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

In order to study myocardial and clinical events during transient coronary occlusion in humans, two-dimensional echocardiography was continuously performed in 15 patients undergoing 49 balloon inflations during percutaneous transluminal coronary angioplasty (PTCA). Transient segmental asynergy developed in all patients 8 +/- 3 seconds after balloon inflation and returned to baseline 19 +/- 8 seconds after balloon deflation. Segmental dyskinesis was seen in only 8 of 11 patients undergoing PTCA of the left anterior descending artery (LAD). A wall motion score, based on degree of asynergy of 13 segments of the left ventricle, was significantly higher during LAD than during right coronary artery inflation (7.9 +/- 1.3 vs 4.0 +/- 1.4, p less than 0.01). Left ventricular size index increased significantly during balloon inflation, from 179 +/- 9 to 196 +/- 10 mm (p less than 0.01). Four patients developed transient ST segment changes in the extremity leads of the ECG and five patients had angina pectoris. The very first sign of ischemia in three patients, who developed all of these symptoms together, was consistently asynergy, followed by ECG changes, and last, angina pectoris. Thus during PTCA, transient asynergy and left ventricular dilatation develop, which are often clinically silent.
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PMID:Two-dimensional echocardiography during percutaneous transluminal coronary angioplasty. 294 Aug 52

We have shown improvement in collateral filling immediately after sudden controlled coronary occlusion in human subjects undergoing elective coronary angioplasty. It has been suggested but not proved that collateral circulation can limit myocardial ischemia. We prospectively studied 23 patients with isolated left anterior descending (n = 14) or right coronary (n = 9) disease and normal left ventriculograms during elective coronary angioplasty. A second arterial catheter was used for injection of the contralateral artery to assess collateral filling before balloon placement and during coronary occlusion by balloon inflation. Left ventriculography was performed during another inflation. Grading of collateral filling was as follows: 0 = none, 1 = filling of side branches only, 2 = partial filling of the epicardial segment, 3 = complete filling of the epicardial segment. Indexes of myocardial ischemia included percent of the left ventricular perimeter showing new hypocontractility and the sum of ST segment elevation measured on a simultaneous 12-lead electrocardiogram recorded during each inflation. Collateral filling during balloon occlusion and indexes of ischemia were assessed at 30 to 40 sec into inflation. Aortic pressure and heart rate did not correlate with the percent hypocontractile perimeter nor the sum of ST segment elevation. There was a significant correlation between the grade of collateral filling during inflation and both percent hypocontractile perimeter (r = -.85) and the sum of ST segment elevation (r = -.87). Anginal pain occurred in all patients with grade 0 or 1 collateral filling but in only 36% of patients with grade 2 or 3 collaterals. In conclusion, collateral circulation limits myocardial ischemia as assessed by the extent of new ventricular asynergy and electrocardiographic changes during coronary occlusion in patients.
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PMID:Limitation of myocardial ischemia by collateral circulation during sudden controlled coronary artery occlusion in human subjects: a prospective study. 294 29

In a randomized double blind placebo-controlled study in 20 patients the influence of the calcium antagonist diltiazem (1.0 mg administered intracoronarily, distal from the stenosis) on the severity of myocardial ischemia during therapeutic coronary occlusion (transluminal coronary angioplasty) of the left anterior descending coronary artery was investigated. The severity and time of onset of ischemic ST and T wave changes as well as anginal pain were significantly reduced 3 and 8 minutes after diltiazem, whereas there was no definite change in the controls. Heart rate and blood pressure were not influenced by diltiazem or placebo. The results indicate a direct antiischemic effect of diltiazem on myocardial cells. The findings can neither be explained by an influence on cardiac afterload nor by coronary vessel reactions, nor a reduction of myocardial contractility. The findings do not permit conclusions in terms of the duration of this direct antiischemic mode of action.
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PMID:[Direct myocardial anti-ischemic effect of diltiazem in the human]. 294 32

Increases in electrocardiographic R-wave amplitude in humans have been described with positive and negative dynamic exercise test findings, episodes of variant angina and myocardial ischemia and infarction. The role of factors other than acute reversible ischemia in the genesis of these R-wave size alterations is unclear. To evaluate the contribution of acute ischemia to changes in R-wave size in the absence of other confounding variables, electrocardiograms were recorded before and during coronary angioplasty balloon inflation. The frontal leads and V1, V2, V5 and V6 were recorded during the last 10 seconds of coronary occlusion in 20 patients and intracoronary epicardial electrograms were recorded continuously during balloon inflation in 10 patients. Inflations were 8 +/- 2 atm for 52 +/- 36 seconds. Chest pain occurred in 26 of 30 patients with balloon inflation and ST elevation occurred in 22. No significant increases in R amplitude were noted in any lead or in the sum of the R waves in all leads, including intracoronary electrograms. In contrast, R amplitude tended to decrease. The initial decrease in both surface and epicardial R amplitude was similar to the first of the biphasic changes observed in animal models. An increase in R-wave amplitude is not by itself always a marker for myocardial ischemia, but depends on severity and duration of the process.
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PMID:R wave of the surface and intracoronary electrogram during acute coronary artery occlusion. 294 13

Coronary occlusion or myocardial infarction occurred in 50 of 394 (13%) one-vessel-disease patients awaiting percutaneous transluminal coronary angioplasty (PTCA). To identify risk factors for these events, we first matched the 37 patients who demonstrated occlusion on the immediate preangioplasty repeat angiogram with 37 patients who did not. Matching was based on the time interval between angiograms, the date of the procedure, and the site of the lesion. Preangioplasty occlusion patients did differ from controls by age (47 +/- 11 vs 54 +/- 8 years, P less than .01), smoking status (34/37 vs 24/37, P less than .01), and angina class (2.6 +/- 1.0 vs 2.3 +/- 0.7, P less than .10) at the time of the first angiogram. Second, we pooled the data of the 37 preangioplasty occlusion patients with those of the 13 patients with preangioplasty myocardial infarction. The 50 cases with complication (coronary occlusion or myocardial infarction) were younger (47 +/- 12 vs 54 +/- 8 years, P less than .01), more often smokers (42/50 vs 24/37, P less than .05), and more symptomatic (2.7 +/- 0.8 vs 2.3 +/- 0.7, P less than .05) than the 37 controls. This study suggests that young smokers with severe angina are at high risk of preangioplasty occlusion and/or myocardial infarction; prompt management of these patients, when considered for PTCA, seems advisable.
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PMID:Risk of preangioplasty occlusion and myocardial infarction in one-vessel-disease patients scheduled for percutaneous transluminal coronary angioplasty. 294 89

Patients undergoing coronary angioplasty who have had a prior transmural myocardial infarction in the distribution of a contralateral coronary artery are considered a high-risk group because of potentially severe left ventricular dysfunction if an ischemic complication occurs. The purpose of this study was to evaluate the safety and efficacy of coronary angioplasty in 28 patients with prior myocardial infarction remote from the artery undergoing dilatation. Prior myocardial infarction was defined by the presence of pathologic Q waves on ECG or segmental akinesis on ventriculography. Angioplasty was successful in 30 of 33 lesions (91%) and in 25 of 28 patients (89%). Mean stenosis diameter was reduced from 91% +/- 7% to 28% +/- 16%; mean translesional gradient after angioplasty was 6 +/- 5 mm Hg. No patient developed severe hemodynamic deterioration from transient coronary occlusion during balloon inflation or from an acute ischemic complication. Three patients underwent coronary artery bypass surgery after unsuccessful angioplasty. There were no new Q wave infarctions or deaths. The results of coronary angioplasty in patients with prior infarction were compared with those of 203 patients without prior remote infarction. Primary success and occurrence of major complications were comparable in both groups. At a mean follow-up of 12 +/- 6 months, 18 of the 25 patients (72%) who underwent initially successful dilatation have remained symptom free with angioplasty alone. Therefore, coronary angioplasty is a suitable therapeutic procedure in carefully selected patients with angina pectoris and prior myocardial infarction at a distance from the site of angioplasty.
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PMID:Percutaneous transluminal coronary angioplasty in patients with prior myocardial infarction: angioplasty at a distance from the prior infarct zone. 296 Feb 24

Eighteen patients with chronic totally occluded coronary arteries underwent percutaneous coronary angioplasty. Eleven of these patients had a proximal occlusion of the left anterior descending artery and seven had occlusion of either the proximal or middle right coronary artery. All patients had severe angina pectoris with clearly positive results of stress treadmill testing. Preservation of a viable myocardium despite an occluded artery was, in each instance, the result of excellent collateral flow arising from the contralateral coronary artery. The guide wire and the dilatation balloon were properly positioned by opacifying the distal segment of the occluded artery by injection of contrast into the contralateral artery in 15 of 18 patients. Almost simultaneous injection, first into the contralateral vessel and then into the occluded artery, allowed evaluation of the true length of the occlusion. Contralateral opacification disappeared immediately after adequate recanalization and reappeared during inflation of the balloon. These examples show that in patients with chronic coronary occlusion, opacification of the distal segment by injection of contrast into the contralateral vessel seems to be helpful and without risk to the patient.
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PMID:Angioplasty of chronic totally occluded coronary arteries: usefulness of retrograde opacification of the distal part of the occluded vessel via the contralateral coronary artery. 296 Dec 31

Thus, in 1987, the following indications for surgical treatment of acute myocardial infarction are: 1) acute evolving myocardial infarction less than six hours from onset, in patients in whom PTCA or streptokinase, depending on the coronary anatomy, has been unsuccessful; in single vessel disease, CABG is unlikely; in multiple-vessel disease, CABG is preferable to SK/PTCA therapy unless a very major "culprit" lesion can be identified with certainty; 2) post-infarction angina hours to days after a transmural myocardial infarction unyielding to maximal medical therapy and in patients with a coronary artery obstruction not amenable to PTCA; 3) occlusion of a coronary artery during cardiac catheterization that cannot be fixed by PTCA and/or streptokinase; 4) occlusion of a coronary artery during PTCA causing hemodynamic obstruction and threatened myocardium subtended by the obstructed coronary artery; 5) balloon-dependent patients in cardiogenic shock without mechanical defects who have adequate residual left ventricular function as determined by regional wall motion studies; 6) ventricular septal defect secondary to myocardial infarction unless there is terminal organ damage; 7) mitral valve replacement with or without coronary bypass for acute papillary muscle rupture; 8) semi-emergent cardiac transplantation, either with or without a mechanical bridge to transplant in young individuals (less than 50 years) who have suffered massive destruction of left ventricular myocardium by an acute coronary occlusion with or without recurring ventricular tachyarrhythmias. Ejection fraction in this clinical category is always under 0.20 and usually under 0.15.
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PMID:Surgical treatment of acute myocardial infarction. 296 16

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

The primary success rate and incidence of major complications have been retrospectively assessed in a consecutive series of 224 patients undergoing percutaneous transluminal coronary angioplasty (PTCA) in one centre. The patients have been divided into three groups; those with angina and no previous myocardial infarction (Group 1; N = 130), those with angina and a previous transmural myocardial infarction (TMI) (Group 2; N = 59), and those with angina and a previous non-transmural myocardial infarction (NTMI) (Group 3; N = 26). The three groups were well matched for age, gender and angiographic severity of stenosis. The primary success rate in Group 1 was 90% compared to 64% in Group 2. The success rate in Group 3 lay in between at 77%. The lower success rates in Groups 2 and 3 were mainly due to an increase in the frequency of major complications. Acute coronary occlusion occurred in seven patients in Group 1, nine patients in Group 2 and four patients in Group 3. In all these patients in Groups 2 and 3 the outcome of acute occlusion was a procedure-related clinical myocardial infarction despite immediate re-angioplasty and/or emergency coronary artery bypass grafting whereas only four patients in Group 1 sustained an acute infarct. In this series of patients undergoing coronary angioplasty for symptom limiting angina, previous myocardial infarction appears to be a risk factor for a lower success rate mainly due to an increase in the frequency and severity of major complications.
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PMID:Success and complication rates of coronary angioplasty in patients with and without previous myocardial infarction. 296 70


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