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

A retrospective analysis was undertaken of clinical data and catheterization studies of 151 consecutive unselected patients who underwent aorta-coronary bypass at the University of Kansas Medical Center between 1971 and 1973. The purpose was to determine the effect of preoperative left ventricular function and extent and severity of coronary artery obstruction on operative mortality rate and long-term survival. The postoperative follow-up period ranged from 10 to 49 months and averaged 26 months. Left ventricular function was assessed by qualitative analysis of left ventricular angiograms. Severity of coronary obstruction was quantified by scoring coronary arteriograms according to the system of Friesinger and associates. Patients with normal or near normal ventriculograms were considered to have good left ventricular function. Patients showing moderate or severe impairment of contraction were considered to have poor left ventricular function. Obstruction scores ranging from 2 to 7 points were classified as low scores, and scores from 8 to 15 points were classified as high scores. Four groups of patients were identified based upon preoperative left ventricular function and obstruction severity: Group I, 29 patients with good left ventricular function and low scores; Group II, 22 patients with poor left ventricular function and low scores. Group III, 28 patients with good left ventricular function and high scores. Elective aorta-coronary bypass in these three groups was accompanied by no operative or late deaths. Group IV comprised 72 patients with poor left ventricular function and high scores. In this group there was a 10 per cent operative mortality rate (7 of 72 patients) and a 5 per cent year late mortality rate. Relief of angina occurred equally in all groups. Thus operative risk can be prospectively determined by analysis of left ventricular function and severity of coronary obstruction. Surgical treatment resulted in negligible operative and late mortality rates (0 per cent) in all patients except those in whom poor ventricular function was accompanied by severe and diffuse coronary artery obstruction. Operation should be offered to this latter group (Group IV) despite the higher operative and postoperative risk because of salutary postoperative results.
J Thorac Cardiovasc Surg 1976 Jul
PMID:Left ventricular function and coronary obstruction as predictors of survival following aorta-coronary bypass. 108 50

The effect of aorta-coronary bypass surgery on left ventricular function was evaluated in 39 patients by cardiac catheterization and recording of the systolic time intervals (STI) before and an average of 4.5 months following myocardial revascularization. All patients were in sinus rhythm, had normal QRS intervals on the electrocardiogram, and had taken no medication for at least 3 weeks prior to the study. The STI was unchanged postoperatively in patients with the following characteristics: freedom from angina; heart rate not more than 15 beats greater than the preoperative level; all grafts patent; and no progression of disease in coronary arteries. Deterioration in left ventricular function after operation as represented by shortened left ventricular ejection time, (LVET) prolonged pre-ejection period (PEP), and increased ratio of PEP/LVET was found in patients with the following characteristics: persistent angina; heart rate more than 14 beats faster than the preoperative level; occlusion of any grafts; progression of disease in the coronary arteries; evidence for postoperative myocardial infarction. Worsening of left ventricular performance as determined by STI was more apparent in patients with occluded grafts and no collateral circulation than in those with occluded grafts and collateral circulation which may have offered protection against ischemia. These investigations supported the use of STI in assessing changes in left ventricular function after coronary bypass and, by inference, in assessing the status of the graft.
J Thorac Cardiovasc Surg 1976 Aug
PMID:The assessment of function of left ventricle and patency of aorta-coronary bypass after operation. A study of systolic time intervals. 108 90

The STI offer a quantitative noninvasive measure of left ventricular performance in man. Extensive studies in animals and man have validated the STI. The STI are also sensitive to changes in inotropic state, preload, and afterload, and distinction must be made between the differing effects of acute and chronic alterations upon the STI. When properly performed and interpreted the STI are useful in diagnosis (aortic valve disease, angina pectoris, and pericardial disease), evaluation of the effectiveness of cardiac compensation (coronary artery disease, mitral valve disease, hypertensive heart disease), and evaluation of surgical or pharmacologic interventions. While much investigation is required for a more comprehensive understanding of the clinical application of the STI, the studies summarized in this review support continued use of these measures for the evaluation of left ventricular performance in man.
Cardiovasc Clin 1975
PMID:Diagnostic value of systolic time intervals in man. 110 Feb 37

Diagnostic pacing has proven useful for the study of a great variety of clinical problems. Rapid atrial pacing is an excellent means of stressing the heart, particularly in patients with ischemic heart disease. Pacing-induced tachycardia has been used to provoke typical coronary pain and to produce hemodynamic, metabolic, and left ventricular contractile changes in patients with coronary artery disease. Because this heart stress is reproducible, it has also been valuable in assessing response to medical and surgic al therapy in patients with angina. Electrophysiologically, pacing has been used to clarify mechanisms of normal and abnormal function of the sinus node and A-V conduction. The pre-excitation states have been more precisely defined, and the introduction of programmed electrical stimuli into the cardiac cycle has helped elucidate the nature of re-entry supraventricular tachycardias.
Cardiovasc Clin 1975
PMID:Diagnostic uses of electrical pacing. 110 Feb 46

Although unusual, coronary artery disease does occur in young women. It may be present to a severe degree between ages 20 and 30, but a typical history of angina pectoris by no means assures the presence of significant coronary artery disease. Proof that oral contraceptives predispose to coronary artery disease is lacking. It seems wise not to recommend them to young women with other known risk factors. Significant risk factors in a group of 1000 women under age 50 studied by cinecoronary arteriography for the evaluation of chest pain included cigarette smoking, hypertension, hypercholesteremia, and glucose intolerance. Combinations of factors increased the risk. Electrocardiographic abnormalities in themselves did not seem to increase the risk of coronary artery disease, but did seem to enhance it in combination with other factors. Electrocardiographic evidence of transmural myocardial infarction without significant coronary artery disease was more common in young women than in young men. Cinecoronary arteriography may possibly be performed after resolution of more severe lesions related to lysis of emboli or thrombi. Special conditions may temporarily increase myocardial oxygen requirements. Angia-like chest pain has been described in patients without significant coronary artery disease. Many have normal electrocardiograms and no known risk factors. Spasm has been mentioned among many possible causes, but is very difficult to tell whether or not underlying atherosclerotic lesions may be present. Whatever the cause, the prognosis for patients with angina-like chest pain and normal coronary arteriography seems excellent; early death is a rarity and improvement is common.
Cardiovasc Clin 1975
PMID:Coronary artery disease in young women. 114 65

Eighty of 654 patients studied because of chest pain were found to have normal coronary arteriography. Fifty of these completed submaximal treadmill exercise studies. The purpose of this study was to determine whether treadmill electrocardiography could obviate the need for coronary arteriography in the evaluation of patients with undiagnosed chest pain. Of patients studied, 22% had typical angina pectoris, while 78% had atypical chest pain. The resting electrocardiogram was normal in 58% of patients, while 42% showed repolarization abnormalities. Submaximal treadmill testing was normal in 64%, incomplete in 12%, and demonstrated classic ischemic S-T depression in 24%. Our findings of 24% positive studies in patients with normal vessels and 12% incomplete tests suggest that stress electrocardiography may be of limited value in predicting the morphologic state of the coronary arteries in patients with undiagnosed chest pain.
Cathet Cardiovasc Diagn 1975
PMID:Exercise stress testing in patients with chest pain and normal coronary arteriography: with review of the literature. 122 21

Alterations in left ventricular end-diastolic pressure and in dp/dt observed in ten patients with coronary heart disease who developed angina pectoris following left ventricular cineangiography were compared with those of six other patients who developed angina spontaneously and with patients who underwent left ventricular cineangiography without experiencing angina. In the patients with post-angiographic angina there was a greater increase in end-diastolic pressure than that seen in the other patients, but there was no significant change in dp/dt. Changes in left ventricular pressure associated with post-angiographic angina would appear to reflect the combined effects of increased preload provided by the contrast material and of ventricular dysfunction including diminished compliance associated with angina. A rise in end-diastolic pressure greater than 20 mmHg following left ventricular cineangiography should alert the physician that the patient may be having myocardial ischemia.
Cathet Cardiovasc Diagn 1975
PMID:Left ventricular pressure responses in post-angiographic angina. 122 35

Short-term results of aggressive surgical management were compared with results of medical management in forty-three patients with preinfarction angina admitted to the coronary-care unit (CCU) over an 18 month period. These patients were selected from 1,609 consecutive admissions to the CCU because they met strict criteria for preinfarction angina: severe chest pain at rest, ST-segment elevation or depression during pain which subsided rapidly after cessation of pain, and normal serum enzymes (CPK, SGOT, and LDH). Twenty-three patients had coronary angiography, done with operating room and pump standby. One patient, who had total occlusion of the left main coronary artery, died during the study. Twenty-one of the remaining patients were considered surgical candidates, and were treated immediately after angiography with 1 to 3 vein bypass grafts. There was one late postoperative death and, of the 20 survivors, 2 had ECG evidence of acute myocardial infarction and one had mild angina at time of discharge. In contrast, of the 21 patients treated medically, 13 sustained acute MI, resulting in 8 instances of congestive heart failure and 4 cases of ventricular fibrillation. Four patients died in cardiogenic shock. With the use of rigid criteria, a small subgroup of patients with variant angina at high risk of developing AMI has been identified and categorized as having preinfarction angina. Our experience suggests that aggressive surgery immediately following coronary angiography offers a lower incidence of MI, morbidity, and death than does medical management.
J Thorac Cardiovasc Surg 1976 Jan
PMID:Management of preinfarction angina. Evaluation and comparison of medical versus surgical therapy in 43 patients. 124 46

Sixteen male patients with typical angina pectoris secondary to coronary atherosclerosis performed two daily standardized exercise tests during two consecutive days. Three hours before each exercise they received placebo or 400 mg practolol administered orally in double-blind fashion in order to complete a cross-over design. Practolol significantly prolonged the exercise duration by 30.6% and delayed the appearance time of ischaemic electrocardiographic changes by 67.7%. Maximal heart rate, systolic pressure, and pressure-rate product were also reduced after medication. In order to investigate further the effects of this beta blocking agent, myocardial function and metabolism at rest and during supine exercise were assessed in 12 male patients with coronary artery disease before and after practolol 30 mg, iv. At rest, practolol produced a decrease in tension-time index (18%), cardiac index (17%), heart rate (10%), and stroke index (7%). A significant reduction was also observed in resting stroke work index (14%) and systolic and mean aortic pressure (6%). Left ventricular end-diastolic pressure remained unchanged. During supine exercise, only time-tension index (12%), heart rate (12%), and cardiac index (10%) were significantly reduced after the beta blocking agent. Practolol did not significantly change the arterial glucose, lactate, inorganic phosphate, potassium, calcium, magnesium, pH, PCO2, or PO2. The beta blocking agent did not modify the myocardial extraction of any of these substrates at rest or during exercise. In the dosage used in both studies, practolol significantly improved the exercise tolerance and reduced the ischaemic manifestations. The efficacy of practolol in angina pectoris may result mostly from its ability to decrease heart rate and systolic pressure during exercise.
Cardiovasc Res 1976 Jan
PMID:Effects of practolol on exercise tolerance and cardiac haemodynamics and metabolism in patients with coronary artery disease. 125 93

The effects of hypertonic glucose infusion on the anginal threshold determined by atrial pacing was studied in 14 patients with significant coronary artery disease. After glucose, angina occurred at a significantly lower heart rate and double product (systolic arterial pressure x heart rate), suggesting a decreased tolerance to ischemic stress. No stoichiometric relationship was noted between glucose uptake and lactate production, and there was no evidence that hypertonic glucose infusion resulted in enhanced anaerobic glycolysis in the ischemic myocardium. Acute elevation of plasma glucose levels may not be beneficial to patients with coronary artery disease.
Cathet Cardiovasc Diagn 1976
PMID:Effects of intravenous glucose during pacing-induced angina pectoris in patients with coronary artery disease. 126 Aug 50


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