Diltiazem alone and combined with nitroglycerin: effect on normal and diseased human coronary arteries

The vasodilatory effect of diltiazem and nitroglycerin on the large epicardial coronary arteries was evaluated in 26 patients with coronary artery disease. The luminal area of a normal and a stenotic coronary artery was determined at rest, after intracoronary administration of diltiazem, during submaximal exercise as well as 5 min after 1·6 mg sublingual nitroglycerin using biplane quantitative coronary arteriography. Twelve patients with no pretreatment prior to the exercise test served as group 1 (controls) and 14 patients with intracoronary administration of 2 to 3 mg diltiazem prior to the exercise test as group 2. Normal vessel: In the control group luminal area increased significantly during exercise (+23%, P<0·01) and after sublingual administration of nitroglycerin (+40%, P<0·001). In group 2 luminal area increased after intracoronary administration of diltiazem (+19%, P<0·01), during bicycle exercise (+23%, P<0·001) and after sublingual administration of nitroglycerin (+39%, P<0·001). Stenotic vessel: In the control group luminal area decreased significantly (−29%, P<0·001) during bicycle exercise but increased after sublingual administration of nitroglycerin at the end of the exercise test (+12%, NS vs. rest). In group 2 intracoronary administration of diltiazem was associated with a mild increase in stenosis area (+11%, P<0·05). There was a further increase in stenosis area during bicycle exercise (+23%, P<0·001 vs. rest) and after sublingual nitroglycerin (+32%, P<0·001). Coronary vasodilation of the stenotic segment was, however, significantly more pronounced after sublingual nitroglycerin in group 2 than 1 (+32% versus 12%, P<0·05). Thus, it is concluded that diltiazem prevents exercise-induced coronary vasoconstriction of the stenotic vessel segment probably due to its direct vasorelaxing action on the smooth vasculature. Diltiazem combined with nitroglycerin elicits an additive effect on coronary vasodilation of the stenotic vessel segments but not on the normal coronary arteries. The exact mechanism of this additive effect is not clear but might be due to the combined action of the two vasoactive drugs with different mode of actio

Leaves and fruits preparations of Pistacia lentiscus L.: A review on the ethnopharmacological uses and implications in inflammation and infection

There is an increasing interest in revisiting plants for drug discovery, proving scientifically their role as remedies. The aim of this review was to give an overview of the ethnopharmacological uses of Pistacia lentiscus L. (PlL) leaves and fruits, expanding the search for the scientific discovery of their chemistry, anti-inflammatory, antioxidative and antimicrobial activities. PlL is a wild-growing shrub rich in terpenoids and polyphenols, the oil and extracts of which have been widely used against inflammation and infections, and as wound healing agents. The more recurrent components in PlL essential oil (EO) are represented by α-pinene, terpinene, caryophyllene, limonene and myrcene, with high variability in concentration depending on the Mediterranean country. The anti-inflammatory activity of the oil mainly occurs due to the inhibition of pro-inflammatory cytokines and the arachidonic acid cascade. Interestingly, the capacity against COX-2 and LOX indicates PlL EO as a dual inhibitory compound. The high content of polyphenols enriching the extracts provide explanations for the known biological properties of the plant. The protective effect against reactive oxygen species is of wide interest. In particular, their anthocyanins content greatly clarifies their antioxidative capacity. Further, the antimicrobial activity of PlL oil and extracts includes the inhibition of Staphylococcus aureus, Escherichia coli, periodontal bacteria and Candida spp. In conclusion, the relevant scientific properties indicate PlL as a nutraceutical and also as a therapeutic agent against a wide range of diseases based on inflammation and infections

Coronary vasomotor tone during static and dynamic exercise

Coronary vasomotion is an important determinant of myocardial perfusion in patients with angina pectoris, and it influences not only normal but also stenotic coronary arteries. The ability of a stenotic coronary artery to change its size is dependent on the presence of a normal musculo-elastic wall segment within the stenosis (i.e., eccentric stenosis). Coronary vasoconstriction of normal and stenotic coronary arteries has been reported by Brown and coworkers (Circulation 1984; 70: 18-24) during isometric exercise. The effect of dynamic exericse on coronary vasomotion was evaluated in one group of 13 patients with ischaemia-like symptoms and normal coronary arteries (group 1) and in a second group of 12 patients with coronary artery disease with exercise-induced angina pectoris (group 2). Luminal area of a normal and a stenotic vessel segment was determined by biplane quantitative coronary arteriography at rest, during supine bicycle exercise and 5 min after administration of 1·6 mg sublingual nitroglycerin. Coronary sinus blood flow was measured in group 1 at rest and after 0·5 mg kg−1 intravenous dipyridamole using coronary sinus thermodilution. Coronary flow reserve was calculated from coronary sinus flow after dipyridamole divided by coronary sinus flow at rest. In group 1, coronary vasodilation of the large (i.e., proximal) and the small (i.e., distal) coronary arteries was observed during exercise in seven patients (subgroup A). However, in the remaining six patients (subgroup B) coronary vasoconstriction of the small arteries (−24%, P<0·001) was found during exercise, whereas the large vessels showed coronary vasodilation (+26%, P<0·001). Coronary flow reserve was significantly (P<0·05) larger in subgroup A (mean 2·5) than in subgroup B (mean 1·2) with exercise-induced vasoconstriction of the small epicardial arteries. In group 2 vasodilation of the normal (+23%, P<0·001) and vasoconstriction of the stenotic coronary arteries (−29, P<0·001) was found during supine bicycle exercise. Administration of sublingual nitroglycerin at the end of the exercise test was accompanied by coronary vasodilation of both normal (+40%, P<0·001 vs rest) and stenotic (+12%, NS vs rest) vessel segments. It is concluded that isometric exercise is associated with reflex coronary vasoconstriction of the normal and stenotic vessel segments due to enhanced sympathetic stimulation. Dynamic exercise in patients with ischaemia-like symptoms and normal coronary arteries is accompanied by an abnormal dilatory response of the small coronary arteries in a subgroup of patients with reduced coronary flow reserve. Dynamic exercise in patients with coronary artery disease is, however, associated with coronary vasodilation of the normal and coronary vasoconstriction of the stenotic vessel segments. The nature of this exercise-induced vasoconstriction of stenotic coronary arteries is not clear, but might be related to endothelial dysfunction with an insufficient production of the endothelium-derived relaxing factor during exercis

Diltiazem alone and combined with nitroglycerin: effect on normal and diseased human coronary arteries

The vasodilatory effect of diltiazem and nitroglycerin on the large epicardial coronary arteries was evaluated in 26 patients with coronary artery disease. The luminal area of a normal and a stenotic coronary artery was determined at rest, after intracoronary administration of diltiazem, during submaximal exercise as well as 5 min after 1·6 mg sublingual nitroglycerin using biplane quantitative coronary arteriography. Twelve patients with no pretreatment prior to the exercise test served as group 1 (controls) and 14 patients with intracoronary administration of 2 to 3 mg diltiazem prior to the exercise test as group 2. Normal vessel: In the control group luminal area increased significantly during exercise (+23%, P<0·01) and after sublingual administration of nitroglycerin (+40%, P<0·001). In group 2 luminal area increased after intracoronary administration of diltiazem (+19%, P<0·01), during bicycle exercise (+23%, P<0·001) and after sublingual administration of nitroglycerin (+39%, P<0·001). Stenotic vessel: In the control group luminal area decreased significantly (−29%, P<0·001) during bicycle exercise but increased after sublingual administration of nitroglycerin at the end of the exercise test (+12%, NS vs. rest). In group 2 intracoronary administration of diltiazem was associated with a mild increase in stenosis area (+11%, P<0·05). There was a further increase in stenosis area during bicycle exercise (+23%, P<0·001 vs. rest) and after sublingual nitroglycerin (+32%, P<0·001). Coronary vasodilation of the stenotic segment was, however, significantly more pronounced after sublingual nitroglycerin in group 2 than 1 (+32% versus 12%, P<0·05). Thus, it is concluded that diltiazem prevents exercise-induced coronary vasoconstriction of the stenotic vessel segment probably due to its direct vasorelaxing action on the smooth vasculature. Diltiazem combined with nitroglycerin elicits an additive effect on coronary vasodilation of the stenotic vessel segments but not on the normal coronary arteries. The exact mechanism of this additive effect is not clear but might be due to the combined action of the two vasoactive drugs with different mode of actio

Artificial reefs: from ecological processes to fishing enhancement tools

info:eu-repo/semantics/publishedVersio

Coronary vasomotor tone during static and dynamic exercise

Coronary vasomotion is an important determinant of myocardial perfusion in patients with angina pectoris, and it influences not only normal but also stenotic coronary arteries. The ability of a stenotic coronary artery to change its size is dependent on the presence of a normal musculo-elastic wall segment within the stenosis (i.e., eccentric stenosis). Coronary vasoconstriction of normal and stenotic coronary arteries has been reported by Brown and coworkers (Circulation 1984; 70: 18-24) during isometric exercise. The effect of dynamic exericse on coronary vasomotion was evaluated in one group of 13 patients with ischaemia-like symptoms and normal coronary arteries (group 1) and in a second group of 12 patients with coronary artery disease with exercise-induced angina pectoris (group 2). Luminal area of a normal and a stenotic vessel segment was determined by biplane quantitative coronary arteriography at rest, during supine bicycle exercise and 5 min after administration of 1·6 mg sublingual nitroglycerin. Coronary sinus blood flow was measured in group 1 at rest and after 0·5 mg kg−1 intravenous dipyridamole using coronary sinus thermodilution. Coronary flow reserve was calculated from coronary sinus flow after dipyridamole divided by coronary sinus flow at rest. In group 1, coronary vasodilation of the large (i.e., proximal) and the small (i.e., distal) coronary arteries was observed during exercise in seven patients (subgroup A). However, in the remaining six patients (subgroup B) coronary vasoconstriction of the small arteries (−24%, P<0·001) was found during exercise, whereas the large vessels showed coronary vasodilation (+26%, P<0·001). Coronary flow reserve was significantly (P<0·05) larger in subgroup A (mean 2·5) than in subgroup B (mean 1·2) with exercise-induced vasoconstriction of the small epicardial arteries. In group 2 vasodilation of the normal (+23%, P<0·001) and vasoconstriction of the stenotic coronary arteries (−29, P<0·001) was found during supine bicycle exercise. Administration of sublingual nitroglycerin at the end of the exercise test was accompanied by coronary vasodilation of both normal (+40%, P<0·001 vs rest) and stenotic (+12%, NS vs rest) vessel segments. It is concluded that isometric exercise is associated with reflex coronary vasoconstriction of the normal and stenotic vessel segments due to enhanced sympathetic stimulation. Dynamic exercise in patients with ischaemia-like symptoms and normal coronary arteries is accompanied by an abnormal dilatory response of the small coronary arteries in a subgroup of patients with reduced coronary flow reserve. Dynamic exercise in patients with coronary artery disease is, however, associated with coronary vasodilation of the normal and coronary vasoconstriction of the stenotic vessel segments. The nature of this exercise-induced vasoconstriction of stenotic coronary arteries is not clear, but might be related to endothelial dysfunction with an insufficient production of the endothelium-derived relaxing factor during exercis