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

The prevalence of significant coronary artery disease (reduction in luminal diameter by more than 50%) among 88 consecutive patients with aortic stenosis requiring aortic valve replacement at Hammersmith Hospital was examined. Twenty two (34%) patients had significant coronary disease. Nineteen of 42 (45%) patients with typical angina had coronary disease; three of 20 (15%) patients with atypical chest pain had coronary disease, while none of 26 patients free of chest pain had significant coronary disease. Risk factors for coronary disease were equally distributed among patients with and without significant luminal obstruction. Because of the small, but definite, hazard of coronary arteriography and in the interest of cost containment it is suggested that patients with aortic stenosis who are free of chest pain do not require routine coronary arteriography. This applies particularly to patients requiring urgent aortic valve replacement.
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PMID:Prevalence of coronary artery disease in patients with isolated aortic valve stenosis. 669 63

Of 7,915 patients undergoing coronary angiography from 1978 to 1983, 39 (25 men and 14 women with a mean age of 57 years [range 37 to 79]) had sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) during the procedure. Nine patients had atypical chest pain and 30 had typical angina. Fifteen had had a previous myocardial infarction. One patient had a history of VT or VF. Electrocardiograms taken at rest revealed a prolonged QT interval in 14. A normal ejection fraction was found in 79%. Coronary angiography revealed that 10 patients had 3-vessel disease, 15 had 1- or 2-vessel disease and 14 had normal coronary arteries. The VT or VF was seen with injection of contrast medium into the right coronary artery in 24, the left coronary artery in 10 and vein bypass grafts in 5 patients. Of the episodes of VT or VF, 67% occurred after injection of contrast medium into a minimally diseased coronary artery. In patients in whom VT or VF occurred after injection into a minimally diseased coronary artery, the arrhythmia was preceded by bradycardia, usually with pronounced widening of the QRS and QT intervals. This response was significantly different from that in patients in whom VT or VF occurred after injection into a coronary artery with significant stenosis; in these patients, VT or VF was initiated by a single premature ventricular contraction on a T wave. VT or VF was successfully cardioverted in all instances, without further arrhythmias.
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PMID:Ventricular arrhythmias during coronary angiography in patients with angina pectoris or chest pain syndromes. 673 Dec 92

154 patients investigated for chest pain underwent 12 lead exercise electrocardiography and also exercise 201-Thallium myocardial scintigraphy performed at coronary angiography. 92 patients had typical angina; in this group the sensitivity and specificity of exercise electrocardiography was good (91% and 86% respectively) and exercise myocardial scintigraphy did not give significantly better results. On the other hand, in cases when exercise electrocardiography was negative (27%) exercise myocardial scintigraphy was positive in 75%. 201-Thallium did not discriminate between ischaemia and necrosis in patients with previous myocardial infarction, ischaemia alone causing hypofixation on basal myocardial scintigraphy. 62 patients had atypical chest pain. The low incidence of coronary artery disease in this group (30%) increases the value of exercise 201-Thallium scintigraphy as it is both more sensitive (59% compared to 21%, p less than 0,05) and more specific than exercise electrocardiography (43% compared to 85%, p less than 0,1). 29% monotruncular lesions had negative exercise electrocardiography and myocardial scintigraphy. However, multivessel and left main coronary disease may be excluded with great probability by a negative exercise 201-Thallium scintigraphy.
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PMID:[Comparison of stress testing and thallium 201 testing in the diagnosis of coronary insufficiency according to the functional class of angina. 154 cases with coronary angiography]. 677 Jul 83

The object of this study was to determine whether transverse radiotomography, despite cardiac movement, could be used to visualise aortocoronary bypass grafts to confirm their patency or obstruction. The results were then compared with those of coronary angiography. 20 patients with a total of 38 grafts (18 on the left anterior descending, 8 on the circumflex and 12 on the right coronary artery) underwent tomography. 1 or 2 60 ml boluses of iodide contrast medium were injected into a fore arm vein and 3-5 films were exposed after each injection at 15 sec intervals. Coronary angiography was performed in 16 patients and the results of tomography were identical to those of coronary angiography : 23 patent and 6 occluded grafts. In one case, subtotal proximal stenosis of the left anterior descending artery allowed sufficient flow for the graft to be opacified and considered patent on tomography. The correlation between transverse radiotomography and coronary angiography was excellent. Transverse radiotomography, a non-invasive technique, is very useful in operated patients with atypical chest pain and in those with recurrent angina in whom obstruction of the graft is feared. It does not seem destined to replace control coronary angiography after bypass surgery, but it may be indicated is selected cases.
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PMID:[Value of transverse radiotomography in the control of the permeability of aortocoronary bypasses, compared with coronary angiography]. 678 37

Because an increase in coronary vascular resistance in response to ergonovine maleate has been suggested as a possible diagnostic aid for variant angina, changes were evaluated in coronary hemodynamics and serial myocardial thallium-201 perfusion scans in 15 patients without angina and with normal coronary arteries in response to ergonovine (0.05, 0.10 and 0.20 mg intravenously). For the group, heart rate-blood pressure product increased significantly (p less than 0.001) without any change in coronary sinus flow, coronary vascular resistance, myocardial oxygen extraction, arterial-coronary sinus oxygen difference and lactate extraction. In 7 of 15 patients, however, coronary vascular resistance increased (mean 39%, range 11 to 75%, probability [p] less than 0.001), and coronary sinus flow decreased (14%, p less than 0.001), despite an increase in heart rate-blood pressure product (36%, p less than 0.02). No electrocardiographic, metabolic or thallium-201 scan abnormalities occurred. Therefore, significant increases in coronary vascular resistance in response to ergonovine may occur in patients with normal coronary arteries and atypical chest pain.
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PMID:Variability in coronary hemodynamics in response to ergonovine in patients with normal coronary arteries and atypical chest pain. 682 71

To determine the incidence and significance of angina pectoris in aortic valve disease, clinical, haemodynamic, and angiographic data concerning 111 consecutive patients aged 27-68 years (mean 52) were retrospectively analysed. 14.4% (group A) had significant, 85.6% (group B) had no coronary heart disease. There was a significant difference between the groups regarding the incidence of typical angina pectoris (62.5% vs 31.6%, p less than 0.01) and freedom from chest pain (12.5% vs 32.6%, p less than 0.05). No difference, however, could be found concerning the incidence of atypical chest pain (25% vs 35.8%). Of 12 patients aged over 50 years with coronary artery disease, no patient was free of angina pectoris. 83% had typical, 17% had atypical angina pectoris. Of 4 patients below 45 years with coronary artery disease, however, none had typical angina pectoris, 2 patients had atypical angina, and 2 patients had none. These results demonstrate that typical angina pectoris in patients with aortic valve disease is not a specific indicator of concomitant significant coronary artery disease. On the other hand, absence of chest pain does not predict absence of coronary artery disease, especially in younger patients. We therefore suggest that coronary angiography be carried out in all adult patients in whom aortic valve surgery is being considered.
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PMID:[Incidence and significance of angina pectoris in aortic valve disease]. 683 83

A 10 year prospective community practice study in Seattle of risk of primary morbidity (defined by hospital admission) and mortality due to coronary heart disease in 3,611 men and 547 women initially free of clinical manifestations of this disease revealed a crude incidence of 202 coronary heart disease events, or 4.9% in 6.1 +/- 2.6 years of follow-up. The case fatality rate was 16.8%. Stratification by clinical classification of asymptomatic healthy persons versus patients with atypical chest pain syndrome (not angina pectoris) and hypertension (as classified by physicians) showed an incidence rate of primary events due to coronary heart disease of 2.9, 5.5 (not significant) and 10.0% (p less than 0.001), respectively. Identification of conventional risk factors is known to be important for risk assessment. However, the presence of any conventional risk factor, in conjunction with two or more selected maximal exercise predictors (which vary with the clinical classification) at enrollment, substantially increased the cumulative 6 year incidence rate to 24.3, 15.5 and 33.3% in asymptomatic healthy men, patients with atypical chest pain syndrome and hypertensive patients, respectively. Observation of the exercise predictors in the absence of conventional risk factors increased the risk much less, suggesting that the use of maximal exercise testing for risk assessment in those with no clinical manifestations of disease might be limited to persons with one or more conventional risk factors.
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PMID:Enhanced risk assessment for primary coronary heart disease events by maximal exercise testing: 10 years' experience of Seattle Heart Watch. 687 20

Ergonovine maleate was administered to 69 patients with chest pain but without significant coronary artery disease (less than 10% luminal diameter obstruction) to determine whether coronary artery spasm could be provoked. Coronary artery spasm was seen at angiography, or inferred from ECG or thallium myocardial perfusion scan changes. The test was positive in 16 patients: all five patients with documented variant angina (Group A); ten of the 19 patients with suspected variant angina (Group B); one of the 11 patients with exercise-induced chest pain (Group C); and none of the 34 patients with atypical chest pain (Group D). Patients with a positive test usually smoked, complained of recurrent nocturnal or early morning chest pain, showed ST changes during spontaneous chest pain and had minot degrees of fixed coronary obstruction (30--70%), when compared to those with a negative test. The only major side effect of the test was transient ventricular tachycardia which occurred in three patients and was reverted by sublingual and parenteral nitroglycerine.
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PMID:Coronary artery spasm: use of ergonovine in diagnosis. 692 78

To assess the accuracy of serial myocardial perfusion scintigraphy with thallium-201 (201Tl) to predict graft patency early and late coronary artery bypass surgery, rest and exercise 201Tl and coronary arteriography were performed preoperatively and 2 weeks and 1 year after operation. The scintigraphic results were compared with graft patency, symptoms, left ventricular function and physical work capacity in a consecutive series of 55 patients with a total of 154 grafts. Serial 201Tl had an 80% sensitivity, 88% specificity and 86% overall accuracy in detecting or excluding graft occlusion, which was predicted by reversible ischemia as well as persistent "new scar" segments. Occluded grafts were correctly localized by 201Tl scintigraphy in 61%. Postoperative apical 201Tl defects were frequent (two-thirds of cases), and were the result of intraoperative transapical venting of the left ventricle. After coronary bypass graft surgery, ejection fraction at rest was unchanged. Left ventricular end-diastolic pressure and physical work capacity improved significantly. In the presence of new perfusion defects detected postoperatively, physical work capacity was reduced significantly. New 201Tl defects in addition to typical or atypical angina provided a high probability of graft occlusion, while in the absence of new 201Tl defects all grafts were patent in more than 90% of patients, all of whom had no or only atypical chest pain. We conclude that serial 201Tl imaging after coronary artery bypass surgery is an accurate noninvasive method that can be used routinely to assess graft function, to localize spatially occluded grafts and to identify patients with a high likelihood of graft occlusion who may need invasive studies.
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PMID:Accuracy of serial myocardial perfusion scintigraphy with thallium-201 for prediction of graft patency early and late after coronary artery bypass surgery. A controlled prospective study. 698 12

Eighty-two patients with mitral stenosis underwent cardiac catheterization with coronary angiography. Twenty-one patients (26 percent) had coronary artery disease. Characteristics of the mitral valve area, cardiac output, pulmonary artery pressure, pulmonary vascular resistance, left ventricular end-diastolic pressure, left ventricular ejection fraction, and atypical chest pain did not correlate with findings of angina pectoris or of coronary artery disease; however, there was correlation with sex, age, and angina. Coronary artery disease occurred only after the age of 40 years and was more frequent in males with angina. Coronary artery disease could not be ruled out in patients with mitral stenosis, especially those over age 40, without coronary arteriography.
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PMID:Coronary atherosclerosis in mitral stenosis. 705 40


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