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Query: UMLS:C0002962 (angina)
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A study is presented of the blood plasma level of opioid peptides in patients with progressive stenocardia. Results indicate non-homogeneity of the patients concerning the content of neuropeptides. Two subgroups were singled out: 1. patients with progressive stenocardia of exertion in which beta-endorphin and leucin-enkephalin were above normal; 2. patients with a severe course of ischemic heart disease. Here the content of same peptides was lower than in the compared group. Similar dependence of changes of the content of methionine-enkephalin was not revealed.
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PMID:[Enkephalins and endorphins in unstable stenocardia]. 233 Jul 14

Data from the preceding low-level exercise test studies have been compiled and are presented in Table II. The table is arranged according to groups of prognostic indicators for future coronary events or indicators for those patients with multivessel coronary artery disease. In summary, current studies demonstrate safety and predictive value in predischarge low-level exercise testing in patients after myocardial infarction. If the test reveals a positive S-T segment change or angina or both, the predictive value for future cardiac events is significant. In addition, a limited duration on the exercise test, a flat or falling blood pressure response, and the presence or absence of premature ventricular depolarizations add to this predictive value. A more sophisticated technique that employs radionuclide ventriculography may add to the sensitivity and specificity of these various tests but should be used selectively. Post-myocardial infarction patients who perform low-level exercise testing prior to discharge and demonstrate no exercise-induced abnormality from baseline may also harbor multivessel coronary disease, and this group of patients needs to be carefully followed. Testing at 3 weeks and 6 weeks after infarction may be beneficial in revealing additional clinical data. Less data are currently available on predischarge low-level exercise testing in patients with myocardial revascularization. However, these limited data support both feasibility and safety of low-level exercise testing in myocardial revascularization patients before discharge. Prognostic data with regard to low-level exercise testing for this group of patients should be forthcoming. Data from low-level exercise testing need to be incorporated during the in-hospital phase to eliminate unnecessary testing as the patient proceeds home and/or to medically supervised exercise programs. Proper therapeutic modalities based on these data should be included. In accord with this, it is imperative that the cardiac rehabilitation team or exercise testing laboratory correspond directly with the private physician regarding all clinical data and recommendations for discharge activity. Follow-up exercise testing for patients after myocardial infarction and coronary bypass surgery utilizes end points similar to those of predischarge low-level testing and therefore will not be discussed in detail. In general the patient should be able to achieve a higher heart rate or MET level in follow-up testing.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Exercise testing for patients after myocardial infarction and coronary bypass surgery: emphasis on predischarge phase. 660 42

Modest elevations of circulating homocysteine are common in patients with vascular disease. We explored interrelations between total plasma homocysteine levels and mutations in genes for three key enzymes in methionine-homocysteine metabolism. Methyltetrahydrofolate reductase (MTHFR) 677C-->T, cystathionine beta synthase (CBS) 68-bp insertion at exon 8, and methionine synthase (MS) 2756A-->G were typed in 685 Australian caucasian patients aged < or =65 years with and without angiographically documented coronary artery disease (CAD). We also assessed associations between homocysteine levels and extracellular superoxide dismutase (EC-SOD) and other CAD risk factors. There were significant correlations between plasma total homocysteine, and EC-SOD (r = 0.170, p = 0.001 for men; r = 0.241, p = 0.003 for women) and LDL (r = 0.153, p = 0.001 for men; r = 0.132, p = 0.081 for women). Levels were also significantly higher among patients with unstable angina (15.30+/-0.44 micromol/l for men, 14.44+/-0.74 micromol/l for women) than those without angina (13.98+/-0.38 micromol/l for men, 13.41+/-0.98 micromol/l for women) or with stable angina (14.00+/-0.37 micromol/l for men, 12.88+/-0.71 micromol/l for women). There were no significant associations between the levels and the presence or severity of CAD. The mutant MTHFR homozygotes tended to have higher levels and those with the MS and CBS mutations tended to have lower levels. We conclude that there is a significant correlation between plasma homocysteine levels and EC-SOD suggesting that elevated homocysteine may exert oxidative stress and that levels are associated with unstable angina, but not the occurrence or extent of coronary stenosis. The contributions to total plasma homocysteine levels of the common mutations of genes coding for the enzymes controlling homocysteine metabolism are modest.
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PMID:Relationship between total plasma homocysteine, polymorphisms of homocysteine metabolism related enzymes, risk factors and coronary artery disease in the Australian hospital-based population. 1048 96

Cardiac insufficiency represents a major risk factor in patients about to undergo non-cardiac surgery. The post-operative mortality is linked to the severity of the pre-operative functional impairment: rising from 4% in NYHA class 1 to 67% in class IV. The operative risk is greater when the cardiac insufficiency is more disabling, the patient is older (> 70 years) and if there is a history of acute pulmonary oedema and a gallop bruit on auscultation. The use of metabolic equivalents (Duke Activity Status Index) is recommended: the functional capacity is defined as excellent if > 7 MET, moderate between 4 and 7, or poor if < 4. A non-invasive evaluation of left ventricular function is necessary in each patient with obvious congestive cardiac insufficiency or poor control under the American consensus, but it is rare that the patient has not already been seen by a cardiologist. The degree of per-operative haemodynamic constraint is linked to the surgical technique and is stratified according to the type of surgical intervention and whether or not it is performed as an emergency. An intervention duration > 5 hours is associated with an increased peri-operative risk of congestive cardiac insufficiency and non-cardiac death. Deaths from a cardiac cause are thus twice as frequent after intra-abdominal, non-cardiac thoracic or aortic surgery and the post-operative cardiac complications are six times more frequent. Numerous studies have attempted to document the impact of different anaesthetic techniques on the prognosis for the population at increased risk of post-operative cardiovascular complications. It is advisable to opt for peripheral nerve blocks. The cardiovascular morbidity and overall mortality do not differ between general anaesthetic, epidural anaesthetic or spinal nerve block. The ASA (American Society of Anesthesiologists) classification is widely used to determine the overall risk. The ASA class and the age are however too coarse as methods of evaluation for the individual risk and for giving judicious pre-operative advice. Multifactorial cardiac risk indexes such as that of Goldman allow overall evaluation (taking the patient and the intervention into account) of the peri-operative cardiovascular risk in non-cardiac surgery as a function of predictive clinical elements. Nine variables concerning the patient's history, the physical examination and several simple supplementary examinations are identified for which the relative weight is recorded under a points system. The average risk score for a given procedure is converted into an average risk for a given patient using a nomogram such as Detsky's. Surgical acts which do not impose major constraints on the cardiocirculatory apparatus (ophthalmic surgery for example) do not require supplementary examinations. The risk of post-operative cardiac complications is low in the absence of the 9 risk factors defined by Goldman, as is an ischaemic syndrome (angina on light physical activity, unstable angina, myocardial infarction). Certain risk factors (jugular congestion, gallop bruit, recent myocardial infarction, non-sinus rhythm, extrasystoles, aortic stenosis) obviously require appropriate treatment beforehand. The sometimes difficult process demands a dialogue between the cardiologist and the surgeon, the recognition of the risk of surgery in a given centre, and the opinion of the patient duly informed of the terms of the discussion about him.
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PMID:[Evaluation of the cardiac risks in non-cardiac surgery in patients with heart failure]. 1193 51

Data on the functional status of the cardiorespiratory system are required to identify patients at risk for postoperative complication in the presence of lung diseases. Very many factors influence the course of an operation and the postoperative period so there is no golden standard or the only parameter for predicting how the postoperative period runs. Patients with normal spirographic values (FEV1, more than 80%??) and without cardiovascular comorbidity are at a slight risk for postoperative complications. These patients do not need to be additionally examined. A less than one-month history of myocardial infarction, instable angina pectoris, decompensated heart failure, severe valvular disease are contraindications to planned surgery. The risk of cardiovascular events is high when the signs of myocardial ischemia occur with low exercise (less than 4 MET). Stress echocardiography, loading tests, and radioisotopic study are used as auxiliary techniques, FEV1, under 60%; ppo-FEV1, and ppo-DC, under 40%; VO2max, under 15 ml/kg/min are the values of a high risk for respiratory complications.
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PMID:[Functional studies in the prediction of postoperative complications in the presence of lung diseases]. 1452 92

The Duke Treadmill Score (DTS) has been shown to predict mortality in women who have symptomatic heart disease, but its ability to do so in asymptomatic women is unknown, as is its comparative advantage to exercise capacity. We investigated whether a decreased DTS is associated with increased mortality in a prospective cohort of 5,636 asymptomatic women. A symptom-limited exercise treadmill test using Bruce's protocol was performed at baseline. DTS was calculated using exercise time, exercise-induced angina, and ST-segment depression. Exercise capacity was measured in METs. Deaths and cause of death were identified from 1992 to 2000. After adjusting for the Framingham Risk Score, the risk of death decreased by 9% for each unit increase in DTS and by 17% for every 1-MET increase (p <0.001). Those who had a DTS <5 (moderate or high risk) had hazard ratios for death and cardiac death that were 2.2 and 2.5 times greater, respectively, than did those who had a DTS > or =5 (low risk), after adjusting for Framingham Risk Score (p <0.001). Receiver-operating characteristic curves for the DTS model and the exercise capacity model were not significantly different. In conclusion, we have demonstrated that, although the DTS is an independent predictor of mortality and cardiac mortality in asymptomatic women, it does not appear to be a better predictor than exercise capacity alone. The role of ST-segment changes and symptoms with stress testing in asymptomatic women does not provide additional prognostic information.
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PMID:Prognostic value of the duke treadmill score in asymptomatic women. 1605 60

The subjects of the study were 30 patients with coronary heart disease (19--with stable, and 11--with instable angina), and 15 practically healthy individuals. The study included measurement of the levels of homocysteine (HC), total cholesterol, cholesterol of low-density lipoproteins, cholesterol of high-density lipoproteins, and lipidperoxidation (LP) products (TBA-reactive products), as well as coagulo-fibrinolytic parameters. The study revealed that patients with instable angina had significantly higher levels of HC and TBA-reactive products compared to those with stable angina and healthy controls. HC level correlated with LP processes in CHD patients (r = 0.55). Methionine loading allowed revealing latent hyperhomocysteinemia.
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PMID:[Study of serum levels of homocystein, lipids and their peroxidation products in patients with coronary heart disease]. 1640 36

Coronary artery disease either presents with acute chest pain or with exercise induced chest symptoms or shortness of breath. The differentiation between stable and unstable Angina pectoris is prognostically important, unstable angina is managed as an acute coronary syndrome including hospital admission, patients with stable symptoms can be further evaluated in an outpatient setting. A broad differential diagnosis of other cardiac and non-cardiac causes must be considered. Important initial diagnostic steps are cardiovascular risk stratification and prove of ischemia (or scar, necrosis) either at rest or usually exercise-induced, if necessary by additional imaging. Exercise capacity is assessed by physiological parameters (watt, VO2max., MET and distance) during exercise tests like ergometry, spiroergometry or 6-minute walking test (e.g. heart failure patients). Additional factors must be considered for the assessment of working capacity.
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PMID:[Outpatient diagnosis of coronary artery disease]. 1935 34

L-Carnitine is an endogenous molecule involved in fatty acid metabolism, biosynthesized within the human body using amino acids: L-lysine and L-methionine, as substrates. L-Carnitine can also be found in many foods, but red meats, such as beef and lamb, are the best choices for adding carnitine into the diet. Good carnitine sources also include fish, poultry and milk. Essentially, L-carnitine transports the chains of fatty acids into the mitochondrial matrix, thus allowing the cells to break down fat and get energy from the stored fat reserves. Recent studies have started to shed light on the beneficial effects of L-carnitine when used in various clinical therapies. Because L-carnitine and its esters help reduce oxidative stress, they have been proposed as a treatment for many conditions, i.e. heart failure, angina and weight loss. For other conditions, such as fatigue or improving exercise performance, L-carnitine appears safe but does not seem to have a significant effect. The presented review of the literature suggests that continued studies are required before L-carnitine administration could be recommended as a routine procedure in the noted disorders. Further research is warranted in order to evaluate the biochemical, pharmacological, and physiological determinants of the response to carnitine supplementation, as well as to determine the potential benefits of carnitine supplements in selected categories of individuals who do not have fatty acid oxidation defects.
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PMID:L-carnitine--metabolic functions and meaning in humans life. 2156 31

An automated method based on a hyphenated SPE-LC-MS/MS configuration has been optimized for the determination of essential amino acids (threonine, valine, methionine, leucine, isoleucine, lysine, tryptophan, and phenylalanine) in human serum, with the aim of discriminating between different states of coronary artery disease. Validation in terms of sensitivity (detection limits below 28.0 ng on column) and precision (repeatability expressed as relative standard deviation below 6.0%) supports the suitability of the method for application to a cohort of 122 atherosclerosis patients confirmed by a catheterization test. The cohort was composed by 80 individuals diagnosed with stable angina and 42 patients who suffered from acute myocardial infarction (AMI). Both groups of individuals are differentiated by the occurrence of ischemia in AMI patients due to the formation of thrombi. The chemometric treatment of the data obtained by multivariate analysis of variance (MANOVA) allowed comparison between both groups of diagnosed patients. Therefore, amino acids whose serum levels were affected by ischemia have been identified. The contribution of risk factors such as obesity and hypercholesterolemia as well as the individuals' gender to the concentration of essential amino acids has also been studied.
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PMID:Determination of essential amino acids in human serum by a targeting method based on automated SPE-LC-MS/MS: discrimination between artherosclerotic patients. 2281 6


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