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)

Twenty-two patients with congenital valvular aortic stenosis were surgically treated between 1967 and July 1975. Five (23%) were under 1 year of age (group I) and 17 (77%) were between 2 and 24 years (group II). All infants exhibited severe congestive heart failure and electrocardiographi (ECG) evidence of left ventricular hypertrophy (LVH) with strain pattern. In group II, angina was present in three cases, syncope and fatigue in two; the ECG indicated LVH in 10 cases (59%) with strain pattern in five (29%). A bicuspid aortic valve was present in 77% (17/22) of the cases; 32% had other cardiac anomalies. Aortic valvotomy was performed on cardiopulmonary bypass in 20 cases, and with deep hypothermia and circulatory arrest in two. Three infants under 1 month of age with associated anomalies died (hospital mortality 14%). Intraoperative average peak left ventricular-aortic systolic pressure gradient decreased from 86 to 21 mmHg (P less than 0.001). Late clinical (in all cases) and haemodynamic (26%) follow-up showed severe restenosis in two patients of group II; one of them had a second operation, the other one died three and a half years postoperatively. Results assessed on the basis of symptoms, ECG changes, aortic valve function, and/or haemodynamic findings were fair in the two surviving infants. Results in group II were excellent in three, satisfactory in seven, fair in four, and poor in two cases. In infants, aortic valvotomy is a palliative procedure which carries a high risk. In the older age group, early and late results are more gratifying.
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PMID:Surgical treatment of congenital valvular aortic stenosis. 96 96

Congestive heart failure developed in a 53-year-old man with a history of bicuspid aortic valve, angina, and pericarditis. Two-dimensional echocardiography showed a sinus of Valsalva aneurysm related to the anterior coronary sinus and color flow mapping identified a perforation of the anterior aortic cusp. These findings were confirmed during surgery.
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PMID:Unruptured sinus of valsalva aneurysm and bicuspid aortic valve with aortic cusp perforation: detection by color flow Doppler mapping. 146 89

Cardiovascular disease, the major cause of death in the elderly, is mostly ascribable to complications of coronary atherosclerosis: angina pectoris, myocardial infarction, and sudden death. However, other degenerative diseases involving several cardiac structures exist, and should be distinguished from age-related cardiac changes. Extensive dystrophic calcification determines aortic stenosis, and may affect either a normally tricuspid or a congenitally bicuspid valve. Surgical valve replacement is now a low risk option, even in elderly persons, whereas the efficacy of balloon valvuloplasty is questionable. Aortic incompetence in adults and aged persons is mostly the consequence of aortic tunica media atrophy with anular ectasia, in the setting of nearly normal aortic leaflets. Mitral valve prolapse is the main cause of mitral incompetence; spontaneous cordal rupture is a late complication in the natural history of this disease, thus warranting prompt surgical valve repair or replacement. The entire spectrum of cardiomyopathies is observed in the elderly: dilated, hypertrophic, restrictive, arrhythmogenic. Cardiac amyloidosis is by far the most frequent secondary form and leads to congestive heart failure by impairing ventricular compliance. Idiopathic fibrosis of the specialized AV junction or dystrophic calcification of central fibrous body are the usual substrates of AV block, which requires pace-maker implantation. Nonrheumatic atrial fibrillation, due to fibro-fatty degeneration of the atrial musculature or dilated left atrium, carries a high risk of thromboembolic complications and cerebral accidents; oral anticoagulants have proven to be effective in preventing stroke. Aortic dissecting aneurysm is a spontaneous laceration, and usually a complication of longstanding systemic hypertension; exceptionally, spontaneous dissection may primarily occur in the coronary arteries. In conclusion, longevity at present is mostly threatened by cardiovascular disease, among which the role of degenerative, non-atherosclerotic disorders may be greater than thought.
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PMID:Degenerative, non-atherosclerotic cardiovascular disease in the elderly: a clinico-pathological survey. 209 63

Despite different aetiologies, acquired aortic stenosis is a self-maintaining, slowly progressive process with good long-term prognosis. In 142 patients with mild stenosis, there was clinical progression within 10 years of the initial diagnosis in only 12% of patients. Twenty-five years after the diagnosis had been established, the severity of aortic stenosis was clinically unchanged in 38%, while 25% of patients had moderate stenosis and 35% had undergone valve replacement. Progression of moderate aortic stenosis was more rapid: the average time interval between the manifestation of moderate aortic stenosis and surgery was 13.4 years. Age at the onset of initial symptoms was related to aetiology: 39 +/- 18 years with rheumatic aortic stenoses, 48 +/- 6 years in patients with bicuspid valves who had no history of rheumatic fever, infective endocarditis or myocarditis, and 66 +/- 12 years in degenerative, calcific stenoses of tricuspid aortic valves. Patients with haemodynamically severe stenosis who had refused the recommended operation (n = 55) had an overall poor prognosis: mean survival averaged 23 +/- 5 months and the five-year probability of survival was 18 +/- 7%. All these patients died within 12 years of observation. Mean survival after the occurrence of angina pectoris was 45 +/- 13 months, after syncope 27 +/- 15 months, and after first occurrence of left heart failure 11 +/- 10 months.
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PMID:The natural history of aortic valve stenosis. 304 4

There have been several recent advances in our understanding of aortic stenosis and in its diagnosis and treatment. Aortic stenosis is now most commonly due to a bicuspid valve. Rheumatic aortic stenosis has become much less common and calcific stenosis of valves in the elderly is a rapidly increasing cause. The prognosis of patients with aortic stenosis can be largely determined by their symptoms, with a mean length of survival of 3 to 5 years for patients with angina, 3 years for patients with syncope, and only 12 to 24 months for patients with heart failure. Virtually all symptomatic patients should be operated on, even those with reduced left ventricular function. The risk of sudden death in asymptomatic adults is low, and thus surgery is generally not needed in these cases. Recently, the noninvasive diagnosis of aortic stenosis has improved dramatically with the advent of two-dimensional and Doppler echocardiography. These techniques provide information on the pressure gradient and can even allow accurate estimates of valve area. Cardiac catheterization is still required, however, to determine the anatomy of the coronary arteries prior to surgery since many patients will have concomitant coronary artery disease. The newest development in the treatment of aortic stenosis is catheter balloon valvuloplasty, which is relatively safe and has shown early promise in reducing the pressure gradient across not increased to the normal range and is significantly less than that following aortic valve replacement. The long-term results of balloon valvuloplasty are still being evaluated.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Recent developments in aortic stenosis. 328 5

Although nonspecific pericarditis, myocarditis, valvulitis, and coronary arteritis are known as cardiac lesions that accompany rheumatoid arthritis (RA), there have been few reports of the occurrence of clinically severe valvular disease. We report here the case of 69-year-old man with a 25-year history of RA who died of acute left-sided heart failure complicating to aortic steno-insufficiency and angina pectoris. Autopsy findings revealed the coincidence of a congenital bicuspid aortic valve with chronic inflammation, fibrosis and calcification; eccentric hypertrophy and myocardial fibrosis of the left ventricle; 75% luminal narrowing of the proximal portion of the coronary artery due to atherosclerosis, and narrowing of the small arteries of the cardiac muscle due to angitis. It is deduced that the coronary artery lesions, aortic valve lesions and myocardial lesions were aggravated by the bicuspid aortic valve, changes with ageing and corticosteroid therapy.
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PMID:An autopsy case of rheumatoid arthritis with aortic steno-insufficiency, angina pectoris and severe heart failure. 648 41

Calcific embolization from aortic stenosis may be more frequent than commonly appreciated. Most calcific emboli are clinically silent, although transient ischemic attacks, cerebral infarcts, blindness (from central retinal artery occlusions), and myocardial infarctions have been reported. We describe a patient with calcific bicuspid aortic stenosis who presented with transient ischemic attacks and angina secondary to a calcific embolus to the second circumflex marginal coronary artery. The calcific embolus was retrieved during aortic valve replacement surgery. A review of the literature suggests that calcific embolization from calcific aortic stenosis may occur more commonly in patients with bicuspid valves.
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PMID:Spontaneous coronary artery embolus associated with calcific aortic stenosis. 816 77

The etiology of acquired aortic stenosis (AS) has changed dramatically as socioeconomic and hygienic conditions have improved and as the general population lives to an older age. Rheumatic disease was responsible for most cases of AS until a few decades ago, whereas now most are due to calcific degenerative or bicuspid etiologies. There is a long latency period from the initial discovery of a murmur and first onset of symptoms. In studies representing clinical experience prior to the 1960s, the mean age at symptomatic presentation was 48 years, while in series representing experience up the 1980s, it was 61 years. The changing etiology of AS has important implications for following patients with AS, and monitoring those who are discovered to have significant AS in the absence of symptoms. AS has become more a disease of the elderly, and it is the elderly patient with AS, especially those with calcific degenerative AS, who develop the most rapid and significant progression of their disease, present with symptoms of left ventricular (LV) failure, and are most likely to have critical outflow tract obstruction at the time of their presentation. Once symptoms develop, the outcome of patients with AS is quite poor: in early studies approximately 50% of such patients were dead at 5 years and 90% were dead at 10 years. Symptoms that represent LV failure, e.g., dyspnea, are associated with a worse survival (average survival 2 years) compared to symptoms that represent LV hypertrophy, e.g., angina or outflow obstruction, syncope (average survival 3 years). There is uniform agreement that once symptoms develop, patients with significant AS should undergo valve replacement.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Management of the patient with asymptomatic aortic stenosis. 818 54

We report on the case of a 45-year-old man with recurrent syncope and angina with shortness of breath on exertion. Invasive and noninvasive diagnostic methods revealed severely stenosed bicuspid aortic valve, postductal coarctation of the aorta, and a coronary artery-descending aorta fistula. After surgical correction of the coarctation, ligation of the fistula, and aortic valve replacement, the patient's symptoms resolved.
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PMID:Coronary artery-descending aorta fistula as an unusual collateral in a patient with postductal coarctation. 1037 17

A 39-year-old woman had exercise-induced ST segment depression associated with chest pain. Cardiac evaluation revealed moderate aortic stenosis (AS), related to the bicuspid valves, with an aortic mean pressure gradient of 22 mmHg, a calculated aortic valve area of 1.3 cm2 and normal left ventricular (LV) peak systolic and end-diastolic pressures, but no LV hypertrophy, resulting in normal LV wall stress. Although the coronary arteries were angiographically normal, rapid atrial pacing and an intracoronary papaverine injection revealed a significantly decreased coronary flow reserve (CFR), which may have played an important role in the pathogenesis of angina pectoris in this patient. Though the CFR is usually decreased in patients with AS, as well as in microvascular angina, in this particular case, it appeared to have decreased as a consequence of microvascular dysfunction rather than of AS-related mechanisms.
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PMID:Microvascular angina in a patient with aortic stenosis. 1154 87


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