Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0002962 (angina)
 21,142 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Coronary bypass surgery may be associated with an increased perioperative mortality rate in patients with unstable compared to stable angina. The mortality rate is excessively high when surgery is performed during evolving myocardial infarction. Elevated plasma MB CPK isoenzyme activity is a remarkably sensitive and specific marker of myocardial damage. Accordingly, we studied 111 patients with unstable angina to determine whether exclusion of patients with initially elevated MB CPK improves the perioperative mortality rate. Plasma MB CPK activity was assayed prior to catheterization and every 2 hours therafter. Of the 111 patients, 16, with initially elevated MB CPK activity, were excluded and managed medically. Catheterization was performed in 59 patients, and severe vessel obstruction was documented in 55. Coronary bypass surgery performed in 47 patients was associated with a mortality rate of 4 per cent. Thus, after exclusion of patients with evolving infarction by MB CPK isoenzyme analysis, catheterization and coronary bypass surgery in patients with unstable angina resulted in a mortality rate comparable to that in patients with stable angina.
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PMID:Perioperative mortality rate in patients with unstable angina selected by exclusion of myocardial infarction. 29 5

During a 6-month period in 1975, 102 patients undergoing scheduled coronary-artery bypass grafting were studied by both conventional ECG and heart-specific enzymatic methods to evaluate the incidence and estimate the extent of myocardial damage associated with an anesthetic management protocol using halothane as a primary agent with adjuvant agents. Anesthetic interventions were made to maintain heart rate and systolic pressure at resting levels or below the heart rate systolic pressure product documented during exercise-induced angina. These interventions included adjustment of halothane concentration in all patients, the use of adjuvant agents in 88.2 percent, vasodilators in 26.5 percent, and the precardiopulmonary bypass use of vasoconstrictor or cardiostimulants in 9.8 percent. There were 2 early postoperative deaths. ECG evidence of infarction was observed in 4 surviving patients. Sustained release of heart-specific CPK-MB isoenzyme occurred in 78 percent of surviving patients. Isoenzyme activity was detected in only 1 patients prior to cardiopulmonary bypass (CPB), in 1 patient during CPB, and in all others after termination of CPB. The extent of myocardial damage as estimated by integrating CPK-MB values over time was directly related to number of vessels grafted and to aortic cross-clamp and CPB times. The ECG and enzymatic data both document a low level of myocardial damage associated with this anesthetic management protocol.
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PMID:Evaluation of myocardial damage in patients undergoing coronary-artery bypass procedures with halothane-N2O anesthesia and ajuvants. 30 24

The reliability of serum myoglobin as a marker for acute myocardial infarction was evaluated in 157 consecutive coronary-care admissions. Admission myoglobin was elevated in 47 of 52 patients with acute infarction. Excluding those patients who presented later than 24 hr after symptom onset, only one patient with acute infarct had a normal admission myoglobin. In 22 of 105 patients with no infarct, myoglobin was elevated in association with angina, congestive heart failure, arrhythmias, and renal insufficiency. The detection of acute infarction by serum myoglobin measurement equals that of serial serum creatine phosphokinase isoenzymes (CPK-MB) by electrophoresis, but an elevated myoglobin is not specific for what is now considered clinically significant myocardial infarction.
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PMID:Assessment of serum myoglobin as a marker for acute myocardial infarction. 43 Jan 83

With the objective of evaluating the clinical usefulness of a new immunologic method (Merck-1-Test CK-MB), in the determination of the CK-MB activity, 48 patients admitted to the Coronary Unit for angina pectoris were studied. Samples of blood were gathered upon admission and every 4 hours for 48-72 hours, determining in each one of them the total CPK, SGOT, LDH, and CK-MB; electrocardiograms (ECG) were taken and all possible causes for the increase in the enzymatic activity were recorded. Results were analyzed in order to study the following aspects: in the patients in which an acute myocardial infarction was diagnosed the CK-MB activity was studied, also the relation of CK-MB to the remaining parameters, each parameter's sensitivity and specificity and the relationship of the CK-MB to the prognosis of the patients. The usefulness of CF-MB in the differential diagnosis of myocardial necrosis and variations in the total CKP curve in the clinical course of acute myocardial infarction unrelated to myocardial necrosis were evaluated too. The following conclusions were drawn from the analysis of the data. The immunological method has the advantages of its sensitivity and easily and quickly performance (15 minutes), but it has the disadvantage that it detects CK-BB (elevated in cebrovascular disorders). Twenty-four hours after the onset of symptoms, the negativity of CK-MB does not exclude the diagnosis of a myocardial necrosis. CK-MB is more sensitive than total CPK in diagnosing the extent of the area of necrosis. CK-MB is very specific for myocardial necrosis but less sensitive than other parameters. A positive CK-MB upon the patient's admission confirmed the diagnosis of necrosis in 60 percent of the cases, but in 18 percent error was induced because of false positives. CK-MB permitted confirmations of the diagnosis of myocardial infarction in 33 percent of cases in which there was only a suggestion of necrosis by the ECG. The variation in the curve of total CPK in the course of an acute myocardial infarction is subjected to such a great number of factors intercurrent with time, that caution should be exercised in trying to relate a specific elevation of total CPK to an unsuccessful maneuver or to a possible extension of the area of necrosis.
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PMID:[Usefulness of creatine phosphokinase isoenzyme, CK-MB, in the diagnosis of myocardial necrosis (author's transl)]. 52 61

1). The MB electrophoretic fraction of the serum CPK is specific in the diagnosis old acute myocardial infarction. 2). It allows us to differentiate ischaemia from myocardial necrosis. 3). The absence of this fraction, when found out during a period of 12 to 24 hours after the start of the angina attack allows us to deny the presence of acute myocardial infarction with a high index of precision. 4). Our results show that the serum sample should be obtained between 12 and 24 hours after starting the clinical case, in order to get a higher sensibility and specificity. 5). The quantification of MB fraction might be useful in the calculation of the amount of cardial muscle destroyed. When calculating the amount of cardial muscle destroyed of 125 cases (12.5%) with positive diagnosis of reinfarction and among the same 125, 12 were found occurring for the third time. Is possible that the real frequency of the iterative infarction is even higher, because many cases were dismissed (27.7%) for lack of electrocardiographic data, clearly pointing to myocardial transmural infarction. 6). Investigations were conduced about the evolutative condition of the danger factors.
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PMID:[Creatine phosphokinase (CPK) and isoenzymes. Correlation with myocardial damage]. 69 59

In the light of 4 personal observations of PPPRINZMETAL's angina, a review has been conducted of the literature in the 15 years since the condition was first described. Although the formal diagnostic criteria for this form of angina simultaneously clinical, biological and electrical - anginal attacks occurring at rest, often at night, during which elevation of the ST segment is recorded which disappears at the end of the attack without any significant rise in enzyme levels (SGOT and CPK) - the frontiers of the syndrome appear to have widened since PRINZMETAL's description: - Severe proximal stenosis of the coronary arteries is not obligatory; they may be only slightly damaged or even healthy. - Prinzmetal's angina is by no means always "spontaneous" but is often induced, either by psychic factors, which explain the fixed time of the attacks, or by organic factors, e.g. cold drinks (Observation No.2). In this event it would appear safer to speak of angina or rest as opposed to angina of effort. - In contrast to what PRINZMETAL thought, effort tests may sometimes induce angina-type pain with elevation of the ST segment, and here the borderline between this syndrome and conventional angina with ST segment elevation after effort test (5% of cases) is less clear-cut. The two nosologic entities probably reflect the same physiopathological situation, i.e. acute myocardial ischemia, and may represent the same affection in different phases of development. The prognosis is equally bad. - Attacks of rinzmetal's angina are often accompanied by severe and sometimes fatal disorders of rhythm, and this influences the therapeutic approach. - The coronary spasm posited by PRINZMETAL and others before the advent of coronarography is indeed, in the majority of cases, the immediate cause of myocardial ischemia and anginal pain, without any preliminary increase in the energy requirements of the heart as in the conventional anginal attack. - A vasoactive substance present in the circulating blood at the beginning of the affection, which may be degraded and subsequently disappear and may be secreted by the pathologic coronary artery, was demonstrated in observation No. 4: this may, in conjunction with vagal hypertonia, be the causative factor in coronary spasm. Study of its pharmacodynamic properties is now in progress.
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PMID:[Prinzmetal's angor. Apropos of 4 cases. Review of the literature]. 108 Aug 80

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.
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PMID:Management of preinfarction angina. Evaluation and comparison of medical versus surgical therapy in 43 patients. 124 46

The aim of this prospective study was to assess the prognostic and most suitable management of AMI in elderly patients (age > or = 75 years). From September 1988 to August 1991, 129 such patients (pts) were evaluated: 35 (27%) were admitted to CCU because of arrhythmias or severe hemodynamic complications; 94 (73%) were addressed, according to bed availability, to CCU (55 pts) or Cardiology Ward (39 pts), where all patients underwent continuous ECG monitoring for at least 72 hours. Age, gender, history of previous angina or myocardial infarction, presence of chest pain or ECG ischemia on admission, site and extent of AMI, delay on admission, CPK-MB peak, recurrent angina, arrhythmias, heart failure, emotional disorders, hospital mortality and length of hospital stay were compared. Our results show that elderly patients who suffered from complicated AMI were at high risk for death and severe in-hospital complications. No significant prognostic differences were observed between the two groups with uncomplicated AMI. Thus hospitalization in the Cardiology Ward seems to be valuable, safe and well tolerated in our population of elderly patients with AMI, and without initial complications.
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PMID:[Management and prognosis of acute myocardial infarct in advanced age: comparison of the cardiac intensive care unit and the cardiology ward]. 129 24

The correlation between persistent negative T wave on basal electrocardiogram and coronary anatomy or global and regional left ventricular function was investigated in 34 patients with unstable angina defined as new onset (< 2 months), crescendo or rest angina. The patients with history of previous myocardial infarction, pathological Q waves on electrocardiogram or documented elevation of CPK were excluded. Eighteen patients (group A) showed T wave inversion (> 1 mV) in at least two leads on the basal electrocardiogram, persisting for at least 48 hours before coronary arteriography. In 16 patients (group B) the basal electrocardiogram was normal. Left ventricular volumes and ejection fraction were calculated and the regional systolic wall motion was analyzed using the area method in the 30 degrees right anterior oblique view. Hypokinesis was defined as more than 2 standard deviation below the mean value calculated in 24 normal subjects. No difference was present for age (A: 61 +/- 9 vs B: 57 +/- 9 yrs) and sex distribution. Critical stenoses of at least one coronary artery was documented in all but one patient (in group B). The number of critical stenosis per patient was equal (1.8) in the two groups. Left main coronary artery showed narrowing > 50% in three patients of group A and in two patients of group B.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Persistent T-wave inversion in unstable angina: the correlation with the global and regional function of the left ventricle]. 142 10

In 386 patients with acute inferior myocardial infarction (AIMI) who were admitted to our institution from 1984 to 1990, temporary pacemaker (TP) was required in 34 patients (9%) due to disturbances in the genesis and/or conduction of the electric stimulus (Group I). The remainder, 352 AIMI, conform the Group II. Each group was divided into groups depending on the presence (Groups Ia and IIa) or absence (Groups Ib and IIb) of right ventricular necrosis (ECG criteria: ST elevation greater than 0.1 mV in a V3r and V4R). Clinical data (cardiovascular risk factors, history of myocardial infarction or angina, CPK and CK-MB peak, Killip class, atrioventricular block and right ventricular infarction) and hospital mortality rate and its cause were analyzed. The Group I patients related to Group II had significantly higher diabetes rate (p less than 0.01), CPK and CK-MB peak (p less than 0.001), Killip class (p less than 0.001), right ventricular involvement and atrioventricular block (p less than 0.001), the mortality rate equally was statistically higher (Group I, 11 patients, 31%, versus group II, 38 patients, 11%) (p less than 0.001). The Group Ia patients related to Group Ib had a higher CPK and CK-MB peak (p less than 0.001), Killip class and atrioventricular block (p less than 0.001). The mortality rate was statistically equal. The group IIb patients related to Group IIb patients had a higher CPK and CK-MB peak (p less than 0.001), without differences in the mortality rates.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Temporal electric stimulation and right ventricular extension in acute postero-inferior myocardial infarction. Influence on clinical characteristics and prognosis]. 180 97


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