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Query: UMLS:C0002962 (angina)
 21,142 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 65-year-old man with unstable angina had a critical left anterior descending coronary artery stenosis which progressed to total occlusion, without evidence of acute myocardial infarction. Thallium imaging revealed defects in the distribution of the left anterior descending coronary artery on exercise and redistribution, 4 h later. 99mTc radionuclide angiography showed a fall in left ventricular ejection fraction on exercise, and contrast cineangiography showed an extensive area of akinesia. Percutaneous transluminal coronary angioplasty was successful without any complications. Repeat radionuclide studies demonstrated improvement of both myocardial perfusion and function. Angiography at 1 year showed normal left ventricular contraction and no evidence of recurrent stenosis. The patient is free of angina, on no medication 2 years after angioplasty. This case illustrates the feasibility of myocardial salvage by elective coronary angioplasty in patients with unstable angina total coronary occlusion.
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PMID:Myocardial salvage following elective angioplasty for total coronary occlusion. 296 94

Increasingly longer balloon inflation times during coronary angioplasty can create significant left ventricular ischemia, amelioration of which was attempted in this study using nitroglycerin. Hemodynamic variables were assessed during inflation of an angioplasty balloon in the proximal left anterior descending coronary artery of 10 patients. Regional wall motion was assessed by left ventriculography during a separate balloon inflation. Nitroglycerin (200 micrograms) was then administered intravenously, and hemodynamic and ventriculographic assessments during balloon inflations were repeated. Balloon inflation resulted in a marked increase in left ventricular end-diastolic pressure (from 9.2 +/- 2.1 to 19.4 +/- 2.9 mm Hg) and time constant of left ventricular relaxation (from 44.2 +/- 6.2 to 62.3 +/- 11.3 ms) and a decrease in distal coronary artery perfusion pressure (from 54 +/- 9 to 33.1 +/- 4 mm Hg). Time to onset of angina was 29 +/- 3 seconds and time to ST segment depression of 1 mm or greater was 30 +/- 3 seconds. Regional wall motion analysis 30 seconds after onset of balloon inflation revealed marked hypokinesia and akinesia in the anteroapical segments with graduated depression of inferior wall motion, greatest at the apex. After the administration of nitroglycerin, balloon inflation resulted in a smaller increase in end-diastolic pressure (from 5.0 +/- 2.7 to 8.3 +/- 2.6 mm Hg) and time constant (from 47.9 +/- 4.7 to 54.4 +/- 9.2 ms; both p less than 0.01 versus standard balloon inflation). Distal coronary artery pressure remained similar to standard balloon inflation (32 +/- 3 mm Hg) despite lower mean arterial pressure (89 +/- 5 mm Hg, p less than or equal to 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Amelioration by nitroglycerin of left ventricular ischemia induced by percutaneous transluminal coronary angioplasty: assessment by hemodynamic variables and left ventriculography. 316 Jul 55

Dyspnea, a potential early symptom of coronary artery disease and congestive heart failure, was evaluated to establish its relation to left ventricular wall motion abnormalities. A group of 67-year-old men, drawn from the general population of Gothenburg, Sweden, was studied. Acceptable studies by 2-dimensional echocardiography were obtained from 42 of 49 men with dyspnea of presumed cardiac origin, and from 45 randomly selected nondyspneic control subjects. Both groups originated from a random population sample of 644 men. All men with akinesia, not limited to the basal inferolateral segment, were dyspneic. Akinesia (inferolateral segment only) was found in 4 of 45 control subjects (9%). Six of 20 men (30%) with low-grade dyspnea and 5 of 5 men with the most severe grade of dyspnea had 1 or more akinetic segments. The severity of dyspnea was related to regional wall motion disturbances (as classified in 11 anatomic segments [p less than 0.02 to p less than 0.0001]) and to presence and number of akinetic segments (p less than 0.0001). The degree of dyspnea was correlated to anterior (p less than 0.0001) but not inferior akinesia. The regional wall motion disturbances measured by echocardiography still contributed significantly to the explanation of dyspnea when taking into account the presence or absence of clinical coronary artery disease determined from a 12-lead electrocardiogram, the history of angina pectoris and myocardial infarction, and the findings on chest x-ray films. Thus, presumed cardiac dyspnea is a sensitive marker of regional wall motion disturbances. Furthermore, the location of these disturbances may be of importance for the hemodynamic changes leading to cardiac dyspnea.
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PMID:Relation of dyspnea to left ventricular wall motion disturbances in a population of 67-year-old men. 359 80

In patients with coronary artery disease, left ventricular (LV) regional wall akinesia can develop during the Mueller maneuver. The present study determines if the presence of myocardial ischemic disease with no infarction is a sufficient condition for this to occur, or if the presence of prior acute myocardial infarction (MI) is necessary. In men, first-pass radionuclide ventriculography was performed in the 30 degree left anterior oblique supine position to measure LV ejection fraction, end-diastolic and end-systolic volumes and heart rate, and to obtain an image of the LV cavitary perimeter. This procedure was performed in 4 subject groups: 13 normal volunteers, 25 patients with coronary artery disease but no prior MI, 13 patients with coronary artery disease and prior nontransmural MI, and 36 patients with coronary artery disease and prior transmural MI. All patients had angina and underwent routine contrast coronary angiography; 60 also underwent contrast coronary angiography; 60 also underwent contrast LV angiography. Ejection fraction decreased during the Mueller maneuver in each of all the coronary artery disease groups (p less than 0.01), but not in the normal subjects. Heart rate increased in groups 1, 2 and 4 (p less than 0.01), and end-diastolic volume decreased in all 4 groups (p less than 0.01), whereas end-systolic volume did not change. Only in group 4 did regional wall akinesia develop (17 patients) during the Mueller maneuver. Among patients who had akinesia during the Mueller maneuver and also underwent routine contrast ventriculography, half of the akinetic segments were not seen on routine contrast study, but were seen only on radionuclide ventriculography during the Mueller maneuver.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effects of the Mueller maneuver on global and regional left ventricular function in angina pectoris with or without previous myocardial infarction. 359 84

During Ergonovine-test a patient with Prinzmetal angina presented (in I, aVL, V3-V6) ST downsloping which, after a temporary phase of alternative normalization (AST) beat to beat in V5, progressed to ST upsloping with typical angina. The M-mode echo-study first discovered, before than ecg, septal impairment (hypokinesia which increased to akinesia in the AST phase) and also asynergy of posterior wall of left ventricle. After intravenous nitrate echo-alterations reversed more rapidly than ecg one (transitional phase of ST decrease). The authors relate the AST to temporary alternative pseudonormalization caused by a phase of electrical instability during progressive vasospastic ischemia involving first the endocardial layers and after the epicardium of a single myocardiocoronary district. Probably also other partially opposite ischaemic districts, as suggested from echo data of posterior wall asynergy took a part in these events. This rare ST-alternans type as new pseudonormalization phenomenon and the usefulness of echo-study during ischaemic attacks are stressed.
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PMID:[Clinical, electrocardiographic and echocardiographic findings in a case of vasospastic angina with alternating pseudonormalization of the ST segment]. 383 2

Episodic mitral regurgitation due to ischaemia of one or both papillary muscles was studied in a review of 39 cases with complementary investigations and compared with previously reported data. The condition occurred after myocardial infarction in 69 p. 100 of cases (usually after inferior infarction: 54 p. 100) associated with ischaemia of the controlateral territory; there was no history of myocardial infarction in 31 p. 100 of cases. The patients were usually elderly (73 years), often hypertensive (77 p. 100) and diabetic (62 p. 100). The clinical syndrome was that of severe anginal pain, mitral regurgitation and left ventricular failure which was critical in some cases. The ECG showed typical ST depression (4.1 +/- 1.6 mm) especially in the antero-lateral leads; left bundle branch block (28 p. 100) with left axis deviation (18 p. 100), sometimes associated with changes of chronic infarction (64 p. 100) was also recorded. Mitral regurgitation and left ventricular failure regressed almost completely in typical cases between attacks, whilst the ECG showed slight residual sub-endocardial ischaemia (ST depression of 1.5 +/- 0.4 mm) in 30 cases and/or subepicardial ischaemia observed in the anterolateral leads in 13 cases. Phonomechanographic recordings (n = 32) showed moderate mitral regurgitation (1-2/6), usually parasystolic (47 p. 100) or early and mid systolic (36 p. 100) in 87.5 p. 100 of cases between attacks, aggravated by handgrip exercise and improved by trinitrin administration. Echocardiography (n = 27) only showed mitral valve changes in 2 patients (increased density of the papillary muscle in 1 case and prolapse of the anterior leaflet in 1 case); however, segmental wall hypokinetic (51 p. 100) or dyskinetic (15 p. 100) motion, was common with increased left ventricular end diastolic dimensions (mean 56.3 +/- 8.0 mm) and decreased fractional shortening (mean 0.30 +/- 0.07) (67 p. 100). Left atrial dimensions were increased (mean 39.7 +/- 6.4 mm) in 52 p. 100 of patients. Thallium 201 myocardial scintigraphy (n = 32) showed hypofixation in 57 (36 p. 100) and a lacuna in 23 (14 p. 100) of the 160 segments analysed. Left ventricular angioscintigraphy (n = 27; 135 segments) showed hypokinesia in 72 segments (53 p. 100); 2.7 segments per patient), akinesia in 19 segments (15 p. 100; 0.7 segment per patient) and dyskinesia in 2 segments (1.5 p. 100); 0.1 segment per patient). The global ejection fraction was 46 +/- 13 p. 100. Coronary angiography (n = 8) showed significant diffuse atherosclerosis.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Paroxysmal mitral insufficiency caused by ischemic dysfunction of the papillary muscles. Apropos of 39 cases]. 391 82

The authors report 2 cases of myocardial infarction with normal coronary arteries occurring at an interval of 2 months in 2 brothers aged 32 and 34. Following an episode of angina, the younger brother, a sportsman, but a smoker, developed an antero-septal infarct at rest, which was complicated by complete persistent right bundle branch block. Ventriculography and coronary angiography were normal. Induced spasm tests were not performed. The elder brother presented an infero-apico-lateral infarct on effort, without any prodromal syndrome, which was complicated by apical akinesia. Ventriculography revealed mitral prolapse. Coronary angiography was normal and the methylergometrine test was negative. In relation to this example of familial infarction with normal coronary vessels, the authors review the features of this type of infarction reported in the literature which predominantly occurs in young people. They discuss the principal points of interest, including the incidence, the criteria of definition based on the coronary angiography, the elements of the prognosis, the pathophysiological mechanisms and the possibility of a genetic predisposition.
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PMID:[Myocardial infarction with normal coronary vessels in young subjects. Apropos of 2 cases with an interval of 2 months in 2 brothers aged 32 and 34]. 400 92

Fifty-five ischemic attacks at rest with ST segment elevation were recorded by two-dimensional echocardiography (2DE) in 20 patients with Prinzmetal angina. Eighteen ischemic attacks were recorded starting from intravenous injection of ergonovine maleate while 37 spontaneous ischemic attacks were recorded from onset of either anginal pain or ECG changes or from the basal state. In each ischemic attack at least one of the following transient alterations was observed by 2DE during ST elevation: (1) Regional hypokinesia, akinesia, or dyskinesia; (2) "step sign," that is, a sharp demarcation between an akinetic or dyskinetic area and an adjacent normal or hypercontracting region; and (3) geometric changes in left ventricular shape, that is, globular appearance in diastole and hourglass silhouette in systole. Regional myocardial asynergy was detected earlier than onset of pain (which was not present in 21 [38%] ischemic episodes) or ST segment elevation on ECG, as documented in 40 ischemic episodes (16 induced and 24 spontaneous) in which echocardiographic monitoring was performed from basal state and carried on up to the appearance of ischemia. All described mechanical changes were fully reversible after pain subsided and ST segment was back to isoelectric, either spontaneously or with nitrates; furthermore, a contractile "rebound phenomenon" of the previously ischemic wall was observed in some episodes. In conclusion, these results outline a role for 2DE in detecting cardiac mechanical impairment due to transient myocardial ischemia with ST segment elevation in humans.
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PMID:Transient changes in left ventricular mechanics during attacks of Prinzmetal angina: a two-dimensional echocardiographic study. 623 83

Stress thallium-201 myocardial imaging was used in two angina-free patients with severe congestive heart failure to identify clinically silent areas of ischemic myocardium and to distinguish between scar and reversibly ischemic myocardium as a cause for akinesia of left ventricular wall segments. Subsequent myocardial revascularization in these patients led to considerable improvement in their clinical state and findings in postoperative nuclear scans. Thus, stress myocardial imaging may be useful in selecting patients with severe left ventricular failure but no angina pectoris for myocardial revascularization.
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PMID:Selection of angina-free patients with severe left ventricular dysfunction for myocardial revascularization. 741 28

Thallium-201 scintigraphy was performed in 20 normals and 60 patients (pts) with angiographically proven coronary artery disease (CAD) at rest after maximal exercise for evaluation of severity and location of CAD. The Tl-scintigrams were quantified by a Tl-score. The results of the Tl-score were compared with invasive and non-invasive parameters. Sensitivity asnd specificity of the Tl-score in evaluation of CAD was 90%. In normals, there were no significant differences from rest to exercise (Tl-score less than or equal to 1.2). Twenty-six of the pts with CAD, who had no evidence of myocardial infarction, showed a significant increase of Tl-score from 5.0 +/- 1.7 to 8.7 +/- 2.6 after exercise (p < 0.001). In 34 pts with CAD and a history of MI, Tl-score increased from 24.9 +/- 3.1 to 33.3 +/- 3.8 (p < 0.001). Exercised-induced ischemia was assessed by exercise electrocardiography in 48%, by Tl-score in 62% and by angina pectoris in 77%. In 37 pts, the Tl-score was compared with the coronary score, ejection fraction (EF) and local wall motion derived from biplane cineventriculograms. There was a significant correlation between the Tl-score and the EF: y = 79.13 - 1.11 x, n = 74, r = 0.688 (p < 0.001). No correlation was found between the coronary score and the Tl-score. Hypokinetic wall motion disturbances were assessed by Tl-score in 34% only, whereas akinesia and dyskinesia were detected in 86% (p < 0.001). The data suggest that Tl-scintigraphy even with a quantitative Tl-score is not sufficient for exact assessment of extent and severity of CAD.
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PMID:[Quantitative Tl-201 scintigraphy in diagnosis of severity and location of coronary artery disease. Comparison of a Tl-score to invasive and non-invasive parameters (author's transl)]. 744 54


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