Comparison of the first dose response of Fosinopril and Captopril in congestive heart failure: a randomized, double-blind, placebo controlled study

The purpose of this study was to compare the safety and tolerability of recommended initial doses of a long-acting angiotensin converting enzyme inhibitor (ACE-I)Fosinopril (FOS) with those of a short-acting ACE-I Captopril (CAP) in diuretic-treated, salt deplete"high risk"patients with CHF. 30 patients were randomized in a double blind fashion to recieve a single dose of either FOS 10 mg or CAP 6.25 mg or placebo.Maximal fall in MAP after theraphy within 24 h was respectively -31%,-22%,-20% (FOS-CAP, p<0.05; FOS - plasebo, p=n.s), The practical importance of the results are: Oral ACE-inhibitors have different effects on the BP after the first dose, this effect does not dependent on the plasma ACE-A level,though FOS produced ACE-I similar to CAP and BP changes similar to placebo, so it is safer in the treatment of CHF

Wolff-Parkinson-White syndrome mimicking acute anterior myocardial infarction in a young male patient - A case report

A young male with Wolff-Parkinson-White syndrome whose electrocardiographic pattern was suggestive of acute anterior myocardial infarction is described. A 21-year-old male with a history of ventricular fibrillation after being successfully resuscitated was admitted to the coronary care unit. His electrocardiogram showed ST elevation in the precordial leads (V-1-V-6). This condition was erroneously interpreted as an acute myocardial infarction. At the fourth day, while ST elevations returned to baseline, short PR interval and delta waves were observed on the ECG. Myocardial infarction was excluded by biochemical tests, echocardiography, and coronary angiography. Electrophysiologic study confirmed Wolff-Parkinson-White syndrome with two accessory pathways

Impaired heart rate variability as a marker of cardiovascular autonomic dysfunction in multiple sclerosis

Multiple sclerosis (MS) can cause alterations in autonomic cardiovascular functions. We aimed to investigate the correlation of disease activity and disability with heart rate variability (HRV) of cardiovascular autonomic dysfunction (CAD) demonstrated by 24-h Holter monitorization. Thirty-four patients with clinically active relapsing-remitting MS, age 33.8 ± 7.6 years, were studied. Twenty healthy volunteers served as controls. The time domain long-term HRV parameters were recorded by a digicorder recorder calculated by ambulatory electrocardiograms.Variabilities in time domain were lower in the MS patients: SDNN (standard deviation of all R-R intervals, p = 0,019), SDANN (standard deviation of the averages of R-R intervals in all 5-minute segments of the entire recordings, p = 0,040), RMSSD (the square root of the mean of the sum of the squares of differences between adjacent R-R intervals, p = 0,026), HRVM (mean of the SDNN in all the 5-minute intervals, p = 0,029), HRVSD (standard deviation of the SDNN in all the 5-minute, p = 0,043). These results suggest that MS causes CAD manifesting as long-term HRV abnormalities. This illness seems to cause a dysfunction in parasympathetic cardiovascular tone. Depressed HRV parameters are independent from the clinical findings, but the illness progression partially seems to provoke a decrease in such parameters

Comparison of the first dose response of fosinopril and captopril in congestive heart failure: A randomized, double-blin, placebo controlled study

The purpose of this study was to compare the safety and tolerability of recommended initial doses of fosinopril (FOS) with those of captopril (CAP), in diuretic-treated, salt depleted "high risk" patients with congestive heart failure. Thirty patients were randomized in a double blind fashion to receive a single dose of either FOS 10 mg, CAP 6.25 mg or placebo. CAP produced a significant early and brief fall in BP, while the first-dose hypotensive response with FOS did not differ significantly from placebo. Baseline plasma angiotensin converting enzyme (ACE) activity was similar in all groups. Only CAP showed an acute and significant fall in plasma ACE activity, whereas FOS and placebo did not change ACE activity. There was no correlation between mean arterial pressure or percentile change in mean arterial pressure and plasma ACE activity. Also no correlation was found between high or low ACE activity level and first dose hypotension. The practical importance of the results are: For patients with congestive heart failure, FOS and CAP have different effects on BP after the first dose, and this effect may be dependent on the plasma ACE activity level. FOS produces ACE inhibition and BP changes similar to placebo so it is the safer choice for the treatment of congestive heart failure