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)

Traditionally, myocardial ischemia has been viewed as an imbalance in the supply and demand of myocardial oxygen. Stable angina is usually considered to involve a fixed lesion, whereas unstable angina involves a fixed lesion as well as such components as platelet aggregation, thrombotic processes, and vasospasm. Variant angina involves primarily vasospasm. A newer concept holds that most angina results from mixed mechanisms in which both fixed lesions and vasomotor alterations play a role. These mechanisms are responsible for mixed ischemic events, characterized by episodes at varying levels of exertion, with or without anginal pain. This concept would seem to be supported by the occurrence of silent ischemia in the setting of stable, unstable, or variant angina, despite differing pathophysiologic conditions. Ischemic events have important prognostic significance; unfortunately, many are unrecognized by patients. The question whether the treatment of ischemic events will improve prognosis remains a matter of debate.
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PMID:Mechanisms of myocardial ischemia. 144 93

A rational therapy of angina pectoris has to consider two recent pathophysiologic insights: 1. Not only in patients with instable but also with stable angina a dynamic, vasospastic component in addition to stenosis plays an important role. Stable angina is often a mixed form of disease. 2. In many patients stable angina is complicated by silent ischemia. Therapy of stable angina has 3 goals: 1. prevention or alleviation of angina; 2. reduction of silent ischemia episodes (number, extent); 3. cardioprotection i.e. prevention of instable angina, infarction and sudden death. The pharmacotherapeutic cornerstones are the nitrates, beta-blocking agents and calcium channel blockers. Their generally equivalent efficacy in short and longterm use is clinically and hemodynamically proven without doubt. Mode of action, pharmacokinetic aspects and recent as well as controversial questions regarding this group of drugs are reviewed. The pharmacotherapy of first choice should be determined for each patient individually and not according to schematic prescription. It should encompass pathogenesis of ischemia, specific indications for or adverse effects of the 3 drug classes, the question of induction of tolerance, possible cardioprotective benefit, side effects, compliance problems and finally cost of treatment. The rational aspects of combination therapy (nitrates and beta-blockers, beta-blockers and calcium antagonists) are explained and the therapeutic procedures for instable angina are outlined.
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PMID:[Therapy of angina pectoris--state of the art]. 196 77

Our group initiated a program of coronary angioplasty (CA) in patients with symptomatic one vessel disease, or multivascular lesions with a critical "culprit" stenosis. In a 16 month period we have performed CA of 28 lesions in 25 patients (20 men) with a mean age of 54 +/- 10 years. Stable angina was diagnosed in 14 patients, unstable angina in 7, and post-myocardial infarction residual angina or stenosis in 4 patients treated with streptokinase. Successful dilatation was obtained in 23 (82.1%) of 28 stenotic segments, reducing the stenosis from 90 +/- 8% (range 70-100) to 9 +/- 12% (range 0-30; p less than 0.00001). In 4 cases with total occlusion, dilatation was not obtained, and in one case the procedure was complicated by fatal brain embolism. There were 4 complications due to coronary occlusion or spasm, all of them resolved during CA without sequelae. The 20 cases with primary success have been followed during an average of 8.6 months. In three cases (15%) restenosis was detected; two of them underwent surgery, and CA was repeated successfully in the other. Disappearance of myocardial ischemia was confirmed in 14 patients, and functional improvement in the other three. In conclusion, CA is an effective and relatively safe therapeutic alternative in different clinical forms of coronary heart disease with a single vessel stenosis, or in selected cases of multivascular lesions with a critical stenosis.
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PMID:[Coronary angioplasty in the treatment of symptomatic myocardial ischemia with one vessel disease]. 237 36

To evaluate the cardiac risk in patients undergoing noncardiac surgery, it has been identified by the multivariated analysis some major and independent correlates of fatal or life-threatening cardiac complications. The most important ones were the history of previous myocardial infarction in the preceding six months, clinical signs of congestive heart failure, third heart sound or jugular venous distention, and for some Authors instable angina class IV CCS. Other predictive factors of complications were premature ventricular and atrial contractions or ectopic rhythms within cardiac diseases, age over 70 years, intraperitoneal, intrathoracic, aortic or emergency operation, severe valvular aortic and mitral stenosis and poor general medical conditions. Stable angina, hypertension, hyperlipidemia and smoking habit were less important. The global evaluation of cardiac risk can be performed by multifactorial index subdividing the patients into four very different risk classes. This is obtained by scores assigned to each statistically significant factor.
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PMID:[Surgical cardiac risk in patients with heart diseases. I. Evaluation of the risk]. 260 75

Stable angina is the most common form of presentation of ischemic heart disease, being more common in women (65%) than men (37%), while the reverse is true for the prevalence, being present in about 3.5% of men over 55 as opposed to 1.5% of women. The overall 10 year survival for individuals with stable angina at a mean age of 60 years is 58% for men and 68% for women. Prognosis is related to several factors: age, sex, the number of coronary vessels involved, collateral flow, ventricular function, and the extent of myocardium at risk. It is estimated that stable angina of recent onset is associated with single-vessel disease in about 40% of cases. Angina is a clinical diagnosis but, if doubt exists, one should exclude coronary atherosclerosis or spasm by cardiac catheterization and not rely on noninvasive techniques. Therapy for unstable angina or acute infarction receives considerable attention and is reasonably well defined, but such is not the case for stable angina. Conventionally, it consists of secondary prevention and prescription of nitrates, calcium blockers, or beta-blockers. There are several problems: No studies have been performed to assess efficacy in reducing the development of unstable angina. The group of drugs most appropriate for first-line therapy has not been identified. It has not been determined if nitrate tolerance is a major problem. The effect of beta-blockers on prognosis in patients with unstable angina has not been defined. A noninvasive means of identifying high and low risk patients with unstable angina has not been developed.
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PMID:Stable angina as a manifestation of ischemic heart disease: medical management. 286 48

Treatment of angina pectoris should follow the clinical course: Stable angina is most often responding to nitropreparations, betablockers or calciumantagonists; differentialtherapy should consider the basic state of the patient: age, heart-rate, hypo- or hypertension, cardiac failure or asthma bronchiale etc. Unstable angina needs more attention and should be transferred to a coronary care unit. Analgetics, sedatives, oxygen and nitrates should be applied under hemodynamic monitoring. Only in rare cases with cardiac failure or with rapid atrial fibrillation glycosides will be necessary. In extreme bradiacardias a pacemaker can be helpful. Captopril might be a new substance in nonresponders.
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PMID:[Therapy of angina pectoris]. 615 89

The need to obviate the risks associated with cardiopulmonary bypass (CPB) in coronary surgery has led to an interest in coronary artery bypass grafting without CPB. From November 1994 to May 1995, 58 patients (49 males and 9 females, mean age 61.8 +/- 9.3 years, range 40-74) were selected for coronary artery bypass grafting without CPB. Three patients had left main stenosis and 6 had left ventricular dysfunction (ejection fraction < 40%). Stable angina was present in 42 patients (27 with low threshold angina) and unstable angina in 16. In 44 patients a routine median sternotomy and in 14 cases a small anterior thoracotomy were performed: in the latter the proximal harvesting of the left internal mammary artery was video-assisted by thoracoscopy. The left internal mammary artery was used in 53 cases; the saphenous vein was used in 36 cases; the radial artery was used in 4 cases; the inferior epigastric artery was used in 2 cases and the right gastroepiploic artery in 1 case. We recorded 1 death (1.7%) and 1 case of postoperative low cardiac output syndrome requiring counterpulsation (1.7%). Perioperative myocardial infarction occurred in 3 cases (5.8%). We did not record noncardiac complications (cerebrovascular, renal failure, prolonged ventilatory support over 24 hours or sternal wound complications). Supraventricular and ventricular arrhythmias were never detected. Mean intensive care unit and hospital stay were 1.1 +/- 0.5 and 5.1 +/- 1.7 days, respectively. In conclusion, according to our experience, "beating heart" coronary surgery is a new promising technique that can be considered alternative in most cases to percutaneous transluminal coronary angio and complementary to conventional coronary surgery.
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PMID:Coronary surgery without cardiopulmonary bypass. 870 63

Stable angina is a common condition with a good overall prognosis and annual mortality is 2-4%, whatever treatment is employed. Medical therapy with nitrates, beta-blockers, calcium antagonists and lipid-lowering agents is appropriate as first-line therapy in those patients not specifically identified as being at risk by exercise testing and/or angiography. Dosage should be optimized. Coronary artery bypass grafting appears to improve prognosis in those at risk when compared with medical therapy but the trials are old and do not take into account major advances in medical therapy nor the use of arterial conduits in coronary artery bypass grafting (CABG). Percutaneous transluminal coronary angioplasty (PTCA) relieves symptoms when medical therapy is ineffective but its role as an initial therapy has not been established, nor does it compare favourably with CABG with regard to the degree of revascularization and subsequent re-intervention or need for additional anti-anginal drugs. There are little substantial data on prognostic effects. PTCA is, however, less traumatic, less expensive and associated with a quicker recovery than CABG, providing a viable alternative for symptomatic (not prognostic) benefit in appropriately selected and informed patients. Medical therapy, PTCA and CABG should not be seen as competitive but complementary strategies. Optimal utilization of all three treatment modalities, either alone or in combination, can provide substantial symptomatic relief for the angina patient.
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PMID:Stable angina: drugs, angioplasty or surgery? 915 63

Stable angina is a common clinical condition in everyday practice. Several studies (ACME, MASS, RITA 2) compared the efficacy of angioplasty with medical management in this context with concordant results: significant reduction in the frequency of angina and improved exercise capacity, without reduction in the number of serious events (death, infarction). Even though developments in the field of angioplasty have provided better clinical results, especially with the use of stents, the indication of dilatation should be clearly defined by a series of clinical and angiographic parameters. Although resistance to well conducted medical treatment is an indication for revascularisation when possible, the indications should be reconsidered if persistent ischaemia with medical therapy has not been proved.
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PMID:[Treatment of stable angina. Coronary angioplasty versus medical treatment]. 1059 42

Stable angina pectoris is a common condition associated with chest pain predictable for a given level of exercise. Sexual intercourse does not lead to exaggerated heart rate or blood pressure responses and is interpreted by the heart as one of many forms of activity that may take place in a 24-hour period. Stable angina patients optimally treated are not at significantly increased cardiovascular risk during sexual intercourse. Erectile dysfunction (ED) increases with age and shares similar cardiovascular risk factors with stable angina. Sildenafil citrate can be safely prescribed for stable patients with ED providing they are not taking oral, topical, or sublingual nitrates. Sexual relationships should not be constrained by the diagnosis of angina pectoris provided appropriate medical advice is given on risk status. Family physicians and specialists are able to provide this advice based on their knowledge of the patient and the social circumstances. Impersonal advice is potentially dangerous and should be vigorously discouraged.
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PMID:Sexual intercourse and stable angina pectoris. 1089 76


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