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)

A within patient double blind prospective study of symptoms and exercise tolerance was designed to determine the preferred pacing mode in 10 patients with programmable dual chamber pacemakers who also had angina pectoris. Patients were randomly allocated to one month in each of the following modes: ventricular pacing at 70 beats/min (VVI) or atrioventricular synchronous upper rate 150 beats/min (DDD 150) or 100 beats/min (DDD 100). Medications were unchanged throughout the study; none was taking beta blockers. At the end of each month patients underwent an exercise test. During each month patients recorded symptoms and their preferred pacing mode. DDD 100 was the preferred mode (seven patients). There was significantly less chest pain with this mode than with either of the other modes. There were significantly more episodes of dizziness in VVI, and two patients who developed pacemaker syndrome were unable to complete the pacing period. Three patients developed angina during exercise testing in DDD 150. Atrial synchronous ventricular pacing is better than ventricular pacing for the control of symptoms in patients with angina pectoris provided that the upper atrial tracking rate is limited.
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PMID:Optimum pacing mode for patients with angina pectoris. 379 Mar 82

Hypertrophic obstructive cardiomyopathy (HOCM) is an autosomal, dominant inherited disease of the myocardium which leads slowly to increasing subvalvular, septal and left ventricular hypertrophy and deterioration of systolic and diastolic left ventricular compliance. Difficult molecular-genetic investigations localized genetic defects on different chromosomes. The disease is pathological-anatomically characterized by asymmetric subvalvular (aortic) septal hypertrophy and left ventricular outflow tract obstruction resulting in additional left ventricular hypertrophy and dysfunction. Histologically the myocytes are hypertrophied, exhibit atypical branching (disarray), and there is a high amount of interstitial connective tissue. In our biopsy material (from myectomies) dysplasia could be detected in more than 30% of dysplastic intramural arteries with partly extential media. These changes may indicate microcirculatory disturbances resulting in arrhythmias, syncopes, sudden death, and anginal pain on the basis of microcirculatory disturbances and scar development. Today the discussion of DDD-pacemaker therapy has resumed, but one must wait for definite results, especially in patients in whom surgical treatment seems to be the best choice. The indication for surgical treatment, which usually is transaortic subvalvular myectomy (Morrow) and modifications, is very restrictive. Only patients in clinical degree III (NYHA) after long-term medical treatment are candidates for surgery. In some mainly younger patients the indication in lower clinical degrees was accepted because of a family history with sudden death and personal experience of syncope, life-threatening tachycardia, or after resuscitation. In the period 1963 to 1994 466 patients were operated upon. The mean age was 44.9 years (range 3 months to 82 years). Total early mortality was 4.9% (n = 12).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Hypertrophic obstructive cardiomyopathy: surgical treatment]. 748 52

Spinal cord stimulators are used to relieve pain associated with peripheral ischemia and angina pectoris. In patients with both permanent pacemaker (PPM) and a spinal cord stimulator (SCS), electromagnetic signals from the SCS may inhibit the PPM. A bipolar PPM configuration is preferred to minimize myopotential or electromagnetic interference but patients have safely had unipolar devices implanted. We report ten patients (six males and four females; median age 73.3 years) with both a SCS and a PPM implanted between 1987-1991. Intermittent interference with one PPM (Ela Medical Model Opus 3001) was noted after an increase in the output voltage of the SCS for continued clinical efficacy. Inhibition was output voltage dependent, and reversion to the noise mode was frequency dependent. Sensitivity to both could be managed by changing the pacemaker sensitivity. Interference with pacemaker function occurred if the SCS output was set above a voltage and pulse duration which resulted in a product of these values above 1.9-2 mVs. Seven VVI, one VDD, and two DDD PPM had been implanted. In five patients both PPM and SCS were unipolar. In two patients the SCS was bipolar and the PPM unipolar, in two patients a bipolar PPM was associated with a bipolar SCS and with one patient, a unipolar SCS. Multiprogrammable and/or bipolar PPMs should be implanted in a patient with a SCS to allow reprogramming of the PPM and to minimize the risk of inter-device interference. Inhibition of the PPM may occur at different SCS stimulation frequencies. The frequency at which inhibition occurs varies with different models of implanted pacemaker.
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PMID:Technical and clinical problems in patients with simultaneous implantation of a cardiac pacemaker and spinal cord stimulator. 769 Sep 31

There has recently been an increasing interest in beneficial effects of cardiac pacing in patients with myocardial diseases, especially in Obstructive Hypertrophic and Dilated Cardiomyopathy. The experience with dual-chamber pacing for obstructive hypertrophic cardiomyopathy is now important. DDD pacing for sinus rhythm patients and VVI pacing in patients with atrial fibrillation have shown considerable symptomatic improvement, with a significant decrease of angina, dyspnea, presyncope and frank syncope. It has been suggested that DDD pacing may prevent sudden death and improve survival rates in these patients, but this has not yet been established. The experience with DDD pacing in dilated cardiomyopathy is more limited, but in specially chosen patients, DDD pacing with short AV delay has shown symptomatic improvement and a decrease in the need for further hospitalization due to worsening of heart failure. There is no current evidence of higher survival rates with this treatment, but DDD pacing may be used in patients with end-stage dilated and isquemic cardiomyopathy who are waiting for a heart transplantation.
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PMID:[Impact of electric cardiac stimulation on ventricular function and the natural history of patients with myocardiopathy]. 875 4

Ventriculo-venous communications (VVC) were angiographically demonstrated in two adult female patients clinically presented with effort angina. During oxymetric studies there were minor to moderate left-to-right shunts. Concomitant, mild valvular aortic stenosis (AS) was present in one patient and hypertrophic obstructive cardiomyopathy (HOCM) in the other. It is believed that ventriculo-venous communications have contributed to the symptomatology in both patients. Symptoms were controlled medically in combination with dual (DDD) cardiac pacing with short AV-delay in one patient and only medically in the other patient. From the differential diagnostic point of view, superselective contrast injection into an 'inert' myocardial sinusoid or intramural contrast staining has been considered but could be excluded.
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PMID:Ventriculo-venous communications in adults: ventriculographic observations in two female patients. 943 68

Spinal cord stimulation (SCS) is currently used to treat peripheral vascular disease (PVD) and refractory angina pectoris not amenable to revascularization. In a case of contemporaneous SCS implant and permanent cardiac pacemaker (PPM), if multipolar electrodes are used it is possible to avoid any interference between the systems. We describe the case of a patient with a DDD pacemaker, in whom two bipolar SCSs were implanted at different times: one to control refractory angina pectoris and the other for PVD. No interference between the three systems has been observed.
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PMID:Efficacy and safety of permanent cardiac DDD pacing with contemporaneous double spinal cord stimulation. 950 51

The association of severe hypertrophic obstructive cardiomyopathy and coronary artery disease increases surgical morbimortality, even more in patients over 65 years. We describe a combined therapeutic approach to these diseases. A 68-year-old woman with a diagnosis of hypertrophic obstructive cardiomyopathy was in functional class IV for angina and dyspnea despite 360 mg of propranolol a day. An echocardiogram and a complete cardiac catheterization were performed under betablocker therapy, confirming a severe hypertrophic obstructive cardiomyopathy and revealing severe stenosis in the proximal left circumflex and the proximal right coronary arteries, and a moderate lesion in the mid-left anterior descendent. They were both treated with balloon PTCA, and a 3 x 15 mm stent was placed in the circumflex and a 3.5 x 20 mm stent in the right coronary, with an excellent angiographic result. A basal hemodynamic study was then performed and A-V sequential pacing was attempted, achieving a significant decrease in the left ventricle outflow tract gradient. A DDD-R pacemaker was implanted. Echocardiographic study was performed post-implantation, and follow-up was made six months later with a new coronary angiography, hemodynamic study and a Doppler echocardiogram. At the present time A-V sequential pacing as a therapeutic option for hypertrophic obstructive cardiomyopathy and coronary angioplasty and stenting for the treatment of coronary artery disease are sufficiently established and supported to be offered as a combined therapy to patients suffering from both diseases, specially those with a higher surgical risk.
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PMID:[The therapeutic focus in severe hypertrophic obstructive cardiomyopathy with multivessel coronary disease]. 1036 86

A 70-year-old woman with severely symptomatic hypertrophic obstructive cardiomyopathy was unresponsive to drug treatment. She had recurrent ventricular tachyarrhythmias and syncope and was at high risk for sudden death; a dual chamber pacemaker defibrillator (DDD-ICD) was implanted. Her initial left ventricular outflow tract gradient was 80 mm Hg and fell to 40 mm Hg during dual-chamber pacing at an atrial ventricular delay of 140 ms. In the follow-up over six months she was asymptomatic with respect to angina pectoris; ventricular tachycardias could be successfully terminated by antitachycardia pacing or by shocks. A dual chamber pacemaker defibrillator is an important therapeutic option for patients with symptomatic hypertrophic obstructive cardiomyopathy and ventricular tachyarrhythmias.
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PMID:[Implantation of a dual chamber pacemaker-defibrillator (DDD-ICD) in a patient with hypertrophic obstructive cardiomyopathy]. 1046 52

Clinical management of patients with symptoms caused by pharmacological refractory hypertrophic obstructive cardiomyopathy must consider surgical myectomy, percutaneous transluminal septal myocardial ablation and implantation of a DDD pacemaker. Until now, no prospective, double blind, randomized studies have yet been carried out to determine the merits of each of these treatment alternatives. However, uncontrolled studies have shown that short atrioventricular delay dual-chamber pacing reduces outflow tract obstruction. Aim of the study was to investigate the results of the pacemaker therapy in a prospective, double blind randomized crossover procedure. All patients with hypertrophic obstructive cardiomyopathy included in this multicenter study were either refractory or intolerant to drugs and typically had pressure gradients higher than 30 mm Hg. In 83 patients, mean age 53 (18 to 82) years who responded favorably to a temporary pacing test, a DDD pacemaker was implanted. After echo- and echo-Doppler-based measurements of hemodynamic parameters the patients were randomized into 2 groups, those with an implanted pacemaker in the inactivated mode (AAI) and those with a pacemaker in the activated mode (DDD with optimized short AV delay). A crossover of these groups was performed after 12 and 24 weeks, respectively. Both objective parameters of echo including Doppler, and spiroergometry, and subjective parameters of angina, dyspnea, and quality of life were recorded. Additionally, subgroups based on age decades were analyzed. After 12 weeks in the DDD mode, regardless of the randomization sequence, a decrease of the pressure gradient from 59 +/- 36 mm Hg (median) to 30 +/- 25 mm Hg was proven significant (p < 0.001). The endurance of the patients who, during screening, achieved less than 10 minutes of exercise by the Bruce protocol improved by 21% under DDD mode. The main symptoms, as measured by the NYHA classification, improved statistically significant from a mean of 2.4 to 1.7 for functional class, from a mean of 2.4 to 1.4 for dyspnea and from a mean of 1.0 to 0.4 for angina. Subgroup analysis showed improvements depended significantly upon age, with a marked improvement between the ages of 60 and 70, which was statistically significant as compared to other decades. Subjective improvements in the quality-of-life of patients was measured using a specially developed questionnaire. These findings justify, by all means, the intention to implant a DDD pacemaker in older patients. In younger and/or such patients with elevated pressure gradients, the results of ongoing randomized studies comparing myectomy, PTSMA and pacing have to be considered.
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PMID:[Pacemaker therapy of hypertrophic obstructive cardiomyopathy. PIC (Pacing in Cardiomyopathy) Study Group]. 1094 82

Prinzmetal's angina is a distinct syndrome characterized by episodes of chest pain and transient ST-segment elevation caused by coronary vasospasm. This variant form of angina is sometimes associated with complete atrioventricular block and ventricular arrhythmias. We report here a case of variant angina with documented severe heart rhythm disturbances and syncope in a 66 year-old woman. Due to recurrent episodes of high-degree atrioventricular block, a DDD pacemaker was implanted. No further symptoms of angina or cardiac arrhythmias were detected on optimal therapy.
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PMID:Prinzmetal's variant angina associated with severe heart rhythm disturbances and syncope: a therapeutic dilemma. 1943 4


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