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

Prospective 5-year follow-up was accomplished among males ranging in age between 50 and 59 and forming four random samples from the respective population of the Bauman region in Moscow subjected to primary cross-sectional epidemiologic survey. The results show that in primary survey general mortality and the mortality of ischemic heart disease were significantly higher among males with ischemic heart disease than among the rest of the individuals examined. The mortality of ischemic heart disease proved to be particularly high among individuals with a history of myocardial infarction (relative death risk 5.8) and among those with typical anginal pectoris (relative death risk 4.4). Ischemic heart disease mortality was lower (relative death risk 2.1) in the group of males who had suffered from silent myocardial infarction or had silent ischemic heart disease than among those who had had myocardial infarction or with angina pectoris, but higher among males who did not have these diseases. To study the prognostic value of atypical chest pain in angina pectoris, it is necessary that prospective follow-up be continued.
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PMID:[Prognosis of life expectancy of patients with ischemic heart disease detected during mass screening]. 30 22

Fifty-three patients with chest pain and a negative exercise test at greater than 85% predicted maximal heart rate underwent coronary arteriography. Twenty-one patients (40%) had significant luminal narrowing in one or two vessels. No patient had left main disease. Pathologic electrocardiographic Q waves were present in only coronary heart disease patients (p less than 0.001). There was no difference (p greater than 0.05) in prevalence of T wave abnormalities, chest pain or ventricular beats during exercise in patients with or without coronary disease. Analysis of sex distribution revealed that typical angina pectoris was uncommon in the women (p less than 0.001) and all twenty-one coronary patients were men (p less than 0.001). We conclude that in patients with chest pain and a negative exercise test, three vessel or left main coronary artery disease is unlikely. Also, women with atypical chest pain and a negative exercise test are unlikely to have a fixed coronary obstruction.
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PMID:Significance of the negative exercise test in evaluation of patients with chest pain. 31 94

The aim of the study was to evaluate the validity of 201Tl scanning for clinical routine use in the diagnosis of coronary heart disease. A computer-aided matrix with very high resolution displaying subtle color nuances was used. For semi-quantitative assessment a scale with 16 colors was applied. This permitted to differentiate between changes of intensity of 6.25%. Compared with the ECG on exercise no higher sensitivity or specifity of 201Tl scanning was found using coronary angiography as the reference method. When a typical angina pectoris and a pathological ECG on exercise was present, confirmation of the diagnosis of coronary heart disease by scanning was readily obtained. Moreover, in the event of equivocal findings in the ECG and of atypical chest pain scanning is helpful without having to resort to invasive methods. Additionally to the exercise ECG, the location of ischemic areas in the myocardium can be easily demonstrated by scanning. When angiography has shown unobstructed coronary arteries but the ECG is suggestive of scar formation, scintigraphy provides additional information regarding the diagnosis of coronary heart disease. It is also possible by scanning to delineate the tissue defect representing fibrotic areas. This is necessary for instance when aneurysmectomy is planned.
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PMID:[Computer-assisted 201Tl myocardial scintigraphy in the routine diagnosis of coronary heart disease (author's transl)]. 36 19

Arterial pressure, coronary sinus blood flow with the thermodilution technique and calculated coronary vascular resistance were measured and coronary arteriography performed at rest and after the administration of ergonovine in 14 patients with atypical chest pain (group 1) and 6 patients with variant angina (group II). Mild diffuse narrowing of the left coronary bed in group I was not accompanied by S-T segment shifts, and coronary vascular resistance did not change significantly. In contrast, severe focal spasm (greater than 90 percent narrowing) of the left anterior descending coronary artery in group II patients was accompanied by S-T elevation and a marked overall increase in coronary vascular resistance (from 0.65 +/- 0.07 to 1.14 +/- 0.10 mm Hg/ml per min) (P less than 0.005). In addition, the myocardial arteriovenous oxygen difference increased and net lactate extraction changed to lactate production in the two patients in group II in whom these measurements were made. Thus, thermodilution coronary sinus blood flow measurement may be a sensitive method for detecting primary increases in coronary vascular resistance due to a high grade focal spasm in the left anterior descending coronary artery.
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PMID:Coronary hemodynamic and myocardial metabolic alterations accompanying coronary spasm. 42 99

Exercise electrocardiography and rest/exercise myocardial perfusion imaging with thallium-201 were performed in 43 patients with typical angina or atypical chest pain; the results were correlated with those of coronary arteriography. Exercise electrocardiography sensitivity was 65%, specificity was 78%, predictive value for a positive result was 73% and for a negative result was 93%. The low sensitivity of the exercise electrocardiogram was mainly due to the number (13 of 43, 30%) of inconclusive results (no ST-segment change on the electrocardiogram, but failure to attain the target rate), most of which were in the group with typical angina. The predictive value of exercise electrocardiography for both a positive and negative result was excellent in typical angina. In patients with atypical chest pain, the negative predictive value was high (90%) but the positive predictive value was very low (50%). The sensitivity of myocardial perfusion imaging was 71%, specificity was 59%, positive predictive value was 52% and negative predictive value 89%. The low specificity of this test is related to the number of false-positive results obtained, most of which occurred in the group with atypical pain. When the results of exercise electrocardiography and myocardial perfusion imaging are combined, the sensitivity is increased but specificity is unacceptably low. However, myocardial perfusion imaging in patients with an inconclusive result from exercise electrocardiography (most of them in the group with typical angina) showed a sensitivity of 80%, specificity of 88%, positive predictive value of 80% and negative predictive value of 100%.
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PMID:Exercise electrocardiography and myocardial perfusion imaging in the diagnosis of coronary artery disease: preliminary report. 45 62

Exercise test diagnostic and prognostic value depends on the purpose for which is performed and on the population studied. In typical angina patients the test is usefull for choosing between medical and surgical therapy and for evaluating treatment efficacy. In patients with atypical chest pain a diagnostic value is recognized. In asymptomatic subjects results of a number of epidemiological studies suggest that this test is recommended only in selected groups or for research purpose. In the appendix definitions of epidemiological measures used in screening tests evaluation are given with examples.
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PMID:[Clinical and epidemiological criteria of evaluation of the exercise test (author's transl)]. 48 94

Sixty-four patients with a history of disabling chest pain belonging to groups III or IV classified according to the NYHA criteria were examined with oesophageal function tests, coronary angiography and bicycle ergometry and also answered a symptom questionnaire. At the exercise test, 52 had effort angina; 45 (89%) of them had a pthological coronary angiogram and 22 (42%) had signs of oesophageal dysfunction (OD). OD as the single possible etiological factor for typical effort angina therefore seemed unlikely. Chest pain was absent or atypical at the exercise test in 12 patients, 11 (92%) of whom had signs of OD. This incidence is significantly higher (p less than 0.01) than that found in the patients with effort-related chest pain. Five (42%) of the 12 patients with atypical chest pain at the exercise test had a pathological coronary angiogram, an incidence which is significantly lower (p less than 0.001) than that found in the group with effort-related chest pain. In patients with a history of disabling chest pain but with atypical chest pain in connection with the exercise test, OD was more frequent than coronary disease and therefore more likely to have caused the symptoms.
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PMID:Oesophageal function and coronary angiogram in patients with disabling chest pain. 69 16

Mitral leaflet prolapse syndrome has been associated with anginal chest pain, atypical chest pain, electrocardiographic abnormalities and positive stress electrocardiograms. These features overlap those of ischemic heart disease. Furthermore, coronary artery disease is frequently associated with mitral leaflet prolapse. This study evaluated the usefulness of stress myocardial scintigraphy in distinguishing these two disorders. Thirty-two patients with an angiographic diagnosis of mitral leaflet prolapse were studied. Of the 22 patients (8 men and 14 women, mean age 48 years) with a normal coronary arteriogram, 5 had "typical" angina pectoris, 6 had resting electrocardiographic abnormalities and 6 had a positive stress electrocardiogram; all 22 patients had a normal stress myocardial scintigram. Of the 10 patients (7 men and 3 women, mean age 55 years) with at least 70 percent stenosis of one coronary artery, 6 had "typical" angina pectoris, 1 had resting electrocardiographic abnormalities and 7 had a positive stress electrocardiogram. Nine of these 10 patients had one or more demonstrable perfusion defects on stress myocardial scintigrams. It is concluded that mitral leaflet prolapse syndrome is not associated with regional myocardial ischemia as demonstrated with stress scintigraphy, and that stress scintigraphy, a noninvasive technique, is useful in distinguishing the mitral prolapse syndrome from mitral prolapse associated with coronary artery disease.
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PMID:Stress myocardial imaging in mitral leaflet prolapse syndrome. 70 87

Changes in coronary arterial size due to ergonovine maleate are described and quantitated in 90 patients--18 with typical angina pectoris, 56 with atypical chest pain, nine with variant angina pectoris, and seven heart transplant (allograft) recipients. We observed two angiographic changes in the diameter of coronary arteries: 1) spasm, which was characterized by occlusion or marked (greater than 85%) focal or diffuse vessel narrowing, or 2) relatively mild and diffuse vessel narrowing, which was interpreted as the normal pharmacologic response to the drug. Serial bolus injections of 0.05 mg, 0.10 mg and 0.25 mg of ergonovine maleate produced diffuse narrowing of the diameter of coronary arteries of 10 +/- 1.5%, 16 +/- 1.4% and 20 +/- 1.3% (mean +/- SEM), respectively, in the 72 patients with anginal syndromes who did not develop coronary spasm. The degree of coronary arterial narrowing was the same in heart transplant recipients and in patients with normally innervated hearts who did not develop coronary spasm. We believe the normal pharmacologic response to ergonovine maleate was due to a direct vasoconstrictor action of the drug; this action was independent of neural control extrinsic to the heart.
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PMID:The effects of ergonovine maleate on coronary arterial size. 75 27

To test the sensitivity and specificity of technetium-99m stannous pyrophosphate myocardial imaging in the diagnosis of acute myocardial infarction, myocardial scintigrams were performed in 115 patients. Positive scintigrams were found in all 48 patients with acute myocardial infarction; uptake was localized in 29 patients with transmural infarction and diffuse in 2 patients with transmural infarction and in the remaining 17 patients with subendocardial myocardial infarction. Positive scintigrams were also found in 31 of 67 patients without clinical evidence of acute myocardial infarction. Diffusely positive scintigrams were found in 3 of 3 patients with unstable angina pectoris, 7 of 30 patients with stable angina pectoris, 4 of 13 patients who had undergone aortocoronary bypass surgery, 4 of 4 patients with congestive cardiomyopathy and 1 patient studied 1 day after direct current cardioversion. Localized uptake of 99mTc-pyrophosphate was found in 9 of 10 patients with left ventricular aneurysm and in 3 of 13 patients after aortocoronary bypass surgery. All four patients with atypical chest pain and two patients with pericarditis had normal scintigrams. Our data confirm the previously reported sensitivity of 99mTc-pyrophosphate imaging in detection of acute myocardial infarction but indicate that positive scintigrams are not specific for this entity.
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PMID:Limited clinical diagnostic specificity of technetium-99m stannous pyrophosphate myocardial imaging in acute myocardial infarction. 83 27


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