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VASCULAR AND CARDIAC CONTRACTILE RESERVE IN DOG HEART WITH CHRONIC MULTIPLE CORONARY OCCLUSIONS

AMERICAN HEART JOURNAL 1976年第5期92卷 600-608页

作者： SCHWARZ, F FLAMENG, W MACK, B TURSCHMANN, W SCHAPER, W MAX PLANCK INST PHYSIOL & KLIN FORSCH D-6350 BAD NAUHEIM FED REP GER

Mongrel dogs (19) survived chronic occlusion of the left circumflex and of the right coronary artery without infarction due to the timely development of a collateral circulation. Only 38% of the conductance of the arteries before occlusion was restored by collateral vessels. In these animals and in 15 control dogs with normal coronary arteries myocardial contractility, contractility reserve and myocardial blood flow were studied. The same was done in dogs with chronic coronary artery occlusion after aortocoronary bypass. In normal dogs norepinephrine alone did not result in maximal coronary flow but only 57% thereof. The norepinephrine-stimulated contractile reserve of hearts with chronic coronary occlusion was apparently comparable to that of normal hearts;however, norepinephrine forced these hearts to spend the entire flow reserve of the remaining normal artery while producing ischemia in collateral-dependent areas. The same dose of norepinephrine did not require the entire flow reserve of normal dogs.

关键词：血压/药物作用慢性病冠状动脉分流术冠状动脉循环/药物作用冠心病/病理生理学冠心病/外科学冠状血管/病理生理学心内膜心率/药物作用充血/病理生理学输注胃肠外心肌收缩/药物作用去甲肾上腺素/药理学氧耗量/药物作用血管舒缩系统/病理生理学动物狗女(雌)性男(雄)性

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ORTHOSTATIC HYPOTENSION - MECHANISMS AND MANAGEMENT

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AMERICAN HEART JOURNAL 1975年第4期90卷 513-520页

作者： IBRAHIM, MM TARAZI, RC DUSTAN, HP CLEVELAND CLIN EDUC FDN CLEVELAND OH 44106 USA CLEVELAND CLIN FDN RES DIV CLEVELAND OH 44106 USA

There is no single drug that proved effective in the treatment of orthostatic hypotension. Oral sympathomimetics like ephedrine, wyamine, aramine, and similar drugs are generally prescribed but, in our experience, their effectiveness is unpredictable; however they should be given a trial. Mineralocorticoids have already been referred to, 9 α fluorohydrocortisone (Florinef) is the one we use. Besides producing salt and water retention and expanding the blood volume, an effect which helps venous filling of the heart, it may increase the responsiveness of arterioles to the neurotransmitter. Recently there are claims that tyramine rich foods combined with monoamine oxidase inhibitors are effective in the treatment of resistant cases of IOH, but results were not encouraging when this regimen was tried in two of our patients. All kinds of drug therapy carry the danger of precipitating hypertension. Frequent observation of arterial pressure at weekly intervals is recommended. When Florinef is prescribed one should start with a small dose (0.1 mg. per day) which can be increased gradually according to therapeutic response. In conclusion the treatment of orthostatic hypotension still presents a challenging problem. The aim should be to keep the patient active and ambulatory as long as possible.

关键词：自主神经系统血压血量缓激肽/血液用力氟氢可的松/治疗应用低血压直立性/药物疗法低血压直立性/病理生理学神经系统疾病/并发症体位压力感受器/病理生理学氯化钠/治疗应用血管阻力血管舒缩系统/病理生理学人类

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MODERN SYSTEM FOR TREATING HIGH BLOOD-PRESSURE BASED ON RENIN PROFILING AND VASOCONSTRICTION VOLUME ANALYSIS - PRIMARY ROLE FOR BETA BLOCKING-DRUGS SUCH AS PROPRANOLOL

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AMERICAN JOURNAL OF MEDICINE 1976年第5期61卷 797-810页

作者： LARAGH, JH NEW YORK HOSP CORNELL MED CTRCTR HYPERTENSION & CARDIOVASC NEW YORK NY 10021 USA

A new system is proposed for treating the spectrum of patients with high blood pressure. It is based on studies of the renin axis using renin profiling, pharmacologic probes and our bipolar vasoconstriction-volume hypothesis. The new system does not require renin profiling, pharmacologic testing or a vasoconstriction-volume analysis for widespread application. But these procedures, whenever available, will make treatment more efficient and more certain, and at the same time provide better base line definition. In the new system, all patients, except the elderly and those with congestive heart failure, bradycardia or a history of asthma, are treated first with propranolol alone, a procedure which will diminish or normalize blood pressure in many patients with high and normal renin levels. For nonresponders, diuretic therapy is then superimposed. Subsequently, a propranolol subtraction trial picks out the low-renin patients who will usually respond to a diuretic alone. This program is likely to be fully effective in possibly up to 85 per cent of patients. For the residual smaller fraction, drugs such as hydralazine, methyl DOPA, clonidine, reserpine or guanethidine are then added in traditional trial and error fashion. The proposed system has the theoretic attraction for long-term commitment, implicit in antihypertensive therapy, of achieving blood pressure control in large fractions with one drug instead of two or with two drugs instead of three or more. Moreover, the large groups who respond to therapy with propranolol alone (most high-renin and normal-renin patients) or to diuretics alone (most low-renin patients) gain the advantage of simpler, more specific, long-term (i.e., antirenin or antivolume) therapy. The use of propranolol alone has practical and theoretic advantages over diuretics. Control may be achieved with even fewer side effects and without hypokalemia and chronic dehydration with its possibly adverse consequences (hyperuricemia, azotemia, hyperlipid

关键词：肾上腺素能β受体拮抗剂/治疗应用利尿药/治疗应用药物疗法联合高血压/血液高血压/药物疗法高血压/病理生理学普萘洛尔/治疗应用肾素/拮抗剂和抑制剂肾素/血液血管舒缩系统/病理生理学人类

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Racial heterogeneity in coronary artery vasomotor reactivity: Differences between Japanese and Caucasian patients

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第6期33卷 1442-1452页

作者： Beltrame, JF Sasayama, S Maseri, A Univ Adelaide Cardiol Unit NW Adelaide Hlth Serv Adelaide SA 5005 Australia Kyoto Univ Hosp Dept Cardiovasc Med Grad Sch Med Kyoto 606 Japan Univ Cattolica Sacro Cuore Cardiol Inst Agostino Gemelli Hosp I-00168 Rome Italy

Japanese investigators have provided a substantial contribution in the understanding of coronary vasomotor reactivity: On occasions, their findings have been at variance with those undertaken on caucasian patients, raising speculation that vasomotor differences between races may exist. In a comparative review of the published literature, we evaluated the vasoreactive differences among Japanese and caucasian patients with variant angina or myocardial infarction. Tn variant angina, Japanese patients appear to have diffusely hyperreactive coronary arteries compared with caucasian people, manifested by their segmental rather than focal spasm, hyperreactive nonspastic vessels and multivessel spasm. These differences may reflect the increased basal tone among Japanese variant angina patients and may relate to controversial differences in endothelial nitric oxide production or autonomic nervous system activity. Provocative vasomotor studies of Japanese patients with a recent myocardial. infarction report a higher incidence of inducible spasm than caucasian studies, an observation recently supported by a controlled study. Furthermore, the hyperreactivity was diffuse, occurring in both non-infarct- and infarct-related vessels. These observations support the existence. of racial coronary vasomotor reactivity differences but require confirmation in further prospectively conducted studies. (C) 1999 by the American College of Cardiology.

关键词：心绞痛变异型/人种学心绞痛变异型/遗传学亚洲大陆世系人群/遗传学自主神经系统/病理生理学冠状动脉循环/遗传学冠状动脉循环/生理学冠状血管痉挛/人种学冠状血管痉挛/遗传学冠状血管痉挛/病理生理学欧洲大陆世系人群/遗传学心肌梗死/人种学心肌梗死/遗传学心肌梗死/病理生理学一氧化氮/生理学血管舒缩系统/病理生理学成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Improvement of endothelial vasomotor dysfunction by treatment with alpha-tocopherol in patients with high remnant lipoproteins levels

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第6期33卷 1512-1518页

作者： Kugiyama, K Motoyama, T Doi, H Kawano, H Hirai, N Soejima, H Miyao, Y Takazoe, K Moriyama, Y Mizuno, Y Tsunoda, R Ogawa, H Sakamoto, T Sugiyama, S Yasue, H Kumamoto Univ Sch Med Dept Cardiovasc Med Kumamoto 860 Japan

OBJECTIVES This study sought to examine whether oral intake of alpha-tocopherol, an antioxidant, could improve endothelium-dependent vasorelaxation in patients with high remnant lipoproteins levels. BACKGROUND Remnant lipoproteins are known to be atherogenic and impair endothelium-dependent arterial relaxation, but the underlying mechanisms remain unclear. Oxidative stress is a common feature of various risk factors for atherosclerosis. METHODS Flow-mediated vasodilation of the brachial artery during reactive hyperemia was examined by high resolution ultrasound technique before and at the end of 4 weeks treatment with oral administration of alpha-tocopherol acetate (300 IU/day) or placebo, which was randomly assigned, in 40 patients with high serum levels of remnants and in 30 patients with low remnants levels in the fasting state (>75th percentile and <25th percentile, respectively, of the distribution of remnants levels in 150 consecutive hospitalized patients). RESULTS Before treatment, flow-mediated vasodilation was lower in patients with high remnants levels than in those with low levels (4.1 +/- 0.3% vs. 6.0 +/- 0.5%, p < 0.01). Treatment with alpha-tocopherol but not with placebo significantly increased flow-mediated dilation in patients with high remnants levels (7.5 +/- 0.1% after alpha-tocopherol vs. 4.2 +/- 0.4% after placebo, p < 0.01). in patients with low remnants levels, alpha-tocopherol was not effective. The beneficial effect with alpha-tocopherol in high remnants patients was associated with decrease in plasma levels of thiobarbituric add reactive substances, an indicator of lipid peroxidation (6.6 +/- 0.3 nmol/ml before alpha-tocopherol vs. 4.6 +/- 0.3 after alpha-tocopherol, p < 0.05). CONCLUSIONS Alpha-tocopherol improved impairment of endothelium-dependent vasodilation in patients with high remnants levels. The increase in oxidative stress may at least partly contribute to endorhelial vasomotor dysfunction in patients with high remnants levels.

关键词：抗氧化剂/投药和剂量载脂蛋白类/血液肱动脉/药物作用肱动脉/病理生理学胆固醇/血液冠状动脉疾病/药物疗法冠状动脉疾病/病理生理学内皮血管/药物作用内皮血管/生理学高胆固醇血症/药物疗法高胆固醇血症/病理生理学高甘油三酯血症/药物疗法高甘油三酯血症/病理生理学脂类/血液脂蛋白类/血液血管舒缩系统/药物作用血管舒缩系统/病理生理学维生素E/投药和剂量成年人老年人女(雌)性人类男(雄)性中年人

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Contribution of endogenous nitric oxide to basal vasomotor tone of peripheral vessels and plasma B-type natriuretic peptide levels in patients with congestive heart failure

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2000年第5期36卷 1605-1611页

作者： Ishibashi, Y Shimada, T Sakane, T Takahashi, N Sugamori, T Ohhata, S Inoue, S Katoh, H Sano, K Murakami, Y Hashimoto, M Shimane Med Univ Dept Internal Med 4 Izumo Shimane 6938501 Japan Shimane Med Univ Dept Physiol Izumo Shimane 6938501 Japan

OBJECTIVES We examined whether a relationship exists between the vasoconstrictive response to endogenous nitric oxide (NO) synthesis inhibition and the severity of heart Failure in patients with congestive heart failure (CHF). BACKGROUND Controversy exists as to whether the vasoconstrictive response to NO synthesis inhibition in patients with CHF is comparable to that in normal subjects or is enhanced. METHODS Forearm blood flow (FBF) and calculated forearm vascular conductance (FVC) were obtained using plethysmography before and after administration of the NO synthesis inhibitor L-NMMA (N-G-monomethyl-L-arginine) in 40 patients with CHF due to dilated cardiomyopathy and in 16 normal control subjects. Basal plasma B-type natriuretic peptide (BNP) and nitric oxide concentrations were measured in all subjects. RESULTS Plasma BNP and nitrite/nitrate (NOx) levels in the patients group were significantly greater and baseline FBF was significantly less. Administration of L-NMMA significantly decreased FBF and FVC in both groups. The percent changes in FBF (%FBF) and FVC (%FVC) from the baseline after L-NMMA correlated significantly with plasma BNP level (%FBF: r = 0,72;%FVC: r = 0.76;both p < 0.001). Percent changes in both FBF and FVC were greater in patients with BNP 100 pg/ml than in normal subjects;however, in patients with BNP < 100 pg/ml they were comparable to those in normal subjects. CONCLUSIONS Vasoconstrictive response to L-NMMA in patients with CHF was preserved or enhanced in proportion to the basal plasma BNP level, indicating a close relationship between the contribution of endogenous NO to basal vasomotor tone and the severity of heart failure. (C) 2000 by the American College of Cardiology.

关键词：心钠素/血液酶抑制剂/药理学心力衰竭/血液心力衰竭/病理生理学肌张力/药物作用肌张力/生理学利钠肽脑一氧化氮/生理学局部血流/药物作用局部血流/生理学疾病严重程度指数血管舒缩系统/药物作用血管舒缩系统/病理生理学 ωN-甲基精氨酸/药理学成年人老年人女(雌)性人类男(雄)性中年人

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CUTANEOUS VASCULAR-RESPONSES IN DIABETICS

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MICROVASCULAR RESEARCH 1975年第1期10卷 8-16页

作者： GREESON, TP FREEDMAN, RI LEVAN, NE WONG, WH UNIV SO CALIF MED CTRDEPT MEDLOS ANGELESCA 90033

Cutaneous circulatory responses in the lower extremities of 26 diabetic patients were studied utilizing plethysmographic and isotope clearance techniques. The diabetic group demonstrated diminished capacity for vasodilatation to both direct and indirect stimuli. The data does not allow differentiation of neuropathic and angiopathic involvement. The diabetic group also demonstrated a significantly lower rate of 133-Xenon and 131-NaI clearance.

关键词：糖尿病血管病变/病理生理学糖尿病神经病变/病理生理学酯类呋喃类/药理学热温度碘放射性同位素刺激剂/药理学烟酸类/药理学物理刺激体积描记术放射性示踪剂放射性同位素稀释技术局部血流/药物作用皮肤/血液供给刺激化学性血管舒缩系统/病理生理学氙放射性同位素成年人老年人女(雌)性人类男(雄)性中年人

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Adaptational responses to hypoxia

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AMERICAN JOURNAL OF PHYSIOLOGY-REGULATORY INTEGRATIVE AND COMPARATIVE PHYSIOLOGY 2002年第6期282卷 R1541-R1543页

作者： Scholz, H Humboldt Univ Johannes Muller Inst Physiol Med Fak Charite D-10117 Berlin Germany

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ABNORMALITIES IN REGIONAL CIRCULATIONS ACCOMPANYING CONGESTIVE HEART-FAILURE

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PROGRESS IN CARDIOVASCULAR DISEASES 1975年第3期18卷 181-199页

作者： ZELIS, R NELLIS, SH LONGHURST, J LEE, G MASON, DT PENN STATE UNIV COLL MEDMILTON S HERSHEY MED CTRDIV CARDIOLHERSHEYPA 17033 UNIV CALIF SCH MEDSECT CARDIOLDAVISCA

In congestive heart failure, patients appear to have a limited ability to dilate their resistance vessels in skeletal muscle in response to a metabolic stimulus. This is true whether the metabolic stimulus is ischemia, dynamic, or static exercise. The mechanism for this limited arteriolar capacity is at least twofold; an increased sodium content of the vessels as well as an increased tissue pressure which is seen in edematous states. This can be considered a positive compensatory mechanism in that it helps to maintain systemic arterial pressure during exercise when the cardiac output fails to increase normally. If the resistance vessels were to dilate normally, then in the face of a limited cardiac output, exercise syncope would be expected to occur. Such a situation does, in fact, occur when patients with congestive heart failure are subjected to intense diuresis. The price paid by heart failure patients for the maintenance of arterial pressure during exercise is an earlier shift to anaerobic metabolism. Because of the limited blood flow to exercising muscle, there is an increased oxygen extraction as the blood traverses the metabolically active muscular beds. This increased oxygen extraction, however, is not sufficient to allow aerobic metabolism to proceed normally. Hence, patients with heart failure are more subject to developing metabolic acidosis during exercise and at lesser levels of exertion than their normal counterparts. This may partly explain the greater oxygen debt seen in patients with congestive heart failure following exercise. A second abnormality present in the peripheral circulations of patients with congestive heart failure is an increased sympathetic alpha adrenergic tone as well as an increased level of circulating catecholamines. This is most true in symptomatic patients at rest and during exertion in most patients with heart failure who are limited in their exercise capacity. This increased sympathetic tone helps to explain the seemingly par

关键词：基膜血流速度心血管系统/病理生理学儿茶酚胺类/生理学洋地黄糖甙类/药理学心力衰竭/病理生理学充血/病理生理学吗啡/药理学肌/血液供给去甲肾上腺素/药理学氧耗量/药物作用强体力活动局部血流/药物作用休息皮肤/血液供给血管舒缩系统/病理生理学静脉压人类

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EXPERIMENTAL BRAIN-DAMAGE FROM FLUID PRESSURES DUE TO IMPACT ACCELERATION .2. PATHOPHYSIOLOGICAL OBSERVATIONS

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ACTA NEUROLOGICA SCANDINAVICA 1975年第1期52卷 27-37页

作者： STALHAMMAR, D UNIV GOTHENBURG DEPT NEUROSURG41345 GOTHENBURGSWEDEN UNIV GOTHENBURG DEPT HYG41345 GOTHENBURGSWEDEN

The significance of the intracranial acceleration pressure pattern at impact to the intact skull in production of brain damage is discussed, particularly as regards the contre-coup pressures. A rigid fluid-filled cylinder was connected to the skull cavity of rabbits; the cylinder was impacted and the intracranial contents acted as a contre-coup end. The pressure pattern was also modified by injection of small quantified air volumes. The pathophysiological effects of "experimental brain concussion" with vasomotor and respiratory disturbances which occurred were related to the contre-coup pressures produced, particularly the magnitude of subatmospheric pressures and the duration of late positive pressures. Some implications on their significance for brain tissue flow are discussed.

关键词：加速度大气压脑损伤/病理生理学疾病模型动物颅内压方法呼吸时间因素血管舒缩系统/病理生理学动物女(雌)性男(雄)性兔

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