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 development of new drugs, especially beta-blocking and calcium entry-blocking agents, has greatly facilitated the medical treatment of angina pectoris. The specific needs of each patient should dictate the appropriate treatment of angina pectoris. Angina may occur in patients who have various concomitant disorders such as hypertension, diabetes mellitus, peripheral vascular disease, chronic obstructive pulmonary disease, or arrhythmias, and the physician must take these factors into account when a drug regimen is prescribed. Individual drugs should be chosen on the basis of specifically desired pharmacologic effects, and the dosages should be gradually adjusted according to the patient's response. Although a therapeutic regimen should be selected primarily on the basis of efficacy, the physician must also attempt to recommend a simple and cost-effective program.
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PMID:Selection of optimal drug therapy for the patient with angina pectoris. 286 9

A double-blind study of the effect of three beta-adrenoceptor blocking drugs (beta-blockers) on exercise muscle blood flow (MBF) in 14 normotensive volunteers was carried out. MBF was measured by the xenon-133 clearance technique. MBF was not altered by placebo, sotalol or labetalol. Atenolol significantly reduced MBF compared with placebo, sotalol and labetalol. We conclude that sotalol and labetalol may be more useful than conventional beta-blockers for treatment of hypertension or angina in association with peripheral vascular disease.
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PMID:Comparison of the effects of atenolol, sotalol and labetalol on muscle blood flow in man. 288 Mar 41

Advantages and disadvantages of the various therapies for stable angina are considered with particular attention to quality of life. Advantages of coronary artery bypass surgery (CABS), apart from the question of survival, include less angina, less activity limitation, and less need for drugs than with medical treatment. However, data from the Coronary Artery Surgery Study (CASS) and others show that there is no difference between medical and surgical therapy in return to work and in need for subsequent hospitalization. In CABS patients, there is also predictable return of angina, substantial late vein graft occlusion, and possibly increased progression of native coronary artery disease in grafted vessels. Percutaneous transluminal coronary angioplasty (PTCA) has advantages similar to those of CABS, with very low initial mortality and major complication rates, minimal discomfort, very short disability period, and moderate cost. Its major disadvantages are a high short-term reocclusion rate and uncertain long-term outcome. Beta blockers provide good control of angina, have additional antihypertensive and antiarrhythmic effects, and may be beneficial in preventing sudden cardiac (arrhythmic) death and limiting myocardial infarct size, should these events supervene in the patient with angina. Disadvantages of beta blockers involve the occasional major side effects, including potential exacerbation of bronchospasm, peripheral vascular disease (PVD), diabetes, congestive heart failure and bradyarrhythmia, and frequent "nuisance" side effects. Calcium blockers control both exercise and rest angina and pose no problem in patients with bronchoconstriction, PVD, or diabetes. Disadvantages include need for frequent dosage, cost, and side effects. Long-acting nitrates have few major side effects and usually transient minor side effects, with little effect on quality of life.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Ischemic heart disease: a patient-specific therapeutic approach with emphasis on quality of life considerations. 288 39

Arm exercise with myocardial scintigraphy and oxygen consumption determinations was performed by 33 men with peripheral vascular disease, 40 to 74 years of age (group 2). None had evidence of coronary disease. Nineteen age-matched male control subjects (group 1) were also tested to determine the normal endurance and oxygen consumption during arm exercise in their age group and to compare the results with those obtained during a standard treadmill performance. The maximal heart rate, systolic blood pressure, pressure rate product, and oxygen consumption were all significantly lower for arm than for leg exercise. However, there was good correlation between all these parameters for both types of exertion. The maximal heart rate, work load and oxygen consumption were greater for group 1 subjects than in patients with peripheral vascular disease despite similar activity status. None of the group 1 subjects had abnormal arm exercise ECGs, while six members of group 2 had ST segment changes. Thallium-201 scintigraphy performed in the latter group demonstrated perfusion defects in 25 patients. After nine to 29 months of follow-up, three patients who had abnormal tests developed angina and one of them required coronary bypass surgery. Arm exercise with myocardial scintigraphy may be an effective method of detecting occult ischemia in patients with peripheral vascular disease. Those with good exercise tolerance and no electrocardiographic changes or 201T1 defects are probably at lower risk for the development of cardiac complications, while those who develop abnormalities at low exercise levels may be candidates for invasive studies.
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PMID:Arm exercise testing with myocardial scintigraphy in asymptomatic patients with peripheral vascular disease. 292 3

Percutaneous transluminal angioplasty (PTA) was attempted on 70 occasions in 63 consecutive patients presenting with advanced ischaemia. The procedure was technically successful in 64 (91%) with haemodynamic improvement in 39 (56%) and clinical improvement maintained at 6 months in 51 (73%). Follow-up ranged from 6 months to 4 years and life-table analysis showed 60% success at 1 year and 58% success at 2 years. Overall limb salvage was 76%. Complications occurred in 6 (9%) and in one case this lead to amputation. The relationship of a number of associated factors to outcome was assessed. The presence of cardiac disease requiring treatment for failure or angina was a highly significant adverse factor (P less than 0.001). Decreasing age and greater extent of disease were also significant adverse factors (P less than 0.05). Therefore, because of its low morbidity and cost, PTA can be seen as a useful procedure in patients presenting with advanced peripheral vascular disease.
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PMID:Percutaneous transluminal angioplasty for severe lower extremity ischaemia. 294 39

In non-obese, non-diabetic patients suffering acute myocardial infarction, angina pectoris, previous myocardial infarction and peripheral vascular disease, the plasma levels of glucose, insulin, C-peptide and glucagon were determined in basal condition and during an intravenous glucose tolerance test. In the four groups there was a high frequency of glucose intolerance. Basal hyperinsulinism was present in all groups; in groups; in those which maintained normal glucose tolerance there was a high B-cell response to the sugar. Basal hyperglucagonemia was found in the early stage of acute ischemic heart disease, in patients with previous myocardial infarction and in those with peripheral vascular disease. The elevated plasma glucagon levels may play a role in the complex disturbance of carbohydrate metabolism present in patients with atherosclerotic vascular disease.
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PMID:Carbohydrate metabolism and plasma levels of insulin and glucagon in patients with atherosclerotic vascular disease. 304 64

Fifty-three of 203 consecutive carotid endarterectomies (26%) performed on the Neurosurgical Service at the University of Iowa were in patients over 70 years of age (mean age, 73.4). This series included 38 men and 15 women. Thirty-three patients (62%) presented with transient ischemic attacks, and the remaining 38% were functional stroke patients. Medical risk factors in this group included hypertension in 70%, previous myocardial infarction in 26%, angina in 17%, peripheral vascular disease in 23%, and diabetes in 13%. Sixty-four per cent of the patients had been previously treated with antihypertensive drugs, 43% with antiplatelet agents, and 4% with anticoagulants. Noninvasive vascular evaluation was performed in 25 of 53 (47%) patients, and all underwent angiography before operation. There were no angiographic complications. All patients were operated on with full-channel electroencephalographic (EEG) monitoring. Indwelling shunts were required in 6 of 53 (11%) cases. Intraoperative heparin was given and not reversed; the mean dose was 5100 units. The mean clamp time was 48 minutes. Patch grafts, fashioned from common facial or saphenous veins, were used in 2 patients. Eight patients had contralateral carotid occlusions, but only 2 (25%) required indwelling shunt placement based on EEG criteria. There were no perioperative deaths in this series. One patient had a postoperative stroke, and 1 patient had a postoperative nonfatal myocardial infarction. Transient surgical complications included 3 wound hematomas, 1 wound abscess, and 2 self-limited cranial nerve palsies (13%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Carotid endarterectomy in symptomatic elderly patients. 337 79

Pentoxifylline, a methyl xanthine derivative, improves symptoms of peripheral vascular disease probably by reducing whole blood viscosity. The authors assessed the value of this agent in treating myocardial ischemia in 11 patients with angiographically documented coronary artery disease and stable angina pectoris. Maximal, symptom limited treadmill exercise stress tests were performed before and after six weeks of therapy with 1200 mg of pentoxifylline per day. Clinical symptoms proved in 9 [82%] of patients; none developed drug side effects. After therapy, mean total exercise time [7.7 +/- 1.3 vs 10.1 +/- 1.2 minutes], time to onset of angina [5.5 +/- 0.9 vs 7.9 +/- 1.0 minutes], heart rate at onset of angina [93.4 +/- 6.7 vs 112.0 +/- 10.5 beats/min] and rate at onset of ST depression [94.0 +/- 5.8 vs 115.9 +/- 7.4 beats/min] all increased significantly [p less than 0.05]. Mean maximum ST segment depression also decreased [1.6 +/- 0.3 vs 1.2 +/- 0.4mm], but the difference was not significant. Thus, pentoxifylline increases exercise performance in patients with angina pectoris and increases exercise capacity before development of of myocardial ischemia. It may, therefore, be a useful agent for treating ischemic heart disease.
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PMID:Efficacy of pentoxifylline in patients with stable angina pectoris. 337 71

Surgical risk factors of abdominal aortic disease. Between January 1, 1982 and October 1986, 327 surgical repairs were performed on abdominal aortic obstructive diseases and aneurysms at the St. Luc University Hospital. 150 pre-, per- and postoperative data were collected retrospectively for each patient. Ninety-one per cent of patients were smokers, 57.5 per cent had heart disease, 43 per cent arterial hypertension, 51 per cent peripheral vascular disease and 28 percent had obstructive lung disease. Concerning cardiac morbidity, the post-operative infarction rate was 4.4 per cent in patients who had previously suffered from an infarction, and 1.9 per cent in patients with no previous infarction. Post-operative angina-ischemia rate were respectively 23 and 4.7 per cent. Two hundred and thirty two elective operations resulted in 6 deaths (2.6 per cent) while 95 emergency operations resulted in 34 deaths (35.8 per cent). The causes of the death and the post-operative complications are detailed. The decrease of the morbidity and the mortality rates inherent to this pathology depends on an early diagnosis and surgical treatment by a team, knowledgeable of this pathology, who are able to prevent and correctly treat the complications, especially those affecting the cardiovascular system.
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PMID:[Risk factors in surgery of the abdominal aorta]. 338 30

A 68-year-old man with peripheral vascular disease and diabetes mellitus underwent coronary artery bypass graft surgery for angina pectoris unresponsive to medical treatment. Postoperatively, the left saphenous vein donor site became infected and developed a nonhealing ulcer. Three months after surgery, a left below-knee amputation was performed. The patient's prosthetic program was uneventful, and he became independent in ambulation with a prosthesis. This rare complication of coronary artery bypass graft surgery may be prevented by careful preoperative evaluation of peripheral circulation of the proposed donor site and consideration of alternative donor sites, such as the internal mammary artery. To our knowledge, this is the first detailed description and second reported case of lower limb amputation of the donor site extremity following such surgery.
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PMID:Lower limb amputation of the donor site extremity after coronary artery bypass graft surgery. 348 23


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