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 and hemodynamic effects of trinitrin (nitroglycerin) have been studied in 5 patients with long-established coronary artery disease who had been receiving long-term beta blockade therapy (propranolol). 5 similar patients not on propranolol acted as controls. Patients on propranolol reported as effective relief of angina with trinitrin as patients not on this therapy. Although the patients on propranolol had an initially lower systolic blood pressure and mean ventricular rate, sublingual trinitrin caused in both groups a similar fall in aortic pressure, pulmonary wedge pressure, oxygen consumption and stroke volume, together with a similar rise in ventricular rate. It was concluded that trinitrin was as effective, both subjectively and objectively, in patients on propranolol as in those without beta blockade and promoted similar side effects.
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PMID:The combined clinical and hemodynamic effects of trinitrin and propranolol. 40 4

The effects of nitroglycerin (TNG) on exercise-induced abnormalities of left ventricular wall motion and ejection fraction are unknown in symptomatic and asymptomatic patients with coronary artery disease (CAD). In the present investigation radionuclide cineangiographic studies were performed in 47 patients with CAD (14 without angina during exercise) and in 25 normal subjects. All CAD patients, including those without symptoms, demonstrated regional wall motion abnormalities during exercise. In all patients, ejection fraction (EF) also responded abnormally to exercise: EF decreased from 48% at rest to 36% during exercise (P less than 0.001). EF increased in all normal subjects from an average of 58% at rest to 71% during exercise (P less than 0.001). In all CAD patients TNG reduced exercise-induced regional wall abnormalities and increased EF attained during exercise from an average of 36 to 48% (P less than 0.001). EF in normal subjects was unchanged by TNG. Thus, exercise can cause abnormalities in left ventricular regional function and ejection fraction in patients with or without symptoms; these abnormalities can be mitigated by prophylactic TNG.
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PMID:Effect of nitroglycerin on exercise-induced abnormalities of left ventricular regional function and ejection fraction in coronary artery disease. Assessment by radionuclide clineagiography in symptomatic and asymptomatic patients. 41 9

From a study of 34 cases, the authors have tried to define the characteristic features of this very specialised type of coronary artery disease. From the clinical standpoint, if the common combination of uncontrolled angina and a past history of myocardial infarction are taken as representative, the basal ECG can in no way differentiate the diagnosis; on the other hand tests on the bicycle ergometer appear to have a good indicative value. Coronary arteriography shows the sharply isolated character of the stenosis of the trunk which is part of the picture of diffuse coronary disease, and the frequency (2 cases out of 3) of total coronary occlusion. The haemodynamic findings are even more variable and unpredictable, and bear no relationship to the degree of trunk stenosis, to the index of the lesion, and to the number of occlusions. However, joint analysis of the index of the lesion and of the degree to which the coronary circulation is compensated or de-compensated allows a better interpretation of the haemodynamic picture.
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PMID:[Stenosis of the trunk of the left coronary artery. Contribution of coronary arteriography and hemodynamic correlations. Apropos of 34 cases]. 41 68

A technique is described for recording the precordial electrocardiographic body surface map before and after exercise. The technique provides an extra dimension to the conventional exercise electrocardiogram because a measurement can be made of the area and severity of S-T segment changes that are projected onto the front of the chest. Sixteen lead isopotential surface maps were recorded before and after exercise in 109 patients with angina who subsequently underwent coronary arteriography. In addition, exercise electrocardiograms were obtained in 53 of these patients using three orthogonal leads and in all patients using a single chest unipolar chest lead. Precordial surface mapping after exercise was found to have a greater sensitivity (95 percent) than electrocardiography using either the orthogonal leads (68 percent) or a single chest lead (64 percent) (P less than 0.01). The specificity of the three techniques did not differ significantly (P greater than 0.05). The technique of precordial surface mapping after exercise improves the ability to diagnose coronary artery disease and can easily be applied to clinical practice.
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PMID:Precordial electrocardiographic mapping after exercise in the diagnosis of coronary artery disease. 42 Jan 3

Thirty patients with triple-vessel coronary artery disease proven by angiography, symptomatic angina and a positive ECG stress test were evaluated with thallium-201 (201TI) scintigraphy. Twenty patients also had aortocoronary saphenous vein bypass surgery; 15 of them had repeat noninvasive evaluation. Seventy percent of these patients showed ischemia by 201TI scintigraphy, of which one-half returned to normal after surgery. Postoperative reversion of the ECG stress test together with 201TI stress/reperfusion imaging correlated well with the completeness of surgical revascularization. We could not explain the prevalence (80%) of infarcts detected by 201TI in this group, of which 76% could be anatomically correlated to epicardial scars. The positivity of infarcts by 201TI exceeded that predicted by previous history of infarction, Q waves on resting ECG or ventriculographic akinesis. These observations suggest that 201TI scintigraphy is a useful noninvasive tool in the follow-up and understanding of patients with coronary heart disease. These conclusions also support the concept that 201TI stress imaging need not have the identical connotation as the ECG stress test.
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PMID:Thallium-201 myocardial scintigraphy in patients with triple-vessel disease and ischemic exercise stress tests. 42 10

The applicability of the adenosine triphosphate (ATP) catabolites, inosine and hypoxanthine as markers of myocardial ischemia in humans with coronary artery disease has been investigated. Inosine and hypoxanthine were assayed enzymatically after separation by a new column chromatographic method. The myocardial lactate extraction at rest (17 +/- 13%) changed to production values (-23 +/- 28%) during pacing-induced angina (P less than 0.0005). Coronary venous inosine values increased from 535 +/- 185 nmol/l at rest to 1030 +/- 740 nmol/l during angina (P less than 0.005), the arterial values amounted to 770 +/- 325 nmol/l and 805 +/- 515 nmol/l respectively (P, NS). The calculated myocardial uptake of inosine at rest (27 +/- 16%) changed to production values (-25 +/- 29%) during angina (P less than 0.0005). Coronary venous hypoxanthine increased from 1000 +/- 760 nmol/l at rest to 1235 +/- 800 nmol/l during angina (P, NS), the arterial values amounted to 1300 +/- 1040 nmol/l and 1235 +/- 800 nmol/l respectively (P, NS). The myocardial extraction changed from 20 +/- 18% at rest to -5.4 +/- 29% during angina (P less than 0.0025). The significant positive correlation (r = 0.61, P less than 0.0025) between myocardial release and uptake of inosine and lactate during severe angina demonstrates that anaerobic glycolysis is accompanied by ATP breakdown. During a second pacing period at less increased pressure--rate product after nitroglycerin, lactate production (-1.7 +/- 22%) already occurred whereas extraction of inosine (19 +/- 19%) and hypoxanthine (24 +/- 15%) did not change. In conclusion, lactate functions as a sensitive marker of myocardial ischemia and inosine is useful in detecting ischemic myocardial energy deficiency by the indication of insufficient glycolytic ATP supply.
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PMID:Myocardial release of inosine, hypoxanthine and lactate during pacing-induced angina in humans with coronary artery disease. 42 23

Platelet survival times were measured in 11 ambulatory patients within 5 to 21 months of out-of-hospital ventricular fibrillation unassociated with acute myocardial infarction. The mean platelet survival time of 7.7 +/- 2.1 days was shortened when compared with 28 normal controls of similar age (9.0 +/- 1.0 days, p less than 0.03) but not different from 56 other patients with stable angina pectoris (6.85 +/- 1.81 days, p less than 0.2). One patient with a near normal survival time of 7.5 days experienced recurrent ventricular fibrillation without associated acute myocardial infarction 1 month following the platelet survival study. Although one platelet inhibitory agent, sulfinpyrazone, may lower the incidence of sudden cardiac death following acute myocardial infarction, the shortened platelet survival time in the group of patients experiencing out-of-hospital ventricular fibrillation did not distinguish them from others with coronary artery disease.
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PMID:Platelet survival in patients previously resuscitated from out-of-hospital ventricular fibrillation. 42 42

Seventy-six survivors of a prior myocardial infarction were subjected to maximal treadmill stress testing. At least two months had elapsed between the acute episode and the inclusion of the patients in the study. In 39% of the cases the infarction was located to the inferior wall of the left ventricle, in 42% it was anterior and in 18% it was both anterior and inferior. The stress test was positive in 51% and negative in 46% of the cases, while it was non-diagnostic in 3%. The high percentage of negative tests may be explained by the fact that, in these patients, the coronary obstructive lesions are limited to the vessels supplying infarcted myocardium, while the remaining muscle has an adequate coronary perfusion. The percentage of positive tests was higher in patients with anterior (59%) than in those with inferior wall infarctions (43%). In the group of patients with anteroapical aneurysms the incidence of ischemic responses to exercise was 73%. In two of these cases, there was an exercise induced elevation of the ST segment. 75% of the patients who had post-infarction angina had positive tests. Ventricular premature beats developed in 17% of the subjects during or immediately after the period of exercise. The great majority of patients showed an impaired functional aerobic capacity. In patients with coronary artery disease, the left ventricle has a diminished capacity to augment its stroke volume. In order to increase cardiac output during effort, these patients depend on early elevations of heart rate. A positive exercise stress test, in patients with prior myocardial infarction, appears to be a valuable means of identifying the existence of residual myocardial ischemia resulting from coronary lesions in other vessels. It may be a prognostic tool helping to detect the high risk subjects and it may also be used to precisely determine the effort capacity in individual subjects.
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PMID:[Exertion test in patients with previous myocardial infarct]. 44 34

Reoperation because of early or late coronary graft failure was performed in 43 patients who were part of a group of 1,985 patients operated on for coronary artery disease and followed for up to 7 years. Considerable variation in the results was noted depending on whether the patients were symptomatic or not before reoperation. Of the symptomatic patients, 85% were asymptomatic late (30 months) after reoperation whereas of those patients reoperated on despite the apparent lack of symptoms, 71.5% remained free from angina later on. Moreover, patency rate was high (94.4% or 17/18 grafts) in the first group and much lower (38.4% or 5/13 grafts) in those reoperated on solely on the basis of an early angiogram showing malfunctioning grafts. Patency rate was higher when the graft was totally replaced (92.3% or 12/13 restudied) rather than repaired simply through interposition of a segment of vein (37.5% or 3/8). It is apparent that results of reoperation in symptomatic patients are identical to those of an initial revascularization. On the other hand, patients who are asymptomatic despite early evidence of malfunctioning grafts should be reoperated on only when optimal angiographic conditions are present, that is, a coronary artery that is a good size, severely narrowed, and supplying a large myocardial area.
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PMID:Reoperation for coronary graft failure: clinical and angiographic results in 43 patients. 45 1

Performing the dipyridamole-test for evaluating coronary artery disease a man at the age of 57 years developed after application of 15 mg dipyridamole intravenously angina pectoris. For removal of angina pectoris 240 mg aminophylline were injected, after what bradycardia and finally cardiac arrest occurred. Resuscitation was successful. Possible reasons and some precautions were discussed.
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PMID:[Complication during the dipyridamole-test (author's transl)]. 46 27


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