Three weeks after myocardial infarction in 50 patients the effect of the infusion of a graded dose of dobutamine was compared with that of symptom limited treadmill exercise testing. The following variables were measured: blood pressure, heart rate, ST segment changes, Doppler aortic blood flow, and cross sectional echocardiographic dimensions. The heart rate and double product increased more during exercise than during dobutamine infusion, while maximum acceleration in the ascending aorta increased more during dobutamine infusion than during exercise. Significant ST depression was recorded in 22 patients during exercise and in 24 during dobutamine infusion; the concordance between the two tests was 88%. In all cases in which ST segment depression occurred in both tests the site of ST depression was the same. Dobutamine stress testing is an alternative to exercise testing in patients after myocardial infarction.

The efficacy of flecainide (100–150 mg bd) in comparison with atenolol (50–100 mg bd) in suppressing frequent (5/hour) ventricular ectopic activity and nonsustained ventricular tachycardia on ambulatory monitoring was assessed in 26 patients one month after myocardial infarction in a randomized, double‐blind trial. Blood drug levels were monitored and monthly follow‐up ambulatory monitoring and exercise testing were performed for three months, A successful response (70% suppression of ectopic activity or elimination of ventricular tachycardia) was seen in 100% of patients randomized to flecainide compared with 50% randomized to atenolol (p

Conference Abstract| January 01 1987 Doppler Ascending Aortic Velocity & Acceleration Detects Improvement in Exercise Function after Coronary Artery Surgery N Mehta; N Mehta 1Dept. Medicine 1, St. George's Hospital & Medical School, London SW17, England. Search for other works by this author on: This Site PubMed Google Scholar ED Bennett; ED Bennett 1Dept. Medicine 1, St. George's Hospital & Medical School, London SW17, England. Search for other works by this author on: This Site PubMed Google Scholar D Mannering; D Mannering 1Dept. Medicine 1, St. George's Hospital & Medical School, London SW17, England. Search for other works by this author on: This Site PubMed Google Scholar J Pepper J Pepper *Cardiology, St. George's Hospital & Medical School, London SW17, England. Search for other works by this author on: This Site PubMed Google Scholar Clin Sci (Lond) (1987) 72 (s16): 88P. https://doi.org/10.1042/cs072088Pb Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Cite Icon Cite Get Permissions Citation N Mehta, ED Bennett, D Mannering, J Pepper; Doppler Ascending Aortic Velocity & Acceleration Detects Improvement in Exercise Function after Coronary Artery Surgery. Clin Sci (Lond) 1 January 1987; 72 (s16): 88P. doi: https://doi.org/10.1042/cs072088Pb Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll JournalsClinical Science Search Advanced Search This content is only available as a PDF. © 1987 The Biochemical Society and the Medical Research Society1987 Article PDF first page preview Close Modal You do not currently have access to this content.

Conference Abstract| January 01 1987 Late Potentials after Myocardial Infarction: Relationship to Doppler Aortic Blood Flow Measurement, Peak Enzyme Levels and Arrhythmias T Cripps; T Cripps 1Depts. Cardiology and Medicine I, St George's Hospital, London SW17 0QT. Search for other works by this author on: This Site PubMed Google Scholar S Gilmour; S Gilmour 1Depts. Cardiology and Medicine I, St George's Hospital, London SW17 0QT. Search for other works by this author on: This Site PubMed Google Scholar D Mannering; D Mannering 1Depts. Cardiology and Medicine I, St George's Hospital, London SW17 0QT. Search for other works by this author on: This Site PubMed Google Scholar D Bennett; D Bennett 1Depts. Cardiology and Medicine I, St George's Hospital, London SW17 0QT. Search for other works by this author on: This Site PubMed Google Scholar D Ward D Ward 1Depts. Cardiology and Medicine I, St George's Hospital, London SW17 0QT. Search for other works by this author on: This Site PubMed Google Scholar Clin Sci (Lond) (1987) 72 (s16): 89P. https://doi.org/10.1042/cs072089P Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Cite Icon Cite Get Permissions Citation T Cripps, S Gilmour, D Mannering, D Bennett, D Ward; Late Potentials after Myocardial Infarction: Relationship to Doppler Aortic Blood Flow Measurement, Peak Enzyme Levels and Arrhythmias. Clin Sci (Lond) 1 January 1987; 72 (s16): 89P. doi: https://doi.org/10.1042/cs072089P Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll JournalsClinical Science Search Advanced Search This content is only available as a PDF. © 1987 The Biochemical Society and the Medical Research Society1987 Article PDF first page preview Close Modal You do not currently have access to this content.

Conference Abstract| January 01 1987 The Optimal Dose of Glyceryl Trinitrate (GTN) in the Treatment of Stable Angina is 20μG/Minute A.L. Kemp; A.L. Kemp 1Department of Medicine One, St George's Hospital Medical School, London SW17. Search for other works by this author on: This Site PubMed Google Scholar D. Mannering; D. Mannering 1Department of Medicine One, St George's Hospital Medical School, London SW17. Search for other works by this author on: This Site PubMed Google Scholar E.D. Bennett E.D. Bennett 1Department of Medicine One, St George's Hospital Medical School, London SW17. Search for other works by this author on: This Site PubMed Google Scholar Clin Sci (Lond) (1987) 72 (s16): 61P–62P. https://doi.org/10.1042/cs072061Pb Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Cite Icon Cite Get Permissions Citation A.L. Kemp, D. Mannering, E.D. Bennett; The Optimal Dose of Glyceryl Trinitrate (GTN) in the Treatment of Stable Angina is 20μG/Minute. Clin Sci (Lond) 1 January 1987; 72 (s16): 61P–62P. doi: https://doi.org/10.1042/cs072061Pb Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search nav search search input Search input auto suggest search filter All ContentAll JournalsClinical Science Search Advanced Search This content is only available as a PDF. © 1987 The Biochemical Society and the Medical Research Society1987 Article PDF first page preview Close Modal You do not currently have access to this content.

The severity of coronary artery disease is an important determinant of prognosis after acute myocardial infarction. The ability of a symptom limited exercise test to predict the presence of triple vessel disease was assessed in 221 patients three weeks after infarction. Coronary angiography was performed in patients with exercise induced ST segment depression. The presence of ST segment depression alone was poorly indicative of triple vessel disease; however, some specific features of ST segment changes on exercise were of predictive value. Downsloping ST segment configuration alone or horizontal ST segment depression associated with an early onset and a late recovery time after exercise correctly identified 30 (90%) of 33 patients with triple vessel disease whereas it incorrectly identified only 6 (15%) of 39 patients with single and double vessel disease. An abnormal blood pressure response was also predictive. In patients with ST segment depression after infarction triple vessel disease can be detected accurately by a combination of the electrocardiographic and haemodynamic variables attained on exercise.

There has been recent controversy over the efficacy of transdermal glyceryl trinitrate (GTN) preparations in the treatment of angina and their effects on exercise tolerance. To determine the dose of GTN that produces significant anti-anginal effects, symptom limited exercise testing has been undertaken in seven patients with stable angina. Doses of 10, 20, 40 and 80 micrograms min-1 of GTN or placebo were infused during treadmill exercise until symptom limiting chest pain or greater than or equal to 3 mm ST segment depression occurred. Compared with placebo, total exercise time increased by 47% at 20 micrograms min-1 (P less than 0.05) with no further change at the higher doses. Duration of exercise before the onset of significant ST segment depression increased by 51% at 20 micrograms min-1 (P less than 0.05) with no further increase at the higher doses. These changes were accompanied by a 21% increase in double product (heart rate X systolic blood pressure) at 20 micrograms min-1 (P less than 0.05) reflecting a higher heart rate achieved as a result of the increased duration of exercise. These results suggest that 20 micrograms min-1 may be the optimal dose of GTN to achieve significant antianginal effects as demonstrated by the improved exercise tolerance and reduction of myocardial ischaemia. This implies that the dose of GTN delivered by transdermal preparations may be below the therapeutic level.

Conference Abstract| December 01 1987 Comparison of Flecainide with Atenolol in the Suppression of Arrhythmias after Acute Myocardial Infarction T Cripps; T Cripps 1Depts. Cardiological Sciences and Medicine I, St George's Hospital Medical School, London Search for other works by this author on: This Site PubMed Google Scholar D Mannering; D Mannering 1Depts. Cardiological Sciences and Medicine I, St George's Hospital Medical School, London Search for other works by this author on: This Site PubMed Google Scholar ED Bennett ED Bennett 1Depts. Cardiological Sciences and Medicine I, St George's Hospital Medical School, London Search for other works by this author on: This Site PubMed Google Scholar Author and article information Publisher: Portland Press Ltd Online ISSN: 1470-8736 Print ISSN: 0143-5221 © 1987 The Biochemical Society and the Medical Research Society1987 Clin Sci (Lond) (1987) 73 (s17): 55P. https://doi.org/10.1042/cs073055Pa Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn Email Cite Icon Cite Get Permissions Citation T Cripps, D Mannering, ED Bennett; Comparison of Flecainide with Atenolol in the Suppression of Arrhythmias after Acute Myocardial Infarction. Clin Sci (Lond) 1 December 1987; 73 (s17): 55P. doi: https://doi.org/10.1042/cs073055Pa Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll JournalsClinical Science Search Advanced Search This content is only available as a PDF. © 1987 The Biochemical Society and the Medical Research Society1987 Article PDF first page preview Close Modal You do not currently have access to this content.

We have studied the haemodynamic effects of the application of the medical anti-shock trouser (MAST) in 10 healthy subjects in the semi-upright position in order to simulate mild hypovolaemia. Left ventricular end diastolic dimension (EDD) was measured by M-mode echocardiography and cardiac output (CO) by the Doppler ultrasound technique. Forearm blood flow (FBF) was measured by plethysmography and blood pressure (BP) by the standard cuff technique. Systematic increases in MAST pressure of up to 80 mm Hg were applied. EDD increased to a maximum of 9.3% (p≤0.01) which was associated with a maximum increase in CO of 31.7% (p≤0.05). FBF increased by a maximum of 54.2% (p≤0.001) whilst BP increased by a maximum of 12% (p≤0.001). These results demonstrate that the application of the MAST is an effective means of transferring blood to the central circulation by compression of the capacitance vessels resulting in significant increases in cardiac output and tissue perfusion. At high pressures there was evidence of compression of resistance vessels, which may be useful in reducing blood loss. The ease and rapidity with which his suit can be applied suggests that it may be useful in the short term treatment of hypovolaemia.

Conference Abstract| January 01 1986 Dobotamine as an Alternative to Exercise Testing in Post Infarction Assessment D. Mannering; D. Mannering 1Departments of Medicine One and Cardiology, St George's Hospital and Medical School London SW17 ORE Search for other works by this author on: This Site PubMed Google Scholar E.D. Bennett; E.D. Bennett 1Departments of Medicine One and Cardiology, St George's Hospital and Medical School London SW17 ORE Search for other works by this author on: This Site PubMed Google Scholar G. Leech; G. Leech 1Departments of Medicine One and Cardiology, St George's Hospital and Medical School London SW17 ORE Search for other works by this author on: This Site PubMed Google Scholar G. Boyle; G. Boyle 1Departments of Medicine One and Cardiology, St George's Hospital and Medical School London SW17 ORE Search for other works by this author on: This Site PubMed Google Scholar H. Valantine; H. Valantine 1Departments of Medicine One and Cardiology, St George's Hospital and Medical School London SW17 ORE Search for other works by this author on: This Site PubMed Google Scholar N. Mehta; N. Mehta 1Departments of Medicine One and Cardiology, St George's Hospital and Medical School London SW17 ORE Search for other works by this author on: This Site PubMed Google Scholar A. Kemp A. Kemp 1Departments of Medicine One and Cardiology, St George's Hospital and Medical School London SW17 ORE Search for other works by this author on: This Site PubMed Google Scholar Clin Sci (Lond) (1986) 71 (s15): 54P. https://doi.org/10.1042/cs071054P Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Cite Icon Cite Get Permissions Citation D. Mannering, E.D. Bennett, G. Leech, G. Boyle, H. Valantine, N. Mehta, A. Kemp; Dobotamine as an Alternative to Exercise Testing in Post Infarction Assessment. Clin Sci (Lond) 1 January 1986; 71 (s15): 54P. doi: https://doi.org/10.1042/cs071054P Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu nav search search input Search input auto suggest search filter All ContentAll JournalsClinical Science Search Advanced Search This content is only available as a PDF. © 1986 The Biochemical Society and the Medical Research Society1986 Article PDF first page preview Close Modal You do not currently have access to this content.

Left ventricular (LV) function was assessed by Doppler ultrasound measurement of ascending aortic blood velocity and maximal acceleration in 165 patients 3 to 4 weeks after acute myocardial infarction (AMI); all were undergoing routine 12-lead electrocardiogram exercise stress testing. Patients were grouped according to electrocardiographic stress test response; a positive response was defined as at least 1 mm of ST-segment depression in any lead. The Doppler velocity signal yielded 3 variables of interest: peak velocity, maximal acceleration (an index of inotropic state) and the systolic velocity integral (an index of stroke volume). All 3 Doppler ejection variables were significantly lower at peak exercise in patients with a positive electrocardiographic stress test response than in those with negative response, with maximal acceleration showing the most significance (p less than or equal to 0.001). Coronary angiography was performed in 63 of the 67 patients with positive responses, and patients were separated into 2 groups according to extent of coronary artery disease (CAD): 1- and 2-vessel or 3-vessel CAD. Peak velocity and maximal acceleration were significantly lower in patients with 3-vessel CAD than in those with 1- and 2-vessel CAD (p less than or equal to 0.01 and p less than or equal to 0.01). Discriminant analysis showed maximal acceleration and peak velocity values at peak exercise to be 65% predictive of 3-vessel CAD, onset time to ST-segment depression was 74% predictive and the combination of Doppler and electrocardiographic variables increased 3-vessel CAD predictive value to 80%.(ABSTRACT TRUNCATED AT 250 WORDS)