Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0002962 (angina)
 21,142 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The clinical course and coronary arteriographic findings in 5 patients with Prinzmetal's variant angina pectoris are reviewed. In 4 patients who had ST-elevations inferiorly, 1 had minimal, 1 only slight, and 1 medium coronary artery disease; 1 had coronary spasm. 1 patient with ST-elevation anteriorly had severe stenosis of the anterior descending coronary artery. All 5 patients had normal left ventriculograms, 3 also had normal left enddiastolic pressure, and 2 slight elevation. Medical treatment was carried out in 2 patients and surgical revascularization in 2. Both treatments were accompanied by marked symptomatic improvement. Spontaneous loss of angina occurred in 1 patient. Prinzmetal's variant angina pectoris may be accompanied by a variety of coronary arteriographic findings and the prognosis appears to be more favorable than previously reported.
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PMID:[Prinzmetal angina: clinical aspects and coronarographic findings]. 0 73

Coronary angiography was performed during 34 angina attacks in thirty patients admitted because of recurrent angina at rest. Nineteen (seventeen with S-T segment elevation and two S-T depression) had angiograms during a spontaneous attack, eleven (nine with S-T elevation and two with S-T depression) during an attack induced by intravenous ergonovine maleate. Control coronary angiograms showed a wide range of atherosclerotic obstruction, from normal vessels to severe triple-vessel disease. During the anginal attack, all patients with S-T segment elevation had vasospasm localised to one of the major branches, often resulting in complete occlusion. Attacks with S-T segment depression were seen only in patients with double or triple vessel disease, and here the vasospasm generally affected coronary branches without causing complete occlusion. When appropriately searched for, vasospastic angina seems to be common.
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PMID:Coronary vasospasm in angina pectoris. 6 16

In 3 patients with Prinzmetal's variant angina there were inferior epicardial injury patterns on the electrocardiogram, corresponding to right coronary artery narrowing. Attacks were provoked by beta-adrenergic blockade and stopped by nitroglycerine and atropine. Spasm of the right coronary artery was demonstrated in the 2 patients who had high parasympathetic activity. In all 3 cases attacks disappeared on verapamil. We suggest that calcium-antagonists, which dilate the coronary arteries, should be used in the treatment of Prinzmetal's angina pectoris rather than beta-adrenergic blockers, which do not have this property.
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PMID:Treatment of Prinzmetal's angina due to coronary artery spasm using verapamil: a report of three cases. 9 8

The clinical significance and mechanism for changes in the axis of the QRS complex during attacks of angina pectoris (excluding cases of Prinzmetal's angina) are unknown. Previous work has suggested that left anterior hemiblock under these circumstances is a sign of unstable angina indicating a lesion in the anterior descending artery. Two cases with left anterior hemiblock associated with frequent attacks of angina have been the subject of careful study. In case one, atrial stimulation tests showed that the left axis deviation was not related to tachycardia. It only occurred when atrial stimulation was carried out for long enough to induce myocardial ischaemia as witnessed by precordial pain and disorders of repolarisation. In case two, the left anterior hemiblock came on at first at the same time as the attacks of angina, and then became permanent. Bypass graft of the anterior descending artery restored the QRS axis to normal, and corrected the repolarisation disorders which were of ischaemic origin. These findings argue in favour of an ischaemic origin of this conduction defect. Unlike ischaemia of the left anterosuperior subbranch, anterior left hemiblock is indicative of extensive ischaemia of the anterior wall of the left ventricle relative to an obstruction in the anterior descending artery or in the main trunk of the left coronary artery.
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PMID:[Isolated left anterior hemiblock during attacks of angina pectoris]. 10 80

31 patients presenting with Prinzmetal variant angina were divided into three groups according to their angiographic appearances. Group I comprised 9 patients with normal or coronary arteries with lesions less than 50% narrowing. Group II comprised 12 patients with single vessel disease. Group III comprised the other 10 patients with significant lesions on two or all three principal arteries. No clinical or electrocardiographical differences were found between the groups as to age, sex or the clinicapresentation of the chest pain. Most patients with normal or nearly normal coronary arteries had normal electrol cardiogrammes between attacjs (8 out of 9) and electrical changes mainly over the inferior wall (8 out of 9). Exercise electrocardiography reproduced ST elevation in 4 of the 9 patients but, in contrast to the patients in the other two groups, never ST depression. However, these features are not specific for patients in Group I as they were observed in 4 patients in the other two groups. Spontaneous or induced coronary spasm were observed in 27 patients, confirming its role as the mechanism of Prinzmetal angina, whatever the anatomical appearance of the coronary tree.
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PMID:[Clinical and angiographic study and pathogenic mechanism of Prinzmetal's angina. Apropos of 31 cases]. 10 80

Methylergometrine (Methergin) was given intravenously (0.4 mg) to 118 patients undergoing coronary arteriography. The electrocardiogramme and intraaortic pressure was continuously monitored whilst coronary arteriography was performed, 1,3, and 5 minutes after the injection of the ergot alkaloid. The test was positive if: 1) coronary spasm was observed; 2) if ST segment elevation was recorded with or without pain. Positive tests were obtained in 13 out of 14 patients with Prinzmetal angina. The test was negative in the other patients. However in 3 patients with Prinzmetal angina, the test produced typical coronary spasm without electrocardiographic changes. In Prinzmetal angina the sensitivity of this test was 93 p. 100 with a high specificity: 96-100 p. 100 depending on whether or not electrocardiographical changes associated with spasm are considered. Taking into account current therapeutic methods of treating Prinzmetal angina the indications of this test of coronary spasm are: 1) patients presenting with resting angina whatever the state of their coronary arteries; 2) patients with documented Prinzmetal angina with "angiographically normal" coronary arteries.
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PMID:[Detection of coronary artery spasm by the methylergometrin test. Technic. Results. Indications]. 10 90

An analysis of 2,394 selective coronary angiograms yielded 23 examples of coronary artery spasm. Of these, nine occurred in patients with Prinzmetal's variant angina and 14 were instances of catheter-induced spasm. Angiographic criteria can distinguish between the spasm of variant angina and catheter-induced spasm. The latter is usually asymptomatic, almost invariably in the right coronary artery, at the catheter tip, smooth, concentric, and less than 2 mm long. The former can occur in any coronary artery at a distance of 1--4 cm from the catheter tip, is usually irregular and eccentric, and is associated with angina, ST segment elevation, hypotension, and dysrhythmia. Response to nitroglycerin is often, but not always, complete in both. Stenoses that seem to be fixed in patients with Prinzmetal's angina should be suspected to be spasm even if unresponsive to nitroglycerin, especially when the rest of the vessel is normal. Additional pharmacologic manipulation and even recatheterization may be necessary to prove the dynamic nature of the lesion and avoid unnecessary surgery.
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PMID:Coronary spasm: Prinzmetal's variant angina vs. catheter-induced spasm; refractory spasm vs. fixed stenosis. 10 65

The authors report 36 cases of spontaneous angina occurring in the absence (group A) or presence (group B) of a myocardial infarct (MI), either recent or old, and accompanied, during the attacks, by transient ST elevation (T ST E) and normal enzyme levels. Group A (16 cases) was characterised by : a) the severity of the prognosis with the development of rhythm disturbances during the attacks in 10 out of 16 cases, and of a MI and/or sudden death in 4 of the 6 cases treated medically; b) the presence, in 12 of the 14 cases explored of surgical stenosis of a major coronary trunck. The simple association of attacks of spontaneous angina and T ST E is in general sufficient to define severe angina, regardless of the height of the elevation, and for which a surgical indication (95 p. cent of our cases) with the same problems as those posed by Prinzmetal angina strictly defined on a series of clinical and electrocardiographic criteria. Group B (20 cases) :a) differed from group A by the incidence of cardiac failure (15 out of 20 cases), the widespread nature and degree of the anatomical lesions, not usually amenable to by-pass; b) the severe prognosis, reflected in 6 of the 17 cases treated medically by extension of the MI and/or sudden death, did not differ fundamentally from that of any subsequent relapse, regardless of its electrocardiographic signs. In these cases, the T ST E related to the presence of the MI does not have the same significance as in Prinzmetal angina, and progressive relapses of MI should no longer be classified in this group on the pretext that they are accompanied by T ST E.
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PMID:[Spontaneous angina with ST elevation. Significance and prognostic value]. 13 Jun 17

Variant angina presents as an atypical form of angina caused by coronary artery spasm. Due to the sudden disruption of blood and oxygen supply to the myocardium, a number of severe hemodynamic changes may occur, including life-threatening dysrhythmias, and left ventricular dysfunction. Rapid intervention can alleviate the symptoms caused by the arterial spasm and prevent catastrophic results. The critical care nurse plays a vital role in the diagnosis of variant angina and rapid treatment of the patient.
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PMID:Variant angina: a nursing approach. 25 69

In order to determine the natural evolution of different clinical types of "unstable angina", 167 patients were included in a prospective study. After angiography, 11 (6.5%) were excluded because they had no significant coronary lesions. The remaining 156 were sorted into different groups according to their clinical characteristics and were followed up for a period of 24 months at least. After that follow-up period, mortality and incidence of acute myocardial infarction (AMI) were as follows: angina of recent onset (Class III--IV NYHA): 8.5% (3/35) and 34.2% (12/35). Progressive angina: 7.4% (2/27) and 7.4% (2/27). Intermediate syndrome: 41.6% (10/24) and 37.5% (9/24). Prinzmetal's angina: 10% (1/10) and 10% (1/10). Post acute myocardial infarction angina: 35% (7/20) and 10% (2/20). Acute persistent ischemia: 2.5% (1/40) and 20% (8/40). Comparison of these figures pointed out significant differences (p less than 0.001 for mortality and p less than 0.03 for AMI incidence respectively). We conclude that it is clinically possible to identify different groups within the so-called unstable angina. Such a division not only allows for the creation of more homogeneous groups, but it contributes to a more rational therapeutic approach and also permits identification of high risk prodromes of greater complications, such as myocardial infarction or sudden death.
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PMID:Clinical spectrum of "unstable angina". 26 65


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