On the other hand, we still lack objective diagnostic methods for recognizing the presence of coronary heart disease with exactness and for differentiating this condition and its manifestations from others such as hypertensive heart disease, certain toxic effects on the heart or even psychoneurosis. Furthermore, we are unable, even after postmortem examination, to state in each instance how many of the clinical symptoms

The effect of carotid sinus pressure on the duration and character of attacks of angina pectoris induced by exercise under controlled conditions has been studied in 13 patients. Observations are presented which are consistent with the hypothesis that stimulation of the carotid sinus induces relief of cardiac pain by interruption of sympathetic reflex arcs or sensory pathways. The usefulness of carotid sinus pressure as a diagnostic test and a therapeutic measure in angina pectoris is discussed.

THE earliest description of angina pectoris, that of Heberden1 in 1786, refers to "the relief afforded by wine and spirituous cordials." Since then alcoholic beverages have frequently been recommended or at least permitted in the treatment of angina pectoris, but few efforts to evaluate such therapy have appeared in the literature. The present study was carried out to obtain an objective evaluation of the use of alcohol in the treatment of angina pectoris.Summary of the LiteratureThe comparative value of brandy, carminatives and nitroglycerin in the treatment of attacks of angina pectoris was studied in 1934 by Evans and . . .

PAPAVERINE, an opium derivative frequentlyused to combat vascular spasm, was first advocated for the treatment of angina pectoris in 1913 by Pal1; no data were presented, however. Three years later, Macht2 reported temporary relief of angina pectoris in 3 patients following injection of 40 mg. of papaverine. In 1923, Pal3 described prompt but transient relief of angina pectoris after the injection of 20 to 30 mg. of papaverine intravenously in an eighteen-year-old patient with aortic stenosis and insufficiency; subcutaneous injections of larger doses were not so effective. In 1921, Boehm4 reported marked success in treating patients with angina pectoris . . .

THE usefulness of cobra venom for the control of pain was first suggested in 1929 by Monaelesser.1 In 1936, Bullrich2 reported favorable results in the treatment of angina pectoris. Seven patients — 5 with syphilitic aortitis and 2 with coronary arteriosclerosis — received 1.25 to 5.0 mouse units§ of cobra venom intravenously; the succeeding doses and frequency of administration varied in each case. The physiologic and pharmacodynamic effects of cobra venom have been investigated by Macht,3 , 4 who demonstrated that its effects were those of a sedative acting on the thalamus. He5 reported relief of various types of pain in approximately . . .

This report resulted from a Nordic seminar on "Thermal Climate—Research Needs", held at the University of Stockholm, Sweden, March 19–21, 1986. The reason for the seminar was that climatic discomfort is an environmental problem highly ranked by most people in industrialized countries. At the same time, there are economical and practical limits to what countermeasures can be taken. Furthermore, demands on energy conservation require a cost-benefit assessment. For that purpose, the biological consequences of thermal distress/discomfort must be examined and evaluated regarding its importance for health, performance, and well-being. This document is a review which evaluates available information on the biological effects of thermal distress/discomfort, identifies research needs, and provides scientific priorities. The report directs itself to both authorities and researchers interested in climate control and in environmental health. It may serve as a basis for priorities in research support. Subsequent to the Nordic seminar, a meeting was held to discuss suggested guidelines on thermal climate in dwellings, sponsored by the Swedish Board of Social Welfare and Health, and a final discussion took place among agency representatives and the seminar participants. The seminar was organized by the Karolinska Institute and the National Institute of Environmental Medicine, in cooperation with the University of Stockholm. The seminar was sponsored by the Swedish Council for Building Research, the Swedish Board of Occupational Health, and the Swedish Board of Social Welfare and Health.

Soluble preparations of quinidine sulfate for parenteral administration have not been readily available. Quinine dihydrochloride has been administered intramuscularly or intravenously. 1 Dilute solutions of quinidine sulfate in dextrose or water 2 and even suspensions of quinidine sulfate tablets in hot water and hydrochloric acid 3 have been administered in emergencies, but there are important objections to these procedures. The necessity for a soluble preparation of quinidine suitable for parenteral administration in treating acute cardiac arrhythmias is obvious, especially when the abnormal rhythm is associated with vomiting, collapse, unconsciousness or other conditions in which absorption from the gastrointestinal tract is uncertain or delayed. A prolonged search of the American market for a soluble preparation has been unsuccessful. The Cinchona Products Institute, however, suggested that such a product might be obtained by adding urea and antipyrine to quinidine hydrochloride according to the following formula: So far as we have been able

Octyl nitrite (2-ethyl-n-hexyl-1-nitrite) is a liquid nitrite of one of the higher alcohols which, because of its volatility, can be administered by inhalation. Krantz, Carr, and Forman,1 who first prepared this substance, state that in laboratory animals it produces a fall in systemic blood pressure and an increase in the coronary blood flow; it dilates isolated coronary artery rings, and, in normal men, the inhalation of large doses (0.2 c.c. for one minute) produces a moderate fall in blood pressure, together with a moderate increase in heart rate. As a result of their studies, the investigators concluded, “Employing cotton impregnated with octyl nitrite, the compound lends itself to medication in an inhaler in the treatment of angina pectoris, asthma, and paroxysmal hypertension.”

In the treatment of patients with angina pectoris some form of medication is usually prescribed, but in the selection of such drugs the physician must rely either on clinical impressions of their therapeutic value or on the unsupported claims of the manufacturers. Many attempts to prove the value of medication have been made, but there has been little objective evidence of therapeutic action. As a result, the Council of pharmacy and Chemistry of the American Medical Association, in 1937,1 in reviewing the claims for the therapeutic efficacy of xanthine derivatives, reversed their decision of 1930,2 and “decided that there is no warrant for claims of efficacy as a dilator of the coronary arteries or of usefulness in overcoming pain in coronary occlusion or angina pectoris.” The purpose of the present investigation is to review the literature and present objective evidence of the pharmacodynamic action of drugs under conditions comparable to those commonly used in the treatment of angina pectoris.

During recent years theophylline with ethylenediamine (aminophylline) has enjoyed considerable popularity in the treatment of angina pectoris. This drug was introduced in 1908 by Dessauer1as a preparation which was more soluble, more effective and less likely to produce nausea than theophylline. More recently theophylline and theobromine have been linked chemically with other compounds in an attempt to imitate and improve on the properties of aminophylline. Each of these drugs has been used in angina pectoris with good results. Unfortunately, however, little exact information is available concerning the relative merits of these purine derivatives. The available reports are based on clinical experience with the drugs.2It has been shown3that clinical evaluation alone gives a false impression as to the efficacy of treatment in angina, for the administration of even inert medication may be followed by clinical improvement. The purpose of the present investigation is to determine

ArticleTHE MECHANISM OF THE CIRCULATORY CHANGES ACCOMPANYING INSULIN HYPOGLYCEMIAA. Carlton Ernstene, Joseph E. F. Riseman, Beatrice Stern, and Benjamin AlexanderA. Carlton ErnsteneFrom the Medical Research Laboratories, Beth Israel Hospital, and the Department of Medicine, Harvard Medical School, Joseph E. F. RisemanFrom the Medical Research Laboratories, Beth Israel Hospital, and the Department of Medicine, Harvard Medical School, Beatrice SternFrom the Medical Research Laboratories, Beth Israel Hospital, and the Department of Medicine, Harvard Medical School, and Benjamin AlexanderFrom the Medical Research Laboratories, Beth Israel Hospital, and the Department of Medicine, Harvard Medical SchoolPublished Online:28 Feb 1935https://doi.org/10.1152/ajplegacy.1935.111.2.440MoreSectionsPDF (1002 KB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat Previous Back to Top Next Download PDF FiguresReferencesRelatedInformation More from this issue > Volume 111Issue 2February 1935Pages 440-447 Copyright & PermissionsCopyright © 1935 by American Physiological Societyhttps://doi.org/10.1152/ajplegacy.1935.111.2.440History Received 25 November 1934 Published online 28 February 1935 Published in print 28 February 1935 Metrics

Since the course of cardiovascular disease varies according to its etiological basis, it has seemed worth while to analyze our results in the treatment of various type of chronic heart disease by total ablation of the thyroid so that the value of the procedure may become more clearly established for each type. Seventy-five patients with chronic cardiovascular disease have been treated by total thyroidectomy at the Beth Israel Hospital during the past eighteen months.1, 2, 3, 4 Thirty-six patients were diagnosed as having arteriosclerotic heart disease. This communication is a summary of our results in treating this group. Before operation these patients, despite the use of all available medical procedures, were incapacitated because of attacks of angina pectoris, cardiac asthma, congestive failure, paroxysmal heart action, or combinations of these conditions. The ages ranged from forty-two to seventy year; twenty-six patients were fifty-five years of age or over. Fifteen had hypertension, and in fourteen there was a history of coronary occlusion (Table I and II).

Article1 June 1934TREATMENT OF ANGINA PECTORIS AND CONGESTIVE HEART FAILURE BY TOTAL ABLATION OF THE THYROID IN PATIENTS WITHOUT THYROTOXICOSISX. WITH PARTICULAR REFERENCE TO THE PRE- AND POSTOPERATIVE MEDICAL MANAGEMENT*H. L. BLUMGART, D. D. BERLIN, DAVID DAVIS, J. E. F. RISEMAN, A. A. WEINSTEINH. L. BLUMGARTSearch for more papers by this author, D. D. BERLINSearch for more papers by this author, DAVID DAVISSearch for more papers by this author, J. E. F. RISEMANSearch for more papers by this author, A. A. WEINSTEINSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-7-12-1469 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIn the treatment of patients with congestive failure and angina pectoris, one not infrequently finds that despite all available medical measures the patients, while improved, nevertheless continue to remain chronically incapacitated. It is well recognized that exercise, emotion and other factors which increase cardiac work tend to increase congestive heart failure and angina pectoris. The enforcement of diminished activity or complete bed rest benefits patients by reducing the demands on the heart. The use of sedatives and the action of digitalis in reducing the ventricular rate in auricular fibrillation have a similar effect.3,10,27The same considerations underlie the treatment of...Bibliography1. BARACH A: Personal communication. Google Scholar2. BERLIN DD: Therapeutic effect of thyroidectomy on congestive heart failure and angina pectoris in patients with no clinical or pathological evidence of thyroid toxicity; operative technic, Am. Jr. Surg., 1933, xxi, 173-179. CrossrefGoogle Scholar3. BLUMGART HL: Velocity of blood flow in health and disease, Medicine, 1931, x, 1-75. CrossrefGoogle Scholar4. BLUMGARTGARGILLGILLIGAN HLSLDR: Studies on velocity of blood flow; circulatory response to thyrotoxicosis, Jr. Clin. Invest., 1930, ix, 69-89. CrossrefGoogle Scholar5. BLUMGARTGARGILLGILLIGAN HLSLDR: Studies on velocity of blood flow; circulation in myxedema, with comparison of velocity of blood flow in myxedema and thyrotoxicosis, Jr. Clin. Invest., 1930, ix, 91-106. CrossrefGoogle Scholar6. BLUMGARTLEVINEBERLIN HLSADD: Congestive heart failure and angina pectoris; therapeutic effect of thyroidectomy on patients without clinical or pathologic evidence of thyroid toxicity, Arch. Int. 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MEANS JH: Address on certain aspects of pathogenesis of angina pectoris, Canad. Med. Assoc. Jr., 1931, xxiv, 193-200. Google Scholar23. MEANSRICHARDSON JHEP: The diagnosis and treatment of diseases of the thyroid; in CHRISTIAN, H. A.: Oxford monographs on diagnosis and treatment, vol. 4, 1929, Oxford University Press, New York. Google Scholar24. MEANSWHITEKRANTZ JHPDCI: Heart in myxedema, with special reference to dilatation and angina pectoris, Boston Med. and Surg. Jr., 1926, cxcv, 455-460. CrossrefGoogle Scholar25. RISEMANSTERN JEB: A standardized exercise tolerance test for patients with angina pectoris on exertion. (To be published.) Google Scholar26. WEINSTEINDAVISBERLINBLUMGART AADDDHL: Observations on the mechanism of the early relief of pain in patients with angina pectoris and congestive failure after total ablation of the normal thyroid gland, Am. Jr. Med. Sci. (In press.) Google Scholar27. WEISSBLUMGART SHL: Effect of digitalis bodies on velocity of blood flow through lungs and on other aspects of circulation; study of normal subjects and patients with cardiovascular disease, Jr. Clin. Invest., 1929, vii, 11-26. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Boston, Massachusetts*Read before the American College of Physicians, Chicago, April 17, 1934.From the Medical Service and Research Laboratories of the Beth Israel Hospital, and the Department of Medicine, Harvard Medical School, Boston.This investigation was aided by a grant from the William W. Wellington Memorial Research Fund of the Harvard Medical School, Boston. Nextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByFunktionelle StrahlentherapieReferencesExperimentelle Befunde zur Frage gesteigerter Thyroxinempfindlichkeit des mechanisch vermehrt belasteten Herzmuskels 1 June 1934Volume 7, Issue 12Page: 1469-1477KeywordsAnginaHeartHeart failureHospital medicineMedical servicesPatientsResearch fundingResearch laboratoriesSedativesThyroid Issue Published: 1 June 1934 PDF DownloadLoading ...