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

The etiology of chest pain in patients with the anginal syndrome and normal coronary arteriograms has not been established. There has been no explanation for the association of electrocardiographic, hemodynamic, and myocardial metabolic abnormalities consistent with myocardial ischemia observed in some patients with this disorder. Historical, clinical, laboratory, and hemodynamic data of 45 patients (24 females, 21 males), mean age 47.5 years, with chest pain and normal coronary arteriograms are reviewed. Left ventriculograms were analyzed utilizing the single-plane cineangiographic measurement of left ventricular volume. Systolic ejection fractions for the 45 patients ranged from 0.66 to 0.91 (mean 0.80 +/- 0.01 SEM). Ventricular volumes determined angiographically revealed mean end-diastolic and end-systolic volumes of 83 +/- 5 ml and 18 +/- 2 ml, respectively. The mean changes in longitudinal and transverse segmental axis shortening that occurred during ventricular systole were 28.8% and 50.7%, respectively. These elevated values for ejection fraction, and reduced measurements of ventricular volumes, indicate that some patients with chest pain and normal coronary arteriograms may have small hearts with hyperdynamic ventricular contraction. These findings suggest that hyperdynamic ventricular contraction may play a causative role in the development of transient, angina-like chest pain in these patients. The etiology of the proposed hyperdynamic ventricle is unknown, but it may be attributable to increased beta-sympathetic stimulation of the myocardium.
Cathet Cardiovasc Diagn 1978
PMID:Elevated ejection fractions in patients with the anginal syndrome and normal coronary arteriograms. 73 29

Regional systolic left ventricular performance after myocardial infarct was assessed from 216 radionuclide angiograms performed in 170 patients. Recording of first transit of an intravenously injected bolus of technetium-99m pertechnetate was made by a multicrystal scintillation camera at a framing rate of 20 per second. The RAO view was used and a simultaneous ECG was employed. Statistics adequate for resolving regional events were obtained by a compact bolus input and phasic summation into one representative cycle of data obtained during left ventricular passage. Emphasis was given to imaging of regional systolic left ventricular function: perimeter images of end-systole and end-diastole, regional stroke volume images and ejection fraction images were processed. New trend images were presented that reflect total systolic contraction and improve image quality: regional rate of decrease and increase images, wall motion trend images and regional mean transit time images. In 96% of the cases, correspondence was found between the electrocardiographic location of the infarct and the region of major wall motion and ejection disorder. Akinesia and/or dyskinesia were seen in 77% of the cases; a ventricular aneurysm was found in 11%. Additional areas of wall motion anomalies were shown by 70%. Image analysis, nuclear image signs and their diagnostic meaning, as well as the indications for this nontraumatic examination in coronary heart disease are discussed. Relevant information for medical or surgical therapy can be obtained from early and follow-up studies in patients with unstable, progressive angina, ischemic electrocardiographic signs and those who have had myocardial infarctions.
Cardiovasc Radiol
PMID:Radionuclide angiography of the heart in coronary heart disease: where do we stand? 74 2

We have studied the natural history of left ventricular aneurysms (LVA) in 40 patients not treated surgically who were followed for a mean period of 5 years, 8 months. These patients have been divided into two groups according to the presence (Group B) or absence (Group A) of significant symptomatology. The causes of death are dominated by arrhythmias and congestive heart failure (CHF). The survival rate at 10 years is 66.7% for the entire group. In asymptomatic patients the 10 year survival rate is 90%, but it is only 46.3% in those who were symptomatic at the time of the initial diagnosis. In general, the clinical course of survivors is stable in Group A but has deteriorated steadily in Group B. Nonfatal complications include arrhythmias (observed in 34% of all patients), thromboembolic phenomena (29%), CHF (29%), and recurrent myocardial infarction (22.5%). Factors influencing prognosis are the extent of the aneurysm, the association of asynergic segments, the ejection fraction of the residual ventricle, the left ventricular end-diastolic pressure (LVEDP), and the presence of ventricular extrasystoles at the time of diagnosis. The mere presence of aneurysm is not, in itself, an indication for operation. Incapacitating angina and refractory CHF are the most valuable indications for surgical resection. The question is raised as to the value of operation in patients with little or no symptoms, in those with isolated life-threatening arrhythmias, and in those in whom a mural thrombus is the only distressing feature.
J Thorac Cardiovasc Surg 1979 Jan
PMID:Natural history of saccular aneurysms of the left ventricle. 75 65

A 47-year-old black male who presented with classical angina pectoris and positive exercise test developed spasm of the right coronary artery in the vicinity of an atherosclerotic lesion resulting in transient total occlusion of the vessel. It seemed unlikely that spasm was catheter induced in this case, and the vessel relaxed promptly following nitroglycerin administration. The occurrence of severe spasm in proximity to atherosclerotic narrowing of coronary artery may contribute to stable and unstable angina, myocardial infaction, and sudden death in patients with these conditions coexisting. The awareness of such a phenomenon is necessary to avoid serious errors in the interpretation of coronary angiograms.
Cathet Cardiovasc Diagn 1975
PMID:Coronary arterial spasm in classic angina pectoris. 81 69

In five patients studied 1 to 3 d after coronary artery surgery isoprenaline and nitroglycerine have been used to alter the systolic (TTI) and diastolic (DPTI) pressure time indices. A close correlation with the predicted relationship between diastolic coronary graft flow and the DPTI/TTI ratio has been demonstrated during isoprenaline-induced tachycardia. Nitroglycerine reduced diastolic coronary graft resistance and increased the DPTI/TTI ratio, effects which are desirable for the relief of angina.
Cardiovasc Res 1976 Mar
PMID:Effect of isoprenaline and nitroglycerine on pressure time indices and coronary graft blood flow in man. 82 Apr 28

External pressure counterpulsation (ECP) has been reported to improve the clinical status of patients with angina pectoris. To document the mechanisms for such an improvement left ventricular oxygen consumption and lactate metabolism, coronary sinus blood flow, and cardiac index were studied in 10 patients with angina pectoris 1) prior to and during ECP; and 2) during right atrial pacing before and after 4 consecutive 2-hour sessions of ECP treatment. During ECP peak early and mean arterial diastolic pressures were significantly raised above control values by 32 and 13% respectively. However, coronary sinus blood flow, left ventricular oxygen consumption and left ventricular lactate extraction, mean systolic arterial pressure and cardiac index were not significantly altered by ECP. Right atrial pacing at 140 beats/min increased coronary sinus blood flow 70% over control values and induced angina and ischemic ST segment changes in 8 patients before and after 4 consecutive treatments of ECP. ECP treatment did not significantly modify the above metabolic and hemodynamic responses at rest or during atrial pacing. Although 5 patients reported improvement in angina symptoms the effect was transitory. No significant improvement over pre ECP-treatment exercise angina threshold was observed immediately following or at 1 and 3 months post treatment. This method of noninvasive circulatory assistance appears to be of doubtful value in the management of patients with stable angina pectoris.
Cathet Cardiovasc Diagn 1977
PMID:External counterpulsation: coronary hemodynamics and use in treatment of patients with stable angina pectoris. 83 32

To clarify the influence of propranolol-and particularly its heart-rate effects-on myocardial ischemia, coronary hemodynamics and metabolism were studied in 15 patients utilizing a protocol to control heart rate. Ten patients had significant coronary narrowing (CAD) and 5 were normal. Systemic pressure, coronary sinus blood flow (CSBF), left ventricular oxygen utilization (LVVO2), ST Segment depression, and myocardial lactate extraction were measured before and after propranolol (10 mg IV), at rest, during pacing-induced tachycardia stress. Propranolol-related reduction in CSBF and LVVO2 at rest was reversed when heart rate was controlled in both patient groups. Propranolol failed to alter heart-rate threshold, tension-time index (TTI), CSBF, or LVVO2 at angina in the CAD patients. Likewise, ischemic-type ST depression, decreases in lactate extraction, and coronary resistance were unchanged compared to values observed during tachycardia stress before propranolol. In normal coronary patients, propranolol also produced no significant change in LVVO2 or coronary resistance when its heart rate effects were controlled. These data imply that a major coronary and metabolic influence of propranolol relates to changes occurring secondary to its influence on heart rate. Furthermore, this agent's anti-ischemic effect is not prominent during tachycardia stress suggesting that this stress test may be clinically useful in patients taking propranolol.
Cathet Cardiovasc Diagn 1977
PMID:Effects of propranolol on coronary hemodynamic and metabolic responses to tachycardia stress in patients with and without coronary disease. 83 33

Considering the increasing number of patients with chest pain who undergo routine coronary artery arteriography, coronary artery aneurysm may be found more frequently. To know how to manage these aneurysms, we must understand their possible complications. The aneurysms can produce symptoms of angina or acute myocardial infarction by total thrombosis of the aneurysm and vessel, embolism to the distal vessel, or progressive enlargement and encroachment upon the distal vessel until it is occluded. Moreover, the aneurysm may enlarge and rupture into the free pericardium or produce a fistula by eroding into a chamber of the heart. The case described herein may represent the first reported case of a coronary artery aneurysm eroding into a cardiac chamber and causing an arteriovenous fistula. The treatment of choice is resection of the aneurysm, closure of the fistula, and re-establishment of continuity of the distal coronary artery with a saphenous vein bypass graft.
J Thorac Cardiovasc Surg 1977 Sep
PMID:Surgical treatment of coronary artery aneurysm with rupture into the right atrium. 89 79

By monitoring arterial blood flow signals across the chest wall in the area of the heart and timing them to the electrocardiogram or the heart sounds, it is often possible to differentiate between coronary artery flow and systemic artery flow. A Doppler ultrasound technique was used for the postoperative follow-up coronary artery reconstruction in ten patients suffering from intractable angina pectoris. Pre-operative coronary angiography showed stenosis or occlusion of the coronary arteries in all the patients. The ultrasound measurements were made pre-, per- and postoperatively with the Doppler flowmeter. Flow signals in all patients could be visualized on sonagrams. There was no postoperative occlusion as proved by postoperative angiography. The signals recorded outside the chest were smaller than those recorded directly from the arteries inside the chest, due to attenuation of the audio signal passing through the tissues of the chest wall. The characteristic pattern of postoperative bypass blood flow was a broad continuous flow over the diastole. The noninvasive character of ultrasound techniques and the safety of the method make Doppler ultrasound scanning an important adjunct to patient monitoring and renders it valuable for post-operative follow-up of arterial graft patency.
Scand J Thorac Cardiovasc Surg 1977
PMID:Monitoring coronary artery blood flow by Doppler shift ultrasound. 89 18

A 60-year-old man presented with complaints on angina pectoris and was found to have a coronary artery fistula between his left main truck and main pulmonary artery. Particles of 99m Tc-Albumin were injected in the ostium of the left coronary artery, and differential radioactive counts were injected in the ostium of the left coronary artery, and differential radioactive counts were obtained over both lung fields and myocardium. The degree of left to right shunt was calculated at 56% of total left coronary artery flow. The patient underwent ligation of the fistula without any complications. This case report represents a new application of myocardial radioisotopic scanning.
Cathet Cardiovasc Diagn 1977
PMID:Coronary artery fistula: estimation of shunt using 99m Tc-albumin particles. 91 35


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