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

The phenomenon of apparently normal angiographic left ventricular wall motion in the presence of greater than or equal to 1 completely obstructed coronary artery was investigated in 16 patients with coronary artery disease (CAD) by quantitative phasic biplane cineangiography. Angiographic contours were digitized at quarterly intervals throughout ejection and 9 areas of motion were measured in both right and left anterior oblique planes. Normal values were derived from 18 other patients who had normal coronary arteries and normal left ventricular function. Areas of asynergy undetected when quantitative analysis was applied only at end-systole in the right anterior oblique plane were found in 12 of the 16 patients with CAD: in 2 patients by end-systolic analysis in the left anterior oblique plane and in 10 patients by phasic analysis of both planes. Of 19 asynergic areas 18 corresponded to sites of high-grade CAD. All patients had angina pectoris, but only 5 had clinical or electrocardiographic evidence of prior infarction.
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PMID:Subtle left ventricular asynergy with completely obstructed coronary arteries. 662 60

We correlated the incidence and degree of exercise induced ventricular arrhythmias (EIVA) with the angiographic severity of coronary artery disease (CAD) in 162 patients with a history of stable effort angina, all showing a positive exercise stress test for myocardial ischemia and a greater than or equal to 70% stenosis of a major coronary artery. Patients were grouped according to the following criteria: presence of electrocardiographic evidence of old transmural myocardial infarction (MI), number of significant coronary stenoses and number of left ventricular (LV) areas showing abnormal segmental wall motion (ASWM). The incidence of EIVA in patients with multivessel CAD was higher than in patients with single vessel CAD, but this difference was not statistically significant. The number of LV areas with ASWM was better correlated with the frequency of EIVA, which was 20.0% in patients with normal LV wall motion, 31.2% in patients with 1 area of ASWM, 54.0% in patients with 2 areas of ASWM (p less than 0.005 vs normal LV wall motion), 74.1% in patients with 3 or more areas of ASWM (p less than 0.001 vs normal LV wall motion and 1 area of ASWM), and 81.8% in patients with LV aneurysm (p less than 0.001 vs normal LV wall motion and 1 area of ASWM, p less than 0.005 vs 2 areas of ASWM). Patients with old MI showed a significantly higher incidence of EIVA than those without MI (p less than 0.001), but this difference was due to the more severe LV asynergy in the MI group. In conclusion, our results show that, in a selected population of patients with CAD, the incidence of EIVA correlates better with the extent of LV segmental wall motion abnormalities than with the number of diseased coronary arteries or the presence of an old transmural MI.
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PMID:Exercise induced ventricular arrhythmias. Angiographic correlation with the severity of coronary artery disease. 664 44

Two patients with angina pectoris were echocardiographically examined during an attack of angina pain. In both patients, segmental asynergy of the left ventricle was present during chest pain. The echocardiographic finding before the attack and after its regression was normal. It appears that angina pectoris and an echocardiographically detectable asynergy of the left ventricle are two processes taking place almost simultaneously, their common cause being myocardial ischaemia. Wall motion abnormalities which develop during an attack of angina pectoris are fully reversible. These findings also indirectly support the assumption that two-dimensional echocardiography can practically immediately after the onset of chest pain in myocardial infarction prove asynergy of the left ventricle.
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PMID:Echocardiography during attack of angina pectoris. 665 29

To determine the physiological significance of the fourth heart sound at rest in patients with angina pectoris without previous myocardial infarction, the tension time index (TTI) and the ratio of the diastolic pressure time index (DPTI) to (DPTI/TTI) were calculated from the recordings of the left ventricular and aortic pressure curves. Thirty patients were subjected to the study and they were classified into two groups: Group A consisted of 15 patients with the fourth heart sound and Group B of 15 patients without it. Nine cases of atypical chest pain without the fourth heart sound served as control group. TTI was significantly higher in Group A than in Group B (p less than 0.01) and control group (p less than 0.01) (2,552 +/- 489 mmHg X sec/min in Group A, 2,024 +/- 425 mmHg X sec/min in Group B, and 2,023 +/- 209 mmHg X sec/min in control group). DPTI/TTI was significantly lower in Group A than in Group B (p less than 0.01) and control group p less than 0.001) (1.16 +/- 0.19 in Group A, 1.55 +/- 0.39 in Group B, and 1.45 +/- 0.15 in control group). Left ventricular systolic pressure tended to be higher in Group A than in Group B and control group. There was no significant difference in left ventricular end-diastolic pressure, left ventricular ejection fraction and cardiac index among three groups and there was no difference in the prevalence of left ventricular asynergy on left ventriculography between Group A and Group B.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Significance of the fourth heart sound in patients with angina pectoris]. 667 54

Dynamic exercise two-dimensional (2-D) echocardiography has been utilized as a valuable method in the diagnosis of coronary artery disease (CAD). However, there are some limitations in this technique including inability to apply for patients whose physical capacity is limited. Moreover, appropriate echocardiographic recordings are frequently difficult because of bodily movements and/or hyperventilation during exercise. In order to overcome these limitations, we examined whether isoproterenol (ISP) infusion stress 2-D echocardiography could detect transient LV asynergy or not. The subjects consisted of 19 cases with angina pectoris (AP), 16 with old myocardial infarction (OMI), nine with atypical chest pain syndrome and six with miscellaneous heart disease. ISP stress test was performed prospectively as follows: ISP was infused at a rate of 0.02 microgram/kg/min until anginal pain occurred or significant ST depression (elevation) developed. Real time 2-D echocardiograms were obtained in the short-axis or apical RAO views of the LV before and every one minute during ISP infusion test. Coronary artery stenosis was considered to be present if the narrowing was 50% or more in the luminal diameter. The results were as follows: Adequate echocardiographic recordings were obtained in 86.1% of LV segments at rest, and in 82.2% during ISP infusion. Echocardiographic recordings during ISP infusion were feasible in almost all cases. LV wall motion abnormalities were detected in 12 (86%) of the 14 subjects with OMI and two (29%) of the seven subjects with AP at rest, while induced or exaggerated in nine (64%) of the 14 subjects with OMI and all of the 7 subjects with AP during ISP infusion. On the other hand, LV wall motion remained entirely normal during ISP infusion in 11 (92%) of the 12 subjects without CAD. In 4 (40%) of these 10 subjects without CAD, electrocardiographic judgements were positive in the ISP stress test. None had hazardous arrhythmias or severe anginal pain. ISP infusion stress 2-D echocardiography possessed feasibility of detecting LV wall motion abnormalities because this method could exclude difficulty of recordings due to bodily movements and/or hyperventilation seen in exercise echocardiography. Compared with ISP stress electrocardiography, 2-D echocardiography seemed to be superior with respect to the specificity in detecting CAD. In conclusion, ISP stress echocardiography is a safe and useful method in the diagnosis of CAD.
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PMID:[Isoproterenol infusion stress two-dimensional echocardiography in detecting coronary artery disease]. 667 62

Left ventricular asynergy has been shown to occur commonly in patients with coronary artery disease (CAD) and to be induced or exaggerated by exercise. The purpose of this study is to report on a method to detect asynergy and estimate its severity by M-mode echocardiographic analysis of left ventricular wall motion at rest and during supine ergometric exercise. Sixteen patients with CAD underwent graded supine ergometric exercise until anginal pain occurred or apparent ischemic changes were noted on ECG. This study was done using the following criteria: 1) Asynergy at rest was defined as occurring when the amplitudes of the interventricular septum and/or the posterior left ventricular wall were below normal values at rest. 2) Asynergy during exercise was defined as occurring when one or both of the two amplitudes were more than 2 mm below the values at rest (severe) or were unchanged in spite of sufficient exercise load (mild). The results were as follows: 1) In the normal subjects, the septal and posterior wall amplitudes increased during exercise (ranging from 7 mm to 9 mm for the septum, and from 13 mm to 16 for the posterior wall). In patients with CAD, asynergy at rest was demonstrated in only 3 cases (19%), whereas septal and/or posterior wall asynergy during exercise was noted in 75% of cases. 2) The location of exercise-induced asynergy detected by echocardiography showed a good correlation with that of coronary artery lesions (greater than or equal to 75% stenosis) recognized by angiography. 3) Significant differences were observed between changes in left ventricular dimensions in patients with CAD and those of normals during exercise. In the normal subjects, left ventricular end-systolic dimension (ESD) decreased without significant change in end-diastolic dimension (EDD) during exercise. On the other hand, both ESD and EDD increased during exercise in patients with CAD. Although echocardiographic analysis of left ventricular wall motion during exercise has some limitations, this study suggests that asynergy induced or exaggerated by ergometric exercise can be successfully detected by M-mode echocardiography.
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PMID:Role of exercise echocardiography as a predictor of coronary artery disease. Detection of exercise-induced asynergy by M-mode echocardiography. 685 57

To evaluate the clinical usefulness of the first-third ejection fraction (1/3 EF) for detecting patients with coronary artery disease (CAD), resting contrast ventriculography and first-pass radionuclide angiography with a high-count-rate, multicrystal camera system were performed in 47 subjects: 22 normal controls (group 1) and 25 patients with clinically stable angina pectoris and severe CAD (mean 2.3 vessels) without (group 2, n = 12) and with (group 3, n = 13) resting wall motion abnormalities. By contrast angiography, only group 3 had depressed global EF or 1/3 EF compared with control (global EF: group 1,0.71 +/- 0.09; group 2, 0.67 +/- 0.09 [NS]; group 3,049 +/- 0.05 [p less than 0.01 vs groups 1 and 2]; 1/3 EF: group 1,0.29% +/- 0.06;' group 2, 0.28 +/- 0.05 [NS]; group 3,0.22 +/- 0.05 [p less than 0.02 vs groups 1 and 2]). Whereas 11 of 25 CAD patients had global EF outside the normal range, only two of 25 had depressed 1/3 EF. Both had left ventricular asynergy and a depressed global EF. Studies performed using first-pass radionuclide angiography revealed similar results i.e., only four of 25 CAD patients, all with left ventricular asynergy and depressed global EF, had depressed 1/3 EF values. A wide range of 1/3 EF values was found in normal subjects by both techniques. Thus, the ejection fraction during the first third of systole at rest is of limited value for detecting patients with CAD.
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PMID:The interval ejection fraction: a cineangiographic and radionuclide study. 707 71

The cause and associated pathophysiology of precordial ST-segment depression (ST decreases) during acute inferior myocardial infarction (IMI) are controversial. To investigate this problem, electrocardiographic findings in 48 consecutive patients with acute IMI were prospectively compared with results of coronary angiography, submaximal exercise thallium-201 (201TI) scintigraphy and multigated blood pool imaging, all obtained 2 weeks after IMI, and with clinical follow-up at 3 months. Patients were classified according to the admission ECG obtained 3.3 +/- 3.1 hours after the onset of chest pain. Twenty-one patients (group A) had no or less than 1.0 mm ST decreases, and 27 (group B) had greater than or equal to 1.0 mm ST decreases in two or more precordial (V1-6) leads. Patients in group B had more prolonged chest pain after admission to the coronary care unit than those in group A (2.8 +/- 3.0 vs 1.2 +/- 1.1 hours, p less than 0.03), greater summed ST-segment elevation in leads II, III, aVF (6.7 +/- 4.7 vs 3.3 +/- 4.5 mm, p less than 0.02), higher plasma peak creatine kinase levels (1133 +/- 781 vs 653 +/- 482 IU/l, p less than 0.01), a higher prevalence of "true posterior" infarction by ECG criteria (26% vs 5%, p less than 0.05), a lower radionuclide ejection fraction (46 +/- 9% vs 54 +/- 6%, p less than 0.001), more extensive infarct-related asynergy (p less than 0.001) and 201TI perfusion abnormalities (p less than 0.01), more complications during hospitalization (p less than 0.03), and more cardiac events at 3 months (p less than 0.02). There were no significant differences between group A and group B in the extent of underlying coronary disease, prevalence of left anterior descending coronary artery disease, exercise-induced ST decreases or angina, and 201TI defects or wall motion abnormalities in anterior or septal segments. Thus, patients with acute IMI who have associated precordial ST decreases have greater global and regional left ventricular dysfunction due to more extensive inferior or inferoposterior wall infarction, rather than concomitant anteroseptal ischemic injury.
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PMID:Precordial ST-segment depression during acute inferior myocardial infarction: clinical, scintigraphic and angiographic correlations. 711 90

Overall left ventricular function and regional wall motion abnormalities visualized by biplane cineangiocardiography were examined in 136 patients with significant coronary heart disease during supine bicycle ergometry. The stress test was tolerated without symptoms in 57 patients (42%) (26 without previous myocardial infarction, 31 with infarction), whereas it was limited by angina pectoris in 79 (58%) (40 without previous infarction, 39 with infarction). A de novo asynergy during exercise was observed in a similar percentage in patients without angina (17/26 [65%] without infarction, 29/31 [94%] with infarction) than in those with angina (29/40 [73%] without infarction, 33/39 [85%] with infarction). During exercise, left ventricular ejection fraction decreased and enddiastolic pressure increased to the same extent in all four subgroups, all changes being highly significant. It is concluded that in patients with coronary heart disease objective signs of ischemia during exercise (de novo asynergy, fall in ejection fraction and rise in enddiastolic pressure) are observed independently of whether angina pectoris occurred or not. Thus, angina is not an indispensable symptom of the occurrence of hemodynamically relevant ischemia during dynamic exercise.
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PMID:[Function of the left ventricle under dynamic load in patients with coronary heart disease with and without angina pectoris]. 715 57

Exercise two-dimensional (2-D) echocardiography was performed in patients with suspected coronary artery disease, and exercise induced left ventricular asynergy was evaluated qualitatively and was compared with the coronary artery stenosis and electrocardiographic ST changes. Subjects were 12 patients with angina of effort, 8 patients with spontaneous angina, 8 patients with chest pain syndrome with the normal coronary artery, and 7 patients with hypertrophic cardiomyopathy (HCM). Cases with myocardial infarction were excluded from this study. 1) Left ventricular asynergy during exercise was observed in 10 and ST depression in 11 of 12 patients with angina of effort. In patients with spontaneous angina, left ventricular asynergy and ST depression during exercise were observed in 2 of 8 patients without anginal pain, and both patients had coronary artery stenosis of 90% or more. 2) Exercise induced asynergy was also observed in 4 of 7 patients with HCM without coronary artery stenosis. It seemed likely that the markedly hypertrophied myocardium and impairment of left ventricular compliance and relaxation may induce relative myocardial ischemia.
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PMID:[Exercise two-dimensional echocardiography: correlation between exercise induced asynergy and coronary artery lesions]. 717 21


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