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

A significant number of patients with severe angina or intractable atypical chest pain referred for coronary arteriography are found to have normal coronary vessels. To determine what therapeutic or economic benefit may be derived from these studies, we analyzed the data of 72 consecutive patients with normal vessels referred for cardiac catheterization because of severe chest pain. The clinical status and hospitalizations were analyzed for the 2 year period before and the 2 year period after angiography. There were no deaths or myocardial infarctions. Although 47 were thought to have angina and 25 atypical pain before catheterization, the chest pain was reclassified with only 15 continuing to have anginal pain, 40 atypical pain, and 17 no pain. Functional improvement by at least one New York Heart Association class occurred in 74 percent of patients with 36 (50 percent) having no functional limitation. The use of cardiac medications was also significantly reduced. Despite functional improvement, no change in employment states could be demonstrated. The use of medical facilities was significantly less, the average number of hospital days per patient declining from 17 to 3.9 and hospitalization decreasing from 1.5 to 0.4. The result was a significant decrease in estimated hospital costs. We conclude that in patients referred for coronary angiography for severe chest pain, documentation of a normal coronary arteriogram significantly alters the clinical assessment of symptoms, improves functional status, modifies medical therapy, and reduces hospitalization and medical costs. These therapeutic and economic benefits deserve consideration in the evaluation of coronary angiography for its overall effectiveness.
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PMID:Therapeutic and economic value of a normal coronary angiogram. 712 77

The results from the step-wise loading test to 75 per cent of the age maximum pulse rate, performed by veloergemeter or thread-mill in 52 patients (9 females and 43 males, II of them with atypical chest pain and II with stenocardia) were juxtaposed to the data from the selective coronarography. It was established that the a reduction of ST segment greater than I mm and the appearance of precordial pain, degree III by the five-grade scale, have almost identical specificity (70% and 64% resp) and a predicting value of the positive result (68% and 70% resp) and a slightly higher sensitivity to pain (68% and 84% resp) in the detection of coronary stenosis greater than 50 per cent of the diameter of a main coronary vessel. The combination of the signs precordial pain degree III and/or ST reduction greater than I mm and/or elevation of ST greater than 2 mm, with same predicting value (67%) maintained, but with a considerably enhanced sensitivity (96%) proved to be most adequate as a criterion of the positive test. A reduction of ST segment greater than 22 mm is characterized by decrease of sensitivity (40%) but with a considerable increase of specificity (96%). The positivation of that sign suggests the presence mainly of a multibranch disease. The patients with coronary stenosis greater than 50%, rarely reach a physical capacity over 100 wt (7 x oxygen consumption) and a product of the maximum reached pulse rate and systolic blood pressure over 20 000 as compared with those without stenosis, but no difference among the patients with one-branch and multi-branch disease was established. The electrocardiographic changes in the patients with a true positive test with loading is more often retained after 4th minute of the rehabilitation phase as compared with those of the patients with false-positive test. Evidence exists to admit that the predicting value of the positive test is poorer in the patients with atypical pains and females.
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PMID:[Comparison between the loading test and selective coronary angiography in stenocardia]. 714 19

Angina-like chest pain frequently arises from the esophagus. However, when a patient has chest pain, the gravity of possible myocardial ischemia indicates that a cardiac workup must be done. Those individuals with typical anginal pain who have normal multistage exercise tests or normal coronary arteriograms and any person with atypical chest pain should be thoroughly evaluated for esophageal disease. This evaluation should include a barium swallow, a Bernstein test, esophageal manometry, and, if indicated, esophagoscopy. Reproduction of the chest pain with the Bernstein test incriminates gastroesophageal reflux disease. Esophageal manometry is required to make the diagnoses of achalasis, DES, and hypertensive LES or esophageal body (Table 1).
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PMID:Chest pain: differentiating esophageal disease from angina pectoris. 716 Jan 64

The detection of coronary artery spasm, which can play an important role in spontaneous angina pectoris, may be particularly important with respect to therapeutic considerations. Since the documentation of spontaneous spasm is a rare occurrence, provocation of spasm under controlled conditions can facilitate the diagnosis. In our laboratory, the provocation test is carried out according to a standard protocol with the use of a bolus injection of 0.4 mg methergine ( a close congener of ergonovine). The 321 patients studied since 1976 were distributed into five groups: none of 99 patients with atypical chest pain had spasm; only one of 42 patients with typical angina pectoris of effort had spasm; spasm was induced in 48 of 104 patients with spontaneous angina pectoris, 41 of whom had Prinzmetal's variant angina with 39 of the latter demonstrating spasm; seven of 52 patients with angina both at rest and of effort displayed spasm; and two of 24 patients with myocardial infarction and normal coronary arteries were found to have methergine-induced spasm. The risk of serious complications (such as arrhythmias) is very low provided that an induced spasm is immediately relieved by intracoronary injection of nitroglycerin. Measurement of coronary sinus blood flow indicates that the mechanism is primarily that of an increase in vascular resistance due to spasm and not an increase in myocardial oxygen demands. Thus, the provocation test is useful and indicated for patients with isolated spontaneous angina pectoris, especially those with Prinzmental's variant angina, patients with angina both at rest and of effort and in patients with myocardial infarcation and normal or nearly-normal coronary arteries.
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PMID:Use of provocative testing in angina pectoris. 719 68

The radioactive isotope thallium 201 behaves physiologically as a potassium analog, and when injected intravenously accumulates rapidly within the cells of many organs. Uptake of the isotope reflects both regional perfusion and sodium-potassium pump activity. The radionuclide emits 80 keV x-rays which are suitable for scintillation camera imaging. The main clinical application of (201)TI scintigraphy has been in myocardial imaging. Abnormal uptake of the isotope results in a cold spot on the myocardial image. In patients with coronary artery disease, the differentiation of ischemic and infarcted myocardium is made by comparing images obtained after injecting the radionuclide at the peak of a maximal exercise test with those obtained after injection at rest. Abnormalities due to ischemia usually are seen only on the stress image whereas fixed defects in both rest and stress studies usually indicate areas of infarction or scarring. Some investigators believe that redistribution images obtained four to six hours after stress injection (without administering further (201)TI) give the same information as a separate rest study. The sensitivity of stress imaging for detecting significant coronary disease is of the order of 80 percent to 95 percent, though computer processing of the images may be necessary to achieve the higher figure. The prediction of the extent of coronary disease from (201)TI images is less reliable. An abnormal (201)TI image is not entirely specific for coronary artery disease and the likelihood of an abnormal image being due to this diagnosis varies according to the clinical circumstances. The main clinical value of (201)TI myocardial imaging is likely to be in the noninvasive screening of patients with atypical chest pain or with ambiguous findings on stress electrocardiographic tests. It has also proved useful in studying patients with variant angina or following a coronary bypass operation. It is doubtful whether the technique is clinically helpful in most patients with suspected or established acute myocardial infarction. Imaging of organs other than the heart with (201)TI has received much less attention but has been reported in patients with peripheral vascular disease and various primary and secondary neoplasms.
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PMID:Thallium 201 scintigraphy. 722 45

114 women with abnormal resting electrocardiograms underwent exercise test on bicycle ergometry; they were grouped as follows: --group I: 40 asymptomatic females; --group II: 67 cases with atypical chest pain; --group III: 7 cases with typical angina. The exercise test was always maximal or submaximal SL. The only criteria used for positive stress was a 1 mm or more ischemic ST segment depression below the resting level, for at least 0.08 sec. The test was positive in 11 subjects (10.7%): 5 women of group II (7.5%) and 6 of group III (85.7%). Our results suggest that repolarisation abnormalities, not caused by hypertrophy, conduction disturbances and drugs, do not modify the outcomes of stress test. Ischemic patterns during exercise test are more frequently seen when flat or diphasic T waves are present in control ECG. In the majority of patients in all groups the T wave either does not change or becomes more positive or less negative after exercise. A greater prevalence of resting hypertension and arrhythmias is present in patients with positive tests.
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PMID:[Exercise test in women with abnormal ecg (author's transl)]. 725 May 88

Under basal conditions the echocardiographic findings in anginal patients (pts.) without previous myocardial infarction appears usually normal. Consequently, the usefulness of the ultrasounds evaluation in angina pectoris has been commonly considered poor and the utilization of this technique in coronary artery disease has been restricted to the detection of myocardial infarction in its acute phase or to its chronic mechanical alterations. The purpose of this study was to assess the possibility offered by M-mode echocardiography to detect changes caused by transient myocardial ischemia at rest in man, in view of the possible diagnostic application of this technique. The reported results were obtained from 25 ischemic attacks (13 spontaneous and 12 ergonovine induced) with ST segment elevation or pseudonormalization of a basally negative T wave at rest. The semiautomatic computerized analysis of echocardiograms continuously recorded during these attacks showed a reduction of motion and of systolic thickening, accompanied by a diastolic thinning of the wall involved by the ischemia. These changes occur very early: they appear few seconds before ECG changes and are accompanied by a reduction of contraction and relaxation dP/dt and precede the onset of chest pain; moreover, they are followed by an increase in left ventricular internal diameters. In conclusion M-mode echocardiography is a sensitive technique capable to detect transient myocardial ischemia in the course of spontaneous or induced angina with ST segment elevation or positivity of negative T wave. This approach could be helpful in the diagnostic evaluation of patients with atypical chest pain and/or aspecific ECG changes and it can be complementary to other non invasive techniques such dynamic ECG and nuclear cardiology techniques.
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PMID:[Diagnosis of transient acute myocardial ischemia in man by M-mode echocardiography (author's transl)]. 732 34

Fifty patients were prospectively evaluated for myocardial ischemia utilizing treadmill testing and thallium-201 imaging. By coronary angiography, 43 had significant coronary stenosis and seven were normal. The sensitivity, specificity, accuracy and predictive value of treadmill testing alone (81 per cent, 71 per cent, 80 per cent and 95 per cent) did not statistically differ from that of thallium-201 imaging (70 per cent, 86 per cent, 72 per cent and 97 per cent). Combined treadmill testing and thallium-201 imaging (84 per cent, 71 per cent, 80 per cent and 98 per cent) did not significantly affect the results of treadmill testing alone. Thallium-201 imaging failed to identify a number of patients with high risk lesions. The high prevalence of disease, the presentation of typical angina, preselection bias, multiple lead monitoring and exclusion of patients with abnormalities on the resting electrocardiogram probably accounted for failure of thallium-201 imaging to improve the results obtained with treadmill testing. The use of thallium-201 imaging in certain subsets of patient (resting electrocardiographic abnormalities, nondiagnostic treadmill testing, atypical chest pain or asymptomatic patients with abnormalities on treadmill testing) may be of value. However, the use of thallium-201 imaging as a routine screening procedure for myocardial ischemia in patients with typical angina, without due consideration of the prevalence of the disease in the population, is not justified.
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PMID:Clinical decision-making with treadmill testing and thallium 201. 738 4

Isolated obstruction of the circumflex branch of the left coronary artery was present in 10 of 1,000 patients undergoing selective coronary angiography for suspected coronary artery disease. The clinical syndrome consisted of typical angina pectoris (six patients), atypical chest pain (three patients) and episodes of myocardial infarction (three patients). Left ventricular damage was mild, never involving more than 20% of the left ventricular circumference as measured during angiography. Left axis deviation was very common on the ECG. In eight patients, the ECG showed a mean frontal QRS axis of 0 degrees or less and in two, an axis of less than -30 degrees. The circumflex lesion typically occurred toward the end of the proximal third of the artery, often immediately after its major anterolateral marginal branch. Two patients had complete obstruction and eight had subtotal circumflex narrowing: the clinical picture was not differnet in these two subgroups. Overall left ventricular function, as measured by ejection fraction and left ventricular diastolic pressure, was normal in most of the patients. End-diastolic pressure was slightly increased in five patients, two of whom also had systemic hypertension.
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PMID:Isolated circumflex coronary artery obstruction. 741 79

This study aimed to determine whether or not endothelium-dependent vasodilation is preserved in spastic segments of human epicardial coronary arteries. Segmental responses of coronary arteries to substance P were examined in 30 patients with variant angina and in 10 patients with atypical chest pain using a quantitative angiographic technique. Coronary diameter at the basal state was matched between spastic and non-spastic segments in patients with variant angina, normal coronary arteries and with atypical chest pain (2.3 +/- 0.2 mm, 2.3 +/- 0.4 mm, 2.4 +/- 0.3 mm, respectively). In segments where vasospasm was induced by ergonovine and/or acetylcholine, changes in diameter in response to substance P did not differ from those in non-spastic segments; maximal dilation averaged 27.1 +/- 9.5% in the spastic segments and 24.4 +/- 9.6% in the non-spastic segments (expressed as a percent increase over the value before drug administration). It would appear that the potential of the endothelium to release endothelium-dependent relaxant factor (EDRF) and the vasodilator response to EDRF are preserved, even in spastic segments.
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PMID:Preserved endothelial function in the spastic segment of the human epicardial coronary artery in patients with variant angina--role of substance P in evaluating endothelial function. 750 36


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