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)

Surgical treatment of coronary artery disease has been under development for more than 35 years, during which time it has been met with considerable enthusiasm. As the surgical risk decreases, indications for coronary bypass procedures are being liberalized somewhat and increasing numbers of patients are being referred for surgical treatment. The most immediate benefit of such treatment is prompt relief from angina and improvement in the quality of life. Other benefits for various patient subgroups are improvement in left ventricular function and prolonged life. Further experience and controlled studies gradually will elucidate further indications for coronary artery bypass surgery and will result in improved evaluation of this treatment.
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PMID:Expectations of myocardial revascularization. 30 81

Cardiovascular disease is the major casue of death in maintenance hemodialysis patients. We report two chronic hemodialysis patients with unstable, disabling angina in association with severe coronary artery disease involving all three major vessels. Both successfully underwent coronary artery bypass surgery and subsequently experienced dramatic clinical improvement. Principles of management are discussed and it is suggested that hemodialysis patients should not be arbitrarily denied consideration of coronary artery bypass surgery when it is otherwise indicated.
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PMID:Successful coronary artery bypass in hemodialysis patients. 30 29

Predictors for operative mortality (OM) were studied in 172 consecutive patients (pts) undergoing coronary artery grafts (CAG) for angina pectoris.Seventy eight pts had Class IV angina; of the 147 patients given propranolol, 41 were gradually withdrawn from propranolol and finally discontinued 24 hours before surgery, and 106 were abruptly withdrawn from propranolol 24 hours before CAG; 20 pts had left main coronary disease; 156 pts had cardiopulmonary bypass (CPB) time shorter than 20 minutes, and 16 pts had a CPB longer than 120 minutes.The operative mortality was 5.2% (9/172) for the entire group. Class IV angina (OM 7%), abrupt propranolol withdrawal (OM 6.6%), left main coronary artery disease (OM 25%), and CPB longer than 120 minutes (OM 50%), all significantly increased OM. These variables were interdependent, however, as many pts belonged to several predictor categories, combinations of predictors were examined, in order to more accurately predict the risk of individual pts. The combination of left main coronary artery disease and CPB longer than 120 minutes; and Class IV angina and CPB longer than 120 minutes were significantly associated with higher operative mortality.We conclude that Class IV angina, abrupt propranolol withdrawal, left main coronary artery disease and prolonged CPB are potent, interdependent predictors of OM in pts undergoing CAG. Consideration of these predictors, alone and in combination, allows effective prediction of OM for CAG in patients with stable angina pectoris.
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PMID:Predictors of operative mortality for coronary bypass grafting in patients with ischemic heart disease. 30 73

43 patients (group A) who had a recurrence of angina after aortocoronary bypass surgery were compared with 93 (group AF) who remained symptom free for at least 1 yr in order to assess the effects of pre- and intraoperative factors on the outcome of surgery. Age and sex distribution, severity and duration of preoperative angina, incidence of preoperative infarction, known coronary risk factors and severity of coronary artery disease assessed angiographically, were similar in the 2 groups. Group A had a lower preoperative exercise tolerance (434 V, 517 ppm/min; P less than 0.05) and a greater proportion of patients with cardiac enlargement (33% V, 14%; P less than 0.05). Fewer grafts were implanted in this group (1.65 V, 2.05; P less than 0.01) which consequently had a higher postoperative coronary score (2.47 V, 1.69; P less than 0.05). It appears that the extent of myocardial revascularization may influence the symptomatic result of aortocoronary bypass surgery.
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PMID:Angina following aortocoronary bypass surgery. 30 78

The results of operative treatment of postinfarction left ventricular aneurysm in 169 patients undergoing operation since 1970 are analyzed in this report. Maximum follow-up extended to 7 year (average 2.9 years). Average patient age was 56 years (range 34 to 82 years). Nearly all patients (94%) had left anterior descending coronary artery disease with anterior aneurysm formation and 73% had multivessel disease. Sixty-eight percent of patients underwent aorta-coronary bypass grafting (ACBG) and/or mitral valve replacement (MVR) concomitantly with aneurysmectomy. The over-all operative mortality rate was 17.8%. Preoperative factors that correlated significantly (p less than 0.05) with increased operative risk reflected primarily the quality of left ventricular function, and included functional classification, cardiac index, contractile function of residual myocardium not involved by aneurysm, and mitral regurgitation. Patients whose primary preoperative disability consisted of angina pectoris (42 patients) exhibited significantly higher over-all survival rates (actuarial 5 year survival 75%) than those undergoing operation because of congestive heart failure (86 patients) or ventricular tachyarrhythmias (38 patients), whose 5 year survival rates were 52 and 57%, respectively. Concomitant ACBG (+/- MVR) was associated with a higher operative mortality rate than aneurysmectomy alone (21.1 versus 10.9%), but late postoperative attrition was similar. The over-all 5 year survival rate, including operative death, was 60%, and 90% of surviving patients were in Functional Class I or II at follow-up evaluation. We conclude from this analysis that the long-term prognosis of patients with symptomatic postinfection left ventricular aneurysms, although determined importantly by preoperative left ventricular function, is enhanced by surgical treatment.
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PMID:Left ventricular aneurysm. Preoperative risk factors and long-term postoperative results. 30 79

The data of 6 patients in whom a left anterior hemiblock appeared in the course of angina pectoris attacks were reviewed. All 6 patients were found to fulfill the criteria for unstable angina. 1 patient who presented the features of Prinzmetal variant angina was included in this group. Coronary arteriography showed significant coronary artery disease in all 6 patients involving 3 vessels in 2 patients, 2 vessels in 1 and 1 vessel in 3. A severe lesion (70--100%) of the left anterior descending artery in the vicinity of the first perforator was demonstrated in every case. The 2 patients with 3-vessel disease were not operable and died 4 and 5 days after the hemodynamic study. These deaths were caused by myocardial infarction with cardiogenic shock in one case and intractable ventricular arrhythmias in the other case. 4 patients were operable and underwent aortocoronary saphenous bypass surgery. There were 2 operative deaths. The 2 survivors are asymptomatic 7 and 16 mth after surgery. This study suggest that transient left anterior hemiblock during an attack of angina pectoris may be a feature of impending myocardial infarction and may be indicative of a severe obstruction of the left anterior descending coronary artery.
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PMID:Transient left anterior hemiblock during angina pectoris: coronarographic aspects and clinical significance. 31 Dec 90

The significant risk of fatal myocardial infarction after carotid endarterectomy in patients with coronary disease long has been recognized. In 1,546 consecutive carotid endarterectomies performed in 1,238 patients over the last 10 years, angina pectoris was present in 17% (212/1,238) of patients; a further 32% (396/1,238) of patients were asymptomatic, but had a history of myocardial infarction. The perioperative mortality (30 day) in the 1,306 consecutive endarterectomies in 1,026 patients without symptomatic coronary artery disease was 1.5% (15/1,026 patients). Of the 212 patients with symptoms, 85 carotid endarterectomies were performed in 77 patients without prior coronary bypass operation with an operative mortality of 18.2% (14/77 patients). The remaining 135 patients had 155 carotid endarterectomies but were treated by either prior coronary artery bypass (84 patients) or simultaneous carotid endarterectomy and coronary artery bypass (51 patients) with an operative mortality of 3% (4/135 patients). The greatly improved survival in those patients with symptomatic coronary disease who had a coronary artery bypass prior to or at the same time as carotid endarterectomy, and the absence of permanent neurological deficit in the 51 of these 135 patients who had simultaneous carotid endarterectomy and coronary artery bypass suggests that significantly improved survival can be achieved after carotid endarterectomy in these high risk patients by the use of simultaneous coronary artery bypass surgery.
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PMID:Improved results of carotid endarterectomy in patients with symptomatic coronary disease: an analysis of 1,546 consecutive carotid operations. 31 51

Coronary arteriographic data have been compared with the ECG response to a maximal exercise test in 53 women with typical or atypical complaints of angina pectoris (AP). All patients with factors known as influencing the repolarization at rest were eliminated and the cases were subdivided according to the presence of a normal (n=26) or abnormal (n=27) resting ECG. The sensitivity (88%) and specificity (81%) of the exertional ECG was not affected by the clinical history nor by the resting ECG data. False positive responses were frequent (32%), particularly among women with atypical AP (50%), but their prevalence was not influenced by the resting ECG data. We conclude that, even in the absence of drug therapy, non-specific resting ECG abnormalities do not influence the ECG response to exercise in women and that they cannot be considered as a factor contributing to the false positive responses: the latter appear to be related to the low prevalence of coronary artery disease in women.
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PMID:Influence of resting ECG abnormalities on the ECG response to maximal exercise in women suspected of coronary heart disease. 31 72

The clinical presentation and surgical results in 124 consecutive patients who underwent aorta to right coronary arterial bypass surgery from January 1970 through June 1977 were reviewed. Preoperatively, 75 percent of the patients were in New York Heart Association functional class III or IV, 9 percent presented with unstable angina and 5 percent had life-threatening ventricular arrhythmias. All patients had high grade occlusive disease confined to the right coronary artery; 34 percent of the patients had associated nonsignificant disease (less than 50 percent intraluminal narrowing) of the left anterior descending or circumflex artery. Left ventricular function was normal in 63 percent and minimally impaired in 37 percent. The operative mortality rate was 1.6 percent. The course of the 122 survivors was followed up for 3.7 years. There were four late deaths, and the 5 year mortality rate was 4.0 percent. Eight patients were reoperated on because of recurrence of symptoms and occlusion of the graft or progression of occlusive disease of the other major coronary arteries, or both. Of the remaining 110 patients, 98 are either in functional class I or II, 60 are taking no cardiovascular medications, 52 are working full time without angina nad 73 are asymptomatic. In summary, bypass surgery for isolated right coronary artery disease has a low mortality rate and results in excellent long-term symptomatic improvement.
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PMID:Occlusive disease confined to the right coronary artery: clinical features, surgical treatment and long-term follow-up in 124 patients. 31 94

Between 1972 and 1974, 121 patients with chronic stable angina pectoris and operative coronary artery disease, excluding significant left main coronary obstruction, were randomized to either medical therapy (60 patients) or surgical therapy (61 patients) as part of a larger Veterans Administration Cooperative Study of Surgery for Coronary Arterial Occlusive Disease. At the time of randomization, medical and surgical groups were similar with regard to clinical and hemodynamic features as well as degree of left ventricular impairment and extent of coronary disease. Follow-up to June 1, 1978, reveals significantly improved survival in surgical patients from 3 through 6 years after randomization. Sixteen cross-over patients (13 medical to surgery, and 3 surgical without surgery) do not appear to influence results. Results of this randomized study from a single hospital differ from the preliminary results of the larger cooperative study, primarily because of a higher mortality in the medical group. The medical mortality in our group is in keeping with other reports of the natural history of patients with angina pectoris, and we propose that the population of patients we randomized closely simulates the usual type of patient with chronic angina being considered for surgical treatment. Our good surgical results thus contrast significantly with the survival of medically treated patients, and this separates our study from the body of the Veterans Administration Cooperative Study.
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PMID:Improved survival after surgical therapy for chronic angina pectoris: one hospital's experience in a randomized trial. 31 9


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