Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0002962 (angina)
 21,142 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The precise timing of intravenous thrombolysis and coronary angioplasty continues to be evaluated for patients who have coronary thrombosis and unstable angina or postinfarction angina. Coronary angioplasty is effective for these patients but is associated with thromboembolic coronary occlusion in 24% to 29% of cases. After adjunctive intravenous thrombolysis and oral antiplatelet therapy to improve the success rate and to decrease the risk of acute occlusion, deferred angioplasty was successful in three patients with intracoronary thrombus and unstable angina or postinfarction angina. Staged thrombolysis and deferred angioplasty is feasible for selected patients with these acute coronary syndromes.
 ...
PMID:Staged thrombolysis and percutaneous transluminal coronary angioplasty for unstable and postinfarction angina. 252 36

To evaluate myocardial perfusion during transient coronary arterial occlusion, thallium-201 was administered intravenously during percutaneous transluminal coronary angioplasty (PTCA) in 12 patients with effort angina, and the resulting perfusion images were compared with those of exercise stress obtained before PTCA. Thallium-201 was injected at the last inflation of an angioplastic balloon and occlusion was maintained for 60 to 90 sec. Three projections of planar images were obtained immediately after PTCA, using a portable gamma camera in an angiography room. These perfusion images obtained during PTCA and exercise were visually interpreted and compared. Myocardial perfusion defects due to the responsible vessel occlusion were observed at early imaging after PTCA, and were fully redistributed three hrs post injection. In 10 patients without angiographically imaged collateral vessels, there were no significant differences in perfusion between images during PTCA and during exercise. Two patients whose collaterals were observed during coronary angiography before PTCA had higher perfusion scores during PTCA than during exercise. We concluded that intravenous injection of thallium-201 during PTCA is a useful means for assessing alteration of myocardial perfusion due to transient coronary occlusion without increasing the risk of angioplastic procedures, and that it provides more precise information about the jeopardized myocardium, perfused by antegrade blood flow.
 ...
PMID:[Thallium-201 myocardial perfusion imaging during transient coronary occlusion at the time of PTCA: comparison with stress imaging]. 253 Mar 35

The calcium entry-blocking drugs produce effects on the coronary vasculature that might be expected to exert anti-ischemia activity. Although these agents cause little vasodilation of the epicardial coronary arteries during basal conditions, they block vasoconstriction that can increase stenosis severity during isometric exercise and interrupt coronary artery spasm in patients with variant angina. Administration of the calcium blockers causes transient vasodilation of the coronary resistance vessels, followed by decreased responsiveness to a brief ischemic stimulus. This results in decreased coronary reactive hyperemia after transient coronary occlusion. By preventing excessive ischemic vasodilation of the resistance vessels, these agents can enhance perfusion of the subendocardium distal to a flow-limiting coronary stenosis. The calcium entry blockers have relatively little effect on the immature coronary collateral vessels that exist at the time of acute coronary occlusion. Diltiazem, however, has been demonstrated to increase collateral blood flow in animals in which chronic coronary occlusion has resulted in growth of moderately well-developed collateral vessels.
 ...
PMID:Effects of calcium entry blockade on myocardial blood flow. 255 78

Between December, 1985, and May, 1988 we have performed coronary angioplasty of 14 lesions in 12 patients. Before angioplasty 8 patients had a history of unstable angina, and 3 developed angina after streptokinase because of an acute myocardial infarction. We attempted angioplasty of 11 proximal and 3 distal lesions; these included a coronary bypass graft lesion, and 3 lesions in one vessel. We successfully dilated 12 lesions (85%). The coronary stenosis was reduced on average from 84.2 +/- 9 to 17.5 +/- 7 per cent (P less than 0.0001); and the pressure gradient was reduced from 74 +/- 16.25 to 18.3 +/- 9 mmHg (P less than 0.001). Procedure-related complications included: coronary occlusion in 4 patients (28.5%) that were successfully resolved during angioplasty in 3 patients, but one developed myocardial infarction (8.3%); and one urgent surgery and death in a patient with 3 vessel disease. Twelve patients (83%) with no evidence of myocardial ischemia returned to their normal activities. These initial data confirm coronary angioplasty as a safe, efficatious and successful alternative in the management of selected patients with coronary artery disease.
 ...
PMID:[Coronary angioplasty. Results observed in 14 cases]. 260 89

We support the concept of a common anatomic and physiologic link between the acute coronary syndromes, which consists of plaque fissuring or rupture, leading to exposure of the circulating blood to collagen, lipids, and smooth muscle cells. This, in turn, results in marked platelet activation and the initiation of the coagulation sequence, both of which lead to thrombus formation. What determines the clinical outcome in these patients is the suddenness of coronary occlusion, the completeness of blood flow deprivation, and most importantly, its duration. In unstable angina, either plaque disruption resulting in an abrupt change in its morphologic configuration with reduction of coronary blood flow or increased myocardial oxygen demand are associated with increased exertional symptoms. In rest angina, two events may take place: formation of a transient and labile thrombus due to platelet and clotting activation, or vasospasm associated with the release of platelet-derived vasoconstrictive substances or loss of endothelial relaxing properties. As a result, transient myocardial ischemia occurs, which may be intermittent and recurrent and may progress to myocardial infarction or sudden death. In myocardial infarction, plaque rupture is usually more severe, leading to the formation of an occlusive or near-occlusive thrombus which may be more persistent and fixed to the arterial wall. The duration of coronary blood flow deprivation needs to be sufficiently long in order to produce myocardial cell death. Moreover, the difference between Q-wave and non-Q-wave infarction is probably determined by the duration of blood flow obstruction, being longer in the former. The presence of a functionally adequate collateral circulation will, in part, determine the survival of the area of myocardium at jeopardy. The coronary events that take place in ischemic sudden death are probably similar to those in unstable angina, namely plaque rupture with thrombus formation. In sudden death, the resulting myocardial ischemia may precipitate fatal ventricular arrhythmias. Alternatively, platelet microemboli from ulcerated arterial plaques may produce multiple areas of myocardial necrosis which can result in electrical instability and ventricular fibrillation.
 ...
PMID:Thrombosis/platelets and other blood factors in acute coronary syndromes. 265 27

A report is presented on 9 cases of left ventricular rupture associated with acute myocardial infarction experienced at Tsuchiya Hospital from January 1983 to August 1987. These cases accounted for 2.6% of the 384 cases of acute myocardial infarction admitted during the same period. Cases of cardiac rupture were classified according to clinical symptoms and hemodynamic findings obtained into three types, blow out type, subacute type, and our newly added intermediate type. In the intermediate type, there is depression of blood pressure to the level of losing consciousness but improvement of blood pressure and consciousness through medical treatment and time is available to permit surgical treatment in comparison with the blow out type. The therapeutic results were studied by the types. Among the four cases of blow out type, closure of the ventricular rupture was made under the extracorporeal circulation in one case, release of tamponade only under thoracotomy in the CCU in one case, and medical treatment only in two case, but none of the cases survived. Surgical closure of the ventricular rupture was made in all the three cases of the subacute type and all the cases are surviving. Of the two cases of the intermediate type who underwent surgical closure of the ventricular rupture, only one case could be salvaged. In examining the risk factors of cardiac rupture, a high rate of cardiac rupture was observed in initial cases of myocardial infarction without a past history of angina attack and in cases of coronary occlusion without evidence of peripheral collateral flow by emergency coronary angiography.
 ...
PMID:[A study of left ventricular rupture associated with acute myocardial infarction]. 273 35

It has been demonstrated in animal experiments that heparin accelerates the coronary collateral development induced by repeated coronary occlusion. We used this effect of heparin for the treatment of patients with stable effort angina. In 10 patients, treadmill exercise was performed according to standard Bruce protocol twice a day for 10 days. A single intravenous dose of heparin (5000 IU) was given 10 to 20 min before each exercise period. Exercise with heparin pretreatment increased the total exercise duration from 6.3 +/- 1.9 (SD) to 9.1 +/- 2.2 min (p less than .001) and the maximal double product (DP) from 18,900 +/- 5100 to 25,500 +/- 6800 mm Hg.beats/min (p less than .001). The DP at the onset of angina was also increased by 35% (p less than .01) and the DP at which ST depression (0.1 mV) first appeared was 19% (p less than .05) greater after treatment. Repeat coronary cineangiography revealed an increase in the extent of opacification of collaterals to the jeopardized myocardium. In an additional six patients, treadmill exercise was performed with no medication twice a day for 10 days. All of the above-mentioned variables of treadmill capacity remained unchanged, despite 20 exercise periods without heparin pretreatment. Thus, heparin accelerates exercise-induced coronary collateral development by promoting angiogenesis. The development of such a therapeutic modality will open a new field for the treatment of patients with ischemia.
 ...
PMID:Improvement of treadmill capacity and collateral circulation as a result of exercise with heparin pretreatment in patients with effort angina. 283 15

Beta blockers reduce myocardial oxygen demand and are therefore useful in ischemic states. They reduce angina pectoris and reduce the risk of death when administered long-term after acute myocardial infarction. Some studies suggest that when administered early after coronary occlusion they can reduce myocardial infarct size. Relative contraindications to beta blockers, such as a history of congestive heart failure, chronic obstructive lung disease, atrioventricular conduction defects and low blood pressure, limit their use. Conventional beta blockers have a relatively long duration of action and are either contraindicated or must be used with particular caution in patients with these contraindications. Esmolol is an ultrashort-acting beta blocker with a biologic half-life of 9 minutes. Therefore, such an agent may be useful in patients with ischemic heart disease in whom reducing heart rate would be beneficial but in whom there is concern that beta blockers might not be tolerated. Esmolol reduced myocardial infarct size in 2 experimental studies of coronary occlusion followed by reperfusion, and improved the recovery of the stunned myocardium when administered during experimental myocardial ischemia. Esmolol's brief duration of action may make it safer than conventional beta blockers for the management of patients with unstable angina or myocardial infarction.
 ...
PMID:Experimental and clinical observations on the efficacy of esmolol in myocardial ischemia. 286 48

This study was undertaken to identify psychosocial and physical characteristics that independently predict anginal pain relief. The original study group comprised over 570 patients in whom the characteristics were identified at the time of coronary arteriography and who were followed up after 6 months of standard medical therapy. In the subset of 382 of these patients who were assessed as having NYHA Class III or IV angina at the time of angiography, a multivariable analysis of 101 baseline descriptors showed that higher scores on the MMPI hypochondriasis scale, unemployment, and more severe right coronary occlusion were significant independent predictors of failure to achieve two-class improvement at follow-up. These three characteristics also predicted continuing severe angina in a subsequent, independent sample of 91 new patients. These findings could help physicians select appropriate treatment by prospectively identifying patients who are unlikely to respond to standard medical treatment of angina.
 ...
PMID:Psychosocial and physical predictors of anginal pain relief with medical management. 287 82

Percutaneous transluminal coronary angioplasty (PTCA) was attempted in 67 patients with total coronary arterial occlusion but without associated acute transmural infarction. No patient received concomitant streptokinase therapy. The duration of occlusion was one week or less in 22 patients, one week to one month in 24 patients, one to three months in 13 patients, and more than three months in eight patients. The occluded vessel was the left anterior descending artery in 38 (57%), the right coronary artery in 22 (33%), and the circumflex coronary artery in seven (10%). A steerable system was used in 29 patients whereas a fixed guide wire system was used in 38. Dilation was successful in 44 patients (66%). When a steerable system was used, PTCA was successful in 76% of the patients, compared with 58% when a nonsteerable system was used. The average size of stenosis after dilation was 32%. In the patients with a recent occlusion (one week or less in duration), PTCA was successful in 82%, which was significantly better than in patients with an older occlusion (greater than 12 weeks), in whom dilation was successful in only 25% (p less than 0.01). In patients with an occlusion of one to three months, PTCA was successful in 65%. During a mean follow-up of 1.6 years in the 44 patients with successful dilation, 37 were asymptomatic without angina, although five had required repeat dilation or coronary bypass surgery. In selected patients with symptomatic coronary artery disease and recent coronary occlusion but without associated myocardial infarction, PTCA alone is an effective means of restoring flow. After successful dilation, the majority of patients remain asymptomatic.
 ...
PMID:Angioplasty in total coronary arterial occlusion. 293 14


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>