Cardiologists Debate Expensive Heart Scans New York Times, United States - 45 minutes ago ?You don?t want to perform an invasive procedure on everyone who has chest pain in the emergency room,? Dr. Lima said. ?We?ve demonstrated that CTA can ...
Learn 'How Not to Die' ABC News - For some unknown reason, Victor decided not to see a doctor, even as the unchecked infection spread to his chest and the pain became excruciating. ...
Dr. Mallika's Files: 'Am I Having A Heart Attack?' WBZ, MA - It causes localized chest pain that is reproduced when you push on the chest wall. Costochondritis often mimics a heart attack, but it's a harmless ...
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Diagnosing chest pain using an angiogram test CaymanMama.com (press release), TX - Nov 29, 2008 But most chest pain patients need to go through the angiography test anyway to find out the extent of blockage in the blood vessels. ...
Woman sues drug company Novartis Quad City Times, IA - Officials said that an analysis found a higher chance of heart attack, stroke and chest pain in patients treated with Zelnorm compared with people treated ...NVS
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The Military Family Network eMilitary.org - Nov 28, 2008 Learning correct lifting techniques and strengthening your back can help to alleviate pain. Use a luggage cart or lighten your load when lifting heavy ...
Closing the gender health gap Toronto Star, Canada - Among the findings: Two-thirds were unaware that the frequently cited symptoms of a heart attack ? sudden pain in the chest, arm, neck, jaw or back ? apply ...
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Recent News and Articles on the Keywords: nitroglycerin + chest + 4,200 Related to the article below (Last Update: 8/7/2008)
FBI: Hospital CEO arrested in health care scheme The Associated Press - At least once, she suffered a serious drop in blood pressure after she was given a nitroglycerin patch for a nonexistent cardiopulmonary condition, ...
Researchers Paving the Way for New Heart Disease Treatments University of Arizona News (press release), AZ - Aug 1, 2008 ... nitric oxide is also the active ingredient in nitroglycerin, which has long been manufactured as a drug to relax blood vessels and control the chest...
Free UM event at Cabela's aimed at hunters' hearts Media Newswire (press release), NY - Aug 2, 2008 ... also ask their doctors if they should carry nitroglycerin tablets, to increase blood flow to their hearts if they suffer chest pain or a heart attack. ...
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Platelet-induced pulmonary hypertension and JE Repine, JE Heffner, SA Shoemaker, EM Canham, M … - Chest - Am Coll Chest Phys ... It Copyright ? 1983 by American College of Chest Physicians on ... requests: Dr Repine,
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Coronary heart disease attack rate, incidence and mortality 1975-1994 in Goteborg, Sweden - L Wilhelmsen, A Rosengren, S Johansson, G Lappas - European Heart Journal, 1997 - Eur Soc Cardiology ... with intravenous beta-blockers followed by oral treatment, nitroglycerin and
thrombolytics ... scruti- nized three times weekly with regard to chest pain, cardiac ...
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Possible mitochondrial damage with chronic use of Nitroglycerin for chest pain
A study by Howard Hughes Medical Institute investigators at Duke University Medical Center has provided evidence on how Nitroglycerin relieves chest pain.
Nitroglycerin relaxes blood vessels to boost blood flow, yet the mechanism by which the drug works has remained a matter of scientific controversy.
The findings bolster earlier indications that the drug may be ineffective for certain patients, and may place others at risk, the researchers said.
The results also suggest that certain other drugs should be avoided by heart patient's taking the blood vessel dilator, as those drugs' activity might counteract nitroglycerin's effects.
Such drugs include sulfonylureas used by diabetics, chloral hydrates used for sleep disorders and Acetaminophen ( also called Paracetamol ). Alcohol may also block the effect of nitroglycerin, said the researchers.
The researchers found through studies in mice that the mitochondria break down Nitroglycerin to release nitric oxide, thereby opening blood vessels and lowering blood pressure.
Nitric oxide normally present in the bloodstream plays a critical role in controlling blood vessel relaxation.
Nitroglycerin loses its effects on blood flow in animals lacking a particular mitochondrial enzyme called aldehyde dehydrogenase ( mtALDH ).
" Doctors have prescribed Nitroglycerin for the relief of chest pain for some 150 years, yet the mechanism by which the drug works has remained a matter of debate," said study author Jonathan Stamler, at Duke. " The findings confirm that mtALDH is critical for nitroglycerin action."
" The results should bring closure to long-standing scientific controversy, and will likely change the way physicians deliver Nitroglycerin therapy to patients," he added. " These findings should certainly motivate a reassessment of this class of drugs."
First discovered in 1847 and brought to public prominence by the famed Alfred Nobel, who manufactured it first as an explosive, Nitroglycerin is a common treatment for chest pain and heart failure.
While the drug can effectively relieve chest pain, it tends to lose it effectiveness over time, Stamler said.
More recent evidence has raised additional concerns about the drug's potential to cause long-term injury to the heart, and perhaps even death.
As a result of the drug's long history of use, its benefits for patient outcomes have never been demonstrated through the rigorous clinical trials that are now standard in cardiovascular care, Stamler explained.
In normal mice, treatment with nitroglycerin led to a drop in blood pressure, which increased with drug dose, the researchers showed.
Mutant mice lacking mtALDH lose the ability to process Nitroglycerin, the team reported. As a result, the drug failed to lower blood pressure in the mutant mice at doses comparable to those prescribed to patients.
" The current study finds that mtALDH is both necessary and sufficient for generating vasodilation from clinically relevant levels of nitroglycerin," Stamler said.
Animals unable to process Nitroglycerin continued to respond to alternative Nitrate drugs that dilate blood vessels, suggesting that those drugs work through an independent mechanism.
" We thought that all of these drugs worked in the same way through the release of nitric oxide," Stamler said. " The current findings require us to revisit the implications of the use of these drugs."
Chronic use of the drug could lead to mitochondrial damage, which may ultimately increase patients' cardiovascular risk, Stamler said. Therefore, the drug should be prescribed judiciously, he added.
Sustained use of the drug might place some patients at particular risk, Stamler said. For example, physicians should use caution in treating patients, such as those with diabetes, who often already suffer mitochondrial damage.
The drug might also be less effective for patients with particular variants of the ALDH gene. Notably, many Asian people carry a mutant version of the gene characterized by reduced ALDH activity. The lower activity enzyme would leave such patients less responsive to Nitroglycerin therapy, Stamler said.
The study is published in Proceedings of the National Academy of Sciences ( PNAS ).
