Lege Artis Medicinae

[IVABRADINE - FROM IF INHIBITION TO THE TREATMENT OF PATIENTS WITH STABLE ANGINA]

KOLOZSVÁRI Rudolf, ÉDES István

NOVEMBER 30, 2006

Lege Artis Medicinae - 2007;17(02 klsz)

[Ivabradine is a new agent that selectively inhibits the If channels of the sinus node. Electrophysiological studies have shown a significant heart rate lowering effect of ivabradine compared to placebo, while no significant changes have been observed in the frequency-corrected QT interval (QTc) or in the conductivity or refractoriness of the atrial muscle, AV node, His- Purkinje system or ventricular muscle. In a noninferiority study that compared ivabradine to atenolol, the same efficacy was shown in terms of increasing effort tolerance and reducing anginal events, with less reduction in heart rate. The same results were obtained with the comparison to amlodipine - the two drugs were equally efficient. The longest trial investigated the efficacy and safety of ivabradine for 12 month; both heart rate and the number of anginal episodes significantly decreased during the entire study period. The ongoing BEAUTIFUL trial tests ivabradine in patients with heart failure. The only important side effect of ivabradine is phosphenes, but this rarely requires the treatment to be discontinued. No other side effects such as symptomatic bradycardia or conduction abnormalities have been observed. Ivabradine is currently indicated as an alternative treatment of stable angina pectoris.]

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[THERAPY WITH TRIMETAZIDINE IN DIABETIC PATIENTS WITH CORONARY DISEASE]

NAGY András

[In the diabetic heart the efficacy of haemodynamic agents is limited due to vascular stiffness. Metabolic drugs such as trimetazidine switch energy production from fatty acid oxidation typical to diabetes to the more efficient glycolysis. The improved energy production increases contractility. Three studies have been conducted with trimetazidine in patients with comorbid diabetes and coronary artery disease. In these, trimetazidine improved left ventricular function without modifying heart rate or blood pressure. Markers of glycaemic control also improved. Trimetazidine also reduced the levels of circulating endothelin-1. In conclusion, trimetazidine is a safe and effective drug that improves both myocardial function and glycaemic control in patients with coexisting diabetes and coronary artery disease.]

Lege Artis Medicinae

[METABOLIC APPROACH IN THE THERAPY OF LEFT VENTRICULAR DYSFUNCTION]

MÁRK László

[Coronary heart disease has traditionally been treated by haemodynamic agents including beta-blockers, calcium channel blockers and nitrates. Trimetazidine, which shifts myocardial energy metabolism from fatty acid oxidation towards glucose oxidation, thereby providing a more efficient oxygen utilization, represents a new, metabolic approach in the medical treatment of this condition. The present review gives an overview of recent studies on the beneficial effects of trimetazidine in severely or moderately impaired left ventricular function. In addition to the parameters that characterize left ventricular ejection function and the to the improvement of clinical symptoms, the beneficial effects of trimetazidine after coronary angioplasty and in the older age are also discussed. Treatment is safe and the efficacy is maintained in the long-term.]

Lege Artis Medicinae

[UNIQUE BENEFITS OF INDAPAMIDE TREATMENT]

NAGY Viktor

[The benefit of blood pressure lowering to high risk cardiovascular patients is proven. Thiazides are first line agents of blood pressure lowering treatment. Indapamide has both thiazide-like and vasodilator effects. Randomized controlled trials have shown that slow release indapamide of 1.5 mg efficiently lowers blood pressure, as well as the risk of various cardiovascular events (left ventricular hypertrophy, secondary stroke, progression of nephropathy etc.). Due to the low dose, the drug is well tolerated. Slow release indapamide is therefore an ideal choice as monotherapy for the beginning of blood pressure lowering treatment, and it is also a base drug of combination treatments.]

All articles in the issue

Related contents

Lege Artis Medicinae

[If-CHANNEL INHIBITION - A NEW APPROACH IN THE TREATMENT OF ISCHAEMIC HEART DISEASE]

TÓTH Kálmán

[Life span, body mass and metabolic rate are strongly related to resting heart rate. Several studies suggest that the reduction of heart rate has a beneficial effect on cardiac morbidity and mortality. Ivabradine, the first selective and specific If- channel inhibitor, has a novel and unique mode of action on cardiac pacemaker activity. It acts at the core of heart rate regulation by specifically binding to the f-channel of the sinus node cell and selectively inhibiting the If (funny) current. Praeclinical studies have convincingly proved that this drug reduces heart rate without any adverse electrophysiologic or haemodynamic side effects.]

Lege Artis Medicinae

[ELEVATED RESTING HEART RATE AND THE RISK OF CARDIOVASCULAR MORTALITY]

BORBOLA József

[In ancient times medical practitioners already knew that heart rate is a measure of the general condition of the soul and body. Worldwide epidemiologic studies in the past decades indicated that decreased resting heart rate, a parameter that can be simply measured, has a favourable direct effect on cardiovascular risk. This consistent beneficial risk-reducing effect can be clearly shown in the asymptomatic general population as well as in patients with hypertension, stable coronary artery disease, acute myocardial infarction and congestive heart failure irrespective of gender, age or ethnic origin. In the asymptomatic general population this beneficial effect is mainly due to reduced early coronary artery disease events and diminished risk of sudden cardiac death. Population studies have clearly shown that decreasing resting heart rate - either by physical exercise or medical treatment - improves cardiovascular survival, and decreases the overall and cardiovascular mortality. It seems reasonable to conclude that in modern pharmacotherapy of cardiovascular disease the use of selective heart rate lowering drugs that directly act on the pacemaker activity of the sinus node (If-channel blockers) are warranted.]

Clinical Neuroscience

[EFFECT OF EPILEPTIC SEIZURES ON THE HEART RATE]

TÓTH Vanda, HEJJEL László, KALMÁR Zsuzsanna, FOGARASI András, AUER Tibor, GYIMESI Csilla, SZŰCS Anna, JANSZKY József

[Background - Sudden death appears in 8-17% of epilepsy patients non-responding to antiepileptic therapy. Some studies suggest that the most common cause of death is seizure-related cardiac arrhythmia. Aim of study - To analyze the alteration of the heart rate six hours before and after the seizures. Methods - Eighteen patients suffering from focal epilepsy were examined before epilepsy surgery. Video-EEG-ECG was carried out for 2-10 days, and 32 seizures were registered. Analysis of the heart rate was based on the 5- minute-long epochs of the ECGs taken at the 5-10-15- 30th minutes and at the 1-3-6th hours before and after seizures. Results - The heart rate increases (from average 69 beats/min to 92 beats/min, p<0.001) immediately after seizures, tough significantly higher heart rate was observed 3 hours after seizures. There were no patients with severe periictal bradycardia. In one of our patients, ectopic cardiac rhythm occurred after a generalized tonicclonic seizure. Conclusions - We can conclude that the sympathic activity increases while the parasympathic activity decreases after seizures. The observed alterations lasted for a long time and predict to fatal arrhythmias. These suggest that sudden death in epilepsy can be induced by cardiac arrhythmias connected with epileptic seizures.]