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 antianginal and anti-ischemic effect of isosorbide dinitrate (ISDN), 120 mg once daily, and nifedipine, 20 mg twice daily, both in slow-release formulations, were compared in 17 patients with variant angina pectoris in a randomized, double-blind trial. The design included a placebo run-in period and two 6-week crossover periods of active treatment. Mean frequency of angina decreased significantly from 43 attacks per week during the placebo period to 4 per week with ISDN and 8 with nifedipine (p less than 0.001). Sublingual nitroglycerin consumption decreased significantly from 37 tablets per week with placebo to 3 tablets per week with ISDN and 7 with nifedipine (p less than 0.001). Both drugs reduced the silent and symptomatic ST-segment deviations on ambulatory electrocardiographic recording and increased maximal exercise tolerance. Episodes of coronary spasm could be provoked, by hyperventilation, in all patients during the placebo phase but in no patient during therapy with either active drug. Thus, both ISDN and nifedipine, in their slow-release formulations, are effective in the treatment of variant angina pectoris.
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PMID:Randomized double-blind comparison of isosorbide dinitrate and nifedipine in variant angina pectoris. 219 Apr 62

Spontaneous angina is an ideal condition in which to study left ventricular (LV) dysfunction induced by acute myocardial ischemia. In 6 patients with Prinzmetal's angina, LV diastolic function during 16 episodes of spontaneous angina was studied by simultaneous recordings of electrocardiographic (ECG), echocardiographic and hemodynamic parameters. In particular, pulsed Doppler echocardiography measured peak velocity of early (E) and late (A) transmitral flow and E/A ratio, as indexes of relative early versus late LV filling. During the ischemic attacks, the time sequence of pulsed Doppler echocardiographic and ECG changes showed 3 distinct phases: (1) "waxing phase: transmitral flow changes with minimal ECG modifications (E/A = 0.85 +/- 0.1); (2) "steady" phase: maximal ECG changes (E/A = 0.9 +/- 0.1); and (3) "waning" phase: regression of the ECG changes (E/A = 1.26 +/- 0.15). In each phase, E/A ratio showed a significant difference from the baseline value (E/A = 1.17 +/- 0.2) as a result of changes in E, suggesting that myocardial ischemia affects mainly the early phase of diastole. In the waxing phase, LV diastolic dysfunction preceded systolic abnormalities, as documented by a significant reduction of E/A ratio in the absence of alterations in LV ejection fraction, as well as in systemic arterial and pulmonary wedge pressures. Finally, all the recorded parameters were consistent with LV "contractile rebound" occurring in the waning phase and affecting both diastole and systole.
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PMID:Doppler assessment of left ventricular filling pattern in silent ischemia in patients with Prinzmetal's angina. 222 Jun 31

A 66-year-old man having a long history of angina on effort has started to show frequent episodes of angina at rest since 6 months ago. He noticed that chest pain was uncommon after taking alcohol. A variant form of angina pectoris (variant angina) was diagnosed by documentation of typical ST elevation during anginal attack and also by inducing coronary arterial spasm with intracoronary administration of ergonovine maleate. Ambulatory ECG monitoring revealed frequent ST elevation during sleep. Since the history suggested that alcohol ingestion could be effective for preventing variant angina, this effect was examined by giving 540 ml of "sake" in the evening. Variant angina was inhibited, while plasma ethanol was detected. The plasma ethanol reached its peak value as 152 mg/dl at 10 o'clock pm and returned to zero after 12 hours. When ethanol disappeared in the plasma, variant angina recurred again. Although the precise mechanism for inhibition of variant angina by alcohol ingestion is not clear, alcohol or its metabolite such as acetaldehyde seems to be able to inhibit coronary arterial spasm.
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PMID:[Inhibition of vasospastic angina by alcohol ingestion]. 223 66

Two cases of perioperative coronary spasm following ASD closure and OMC are reported. A 36-year-old female had been diagnosed of vasospastic angina and another 47-year-old female patient was diagnosed of effort angina for 99% stenosis of the right ventricular branch preoperatively. Both patients suffered from coronary vasospastic attack and ventricular fibrillation several times within 17 hours postoperatively. Although the coronary dissolution was obtained finally following aggressive cardiac massage, administration of spasmolytic agents, such as NTG, lidocaine, DBcAMP and the start of IABP, the resolution was stormy due to the hemodynamic derangement. To prevent the coronary spastic episode, it is suggested, for patients of possible coronary spasm, to avoid arousal stimulation and to administer spasmolytic agents prophylactically within the first postoperative day.
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PMID:[Two cases of perioperative coronary vasospasm following ASD closure and OMC]. 225 Apr 35

Variant angina is frequently accompanied by serious arrhythmias. The aim of our study was to verify the role of early nitrate administration in prevention of these arrhythmias. We compared arrhythmias occurrence in the course of 104 episodes of chest pain with ST elevation during which short acting nitrate was not administered (group I) and 114 episodes with administration of 2.5 mg isosorbit dinitrate (ISDN) spray (group II). Serious arrhythmias occurred in spontaneous episodes in 41 cases (39%) and in episodes with early ISDN administration in 15 cases (13%). Particular types of arrhythmias were as follows: ventricular premature beats in group I 32 and in group II only 12, supraventricular premature beats 4, resp. 3, A-V block IInd or IIIrd degree 5, resp. 1, ventricular tachycardia 5, resp. 0, junctional bradycardia 0, resp. 1. In conclusion, early administration of nitrates at the very beginning of stenocardia during coronary spasm can prevent or reduce the occurrence of serious arrhythmias.
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PMID:[Decreasing the occurrence of arrhythmia during coronary spasm by the early administration of nitrates]. 226 24

Coronary artery disease may present as silent ischemia, chronic typical angina pectoris, unstable angina, Prinzmetal angina, acute myocardial infarction, and sudden cardiac death. These manifestations can usually be differentiated by the clinical history. Each of them has its own pathophysiology and, accordingly, therapy and prognosis are different. Myocardial ischemia is common to all of the manifestations and this can be assessed by history taking, ECG stress-testing, ambulatory monitoring, myocardial perfusion scanning, or radionuclide angiography (RNA). The diagnostic accuracy of these diagnostic procedures varies from 70% (history) to 81% (RNA).
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PMID:[Clinical presentation and diagnosis of coronary heart disease]. 231 79

We experienced two cases of primary coronary artery dissection. (Case 1) 55-year-old man had frequent episodes of chest oppression at early morning and midnight. During chest oppression, electrocardiogram showed transient ST-segment elevation in leads II, III, and a VF. Then, he was diagnosed as having angina pectoris. This diagnosis was based on the fact that he presented coronary spastic syndrome. Right coronary angiogram demonstrated an intimal flap and false lumen at segment 3, and primary coronary dissection was confirmed. (Case 2) A 27-year-old woman complained of back pain while taking a bath. Electrocardiogram showed ST-segment elevation and abnormal Q in leads V2, V3 and V4. She was diagnosed as having acute anterior wall myocardial infarction. Presence of coronary artery dissection at segment 6 was identified by left coronary angiogram. Primary coronary artery dissection is clinically diagnosed by coronary angiogram very rarely. Only 27 such cases have been reported. It was speculated that, in case 1, vasospastic angina may be associated with primary coronary artery dissection. Case 2 had primary coronary artery dissection at segment 6 of the left anterior descending artery. Thus, her clinical picture was similar to those of previously reported cases.
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PMID:[Two cases of primary artery dissection]. 233 Apr 59

173 patients, aged 46.8 years on the average, were examined in the first 3 months after onset of angina pectoris. 97% of them presented at least one of risk factors (smoking, arterial hypertension, overweight, dyslipoproteinaemia), in 79% two or more risk factors were present simultaneously. A greater than 70% stenosis of one coronary artery was present in 51%, in 10% the stenosis was smaller than 70%, in 4% the coronary arteries were intact. In 131 patients without a history of myocardial infarction, vasospastic angina, overweight, and simultaneous presence of 3 or 4 risk factors occurred more frequently than in 42 patients with a history of myocardial infarction. In the first month, complications were registered only in patients with unstable angina pectoris (5 out of 41, i.e., 12%). During the later period of follow-up in 102 patients, complications occurred in 5% and complete clinical remission was registered in 35%. In patients with remission, positive exercise tests and haemodynamically significant stenoses of 2 or 3 coronary arteries were less frequently found on initial examination than in patients with sustained angina pectoris.
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PMID:New-onset angina pectoris: initial characteristics and results of a 6 to 12-month follow-up. 235 Sep 72

Restenosis after percutaneous transluminal coronary angioplasty (PTCA) probably results from pathophysiological mechanisms that are initiated during PTCA. Platelet deposition or exposed subendothelial connective tissue initiates complex blood element and vessel wall interactions that are not completely understood and leads to a proliferative response at the site of injury. The incidence of restenosis is also related to clinical, anatomic, and procedural variables. An increased frequency of restenosis is seen in patients who have recent onset of angina, unstable angina, or vasospastic angina, and in those who have diabetes. Stenoses in the proximal left anterior descending coronary artery, the ostium of the right coronary artery, and the proximal portion of a bypass vein graft have higher rates of restenosis than lesions at other sites. Restenosis can be predicted by an incomplete PTCA, which is identified by a high residual pressure gradient across the stenosis. Mechanical and pharmacological methods of preventing restenosis are under investigation. Intravascular stenting with expandable metal sleeves and laser angioplasty have shown encouraging results. Longer balloon inflation time can help prevent early elastic recoil. Platelet inhibitors (e.g., aspirin, dipyridamole, and sulfinpyrazone) do not appear to have an effect on restenosis. Agents, however, that interfere with platelet deposition at the PTCA site and that modify the effect of platelet-derived growth factor and medial cell proliferation show promise for control of restenosis.
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PMID:Restenosis after percutaneous transluminal coronary angioplasty--anatomic and pathophysiological mechanisms. Strategies for prevention. 240 72

Heart rhythm and conductivity disorders, developing during anginal attacks, and their relation to the pattern of myocardial ischemia have been studied, using 24-hour ECG monitoring, in 60 patients with stable angina, and in 67 patients with unstable angina. Heart rhythm and conductivity disorders at the ventricular level were much more common in Prinzmetal's angina (73%), as compared to the attacks involving ST depression (10%). Their incidence depended both on the direction and magnitude of ST displacement. The probability of supraventricular arrhythmias was unrelated to the magnitude and direction of ST displacement. They tended to develop during the attacks, accompanied by slanting ST depressions (43%) rather than flat ones (8%). Arrhythmias were considerably more common as a complication of the attacks of unstable angina (42%) rather that stable angina (15%) owing to more severe myocardial ischemia.
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PMID:[Disorders of cardiac rhythm and conduction during attacks of stenocardia]. 247 Sep 49


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