Coronary Dilators and Angina

Silber, Earl N.

doi:10.1001/jama.1953.02940290007003

Cited by 19 publications

(6 citation statements)

References 8 publications

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“…Figure 2 graphically shows the effect of nitroglycerin. In this experiment, 3 3) it is noted that the placebo curve differs from the diurnal curve previously shown on the "control" subjects. The explanation for this apparent discrepancy is the difference in the time of collection of the blood specimens.…”

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confidence: 54%

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An Evaluation of Blood Nitrate Levels

Berry

Roach

1958

Circulation

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The lack of a suitable objective yardstick to measure the effect of anti-anginal drugs has led to confusion in their clinical evaluation. A method of quantitating the nitrate level in the serum has furnished a means of correlating the subjective relief with this group of drugs. Representative samplings of serum from noncardiac and cardiac patients were analyzed to establish control nitrate levels. The cardiac patients were selected for their good responses to nitroglycerin and pentaerythritol tetranitrate. A good subjective response to the drugs correlated with the increased blood nitrate levels.T HE difficulties inherent in evaluating anti-anginal drugs have been stressed by a number of authors.

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confidence: 54%

“…[1][2][3] In general the lack of an objective yardstick for determining a subjective response remains the problem. It has been noted that favorable reports of a variety of drugs when subjected to the double blind technic of administration fail to bear out the initial enthusiasm.…”

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confidence: 99%

An Evaluation of Blood Nitrate Levels

Berry

Roach

1958

Circulation

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“…The maximum number of pains during a control period (period without anti-anginal medication) was 29; the minimum, 0-during a period of complete remission. For the individual patient, a maximum variation of 12 episodes of severe pain was reported during control periods; on the average, variation among control periods was 6 pains.…”

Section: Curvesmentioning

confidence: 96%

“…Three curves showed a steady ascending slope of increased frequency of chest pain, that follow'ved myocardial infarction in one instance, and general deterioration of the patient's condition in the others. 6. In 1 instance there was a dip showing a decrease in attacks of chest pain during a period of active drug therapy (Peritrate) as compared with periods of placebo and no medication.…”

Section: The Drugs Metaminementioning

confidence: 98%

Assay of Anti-Anginal Agents

1957

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The measure of an anti-anginal agent is its ability to decrease chest pain. Because of the subjective character of pain, extreme care is necessary in choosing patients upon whom anti-anginal medication is to be tested. We have used the double-blind technic and an initial control period to neutralize the many extraneous mental and physical factors, such as bias or the patient-physician relationship itself, that might interfere with an accurate appraisal. This study shows, in addition, that proper evaluation of an anti-anginal agent requires that its effect be measured against multiple control periods without medication throughout the various phases of angina pectoris.OPINIONS concerning the efficacy of each 1 of the various medical agents in the continuous treatment of angina pectoris have ranged from the enthusiastic to the negative. In an attempt to determine the place of antianginal agents in the management of this symptom-complex and to resolve these recurrent discrepancies, 4 drugs were tested: triethanolamine trinitrate (Metamine), calcium theophyllinate (Calphyllin), pentaerythritol tetranitrate (Peritrate), and chlorpromazine (Thorazine). * PROCEDURE An angina study group was formed to which patients with angina pectoris were referred from the cardiac outpatient clinic of the Los Angeles County Hospital. The group met with patients at weekly intervals over a 2-year period. At the initial visit each patient was carefully evaluated as to the presence of angina pectoris on the basis of coronary artery disease-from history, physical examination, electrocardiograms, and other laboratory procedures. Xt each follow-up visit patients were questioned concerning the course of the disease and the effect of medication they were taking; they were weighed, their blood pressures were taken, and heart and lungs were examined. Every patient was instructed in keeping a daily record sheet of the number, frequency, duration, and severity of anginal attacks,

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“…A variation of 2 to 4 trips was observed in 18 patients, from 5 to 6 trips in eight patients and from 7 to 9 trips in the remaining six patients. Thus, the variation from the average standardized exercise tolerance was plus or minus 2 to 9 per cent in 15 28 per cent) could do no more work (or less than 20 per cent more work) after the sublingual administration of nitroglycerin than was possible without the drug. The patients' response to nitroglycerin was an index of the likelihood of his response to other effective medication; the results, therefore, are examined accordingly (tables 3 and 5).…”

Section: Miscellaneous Control Studiesmentioning

confidence: 99%

Treatment of Angina Pectoris with Cinchona Alkaloids

Riseman¹,

Steinberg²,

Altman³

1954

Circulation

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Reports indicating the value of quinidine sulfate in angina pectoris led to (1) a search for related drugs which were equally effective but less toxic, and (2) a study of the mode of action of these drugs. It was found that quinidine, quinine, cinchonadine, and cinchamidine decrease the frequency of attacks in daily life and increase the exercise tolerance as measured by a standardized test. Quinine sulfate (0.3 to 0.4 Gm. every eight hours) appears to be the drug of choice from the standpoint of availability and low toxicity as well as effectiveness. The value of these drugs is apparently due to a vasodilating action which in turn is dependent on the presence of the quinoline ring.P REVIOUS studies1-6 have demonstrated the value of quinidine sulfate in the treatment of some patients with angina pectoris. However, most general practitioners and, in fact, many cardiologists hesitate to use quinidine in angina because of the complications which occasionally follow its use in the treatment of cardiac arrhythmias. Furthermore, many physicians hesitate to use quinidine in angina pectoris because its mode of action in this condition is not clear. It seemed worthwhile, therefore, to study the activity of drugs related to quinidine in an attempt to find a substance equally effective but possibly less toxic and also to throw some light on the mechanism of action in the treatment of angina pectoris.The comparative value of 12 pharmaceutical preparations was investigated in patients with angina pectoris. Five of these 12 were cinchona alkaloids (the sulfate salts of quinidine, quinine, cinchonine, cinchonidine, and cinchamidine); these were studied to determine whether drugs which were similar to quinidine in chemical structure but different in cardiodynamic and cardiotoxic effects were of therapeutic value in angina. Procaine amide (Pronestyl) was included because, like quinidine, it is of value in eliminating ectopic ventricular beats. Three

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Coronary Dilators and Angina

Cited by 19 publications

References 8 publications

An Evaluation of Blood Nitrate Levels

An Evaluation of Blood Nitrate Levels

Assay of Anti-Anginal Agents

Treatment of Angina Pectoris with Cinchona Alkaloids

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