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Effects of treatment with captopril on exercise tolerance and plasma catecholamines in elderly hypertensives.

We examined the effects of antihypertensive therapy with captopril, an angiotensin converting enzyme inhibitor, on exercise tolerance and humoral factors in 19 elderly patients (greater than 60 years old) with essential hypertension. Captopril (37.5-75 mg/day) was administered for 8 weeks. Fourteen of the 19 patients in whom captopril was effective took a treadmill exercise test according to Kattus' protocol. Exercise tolerance was increased in all patients (from 13.1 +/- 1.3 to 16.5 +/- 1.0 min, P less than 0.01). Captopril attenuated the rise in blood pressure during the exercise test but did not affect the heart rate. Resting values of plasma adrenaline decreased by 47% and noradrenaline by 17%, with no significant changes in plasma renin activity (PRA) or aldosterone. The change in mean blood pressure showed an inverse relationship to pretreatment plasma noradrenaline (r = -0.73, P less than 0.01). The results show that captopril is effective in the treatment of hypertensive elderly patients, and suggest that the sympathetic nervous system is involved in the mechanism of the antihypertensive response to captopril therapy.

Aged↗

Correlation among the indices of high-resolution computed tomography, pulmonary function tests, pulmonary perfusion scans and exercise tolerance in cases of chronic pulmonary emphysema.

BACKGROUND: Mismatched distribution of pulmonary blood flow is a common characteristic in emphysematous patients. But few reports have mentioned the relationships between the morphological changes in the lungs as assessed by high-resolution computed tomography (HRCT), pulmonary blood flow (PBF) scan and the indices of exercise tolerance. We investigated these relationships. OBJECTIVE: Pulmonary function tests (PFT), HRCT, single photon emission computed tomography ((99m)SPECT) and treadmill exercise tests were performed on emphysematous patients, and the correlations between these examinations were studied. METHODS: We evaluated 20 patients (M 18, F 2, age 66 +/- 8.0 years). CT evaluation was performed according to the grade of emphysematous change. (99m)SPECT was performed to evaluate mismatched PBF by the score method. The better flow of the middle lobe was selected to be the standard lobe for the basic PBF. That score was set to 1 when the blood flow was below 60 or above 140%. PBF between 60 and 140% was scored as 0. RESULTS: FEV(1 )(r = 0.648, p = 0.002) and VC (r = 0.767, p = 0.001) correlated significantly with Vdot;O(2) peak. FEV(1) (r = 0.667, p = 0.0018) correlated significantly with anaerobic threshold (AT). CT grade did not correlate with PBF mismatch score (r = 0.266, p = 0.3376). %Vdot;O(2 )peak did not correlate with CT grade (r = -0.467, p = 0.0689) or with mismatch PBF score (r = -0.327, p = 0.2377). CONCLUSIONS: HRCT and (99m)SPECT were advantageous for detecting the progression of disease and emphysematous changes. However, the severity of anatomical emphysematous changes did not necessarily correlate with the indices of exercise tolerance and pulmonary function tests.

Aged↗

Atrioventricular interval optimization and exercise tolerance.

Modern pacemakers offer many programming options regarding the AV interval including the ability to vary AV intervals depending on whether atrial activity is paced or spontaneous and to shorten AV intervals with increasing rates. To determine if optimization of these features improves exercise tolerance, 14 patients with intact sinus node function and AV block treated with dual chamber pacemakers were enrolled in a randomized double-blind crossover trial. Doppler echocardiographic measurements of cardiac index and mitral flow were assessed over a range of programmable AV intervals at rest to determine each patient's optimal AV interval. Eleven patients completed serial graded exercise tests with spiroergometry after randomly programming the AV interval three ways in a crossover manner: fixed AV interval = 150 ms without rate adaptation (150/Fixed), fixed AVinterval = 150 ms with rate adaptation (150/R), or optimized AV interval with rate adaptive AV interval shortening (optimized/R). Exercise capacity was determined by maximum oxygen uptake. Ten men and four women, age 64 +/- 8 years, were enrolled. At rest, optimization of the AVintervalimproved the cardiac index by 21% (P < 0.001) and mitral flow by 13.4% (P < 0.001) when compared to least-favorable AV intervals. During exercise, no differences in maximum heart rates were noted. Maximum oxygen uptake was increased in both groups with rate adaptive AVinterval shortening when compared tofixed AVinterval without rate adaptation: 13.9% (adjusted P < 0.04) and 14.6% (adjusted P < 0.02) in optimized/R and 150/R, respectively. No differences were noted between optimized/R and 150/R. In conclusion, rate adaptive AV interval shortening improved exercise tolerance independent of changes in heart rate. However, optimization of the AV interval with Doppler echocardiography at rest did not further improve exercise capacity.

Atrial Function↗

Improved exercise tolerance after propranolol, diltiazem or nifedipine in angina pectoris: comparison at 1, 3 and 8 hours and correlation with plasma drug concentration.

Exercise tolerance 1, 3 and 8 hours after 80 mg of propranolol, 120 mg of diltiazem and 20 mg of nifedipine, and after 20 minutes of 0.6 mg of sublingual nitroglycerin were compared with placebo in 15 men who had chronic stable angina pectoris. Three hours after drug ingestion, the exercise time was prolonged by 72 +/- 26, 162 +/- 27 and 161 +/- 30 seconds (p less than 0.05) for propranolol, diltiazem and nifedipine, respectively, and by 123 +/- 35 seconds (p less than 0.001) 20 minutes after sublingual nitroglycerin compared with placebo. The onset of ST-segment depression greater than or equal to 0.1 mV was delayed by 120 +/- 34, 203 +/- 29 and 189 +/- 35 seconds (p less than 0.05) and by 79 +/- 23 seconds (p less than 0.05), respectively. After propranolol, the peak rate-pressure product decreased compared with placebo (15.1 +/- 1.1 U [10(-3)] vs 20.0 +/- 1.5 U, p less than 0.01). In contrast, the peak rate-pressure product was greater after diltiazem and nifedipine than after placebo (22.2 +/- 1.3 U [p less than 0.05] and 23.8 +/- 1.4 U [p less than 0.01]). The maximal increase in exercise tolerance was most marked for each drug at 3 hours, but was also significant at 1 hour for nifedipine and at 8 hours for diltiazem. At 3 hours, an increase in exercise time of more than 2 minutes was observed in 4 of 6 patients who had plasma propranolol concentrations greater than 40 ng/ml, 8 of 9 who had a plasma diltiazem concentration greater than 150 ng/ml, and in 7 of 7 who had a plasma nifedipine concentration greater than 90 ng/ml.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

[The practicability of increasing exercise tolerance in mild to moderate asthmatic patients].

OBJECTIVE: By performing the cardiopulmonary exercise testing in mild to moderate asthmatic patients and healthy volunteers, to assess the practicability of increasing exercise tolerance and improving life quality in the patients, and to assess the relationship between the resting IC and the maximal workload. METHODS: 19 mild to moderate asthmatic patients participating in the cardiopulmonary exercise testing with 19 health volunteers as controls. The incremental test was used. Forced expiratory volume in one second (FEV1) and inspiratory capacity (IC) were measured before the test and FEV1 measurements were repeated after exercise. Heart rate(HR), oxygen uptake(VO2), ventilation per minute(VE), breathing frequency(BF) were continuously measured during the test. RESULTS: There were changes of FEV1 after exercise in asthmatic patients [-(15.5 +/- 13.2)%] vs [+(1.7 +/- 2.7)%], (P < 0.05). They could achieve comparable VO2max (1.8 +/- 0.5) L/min vs (1.8 +/- 0.4) L/min, VEmax (29 +/- 7) L/min vs (31 +/- 5) L/min and O2-pulse max (0.0110 +/- 0.0020) L/beat vs (0.0110 +/- 0.0020) ml/beat with controls, but the BF at maximal exercise in asthmatic patients is significantly decreased (37 +/- 5) times/min vs (41 +/- 6) times/min, (P < 0.05). IC correlate with the maximum workload (r = 0.695, P < 0.05). CONCLUSION: The mild to moderate asthmatic patients had the same cardiopulmonary exercise response as the healthy volunteers, indicating that they did not have ventilatory and circulatory limitation to exercise.

Adult↗

[Comparison of 14-day rehabilitation and oxygen therapy on exercise tolerance and percutaneous oxygen saturation in patients with advanced COPD].

UNLABELLED: Whether rehabilitation may be as beneficial as oxygen therapy (T) in the management of chronic obstructive pulmonary disease (COPD) is still not known. The aim of the was to compare the effects of T or R on exercise tolerance (ET) and percutaneous oxygen saturation (SO2) at rest and at the peak exercise in 21 patients with COPD (FEV1, 1.29 L +/- 0.5) Eleven patients with COPD were treated with oxygen (17 hour per day) for 14 days and 10 patients were rehabilitated. Both groups did not differ in age 63.7 vs 69.3 years, in the baseline values of FEV1, PaCO2 and PaO2 and resting SO2%. Before the study patients R and T had similar resting SO2 values and ET (4.5 +/- 1 vs 3.4 +/- 2 METs, p = NS), but those in the R group revealed higher drop in SO2 at peak exercise test (10.9 vs 3.4%, p = 0.007). RESULTS: We found no significance impact of 14- day R and 14- day T on results of exercise test and exercise pulse oximetry in studied patients. However, rehabilitated patients, as opposite to patients on oxygen therapy had tendency to increase number of Mets and to diminish maximal drop in pulse oximetry during exercise. As a result, when we compared group R i T after study patients of R group differed from T patients with number of METs achieved (4.6 vs 3.0, p = 0.02), whereas maximal drop in SO2 at the peak exercise test in R and T patients equalized (7.9 +/- 7 vs 3.2 +/- 3%, p = NS). We conclude that the results of our short term study may suggest better effects of rehabilitation than oxygen therapy on exercise tolerance and oxygen saturation during exercise in COPD patients and justify further studies.

Aged↗

The effects of pentoxifylline on oxygenation, diffusion of carbon monoxide, and exercise tolerance in patients with COPD.

Pentoxifylline has been reported previously in an unblinded study to improve oxygen saturation, treadmill walk time, and resting diffusion of carbon monoxide (Dco) in patients with COPD. We recruited 12 patients with moderate to severe COPD whose exercise capacity was limited by ventilation or who developed hypoxemia with exercise. Patients were randomized to receive pentoxifylline or placebo, each for a 12-week period in a prospective, double-blind, crossover design study, to assess the effects of pentoxifylline on oxygenation, resting Dco, and exercise tolerance using arterial blood gas analysis. Eleven patients with a mean FEV1 of 0.94 L and a mean Dco of 9.85 mL/min/mm Hg completed the study. One patient withdrew from the study after developing pneumonia. There were no significant differences in resting oxygenation, resting Dco, or spirometry after 12 weeks of pentoxifylline relative to placebo. The 12-min walk test and dyspnea index for activities of daily living were also not significantly different while taking pentoxifylline. Finally, at maximal exercise, there were no differences in workload attained, exercise duration, oxygen consumption, carbon dioxide production, minute ventilation, oxygen saturation, PO2, alveolar-arterial oxygen pressure difference, or Borg score while taking pentoxifylline relative to placebo. We conclude that pentoxifylline does not improve oxygenation, resting Dco, exercise tolerance, or dyspnea in patients with moderate to severe COPD.

Carbon Monoxide↗

Oral diamorphine: lack of effect on dyspnoea and exercise tolerance in the "pink puffer" syndrome.

The aim of this study was to assess the effects of diamorphine on breathlessness and exercise tolerance in patients with severe chronic airflow obstruction and normal arterial carbon dioxide tension (PCO2) levels ("pink puffer" syndrome). In this double-blind, cross-over, randomized study we examined both acute and chronic effects of single and multiple doses of oral diamorphine in 14 "pink puffer" patients. Their mean resting forced expiratory volume in one second (FEV1) was 36% predicted normal, mean arterial oxygen tension (PaO2) was 9.2 kPa and mean PaCO2 was 5.2 kPa. Ten patients took either diamorphine 2.5 or 5 mg or placebo elixir 6 hourly for 2 weeks, recording on a diary card dyspnoea, sleepiness and well-being on a visual analogue scale (VAS). The final treatment was given 30 min before measuring spirometry, arterial blood gases, plasma morphine levels, 6 min walking distances, time walked on treadmill and self-assessment of dyspnoea on a VAS scale after exercise. On two further days, eight patients took two doses, 4 h apart, of either diamorphine 7.5 mg or placebo elixir. Spirometry, 6 min walking distance with a VAS score for dyspnoea were measured before and at 1 h after each dose. Morphine levels and blood gases were also measured. Whether given in single or repeated doses, oral diamorphine had no significant effect on exercise tolerance and breathlessness when compared with placebo. Diamorphine 2.5-7.5 mg produced neither sleepiness nor a deterioration in blood gases. However, plasma levels associated with analgesic efficacy were not achieved with these doses. Thus, as given in this study, oral diamorphine is unlikely to have therapeutic potential in the treatment of dyspnoea in the "pink puffer" syndrome.

Administration, Oral↗

Effects of nipradilol, a new beta-blocking agent with vasodilating properties, on exercise tolerance in patients with stable effort angina: a double-blind study.

The effects of nipradilol, a new beta-blocking agent with vasodilating properties, on exercise tolerance were examined in eight patients with stable effort angina. Symptom-limited treadmill tests were performed two hours after administration of oral nipradilol (9 mg) or placebo in a double-blind manner. Exercise time to the onset of angina was significantly longer after nipradilol than after placebo (6.8 +/- 2.5 min versus 5.0 +/- 1.2 min, P less than 0.05). Exercise duration after nipradilol was not statistically different from that after 0.3 mg of sublingual nitroglycerin (7.2 +/- 1.9 min). Nipradilol significantly decreased heart rate both at rest and during exercise (P less than 0.01). Systolic blood pressure at rest did not change after nipradilol. However, an increase in systolic blood pressure during exercise was inhibited by nipradilol. The pressure rate product was significantly lower after nipradilol than after placebo. It is concluded that nipradilol improves exercise tolerance in patients with stable effort angina by decreasing the myocardial oxygen consumption during exercise.

Adrenergic beta-Antagonists↗

[Effect of a compound preparation pumpan on exercise tolerance and clinical course of ischemic heart disease].

AIM: To study effects of the drug pumpan on exercise tolerance and myocardial ischemia induced by exercise in patients with ischemic heart disease of functional class II-III. MATERIAL AND METHODS: The study included 30 patients with various forms of ischemic heart disease (myocardial infarction, coronary artery bypass grafting) having stable effort angina of functional class II-III. RESULTS: The addition of a compound drug pumpan to a standard antianginal therapy reduced the number of anginal attacks and ST depression at bicycle exercise test. CONCLUSION: Pumpan is an adjuvant medication in conduction of antianginal therapy in ischemic heart disease patients with stable angina of effort of functional class II-III.

Blood Pressure↗

[Effect of physical training with reference to anaerobic threshold on the indicators of exercise tolerance and restoration of work capacity in patients after myocardial infarction].

In patients who had sustained myocardial infarction including that of complicated history, the anaerobic threshold was defined to choose the optimum intensity of physical training. The latter were also examined for effects on exercise tolerance. It was ascertained that measuring physical exercise by heart rate at the level of the anaerobic threshold made it possible to choose the optimal conditions for the aerobic supply of metabolic demands during physical training. Applying physical training under aerobic conditions greatly increases exercise tolerance, prevents recurrent myocardial infarctions and plays an important role in the secondary prevention of coronary heart disease.

Adult↗

Fibrositic myofascial pain in intermittent claudication. Effect of anesthetic block of trigger points on exercise tolerance.

The blocking of trigger points in the calf by the local injection of an anesthetic agent was performed in 15 patients with intermittent claudication. Reactive and exercise hyperemia, work load and duration of exercise were recorded before and after infiltration of the trigger points. Reactive hyperemia does not change, but the exercise tolerance of the leg significantly improves after local blocking of the trigger areas and the exercise hyperemia increases because of the higher work load. The pain pattern of intermittent claudication can be activated by the summation of abnormal input from muscles, due to contraction in the presence of anoxia, with activity from trigger points. Local infiltration of trigger areas blocks theirir activity. The vicious cycle of pain is interrupted and the exercise tolerance of the leg is increased, without improving blood circulation.

Adult↗

The relationship between exercise tolerance and quality of life in angina pectoris.

The relationship between exercise tolerance assessed by a conventional exercise stress test using a standard Bruce protocol and quality of life (QoL) was studied in 50 patients with stable angina pectoris (AP). Before the exercise test, patients completed three self-administered QoL questionnaires, the Psychological General Well-Being Index, an Angina-Specific QoL Questionnaire, and Jenkins' Sleep Dysfunction Scale. Total exercise time (r = -0.40) and time until onset of pain (r = -0.44) were significantly correlated with perceived physical limitations. Somatic symptoms were related to total time (r = -0.38). Apart from a significant correlation between depressed mood and total exercise time (r = 0.36), there was no corresponding correlation with well-being and sleep disturbance. These results suggest that exercise stress tests do not reflect quality of life in patients with AP.

Activities of Daily Living↗

Tyrosine improves appetite, cognition, and exercise tolerance in activity anorexia.

PURPOSE: We have modified for mice the activity wheel model of Routtenberg to study the effects of tyrosine on exercise tolerance, behavior, and brain neurochemistry. METHODS: Mice were fed for 2 h.d(-1) over a 2-wk period. During the second week, each group was injected daily with either saline or tyrosine (100 mg.kg(-1).d(-1)) and exercised on a running wheel. Controls were in cages with inactivated wheels and received the same treatment and feeding protocols as the experimental groups. Food consumption and cognitive function (eight-arm maze) were evaluated for 1 wk. Brains were then assayed for adrenergic and serotonergic metabolites. RESULTS: Activity together with a restricted diet caused extreme weight loss (27%) (P < 0.001) together with decreased food consumption (22%) (P < 0.001). Tyrosine restored food consumption to that of the controls (P < 0.001) with no effect on weight, since there was a 22% increase in activity (P < 0.001). Saline injections caused an 18% decrease in activity (P < 0.001). Both activity and tyrosine improved maze performance (P < 0.05). In the hypothalamus, activity caused a significant increase in 5-hydroxytryptamine (5-HT) (P < 0.001), 5-hydroxyindoleacetic acid (5-HIAA) (P < 0.01), and dopamine (P < 0.05); tyrosine prevented the increase in 5-HT (P < 0.05) and increased 5-HIAA in the controls (P < 0.01). With regard to hippocampal 5-HT, there was a significant increase in 5-HIAA following activity (P < 0.05), whereas tyrosine caused significant increase in 5-HIAA in the controls (P < 0.01). Activity significantly decreased the level of hippocampal 3,4-dihydroxyphenylacetic acid (DOPAC), whereas tyrosine decreased its level only in the controls (both at P < 0.0001). The level of tyrosine hydroxylase increased with activity (P < 0.05), and tyrosine decreased it significantly (P < 0.05). CONCLUSION: Activity anorexia is associated with increased hypothalamic 5-HT concentrations. Tyrosine administration reverses this, and significantly improves food consumption, cognitive behavior, and activity performance. Such nutritional modulations may have implications for the treatment of eating disorders and, in normal circumstances, tyrosine may improve exercise tolerance and delay fatigue.

Animals↗

The effect of lidoflazine on exercise tolerance in patients with angina pectoris.

The effect of therapy with lidoflazine on maximal exercise in the upright position was evaluated in 21 patients with angina pectoris. The study consisted of the following three consecutive periods: (1) a three-month period of receving placebo; (2) six months of therapy with lidoflazine; and (3) a six-month period in which patients were randomized to either therapy with lidoflazine or placebo. Functional status was monitored by multistage tests of exercise capacity and the amount of nitroglycerin consumed. From period 1 to period 2, the mean maxial exercise time increased from 4.4 to 6.5 minutes (48 percent; P less than 0.001), and the external workload increased by 68 percent (P less than 0.001). the mean heart rate at two minutes of exercise decreased from 114 to 101 beats per minute (P less than 0.001) but was unchanged at symptom-tolerated maximal exercise. During period 3, the patients receiving therapy with liodflazine maintained their improved exercise tolerance, and the reduction in mean heart rate at two minutes of exercise persisted. Patients receiving placebo during period 3 had a decrease in exercise tolerance, and the mean heart rate at two minutes of exercise increased to control values. Lidoflazine in effective as an antianginal medication, in part due to suppression of the heart rate during exercise.

Angina Pectoris↗

Effects of continuous positive airway pressure on pulmonary function and exercise tolerance in patients with congestive heart failure.

STUDY OBJECTIVES: Continuous positive airway pressure (CPAP) has been used to improve cardiopulmonary function and reduce pulmonary edema symptoms in patients with congestive heart failure (CHF). The objective of this study was to evaluate the efficacy of CPAP therapy on pulmonary function and exercise tolerance in patients with CHF. DESIGN: Prospective blind randomized clinical study. PARTICIPANTS: Twenty-four patients with class II or III CHF and dilated cardiomyopathy were randomly assigned to 30 min of CPAP therapy and respiratory exercises (CPAP group) or respiratory exercise only (control group) once a day for 14 days. MEASUREMENTS AND RESULTS: Evaluation of pulmonary function was performed measuring FEV1 and FVC. Exercise tolerance was assessed measuring the distance walked during the 6-min walking test (6MWT). These parameters were measured before treatment and 4 days, 9 days, and 14 days later. CPAP therapy caused a progressive increase (p < 0.05) in both FVC (maximum of 16% after 9 days) and FEV1 (maximum of 14% after 14 days) compared to basal values, without significant changes in the control group. The 6MWT showed a progressive improvement in the distance walked in the CPAP group, reaching approximately 28% above the basal values in the CPAP group and without significant changes in the control group. CONCLUSIONS: These data show that the use of CPAP therapy for 2 weeks on a daily basis is able to enhance pulmonary function and consequently improve the tolerance to physical activities in patients with CHF. The clinical implication of this finding is that CPAP therapy could potentially be used as an adjunct to the treatment of CHF patients.

Analysis of Variance↗

Assessment of physical function and exercise tolerance in older adults: reproducibility and comparability of five measures.

This study examined the reproducibility and comparability of five measures of function and exercise tolerance. The test battery and questionnaire on function and physical activity were administered twice, 7-10 days apart to 38 men and 12 women aged 54-80 years at the Baltimore Veterans Affairs Medical Center. Tests included fast pace 4 and 20-meter walks, 6-minute and graded treadmill walks, and a seated step test. All tests demonstrated good reproducibility with Pearson and intraclass correlation coefficients ranging from 0.84 to 0.98, and percent differences on retest ranging from 4 to 11%. Although correlations between different tests were all significant (range 0.34-0.89), comparison of performance ranks and linear regression analyses indicated that the short fast walks and seated step test may not be suitable substitutes for treadmill or long self-paced corridor walks. Only 28% had the same quintile performance ranking on the step test as on the treadmill walk, and 36% had rankings 2 or more points apart. The fast 20m walk shows the most promise as a low-level alternative to the 6-minute walk; performances had a correlation of 0.73, 82% of ranks were within one point, and 20m speed explained 42% of the variance in distance covered. More development is needed for comprehensive assessment of exercise tolerance in older adults; the 6-minute walk did not adequately discriminate fitness level in persons who walk regularly, and the treadmill posed problems for those with walking difficulty.

Aged↗

Effects of cedilanid-D in combination with metoprolol on exercise tolerance and systolic time intervals in angina pectoris.

The interaction between cedilanid-D and metoprolol, a selective beta receptor blocking agent, on exercise tolerance and systolic intervals was studied in 15 patients with angina pectoris. The patients had been treated with metoprolol for several months in a dose of 50 mg, three times daily (one patient received 25 mg three times daily). Each patient participated in two studies separated by at least 1 week. After arriving at the laboratory each received 50 mg of metoprolol orally; thereafter, either cedilanid-D or placebo was infused intravenously in a double-blind study performed in randomized order. When the effect of the drugs was maximal, the systolic intervals and the heart volume were recorded at rest, and the exercise tolerance was tested with a bicycle ergometer. The mean maximal value of plasma concentrations of metoprolol assessed during the study was about 50 ng/ml but the variation among subjects was great (20 to 187 ng/ml). After administration of cedilanid-D there was a shortening of the pre-ejection period and left ventricular ejection time compared with results after placebo; the reduction was similar to that found after administration of cedilanid-D without beta blocking drugs. The total heart volume decreased by an average of 55 ml, but the individual variation was great. The patients' average work capacity, expressed as total work, was not altered by cedilanid-D when compared with results after placebo. No relation was found between initial heart size and the effect of cedilanid-D on capacity for physical work. It therefore appears that there is no indication for the routine use of digitalis during beta blocking therapy in patients with angina pectoris who do not have cardiac failure.

Adrenergic beta-Antagonists↗