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

We made myocardial gammagraphies on a group of 141 patients with acute thoracic pain, using 99 mtc diphosphonates. We obtained images with three projections (LOA, LL and PA); for reading the gammagraphy we used the diagnostic criteria of Berman and Cols. Studying 106 patients with acute myocardial infarction we found affirmative diagnosis in 89 cases (83.93%). In another group, 32 patients with chest angina, the results were negative in 20 cases (62.5%). We got a total of eight false positive images in patients showing post-infarction aneurism, post-defibrillation damage, and myocardial metastatic tumors. This method showed a specificity of 62.9%. Correlation with the electrocardiogram refering to the localization of the infarction, was of 85.39%. This method proved to be of high sensibility and specificity in confirming the diagnosis of acute myocardial infarction or establishing it with certainty in some patients when the electrocardiogram fails and, in some cases, to find out about the evolution and prognostic of the acute myocardial infarction.
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PMID:[Usefulness of technetium 99m diphosphate scintellography in the diagnosis of acute myocardial infarction. Electrocardiographic correlation]. 70 35

3 patients with different clinical and electrocardiographic manifestations of coronary artery spasm are discussed. All 3 patients had anginal attacks at rest. In addition, 2 of these patients, who did not have significant preexisting narrowing of their coronary arteries, also had anginal pain related to exercise. During pain, 1 patient showed ST-segment elevation, the other ST-segment depression, while the third showed ST-segment depression shortly followed by ST-elevation on the electrocardiogram. At coronary angiography, spontaneous or induced spasm of one of the major coronary arteries could be demonstrated in all 3 patients. In 2 cases, sublingual nitroglycerin failed to completely relieve the spasm. This raises the question whether a residual stenosis after NTG conclusively proves a fixed organic narrowing. It is concluded that the clinical spectrum of spasm of the coronary arteries is wider than was originally reported by Prinzmetal and coworkers. Clinical and electrocardiographic manifestations are probably dependent on the site and severity of the spasm, which may cause different degrees of myocardial ischemia.
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PMID:Variant forms of angina pectoris. 71 Apr 90

The author describes a 47-year-old patient in whom lingual hemiatrophy developed one month after angina. The development of hemiatrophy was preceded by occipital headaches and pain behind the ear on the side of hemiatrophy. In the differential diagnosis the author excluded inflammatory processes neoplasms and developmental anomalies and thinks that the cause of this short-lasting hemiatrophy might have been tonsillitis with compression of the nerve by the oedematous inflamed tissues with action of bacterial toxins on the nerve.
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PMID:[Short-lived semi-atrophy of the tongue]. 71 30

The authors examined 100 patients in whom cervical osteochondrosis developed with pain in the heart, intercostal, sternum area, left hand, as well as radicle, pain, vegetative and reflectory-dystrophical disturbances. The differential diagnosis between pseudocardialgia and cardialgia, on the one hand, and stenocardia, on the other, is not always simple and is based on clinical data, x-ray and ECG examinations. The basis of the pathogenesis in pseudocardialgia is the irritation of posterior sensory radicles by osteophytes or disc protrusion. Cardialgia is an incarceration and excitation of sympathical nerves, leading to disturbances in the myocardial metabolism. A comprehensive conservative treatment may give a favourable effect in the majority of patients, while indications for surgical operations are very rare.
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PMID:[Neurologic features of cervical osteokhondrosis with pseudocardiac and cardiac pain syndromes]. 72 52

A 44-yr-old man suffering fro exertional, emotional and spontaneous angina underwent coronary arteriography. During the examination he had a spontaneous attack of angina with ST elevation in the anterior leads. Injection of a contrast medium in the left coronary artery during pain showed marked spasm with anterior descending artery occlusion. The spasm was quickly relieved by nitroglycerin. Intravenous administration of 0.4 mg of ergonovine maleate reproduced the anginal episode with pain, ST elevation in the anterior leads and coronarographic patterns of a spasm occluding the anterior descending artery at the same level. After nitroglycerin, the pain disappeared and the electrocardiographic and coronarographic findings returned to basal conditions.
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PMID:Spontaneous and provoked coronary artery spasm: are they the same? 72 96

A study was undertaken to evaluate the role of positive infarct scintigraphy in the diagnosis of acute myocardial infarction (AMI), using Technetium99m stannous pyrophosphate (Tc-PYP) and a portable gamma camera. Sixty-one patients admitted to the Coronary Care Unit (CCU) with a presumptive diagnosis of AMI or ischaemic cardiac pain were studied. Positive scans were present in 24/25 (96%) patients with AMI and new Q waves, and in 10/12 (83%) patients with AMI and no Q waves. Nine of eleven (82%) patients with chest pain and no infarction had negative scans. Of thirteen patients with unstable angina, ten (77%) had positive scans. A further eight patients undergoing coronary artery bypass surgery for angina pectoris were studied pre- and postoperatively. Two patients had strongly positive postoperative scans. The Tc-PYP scan is valuable in the detection of peri-operative infarction following coronary artery surgery, and in patients with unstable angina the technique may detect small amounts of myocardial necrosis undetectable by more conventional means. When the diagnosis of infarction is obvious from the ECG, enzymes, or a combination of the two, the Tc-PYP scan provides no extra information helpful in patient management.
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PMID:Positive myocardial scintigraphy at the bedside--evaluation using a portable gamma camera. 74 May 89

A 57 year old women with substernal nonexertional chest pain and angiographically patent coronary arteries was evaluated with two dimensional echocardiography and myocardial perfusion scintigraphy after provocation of pain with methacholine. Simultaneous with the development of angina pectoris, the electrocardiogram demonstrated S-T segment elevation in leads II, III and aVF, followed by atrioventricular block. The echocardiogram revealed akinesia of the previously normally contracting left ventricular posterior wall during pain followed by hyperkinesia after the administration of nitroglycerin. Perfusion imaging suggested reversible inferior wall hypoperfusion. Thus, these studies provided noninvasive documentation of segmental left ventricular dysfunction and hypoperfusion during variant angina.
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PMID:Noninvasive documentation of Prinzmetal's angina. 76 Apr 85

Variant angina pectoris, usually not precipitated by exertion or emotional stress, often is more severe and lasts longer than classic angina. The pain tends to recur at about the same time each day. Arrhythmias, usually ventricular, occur in about 50% of cases during the peak of pain. Electrocardiograms show a characteristic ST segment elevation during pain, which is in contrast to the ST segment depression of classic angina pectoris. Pain may be due, at least in some cases, to a temporary increase in tonus of a single, large, narrowed coronary artery. Chemical changes in the myocardium and plasma catecholamine changes differ from those occurring in classic angina pectoris. The course of the disease is highly variable but the prognosis must be regarded as grave, since single large vessel disease, present in most cases, is associated with severe myocardial ischemia. Patients with variant angina pectoris should be studied early with coronary arteriography and considered for coronary artery bypass surgery if appropriate.
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PMID:The variant form of angina pectoris. 76 70

Propranolol and practolol were tested in patients with repeated daily occurrence of spontaneous angina. Twenty-one showed ST segment depression (type I) and 15 ST segment elevation (type II) during angina. The efficacy of the treatment was evaluated in subjective (number of reported episodes of pain) and objective terms (number of episodes of electrocardiographic abnormalities documented during periods of continuous recording): practolol was fully effective in 42 per cent and propranolol in 38 per cent of type I cases; in type II angina 73 per cent of the cases fully responded to propranolol, none of the patients in this group given practolol improved. The study also showed that: (a) the effects on angina are strictly dose-dependent, and optimal results are achieved at individualized doses; (b) within the same subject the response may be preferential to one beta-blocker as opposed to the other; (c) propranolol is more effective in type II angina; (d) the occurrence of heart failure is uncommon even with high doses of beta blockers;(e) the relief of angina is due to prevention of ischaemia and not to a placebo or anaesthetic effect; (f) the prevention of ischaemia is not adequately explained by reduction of the mechanical effort and the oxygen need of the myocardium; (g) the antianginal effect is possibly dissociated from the beta blockade of the heart. The hypothesis that beta-blocking agents influence the conronary vasomotion is discussed.
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PMID:Treatment of spontaneous angina pectoris with beta blocking agents. A clinical, electrocardiographic, and haemodynamic appraisal. 77 91

Unstable angina is a syndrome which comprises a spectrum of symptomatic manifestations of coronary artery disease which lies between stable angina pectoris and acute myocardial infarction. Patients fall into three groups: angina of recent onset (4 weeks), angina of changing pattern, and angina occurring at rest (longer than 15 minutes). The syndrome may presage acute myocardial infarction or sudden death, or may itself be the manifestation of a myocardial infarction. The pathophysiology may involve primary cardiac events or extracardiac precipitating factors, and does not appear to be the consequence of a particular anatomic pattern of coronary artery disease. Pain may occur as a result of regional reduction of coronary flow to pressure-dependent areas of myocardium during states of increased myocardial oxygen demand. Persisting ischemia leads to infarction via a series of events which may include myocardial edema formation, increased beta-sympathetic tone, and others which have been experimentally modified by interventions designed to limit infarct size. Although the incidence of acute myocardial infarction and death was high in early studies, in recent reports acute infarction occurs in under 15.5 per cent and death in under 2 per cent. Patients at high risk are those pain persists with bed rest, and those with preceding stable angina pectoris or myocardial infarction. Prognostic differences among Groups 1, 2, and 3 may exist but cannot be assessed from available studies. Studies of the management of unstable angina have generally been uncontrolled. Hospitalization, bed rest, and short- and long-acting nitrates are generally employed in Groups 2 and 3 patients and the marked reduction in myocardial infarction rates from early to recent studies tends to support these approaches. Anticoagulants are less used now than formerly. Propranolol can produce a significant reduction of myocardial oxygen consumption and may redirect coronary flow to ischemic areas. The drug has effectively controlled pain in several studies and is now widely used to manage unstable angina. Aortocoronary bypass surgery has been extensively employed but there is only one preliminary report of a controlled study available. The role of surgery is not yet defined. The optimal approach to therapy may eventually involve the use of medical therapy, including beta-blockade to stabilize patients, with delayed semielective coronary angiography and surgery in those who respond. Emergency angiography and surgery might then be reserved for the high-risk group of patients whose pain persists during optimal medical therapy.
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PMID:Unstable angina pectoris. 78 21


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