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Biomedical subjects

I L Pina

Publications and source records attributed to I L Pina.

11 recordsLinked to original sources
PubMed1992

Hemodynamic and neurohumoral responses to intravenous nicorandil in congestive heart failure in humans.

Nicorandil is a vasodilator drug that combines potassium channel opening properties with nitrate effects. The resulting potent and unique vasodilating properties suggest a potential therapeutic role in congestive heart failure. We therefore studied the acute hemodynamic and neurohumoral responses to nicorandil, given as single intravenous bolus doses of 158, 251, 398, or 630 micrograms/kg, to 22 patients with chronic congestive heart failure (ejection fraction less than 40%). Hemodynamic responses occurred within 5 min of dosing and terminated within 240 min. The heart rate was significantly increased only at 5 min after the 158 micrograms/kg dose, and was unchanged after all other doses. The mean arterial pressure was reduced only by the 398 and 630 micrograms/kg doses. The pulmonary capillary wedge pressure and right atrial pressure were significantly reduced by all doses within the initial 30 min; this reduction in pulmonary capillary wedge pressure was better sustained over time by the two larger doses, whereas the reduction in right atrial pressure was sustained only by the 158 micrograms/kg dose. The cardiac index was reduced by the 158 micrograms/kg dose, but increased after 251, 398, and 630 micrograms/kg of nicorandil. Plasma nicorandil concentrations were positively correlated with changes in cardiac index, systemic arterial pressure, pulmonary capillary wedge pressure, heart rate, and systemic vascular resistance. When measured 1 h after dosing, plasma immunoreactive ANF decreased, norepinephrine concentrations did not change, and plasma renin activity increased, but only at the 630 micrograms/kg dose level.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Clinical pharmacology education in a division of cardiology.

A working model of how clinical pharmacology education can be interwoven into the matrix of an academic cardiology program that includes didactic teaching, clinical research, and patient care has been presented. Essential to the success of such a program is the commitment and dedication of both its full-time and voluntary faculty. Moreover, a comprehensive plan of organization and allocation of efforts is vital to the success of such a complex undertaking. As we look to the future, the discipline of clinical pharmacology will be increasingly relevant to the practicing cardiologist.

Cardiology↗
PubMed1991

Intrinsic conduction maximizes cardiopulmonary performance in patients with dual chamber pacemakers.

Dual chamber pacemaker programmability allows the possibility of atrially-tracked ventricular pacing in patients who would otherwise have intrinsic atrioventricular (AV) conduction. Thirteen patients with permanent AV sequential pacemakers (ages 50-79) were evaluated with paired exercise tests to determine the cardiopulmonary effects of pacemaker induced right ventricular activation compared with normal AV and intraventricular conduction. Peak oxygen uptake (VO2), oxygen pulse (O2P), respiratory rate (RR), and respiratory exchange ratio (RER) were determined using breath-by-breath analysis of expired gases. Patients exercised to fatigue and exercise tests were performed in random sequence. For patients with intrinsic AV conduction (group I, n = 8) the AV delay was programmed to preserve intrinsic conduction during one study; the alternate test used AV delay programming to produce ventricular pacing. Five patients with chronic AV block (group II) acted as a control for the effects of a rate adaptive AV delay compared to a fixed AV delay. Paired t-testing showed a significantly lower peak VO2 (P less than 0.015) and O2P (P less than 0.01) in patients with atrially-tracked ventricular pacing compared to intrinsic conduction. In contrast, group II showed a significant improvement in peak VO2 with rate adaptive AV delay compared to fixed AV delay programming (P less than 0.05). In conclusion, intrinsic conduction should be preserved in patients with dual chamber pacemakers whenever possible.

Aged↗
PubMed1987

Recent advances in the diagnosis of fascicular blocks.

The electrocardiographic criteria for the diagnosis of left fascicular blocks have been a subject of debate and speculation. Nevertheless, careful analysis of certain electropathologic studies, extrapolations from animal experiments, and studies resulting from the inadvertent section of the various fascicles and of tracings obtained at the moment that the conduction disturbances appeared or disappeared have led to the acceptance of characteristic patterns. Although the specificity and sensitivity of electrocardiographic criteria of left anterior and left posterior fascicular block still require independent confirmation, there are already some methods that appear promising in this regard.

Bundle of His↗
PubMed1987

Clinical parameters of adolescent Hispanic male hypertensive subjects: a new subject?

We have previously reported an increased prevalence of elevated blood pressure in Hispanic adolescent males. The pressure elevation did not correlate with weight. In this study, we evaluated the response to antihypertensive therapy of eight adolescent Hispanic males found to have elevated pressure during high school screening. All patients were placed on placebo tablets b.i.d. for 2 weeks with weekly blood pressure readings. Those with persistently elevated pressures (at or above the 95th percentile) underwent laboratory testing, exercise testing, and echocardiography. An age-matched group of Hispanic adolescents with blood pressure recording below the 90th percentile were also exercised. Patients were then placed on 0.1 mg clonidine b.i.d. for 12 weeks. Pretherapy exercise testing demonstrated an abnormal systolic hypertensive response (mean 193 +/- 43 mmHg) that improved after therapy (mean 167 +/- 28 mmHg). Echocardiographic data were normal. All patients had elevated levels of VLDL and triglycerides. Five patients also had HDL levels below the 50th percentile for age and sex. We conclude that this population is similar to other hypertensive adolescent populations in exercise response pre- and posttherapy with clonidine, but they demonstrated a unique clinical feature in the elevation of the VLDL and triglyceride lipoprotein fractions.

Adolescent↗
PubMed1984

Evaluation of an immunoradiometric assay specific for the CK-MB isoenzyme for detection of acute myocardial infarction.

Clinical evaluation of patient's symptoms, electrocardiographic changes and increased serum enzyme levels, specifically creatine kinase (CK)-MB by electrophoresis, are established as the primary diagnostic indicators for myocardial infarction (MI). Two hundred fifteen patients were evaluated in this study. Of these patients, 102 were admitted to the coronary care unit and 113 were admitted to the emergency room and screened for possible MI. The immunoradiometric assay used in this study was a double antibody "sandwich" technique, which utilizes antibody to the M and B monomers of the CK isoenzymes. This assay is specific for the CK-MB isoenzyme, which is present in increased levels in MI. The intraassay coefficients of variation for 30 samples were 11.7% (mean 4.1 equivalent units [EU]/liter) and 8.4% (mean 15.4 EU/liter) and the interassay coefficients of variation for 30 samples were 11.1% (mean 2.6 EU/liter) and 8.1% (mean 13.6 EU/liter). The diagnostic sensitivity, specificity and accuracy in this study was 100%, respectively. The CK-MB by the immunoradiometric assay was found to be significantly more accurate than electrophoresis and, therefore, a reliable and also technically simpler replacement for electrophoresis.

Clinical Enzyme Tests↗
PubMed1984

Lead systems: sensitivity and specificity.

In this article, the modified 12-lead system and the bipolar lead systems are discussed, both of which may provide adequate sensitivity and specificity of stress tests for clinical purposes. A single lead V5 or, preferably, bipolar modification of lead V5 may be adequate in certain situations in which cost or the type of population being tested legitimizes such a choice. However, the modified 12-lead system is far more popular for the diagnosis and follow-up of patients with ischemic heart disease. The final choice of lead system for monitoring stress tests will ultimately depend on the needs and resources of a given laboratory.

Coronary Disease↗