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

Cardiovascular rehabilitation is defined as the process of development and maintenance of a desirable level of physical, social, and psychologic functioning after the onset of a cardiovascular illness. Patient education, counseling, nutritional guidance, and exercise training play prominent roles in the process of rehabilitation. Benefits from cardiac rehabilitation include improved exercise capacity and decreased symptoms of angina pectoris, dyspnea, claudication, and fatigue. Recent pooled data regarding exercise training after myocardial infarction demonstrated a 20 to 25% reduction in mortality and major cardiac events. Exercise training may result in an improvement in systemic oxygen transport, a reduction in the myocardial oxygen requirement for a given amount of external work, and a decrease in the extent of myocardial ischemia during physical activity. The efficacy of modification of risk factors in reducing the progression of coronary artery disease and future morbidity and mortality has been established. Herein we review the history, current practice and results, and future challenges of cardiovascular rehabilitation.
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PMID:Cardiovascular rehabilitation: status, 1990. 219 53

Anginal chest pain in patients with angiographically normal coronary arteries may be caused by a limited coronary flow response to stress because of abnormal function of the coronary microcirculation (microvascular angina). Studies of forearm arterial function suggested that patients with microvascular angina may have a diffuse disorder of smooth muscle tone. Because dyspnea is common in these patients and seems disproportionate to the severity of myocardial ischemia, we studied air flow (forced expiratory volume in 1 second, or FEV1) in the basal state and after methacholine inhalation to determine whether bronchial smooth muscle is affected in this syndrome. Five of 36 patients with microvascular angina had a basal FEV1 of less than 70% of that predicted and did not receive methacholine. Of the remaining 31 patients, 14 (45%) had a more-than-20% reduction in FEV1 after methacholine inhalation (as much as 25 mg/ml), a response significantly greater than that of nine patients with heart disease (0%, p less than 0.025) and 24 normal volunteers of similar age and gender distribution (13%, p less than 0.025). Furthermore, the product of the methacholine dose inhaled and the magnitude of decline in FEV1 from baseline (methacholine response score) was significantly lower in patients with microvascular angina than in normal volunteers (16 +/- 8.6 versus 22.2 +/- 3.7, p = 0.026). We conclude that airway hyperresponsiveness is frequently demonstrable in patients with microvascular angina; these findings are consistent with our hypothesis that this syndrome may represent a more generalized abnormality of vascular and nonvascular smooth muscle function.
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PMID:Airway hyperresponsiveness in patients with microvascular angina. Evidence for a diffuse disorder of smooth muscle responsiveness. 224 25

In a prospective study 53 patients with alcohol-induced liver disease (fatty liver in 27, cirrhosis in 26) were studied clinically and with non-invasive techniques (electrocardiogram, systolic time intervals, M-mode echocardiography, upright bicycle stress test) to detect a possible cardiac involvement. Mean daily alcohol consumption was comparable in both groups (136 g/day over 16 years vs 124 g/day over 14 years). 15 to 41% of patients (more patients with fatty liver) complaint of angina pectoris and dyspnea at exercise or had palpitations. Echocardiography and systolic time intervals demonstrated in both groups (in patients with cirrhosis despite of a more intensive therapy with digitalis and diuretics) a marked enlargement of left ventricular dimensions with a significant (p less than 0.05) degree of dysfunction (PEP/LVET). Electrocardiography showed abnormalities in 26 to 44% of patients: signs of right ventricular enlargement in 26% of patients with fatty liver, and a prolongation of myocardial repolarisation (QTc) in 44% of patients with cirrhosis. Patients with alcohol-induced liver disease deserve more attention of their cardiac complaints, clinical and functional findings.
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PMID:[Cardiac findings in alcoholic liver disease]. 226 11

Fifty-two patients with a mean age of 67.6 years underwent coronary artery bypass plus mitral valve replacement from 2 April 1984, through 6 February 1989. All but four of these 25 males and 27 females were in the New York Heart Association Functional Classes III and IV, with presenting symptoms of angina and/or dyspnea. Twenty-four patients (44.2%) presented with acute myocardial infarctions, and eleven patients (21.2%) had a past history of rheumatic fever or rheumatic heart disease. Forty-five patients (86.5%) had a diagnosis of coronary artery disease plus mitral regurgitation. Treatment included a mean of 2.3 bypass grafts per patient plus mitral valve replacement with Carpentier-Edwards (41), St. Jude (10), and Bjork-Shiley (1) prostheses. The four operative deaths (7.7%) were attributed to congestive heart failure (1), mediastinal bleeding (1), mediastinitis (1), and stroke (1). There were eight late cardiac deaths (16.7%) and six late noncardiac deaths (12.5%), a mean of 16.6 and 18.9 months postoperatively, respectively. Thirty-four patients have survived from 10 to 65 (mean 33.7) months postoperatively with a mean New York Heart Association Functional Class 1.6. Follow-up determination of patients' attitudes toward their surgery was ascertained in 28 of the 34 survivors, and 26 (92.8%) patients indicated that they were pleased with their surgery. These results compare favorably with data reported in the recent literature. In addition, the study shows that patients requiring supportive treatment in a critical care unit preoperatively had the same operative mortality but more postoperative complications and a longer mean hospital stay than the equal number of patients who were not in a critical care unit preoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Coronary artery bypass plus mitral valve replacement. A five-year study. 228 98

Sudden death after sporting activities is not a rare occurrence on the basis of the statistics of a country: there appear to be 100 to 1,500 cases each year in France, and possibly even 10 times as many. This event is of cardiovascular origin or linked to the use of stimulants, if accidental causes are left out. Almost all unexpected deaths of medical origin are due to cardiac arrest. In practice, this only rarely involves an apparently healthy organ. Cardiomyopathies (almost 50% of cases occurring before the age of 35) and coronary disease (80% of individuals dying over 35 and 75% of all cases) are among the essential causes. The final mechanism most often (62.4%) is ventricular fibrillation following a ventricular tachycardia. These sudden deaths are sometimes preceded by cardiorespiratory symptoms (angina pectoris, faintness, dyspnea) and by extrasystoles, with the latter showing their potentially malignant nature in some cases. These features must be sought and identified if an attempt is to be made to reduce sudden cardiac deaths in athletes. Detailed and routine sophisticated investigations would have little to offer and are expensive. It would seem more valid to educate general practitioners and athletes themselves, but this should be on a very wide scale, i.e. at national level.
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PMID:[Sudden death during sport activities. How can the incidence be reduced?]. 229 6

To determine the clinical course of apical hypertrophic cardiomyopathy, 26 patients (mean age 45 years) with asymmetric apical hypertrophy diagnosed by echocardiography or angiography were followed up for an average of 7.3 years (range 1 to 22). Presenting symptoms included atypical chest pain (n = 10), typical angina (n = 6), dyspnea (n = 5) and palpitation (n = 8). Ten patients were asymptomatic. At follow-up all patients had inverted precordial T waves, and 14 had the syndrome of "giant T wave negativity" (greater than or equal to 10 mm). In six patients with electrocardiographic follow-up of greater than 10 years (mean 13.4), precordial T wave inversion had progressed from -0.8 +/- 3.9 to -11.2 +/- 8.0 mm in lead V4 in association with increased QRS amplitude. Episodic atrial fibrillation occurred in 4 of 10 patients with echocardiographic left atrial enlargement. Although left ventricular systolic function was normal, diastolic relaxation was impaired in comparison with values in 10 healthy control subjects: in all 18 patients studied peak filling rate was decreased (4.44 +/- 0.44 versus 6.13 +/- 1.54 stroke volumes/s); time to peak filling was increased (174 +/- 40 versus 147 +/- 32 ms); and atrial systolic contribution to ventricular end-diastolic volume was increased (21.5 +/- 6.8 versus 11.5 +/- 4.6 stroke volume %). During follow-up, 21 of the 26 patients remained in stable condition or were asymptomatic. One patient with normal coronary arteries had an apical myocardial infarction with development of a discrete apical aneurysm and loss of "giant T wave negativity." This patient was the only one to have documented life-threatening ventricular arrhythmias.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Apical hypertrophic cardiomyopathy: clinical follow-up and diagnostic correlates. 229 48

The natural history of asymptomatic, hemodynamically significant, valvular aortic stenosis in adults was documented. Of 471 patients with aortic stenosis identified by Doppler echocardiography (peak systolic flow velocity greater than or equal to 4 m/s) from January 1984 through August 1987, 143 were asymptomatic and had isolated valvular aortic stenosis. Thirty patients underwent aortic valve intervention within 3 months (group 1); the remaining 113 patients did not have an intervention within 3 months (group 2). Follow-up information was available for all patients; the mean duration of follow-up study was 20 months (range 6 to 48). Three cardiac events occurred in the 30 group 1 patients after operation (two deaths, one reoperation). Among the 113 group 2 patients, three had cardiac death presumed to be a result of the aortic stenosis; all three developed symptoms at least 3 months before death. The actuarial probability of remaining free of symptoms of angina, dyspnea or syncope for group 2 was 86% at 1 year and 62% at 2 years. For this group, the 1 and 2 year probabilities of remaining free of cardiac events, including aortic valve intervention or cardiac death, were 93% and 74%, respectively. Of all clinical and echocardiographic variables (group 2), only Doppler flow velocity (p = 0.004) and ejection fraction (p = 0.01) were independent predictors of subsequent cardiac events. Among the 44 patients (groups 1 and 2) with a flow velocity greater than or equal to 4.5 m/s, the relative risk of sustaining a cardiac event (by Cox regression analysis) was 4.9 (p = 0.004).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The natural history of adults with asymptomatic, hemodynamically significant aortic stenosis. 231 55

Trimetazidine (TMZ) has been shown to have anti-ischaemic properties improving exercise tolerance without haemodynamic effects. A 6-month double-blind placebo-controlled study was carried out in 20 patients, mean age 59 +/- 6 years, to examine the benefit of adding 60 mg of TMZ vs placebo to the classical therapy, excluding those previously treated with calcium-antagonists, conversion enzyme inhibitors, vasodilators and antiplatelet agents. All patients had severe ischaemic cardiomyopathy, confirmed by coronary angiography; six were in NYHA class IV; 14 in NYHA class III; four had mild recurrent angina pectoris. assessment included clinical and biological evaluation, electrocardiography (ECG), 24-h ECG monitoring, cardiac volume evaluation with chest X-ray, left ventricular fractional shortening by echocardiography, left ventricular ejection fraction by radionuclide angiography. Baseline characteristics were similar in placebo (11 patients) and TMZ (nine patients) groups. Eighteen patients (nine in each group) were followed up for 6 months. In eight patients of the placebo group, treatment had to be modified (addition of calcium antagonists: four patients, conversion enzyme inhibitors: two patients; digitalics: one patient; diuretics: one patient). In the TMZ group, digitalic therapy was withdrawn in one patient and added in one patient (P less than 0.01). At 6 months, all TMZ group patients were free from angina; dyspnoea was improved in all TMZ patients and in only one placebo patient (P less than 0.001). Ejection fraction, increased by 9.3% in the TMZ group and decreased by 15.6% in the placebo group (P less than 0.018), CV decreased by 7% with TMZ, increased by 4% with placebo. (P = 0.034).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Therapeutic value of a cardioprotective agent in patients with severe ischaemic cardiomyopathy. 231 23

External respiration was evaluated in coronary patients with varying duration of the disease. Bronchial obstruction was not a rare finding especially in patients with a long history of angina pectoris. In most of the patients the obstruction was reversible as shown by respiration parameters upon inhalation of broncholytics with various mechanisms of action. Respiratory disorders were not associated with dyspnea, derangement of gaseous exchange and could not be attributed to attendant bronchopulmonary diseases, smoking as such patients had not been entered in the study. A 3-year follow-up was not indicative of spontaneous progression of bronchial obstruction.
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PMID:[Respiratory function in newly developed stenocardia and in long-term course of ischemic heart disease]. 233 49

The prevalence of silent myocardial ischemia was prospectively assessed in a group of 103 consecutive patients (mean age 59 +/- 10 years, 79% male) undergoing symptom-limited exercise thallium-201 scintigraphy. Variables that best correlated with the occurrence of painless ischemia by quantitative scintigraphic criteria were examined. Fifty-nine patients (57%) had no angina on exercise testing. A significantly greater percent of patients with silent ischemia than of patients with angina had a recent myocardial infarction (31% versus 7%, p less than 0.01), had no prior angina (91% versus 64%, p less than 0.01), had dyspnea as an exercise test end point (56% versus 35%, p less than 0.05) and exhibited redistribution defects in the supply regions of the right and circumflex coronary arteries (50% versus 35%, p less than 0.05). The group with exercise angina had more ST depression (64% versus 41%, p less than 0.05) and more patients with four or more redistribution defects. However, there was no difference between the two groups with respect to mean total thallium-201 perfusion score, number of redistribution defects per patient, multi-vessel thallium redistribution pattern or extent of angiographic coronary artery disease. There was also no difference between the silent ischemia and angina groups with respect to antianginal drug usage, prevalence of diabetes mellitus, exercise duration, peak exercise heart rate, peak work load, peak double (rate-pressure) product and percent of patients achieving greater than or equal to 85% of maximal predicted heart rate for age. Thus, in this study group, there was a rather high prevalence rate of silent ischemia (57%) by exercise thallium-201 criteria.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prevalence of and variables associated with silent myocardial ischemia on exercise thallium-201 stress testing. 235 86


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