Anomalies of coronary arteries

Concealed undiagnosed congenital anomalies of coronary arteries (CACA) can cause sudden death of young men. Isolated CACA are detected at 0.6-1.8% of coronary angiographies. Classification of CACA (2002) includes anomalous origin of coronary artery from pulmonary artery, anomalous origin of coronary artery from the aorta, congenital atresia of the left main coronary artery, coronary arteriovenous fistula, coronary artery with myocardial bridge, coronary artery aneurism, coronary artery stenosis. In most cases coronary artery anomalies for long time remain asymptomatic. Clinical picture of anomalous origin of coronary artery from pulmonary artery is often erroneously related to cardiomyopathy or myocarditis because of signs of heart failure. Modern methods of visualization are used for diagnosis of CACA: echocardiography (transthoracic and transesophageal), computer angiotomography (electron beam tomography, multispiral computer tomography), magnetic resonance angiography, thallium stress scintigraphy, single photon positron emission tomography, dobutamine stress echocardiography, endovascular ultrasound study. Coronary angiography is the gold standard for diagnosis of congenital anomalies of coronary arteries. Drug therapy, transluminal balloon angioplasty with stenting or surgical revascularization are indicated to patients with overt clinical picture.     

Efficacy of fixed combination amlodipine/valsartan in hospitalized patients with hypertensive disease

Efficacy and tolerability of fixed amlodipine/valsartan combination was studied in 86 patients with hypertensive disease hospitalized in departments of general internal medicine or cardiology. All patients had indications for antihypertensive therapy and were randomized either to fixed combination amlodipine/valsartan (n=43) or to therapy which corresponded to the hospital formulary (n=43). Correction of antihypertensive therapy was performed by treating physician at daily rounds. Self-control of blood pressure (BP) was performed by patients with the use of UA767PC apparatus. Results of BP self-control were compared with clinical measurements in order to detect concealed inefficacy of treatment. Results. Rate of achievement of target BP with fixed combination amlodipine/valsartan (93%) was comparable with that on traditional therapy (90%). But the use of fixed combination amlodipine/valsartan compared with traditional therapy was associated with lower clinical and self measured BP, quicker achievement of target BP (5.8+/-2.3 and 9.2+/-1.8 days, respectively, p<0.05), lesser number of antihypertensive drugs (2.5+/-0.6 and 3.0+/-0.9 days, respectively), lower rate of concealed inefficacy of treatment (12 and 31%, respectively, p<0.05). Conclusions. We have demonstrated appropriateness of inhospital administration of fixed amlodipine/valsartan combination as an approach allowing to achieve target BP in shorter time, with the use of fewer antihypertensive drugs, and diminishing concealed inefficacy of treatment.     

Efficacy and tolerability of felodipine based antihypertensive therapy in hospitalized patients with hypertension

AIM: To compare efficacy and tolerability of felodipine based antihypertensive therapy with those of standard hospital treatment of hypertension. MATERIAL: Inhospital patients were randomized 1:2 to standard antihypertensive therapy or to therapy which included felodipine (n=50 and 100, 36 and 35% men, mean age 66.0+/-8.4 and 64.3+/-8.1 years, initial blood pressure 162.4+/-9.3/99.3+/-6.4 and 163.2+/-10.3/98.2+/-6.5 mm Hg, respectively). Felodipine was used: (1) as first drug with subsequent addition of other drugs as required; (2) after cessation of previously ineffective therapy; (3) in cases of intolerance to previous therapy, (4) as supplementation to previously insufficiently effective therapy. Results. At discharge in felodipine group 6, 25, 29 and 40% of patients received mono- (felodipine 10 mg/day), 2, 3 and 4 component therapy, respectively. In standard treatment group all patients received combination therapy with 3 (48%) or 4 (52%) drugs. Felodipine group compared with group of standard therapy was characterized by less frequent correction of antihypertensive therapy (0.8+/-0.6 and 2.2+/-0.9, p<0.05), smaller number of drugs used (3.03+/-0.95 and 3.52+/-0.5, p<0.01), more frequently achievement of target blood pressure level (88 and 64%, p=0.0075), less pronounced difference between morning and evening self-measured blood pressure. CONCLUSION: The use of felodipine in hospitalized patients with hypertension allowed achieving target blood pressure with fewer drugs. Felodipine was safe and well tolerated.