Nitrates III
Cardiovascular Effects
Published on 1. September 1981
Book
Hardback
XXII, 600 pages
978-3-540-10761-3 (ISBN)
Description
Pharmacological and clinical research on nitrates continues to be of growing interest in many centers. This is surprising in view of the fact that their favorable effects in angina pectoris were described by Brunton and by Murrell in the Lancet more than 100 years ago. As expected, a host of new information has been collected since the two previous symposia on nitrates held in Stockholm in 1975 and Berlin in 1978. New insights were gained into the pharmacology, pharmacokinetics and pharmacodynamics of nitrates, as well as into their clinical effects in acute and chronic ischemic heart diseases and in severe congestive heart failure. Relatively little progress, however, was observed in research into the basic action of nitrates. Although most investigators agree that intracellular sequestration of calcium is probably the main mechanism by which nitrates lead to the reduction of vascular smooth muscle tone, the exact site of their action still remains undefined. In contrast, dose-dependent differences in venous and arteriolar tone have long been clearly established. Treatment was again in the main stream of discussion. The question of tolerance following long-term administration was discussed in depth and the term "pseudotolerance" was introduced to describe the adaptation of the body's circulatory system to chronic vasodilation. This is especially important in long term prophylactic antiischemic treatment in stable, as well as in unstable angina pectoris (i.e. during increased vasomotor tone - spasm).
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Content
I Basic Action of Nitrates.- Pharmacology of Nitrates in Relation to Antianginal Action.- Pharmacokinetics - Pharmacodynamics and the Bioavailability of Organic Nitrate Drug Products.- Fate of Isosorbide Mononitrates in Man.- Tolerance to Circulatory and Clinical Effects of Nitrates.- Panel Discussion.- II Pharmacodynamics and Kinetics.- Pharmacokinetics of Isosorbide Dinitrate in Human Subjects.- Pharmacokinetics of Isosorbide Mononitrates in Human Subjects.- Comparative Haemodynamic and Pharmacokinetic Investigations After Oral Isosorbide-2-mononitrate and Isosorbide-5-mononitrate.- Newer Methods of Administration of Nitrates to Man to Give a More Predictable Therapeutic Response.- Plasma Concentrations and Hemodynamic Effects of Percutaneously Administered Nitroglycerin and Isosorbide Dinitrate in Healthy Volunteers.- Effects of Acute and Chronic Administration of Isosorbide Dinitrate, Sustained-Release Form, in Patients with Angina Pectoris.- May Prolonged High Doses of Nitrates Cause Tolerance? Preliminary Results on the Response to an Additional Dose by Infusion.- The New Tropical Drug Delivery System for Nitroglycerin.- Echocardiographic Assessment of Different Doses of Oral Isosorbide Dinitrate in Patients with and without Heart Failure: Increase in Response with Dose.- Unchanged Efficacy of Acute Sublingual Nitrate Compounds During Long-term Treatment with Percutaneously Applied Isosorbide Dinitrate Ointment.- Induction and Inhibition of Organic Nitrate Metabolism.- Digital Pulse Plethysmography: a Sensitive Test of the Pharmacodynamics of Nitrates - Reproducibility and Quantitation of the Technique.- Discussion.- III Hemodynamics.- Direct and Indirect Effects of Nitroglycerin on Systolic and Diastolic Left Ventricular Function.- Left Ventricular Function and Regional Wall Motion After Intracoronary Application of Nitrates in Coronary Heart Disease..- Different Effects of Intracoronary and Intravenous Administration of Nitroglycerin on the Microcirculation of the Ventricular Myocardium of the Cat and Rat Heart.- Diastolic Pressure-Volume Relation and Left Ventricular Mass in Man After Autonomic Blockade and During Afterload Variation with Isosorbide Dinitrate and Methoxamine.- Early Hemodynamic Responses to Single Dose Intravenous Nitroglycerin: Time Course Relationships.- Demonstration of a Real Inotropic Effect of Nitrites on Myocardial Contractility During Anoxia and Reoxygenation: Attempt to Determine Action Site with the Contribution of Calcium Antagonistic Compounds.- Use of Intravenously Administered Isosorbide Dinitrate to Determine Reversibility of Myocardial Asynergy After Myocardial Infarction.- Hemodynamic Interaction of Beta-Blockers and Nitrates in Coronary Heart Disease.- Discussion.- IV Coronary Flow, Perfusion.- Effect of Nitrates on Myocardial Blood Flow During Angina: Comparison of Results Obtained by Inert Gas Clearance and 201 Thallium Imaging.- Collateral Pressure Distal to Coronary Obstructions - Influence of Nitrates.- Effects of Systemic Nitroglycerin on Perfusion of Ischemic Myocardium in Clinical Coronary Artery Disease.- Effects of Nitroglycerin on Blood Velocity and Flow in Coronary Arteries and Bypass Grafts in Man.- The Effect of Nitrates on Pressuretime Indices and Coronary Graft Blood Flow in Man.- Angina Pectoris and Other Effects After Intracoronary Administration of Nitroglycerin.- Discussion.- V Vascular Effects.- Comparative Vasodilating Effects of Nitroglycerin and Verapamil on Large Coronary Arteries in Man.- Quantitative Coronary Angiography: Effect of Isosorbide Dinitrate on Coronary Artery Stenoses.- Threshold Dosages of Nitroglycerin for Coronary Artery Dilatation, Afterload Reduction, and Venous Pooling in Conscious Dogs.- Influence of Nitroglycerin on Aortic Compliance, Capacity of the Windkessel, and Peripheral Resistance.- Echocardiographic Findings of Left Ventricular Function Before and After Isosorbide Dinitrate in Chronic Hemodialysis Patients.- Hemorrheological and Hemodynamic Effects of ISDN in Essential Hypertension and Obliterative Arterial Disease.- Coronary Artery Spasm Combined with Walk-through Phenomenon - a Special Type of Prinzmetal's Angina.- Discussion.- VI Pulmonary Circulation.- Effect of Nitroglycerin on the Diameter of Peripheral Arterial and Venous Pulmonary Vessels.- Nitrates in Patients with Pulmonary Hypertension Due to Airways Obstruction.- Comparison of the Effects of Nitroglycerin and Aminophylline on Hemodynamics and Lung Function in Patients with Chronic Obstructive Lung Disease.- Influence of Nitroglycerin on Central Hemodynamics and $${\dot V_A}/{\dot Q_C}$$ of the Lungs in the Postoperative Period After Coronary Bypass Surgery.- Effect of Sustained-Release Isosorbide Dinitrate on Pulmonary Arterial Hypertension in Patients with Chronic Cor Pulmonale.- Influence of Isosorbide Dinitrate of Pulmonary Circulation and Gas Exchange in Acute Respiratory Distress Syndrome.- Discussion.- VII Acute Myocardial Infarction and Unstable Angina.- The Use of Sodium Nitroprusside in the Treatment of the Acute Phase of Myocardial Infarction.- The Role of Nitroglycerin in Acute Myocardial Infarction.- Nitroprusside and Nitroglycerin in Acute Myocardial Infarction.- The Effect of Intracoronary Nitroglycerin in Acute Myocardial Infarction.- Panel-Discussion.- Intracoronary Thrombolysis in Evolving Myocardial Infarction.- Feasibility of Nitroprusside Therapy in Patients with Hypotension Due to Severe Left Ventricular Failure in Acute Myocardial Infarction.- Vasodilator-Induced Changes in Global and Regional Ventricular Function in Acute Myocardial Infarction.- A Randomized Trial of Prolonged Nitroglycerin Infusion in Acute Myocardial Infarction.- Intravenous Nitroglycerin in Unstable Angina.- The Action of Nitroglycerin on Pacing-Induced Arrhythmias.- Discussion.- VIII Exercise.- Assessment of the Effect of Isosorbide Dinitrate on Left Ventricular Hemodynamics at Rest and Under Exercise in Patients with CHD by Gated Blood Pool Scintigraphy.- Influence of Isosorbide Dinitrate and Mononitrate on the Ejection Fraction and Wall Motion Parameters at Rest and Under Exercise in Patients with Coronary Heart Disease.- Influence of Nitroglycerine on Myocardial Metabolism of Cyclic AMP, Cyclic GMP, Lactate, Free Fatty Acids, and Glucose at Rest and During Exercise in Patients with Coronary Heart Disease.- Attenuation of Nitrate Preload Reduction by Exercise in Patients with Severe Chronic Heart Failure.- Sustained Effect of Isosorbide Dinitrate Ointment on Angina and Exercise-Induced Electrocardiographic Changes in Patients with Ischemic Heart Disease.- Exercise-Induced Nonischemic Angina Pectoris Due to Abnormal Left Ventricular Compliance: Effects of Nitroglycerin.- Long-Term Effects of Isosorbide Dinitrate and Molsidomine on Left Ventricular Wall Motion and Dimensions in Patients with Coronary Heart Disease and Stable Angina Pectoris.- Myocardial Oxygen Consumption and Coronary Blood Flow at Rest and During Exercise After Application of Nitroglycerin.- Effect of Isosorbide Dinitrate and Coronary Bypass Surgery on the Perfusion Distribution and Regional Tracer Uptake in 201 Thallium Stress Scintigraphy.- Effects of Nitrates at Rest and During Bicycle Exercise and Cross-Country Walking.- Discussion.- IX Chronic Heart Failure.- Peripheral Circulation in Congestive Heart Failure.- General Principles of Treatment with Vasodilators.- Chronic Refractory Pump Failure: Effects on Hemodynamics and Circulating Catecholamines of Intravenous Isosorbide Dinitrate.- Treatment of Low-Output Failure After Open Heart Surgery with Nitroglycerin and Dobutamine.- Afterload Reduction with Dipyridamole and Preload Reduction with ISDN in Congestive Heart Failure.- Panel-Discussion.- Effect of Nitroglycerin on Hemodynamics and Catecholamines in Patients with Left Heart Failure.- Dose Response Study of Acute Hemodynamic Effects of Intravenous Isosorbide Dinitrate in Patients with and without Heart Failure.- Comparative Efficacy of Nitroprusside and Prazosin on Cardiocirculatory Function in Chronic Congestive Heart Failure.- Efficacy of Long-Term Nitrate Treatment in Chronic Left Ventricular Failure.- Haemodynamic Effects of High Dose Isosorbide Dinitrate (160mg Daily) in Severe Congestive Heart Failure.- Renal Changes in Low Cardiac Output Failure: Improvement with Vasodilators.- Discussion.- X Bypass Surgery; Valvular Heart Disease.- Comparison of Intravenous Nitroglycerin and Nitroprusside as Arterial Vasodilators.- Influence of Sodium Nitroprusside on Myocardial Function Early After Aortocoronary Bypass Surgery.- Influence of Deliberate Hypotension on Oxygenation and Plasma Catecholamines During Coronary Bypass Surgery.- The Effects of Nitroglycerin in Patients with Valvular Heart Disease: Hemodynamic and Radionuclide Cineangiographic Studies.- Effects of Volume Expansion and Vasodilators on Hemodynamics and Organ Perfusion in Acute Pericardial Tamponade.- Effects of Nitroglycerin on Left Ventricular and Myocardial Function in Aortic Stenosis.- Discussion.- XI Poster Session.- Sodium Nitroprusside: Indication that Peripheral Vascular Beds are the Sites for its Rapid in Vivo Inactivation.- Influence of ISDN, Molsidomine, Nifedipine, and DHE, on the Venous Tone in Man.- Effects of Sodium Nitroprusside (Nipruss) in Addition to Volume Administration in Shock States Associated with Increased Total Peripheral Vascular Resistance.- Organic Nitrates - A New Principle in Glaucoma Therapy?.- Nitrates: Concluding Remarks.