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)

Patients with single-vessel disease, with normal or mildly abnormal ventricular function (EF greater than 40%), have a good prognosis both for natural survival and long-range symptomatic improvement; therefore medical therapy is strongly recommended. Surgery is considered only if symptoms persist after aggressive medical therapy. It is possible that single-vessel left anterior descending disease is a special variant of this group, and surgery may, with further reports, show an increased survival. However, no adequately designed study has yet suggested this, and it is currently our opinion that patients with single-vessel disease do not have an improved survival following surgery. It is not clear whether surgery improves survival in patients with multivessel disease and normal or mildly abnormal ventricular function (EF greater than 40%). Consequently, cardiologists are divided as to whether to advise surgery in these patients solely for survival. Currently, it is our opinion that these patients should have surgery only for improvement of symptoms after failure of medical therapy. In left main coronary disease the evidence favoring improved survival after surgery has convinced most cardiologists, including ourselves, to recommend surgery. Patients with poor ventricular function (EF less than 30%) secondary to coronary artery disease often have congestive heart failure and not angina as their chief symptom. Surgery is usually not advisable for these patients, because of the increased operative mortality and lack of improvement in ventricular function. Patients with poor ventricular function with angina are not usually significantly improved by surgery. In patients with moderately abnormal ventricular function (EF = 30-40%), relief of angina is frequently obtained, but with some added surgical risk. We recommend surgery in these patients after aggressive medical therapy has failed. Patients with unstable angina are initially medically stabilized, after which they are generally managed as stable angina. Patients with persistence of pain at rest in spite of vigorous medical therapy are usually managed by early catheterization and surgery.
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PMID:Critique of coronary artery bypass surgery. 32 63

This study included 89 patients, 70-82 years (mean 72.8 years), who had procedures using cardiopulmonary bypass since 1955. Twenty-six patients had elective aortic valve replacement (AVR), with two hospital deaths. One patient who underwent emergency AVR for bacterial endocarditis died of septic shock. Ten patients had AVR and coronary artery bypass surgery (CABG), with one hospital death (10%). Fourteen patients had mitral valve replacement (MVR), with eight hospital deaths (57%). Two died of left ventricular rupture after leaving the operating room, and the remainder died of low cardiac output. Twenty-five patients had CABG with no early deaths. Seven patients had aneurysms of the thoracic aorta, with two early deaths. Six patients had other procedures with one death, making a total of 16 operative deaths in the 89 patients. Eighty-four of the patients (94%) were New York Heart Association (NYHA) Functional Class III or IV for congestive heart failure and/or angina, preoperatively. Of these, 12 were in extremis immediately before surgery, and six survived. There were 10 late deaths. The actuarial survival rates for one, two and five years for all patients were 69% (40 patients), 47% (20 patients) and 21% (seven patients), respectively. At recent follow-up (mean 20 months) 84% of the hospital survivors were symptomatically improved at least one NYHA Functional Class. We conclude that CABG and/or AVR can be performed in elderly patients with a low hospital mortality and with symptomatic improvement. However, MVR in the elderly carries an unusually high mortality (7.3 times greater than patients less than 70, in our experience), and this risk must be weighed when considering MVR in these patients.
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PMID:Surgery using cardiopulmonary bypass in the elderly. 35 72

A feasibility trial to investigate the practicality of determining the advantages and disadvantages of prompt pharmacologic treatment for mild hypertension was jointly funded by the Veterans Administration and the National Heart, Lung and Blood Institute. Its clinical phase has been completed, and it demonstrated 1. that the required relatively young asymptomatic population could be enrolled in the study and 2. that it could be persuaded to adhere to the protocol for 2 years; however, it was evident that intensive efforts would be required in both areas. The feasibility trial screened almost 120,000 potential subjects over a period of 16 months to randomize about 1,000 subjects at four clinical centers. These men and women were 21 to 50 years old, had diastolic pressures from 85 to 105 mm Hg as outpatients, and had no evidence of cardiovascular renal abnormalities. They were randomized in double-blind fashion into active drug therapy and placebo groups. Stepped care therapy involved 50 mg chlorthalidone (Step 1), 100 mg chlorthalidone (Step 2) and 100 chlorthalidone plus 0.25 mg reserpine (Step 3). Death, myocardial infarction, stroke, angina pectoris, and congestive heart failure were the "major" morbid events that were looked for; also recorded were "minor" morbid events consisting primarily of electrocardiographic arrhythmias. The development of significant hypertension was considered a treatment failure. Side effects were carefully tabulated in both active drug and placebo groups. The study revealed an average drop in diastolic pressure of almost 12 mm Hg for active drug group and less than half of that for the placebo group; once established 6 months after randomization, the new pressure levels persisted almost without change throughout the study. Although the feasibility trial was not designed to answer the primary question regarding the benefits of treatment, the events were tabulated for each group. A total of 12 placebo-treated subjects developed significant hypertension and were put on active drug. There was not a significant difference between the two groups in the incidence of "major" morbid events; a total of eight active and five placebo patients developed myocardial infarction or died suddenly. There, however, was an excess of arrhythmias among the active drug subjects (17 in the active group versus 8 in the placebo group on the basis of preliminary data). Finally, there were twice as many side effects and 20 times as many chemical abnormalities among the active as among the placebo subjects. A protocol for a full scale study of the benefits of pharmacologic therapy in mild hypertensives has been prepared and is ready for implementation as needed; it involves relatively minor modifications of the protocol tested in the feasibility trial.
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PMID:Evaluation of drug treatment in mild hypertension: VA-NHLBI feasibility trial. Plan and preliminary results of a two-year feasibility trial for a multicenter intervention study to evaluate the benefits versus the disadvantages of treating mild hypertension. Prepared for the Veterans Administration-National Heart, Lung, and Blood Institute Study Group for Evaluating Treatment in Mild Hypertension. 36 Sep 21

With advancing age blood pressure rises in most populations with the exception of some isolated tribes. In western countries 30 to 40% of the people above the age of 60 years have casual blood pressure levels greater than or equal to 160/95 mm Hg. Advancing age per se produces a number of physiological changes related to blood pressure, such as a decrease in cardiac output, an increase in peripheral vascular resistance and a decrease in plasma renin-angiotensin-aldosterone levels. The mechanism causing the elevation in pressure with age are unknown though increased rigidity of the great vessels contributes to the rise in systolic pressure. There is a decline in the sensitivity of the baroreceptor reflex, but the contribution of this to the elevation of pressure has not be elucidated. Elderly patients with uncomplicated essential hypertension have a low cardiac output and high peripheral vascular resistance. The rise in blood pressure is associated with an increased cardiovascular morbidity and mortality even in the elderly hypertensives. The available data on the efficacy of hypotensive treatment in the elderly is scanty. There are no data proving that hypotensive therapy prolongs life. Controlled studies on the prevention of organ damage especially cerebrovascular accidents are inconclusive, showing either a significant decrease or no effect. Isolated reports illustrate, however, that drastic blood pressure reduction can provoke serious side effects, thus decreasing the quality of life. Hypotensive treatment is indicated in elderly hypertensive patients with hypertensive retinopathy grade III or IV, congestive heart failure or cerebral haemorrhage, in elderly patients with a markedly elevated diastolic blood pressure (greater than or equal to 120 mm Hg) and a trial of hypotensive therapy should be offered in milder forms of hypertension when it is accompanied by certain specific symptoms such as angina, headache and dyspnoe. The management of elderly hypertensive patients is more difficult than in the young. General measures are often not well accepted. The dose adjustment of the hypotensive agent is more critical and volume depletion or orthostatic hypotension are more likely to occur.
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PMID:Aging and the cardiovascular system. 37 49

The reliability of serum myoglobin as a marker for acute myocardial infarction was evaluated in 157 consecutive coronary-care admissions. Admission myoglobin was elevated in 47 of 52 patients with acute infarction. Excluding those patients who presented later than 24 hr after symptom onset, only one patient with acute infarct had a normal admission myoglobin. In 22 of 105 patients with no infarct, myoglobin was elevated in association with angina, congestive heart failure, arrhythmias, and renal insufficiency. The detection of acute infarction by serum myoglobin measurement equals that of serial serum creatine phosphokinase isoenzymes (CPK-MB) by electrophoresis, but an elevated myoglobin is not specific for what is now considered clinically significant myocardial infarction.
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PMID:Assessment of serum myoglobin as a marker for acute myocardial infarction. 43 Jan 83

Debate exists over the most appropriate form of treatment for patients with unstable angina pectoris. This study examined 106 patients randomized at the University of Alabama in Birmingham as part of the National Cooperative Study Group and focuses on the phenomenon of patients who fail medical therapy and thus require late surgery, and the costs of therapy. Discriminant function analysis revealed that the significant predictors (p less than 0.01) of patients who would later require surgery were: total number of vessels diseased, angina severly, presence of congestive heart failure, hypertension, and number of years that the patient had had angina. By means of this analysis, 85% of the late surgery patients were correctly predicted. Late surgery patients averaged 2.4 diseased vessels vs 1.5 for persistent medical patients (p less than 0.01). Mean charges for the first 2 years in the study were $6,226 (SD $2,967) for persistent medical patients, $10,416 (SD $2,146) for surgery patients, and $20,059 (SD $10,748) for late surgery patients (p less than 0.001). These data indicate that surgery is clearly an expensive procedure; but that it is more expensive for late surgery patients, who have total costs that are twice as high as surgical costs and 3.5 times as high as persistent medical costs.
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PMID:Unstable angina pectoris: an examination of modes and costs of therapy. 44 72

During 20 years of follow-up of 5,127 men and women initially free of coronary heart disease in the Framingham cohort, 193 men and 53 women had one or more recognized, symptomatic myocardial infarctions. An additional 45 men and 28 women had unrecognized myocardial infarctions. Subsequent mortality and morbidity including angina, reinfarction, congestive failure and sudden death were ascertained. One in five men who had a first myocardial infarction died within 1 year, a mortality rate 14 times that of those free of coronary heart disease. In men who survived the 1st year, a recognized myocardial infarction increased risk of death over the next 5 years to 23 percent, four times that of the general population. The next 5 years carried a 25 percent mortality (three times that of the general population). The prognosis was distinctly worse in women than in men chiefly because of a higher (45 percent) early mortality rate in women. Patients with recognized and unrecognized myocardial infarctions had similar survival rates after 3 years. A second myocardial infarction occurred in 13 percent of the men and in 40 percent of the women within 5 years of the first infarction. Thus, women were more prone to death and reinfarction than men. Congestive heart failure occurred as commonly as reinfarction, affliction 14 percent of the men within 5 years of the initial infarction. Once congestive failure ensued, half of the affected patients were dead within 5 years. Angina developed in one third of the patients within 5 years of their first infarction.
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PMID:Prognosis after initial myocardial infarction: the Framingham study. 45 46

In a retrospective study, 29 patients at least 20 years of age with known aortic stenosis are reported who had the peak systolic gradient (PSG) measured on at least two occasions without an intervening surgical procedure or episode of endocarditis. In these 29 patients, there were 31 intervals available for evaluation with a mean follow-up time of 43.5 months (1 week to 120 months). In 16 of the 31 intervals, the PSG increased by 50% or more and in 15, it did not. In the group where the PSG increased, the average rate of increase was 1.3 mm. Hg/month with the most rapid gradient increase at 3.8 mm. Hg/month. Progression to high gradient was correlated with the development of angina pectoris or left ventricular hypertrophy by voltage and ST-T wave changes. In this study, other symptoms were not helpful in predicting an increase in severity. It is still recommended, however, that any patient with aortic stenosis and the development of symptoms of congestive heart failure or exertional syncope should be suspected of having progressed to severe aortic stenosis and should be restudied.
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PMID:Rate of progression of severity of valvular aortic stenosis in the adult. 49 18

Seventy-seven patients with chronic ischemic heart disease were treated in single-seater oxygen hyperbaric chambers; 52 patients had angina pectoris of effort or angina of effort and at rest while 25 patients with macrofocal postinfarction cardiosclerosis had insufficiency of pulmonary or systemic circulation. Treatment consisted of 12--15 procedures. The use of hyperbaric oxygenation in a complex with drug therapy makes it possible to alleviate or arrest the attack of angina pectoris and relieve considerably the symptoms of cardiac decompensation. The initial condition of central hemodynamics affects greatly the results of barotherapy. Normal parameters of hemodynamics hardly change after treatment. At the same time, in patients with markedly reduced myocardial contractility hyperbaric oxygenation causes evident positive changes in hemodynamics. The combination of hyperbaric oxygenation with drug therapy improves the effect of treatment significantly.
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PMID:[Hyperbaric oxygenation in the overall therapy of chronic ischemic heart disease]. 51 59

Thirty-six young patients with idiopathic hypertrophic subaortic stenosis were studied. Twenty-seven patients were male and 9 female, and their mean age was 11.3 years (range 5 months to 20 years). Twenty-three patients (64 percent) had symptoms, the most common being dyspnea, angina and syncope. Diagnostic difficulties were encountered frequently in younger patients, especially those with right heart involvement, and in asymptomatic patients with murmurs suggestive of other cardiac defects. Patients were classified retrospectively into three groups on the basis of management. The first group consisted of 16 patients who were operated on; 4 of these patients died, 1 operatively and 3 suddenly late postoperatively (at 1.6, 2 and 10 years). The 12 long-term survivors (average follow-up period 6.2 years) have had good relief of symptoms. The second group comprised seven patients treated with propranolol; none of these died. The 13 patients in the third group received no therapy; 7 of these patients died, 6 suddenly and 1 from congestive cardiac failure. Idiopathic hypertrophic subaortic stenosis is a serious disorder that may present at any age and that may be difficult to diagnose. All patients with this disorder should be treated with propranolol; surgical intervention, although it does not totally abolish the risk of sudden death, appears to offer symptomatic improvement in most cases over a long-term follow-up period.
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PMID:Idiopathic hypertrophic subaortic stenosis in the young. 56 78


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