatively young patients, who exhibit a tendency towards higher than normal baseline heart rates. Overall, there was a shift of the heart-rate curve towards more controlled levels clustered around heart rates between 65 and 75 beats/min. Home self-measurement showed that the data gathered by the patients at home are reliable and that, when cut-off values of 140/90 mm Hg for blood pressure are used, the percentage of patients with controlled blood pressures is 62%, whereas the percentage obtained in the medical office by the physician is 56%. If cut-off values of 135/85 mm Hg are considered for self-measurements at home, according to the VI JNC recommendations, the percentage of patients with controlled blood pressures is 25.4%.

[Quality of life and social support in patients with non-complicated acute myocardial infarct]. / Calidad de vida y apoyo social en pacientes con infarto agudo de miocardio no complicado.

INTRODUCTION: There is a relationship between social support and health. However, there is no very much available research in the area of ischemic heart disease related to the influence of social support on the quality of life. OBJECTIVES: To study the social aspects of patients. To measure emotional and instrumental social support and quality of life, after a first acute myocardial infarction. PATIENTS AND METHODS: 155 patients were studied under two pieces of assessment: at admission's time and six months later. A protocol was selected with clinical, socio-economic, social support and quality of life variables. RESULTS: 90.9% could read and write, however 42.3% have any study or completed their primary studies. Moreover, 45.1% of patients were working, at six months only 14% of them had returned to their jobs. They were blue and white collar patients. Availability of instrumental and emotional social support was referred by 78.7% and 69.9% respectively of patient's. At the beginning, the mean quality of life was 108.1 +/- 19.3. Six months later was 101.1 +/- 19.1 SD. Statistics revealed that the availability of instrumental and emotional social support impacts favourably on human being's health. CONCLUSIONS: The quality of life is related to the patient's perceived social support. The perceived social support depends directly on the size of their network. Moreover, there is a relationship between quality of life and educational achievement, so that, the lower that patient's quality of life, the lower the educational achievement. After the first not complicated myocardial infarction the return to their jobs is really low.

[An anomalous origin of the left coronary artery associated with a right coronary spasm as the cause of angina and presyncope]. / Origen anómalo de la arteria coronaria izquierda asociado a espasmo de la coronaria derecha como causa de angina y presíncope.

We describe the rare association of angina at effort and presyncope in a young patient with an anomalous origin of left coronary artery and associated coronary spasm in the normal right coronary artery. The patient did well under calcium channel blocker therapy after seven years of follow-up, which is in contrast with the usual recommended management of these patients.

[Pulmonary hypertension: current aspects]. / Hipertensión pulmonar: aspectos actuales.

Primary pulmonary hypertension, although less frequent than secondary forms, represents the true paradigm of this disease. The recent investigations on pulmonary vascular response mechanisms to different stimuli has increased our knowledge about the mechanism of high pulmonary pressure. Molecular biology of the endothelial cell has provided evidence that endothelial injury plus a genetic individual predisposition may be the pathogenic mainstream of this disease. The histologic findings of pulmonary hypertension are still a matter of controversy, although the clinical, epidemiological and prognostic features are better defined. Therapeutically, there has been important advances, specially with various vasodilators, like calciumantagonists, prostacyclin, adenosine and nitric oxide, as well as new routes of administration. In more advance stages of the disease, atrial septostomy (only paliative) and pulmonary or cardio-pulmonary transplantation, are other therapeutic options to consider, after an adequate selection of patients.

[Cardiomyopathies (VII). Natural history of hypertrophic cardiomyopathy]. / Miocardiopatías (VII). Historia natural de la miocardiopatía hipertrófica.

After a short historic review of conceptual developments in hypertrophic cardiomyopathy, the natural history of the disease is analyzed according to each of its morphologic and functional abnormalities. The lack of association between hypertrophic morphology and sudden death is considered. Diastolic dysfunction and LV obstruction, although a frequent cause of dyspnea and heart failure, is not a risk factor for sudden death. Something similar occurs with the infrequent appearance in this disease of contractile failure. Myocardial ischemia is frequent in hypertrophic cardiomyopathy and general prognostic information about it is still lacking. Nevertheless, in young patients with family history of sudden death, a positive Thallium effort test may be a marker of sudden death (without an arrhythmogenic substrate), and may respond to verapamil. Finally, the new knowledge about genetic mutations in hypertrophic cardiomyopathy are analized. We conclude with some futuristic comments about hypertrophic cardiomyopathy.

[Effect of 3 hypertensive++ agents on ventricular geometry and function]. / Efecto de tres antihipertensivos sobre la geometría y función ventriculares.

BACKGROUND: To assess the prevalence of left ventricular hypertrophy in hypertensive patients referred to an outpatient cardiology unit, and to assess its evolution under antihypertensive treatment. METHODS: One hundred and seven mild to moderate hypertensive patients were randomized to receive either xipamide, verapamil or atenolol. Cross-sectional echocardiography was performed in order to assess left ventricular mass and function. RESULTS: Mean age was 56 years, with a 4:1 female/male ratio. Mean follow-up was 120 days. Left ventricular hypertrophy was very common (65%) and decreased to 54% under antihypertensive treatment. Left ventricular mass decreased from 134.3 g/m2 to 118.1 g/m2 (p < 0.001). Concentric hypertrophy was the most common geometric pattern (42%), decreasing to 30% with treatment. Xipamide decreased ventricular mass by decreasing left ventricular diameters, while verapamil and atenolol decreased left ventricular thickness, mainly in septal wall. Systolic function was not modified during the treatment period. Diastolic function was not modified by xipamide and verapamil, and improved with atenolol. CONCLUSIONS: Left ventricular hypertrophy is very frequent when determined by echocardiography and all three drugs produced regression of left ventricular hypertrophy in a different way with respect to left ventricle geometry, an effect which could have potential therapeutic implications.

New technique for right heart catheterization using a Mullins' sheath.

A new technique for right heart catheterization using a Mullins' sheath is described. This device allows a Swan-Ganz catheter to reach pulmonary artery position easily and permits simultaneous pressure recordings in right heart chambers, thus avoiding a double venous puncture and two catheters. This new technique, its indications, and our experience in 29 patients are described. It is most useful in patients with severe pulmonary hypertension and in those conditions in which accurate right heart pressure measurements are needed.

Right coronary artery-right atrium fistula in primary angiosarcoma of the heart.

We report a case of angiosarcoma of the heart, manifested as a continuous murmur. Right coronary arteriography disclosed a paracardiac mass with fistulas from the coronary vessel to the right atrium. Histologic study revealed this to be an angiosarcoma with sinusoidal pattern. To our knowledge, this is the first case of this kind of cardiac tumor presenting as a fistula from a coronary artery to the right atrium.

Treatment of transient myocardial ischemia in patients with stable angina: a comparative study of verapamil slow-release and nifedipine plus propranolol.

We compared the effect of verapamil slow-release (VSR) and the combination of nifedipine plus propranolol on transient myocardial ischemia in a double-blind study comprising 20 patients with proven coronary artery disease and chronic stable angina. According to the results of 24-h Holter-monitoring recording, patients were divided into two groups: 10 patients with fixed coronary reserve and 10 patients with variable coronary reserve. The number of ischemic events was reduced with both therapies: from 12 +/- 10 at baseline to 3.4 +/- 4.0 (p less than 0.05) with verapamil and to 3.9 +/- 7.0 (p less than 0.05) with nifedipine plus propranolol (N + P). When total ischemic burden was measured, findings were similar: It was reduced from 104 +/- 196 min to 27 +/- 57 (p less than 0.05) with N + P and to 17 +/- 18 min with verapamil in patients with fixed coronary reserve and from 36 +/- 44 to 5 +/- 9 min (p less than 0.05) with verapamil and to 5 +/- 10 min with N + P in patients with a variable coronary reserve. VSR shows antiischemic efficacy similar to that of the combination of N + P in treatment of transient myocardial ischemia in patients with stable angina.

Different hemodynamic responses between acute and chronic infusion of iloprost (prostacyclin-stable analogue) in severe pulmonary hypertension.

We report the hemodynamic and clinical effects of acute and chronic administration of iloprost in two patients with severe pulmonary hypertension caused by toxic oil syndrome. We tested the acute effect of progressive increments of iloprost, followed by long-term infusion of the drug during 14 days. The acute response produced an increase in cardiac output and moderate reduction in pulmonary vascular resistance, with no change in pulmonary artery pressure. Nevertheless, a maintained reduction in pulmonary artery pressure and resistance, as well as clinical improvement, was observed after chronic infusion. We conclude that (1) the acute effect of iloprost does not necessarily predict long-term hemodynamic response, and (2) iloprost given in long-term infusion seems to have been an efficacious and safe drug in our two patients, and it opens a new line of treatment.

Clinical and pathologic manifestations of pulmonary vascular disease in the toxic oil syndrome.

The toxic oil syndrome in Spain affected greater than 20,000 people. In the initial stages, it was characterized by a respiratory distress syndrome with myalgias and eosinophilia. Pulmonary hypertension developed in 20% of the patients and in many, it has spontaneously regressed. Nevertheless, in a small subgroup, it has progressed to a malignant course of cor pulmonale, leading rapidly to death. Clinical and pathologic features of 40 patients with severe pulmonary hypertension due to the toxic oil syndrome are presented (32 female and 8 male patients; mean age 26 +/- 13 years). The study began in June 1981, which was near the onset of the toxic oil epidemic, and ended in December 1987, greater than 6 years later. The pulmonary hypertension is clinically and pathologically indistinguishable from primary pulmonary hypertension. Direct endothelial injury by the toxic agent is proposed as the initial trigger of this type of pulmonary hypertension, but an interaction between the toxic agent and specific individual susceptibility is probably required in its pathogenesis.