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)

Aim of this study was to analyze the cardiovascular response to graded physical exercise in patients who have undergone cardiac transplantation and to assess the ability of exercise stress testing in early detection of coronary artery disease. We studied 114 transplanted subjects (100 men and 14 women, mean age 46.6 +/- 11.3 years), who performed exercise stress testing 6 months after bypass and then every 6 (+/- 1) months during a 5-year follow-up. Variations of hearth rate (HR), systolic blood pressure (SBP), heart rate-pressure product (RPP) values and exercise stress tolerance were studied both in basal and maximum workload conditions. Mean HR values at basal conditions (103.9 +/- 11.3 b/min at 6 months and 89 +/- 12.7 b/min at 60 months, p < 0.05) and maximum workload tolerance (67.7 +/- 20.4 W at 6 months and 100 +/- 17 W at 60 months, p < 0.05) were significantly different at the beginning and at the end of follow-up. SBP values both at basal conditions and at peak exercise had always been constant. Exercise was stopped for leg muscle fatigue in 92% and dyspnea in 7% of the subjects; isolated T-wave and ST segment changes were found in 29.8% and in 10.5% of the patients respectively, whereas 11.4% exhibited both ST-T variations. Angiographic examination (performed in 80/114 patients) showed significant coronary disease (stenosis > 50%) in 8, coronary atherosclerosis (CAD) of minor degree in 4 and provoked spasm in 2 subjects. In this subgroup exercise stress testing induced ischemic ECG changes (ST segment depression > or = 1 mm) without angina in 1 patient, ST-T segment variations only in 5 and no electrocardiographic alterations (negative tests) in 2 patients. Four subjects with CAD and 1 with coronary spasm induced by angiography showed isolated ST segment and T-wave changes. Our work demonstrated that exercise stress testing plays a relevant role in the study of the denervated heart response to dynamic exercise. The rise in workload tolerated, observed in our population, seems to be related to time elapsed from surgery, improvement in clinical conditions, psychological stability and patient's confidence in his own abilities. The tolerance to exercise 6 months after graft seems to predict the quality of performance in the following tests. Our angiographic results reveal a low sensitivity of the exercise stress test in detecting CAD in this population according to traditional electrocardiographic criteria for myocardial ischemia.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[The ergometric test after a heart transplant: its usefulness and limits]. 808 12

Over a seven year period, 8.6% of 990 patients subjected to coronary arteriography because of angina pectoris were found to have normal coronary arteries (NCA). The subsequent histories of these patients were compared to those of a group of patients (N = 112) with coronary atherosclerosis (CAD). On average 44 months after coronary arteriography, 2.4% (NCA) had died versus 20.5% (CAD) (p < 0.001). Myocardial infarction had occurred in 0% (NCA) versus 12.8% (CAD) of the survivors (p < 0.001). Chest pain was unchanged or had worsened in 58.2% (NCA) versus 21.1% (CAD) (p < 0.001). Of the NCA patients, 33.3% had ischaemia during exercise-ECG. Three patients developed ischaemia during hyperventilation test. Eighty % (NCA) versus 63.9% (CAD) gave up work due to chest pain (p < 0.05). Further, 55.7% (NCA) versus 34.6% (CAD) had reduced daily activities (p < 0.01); similarly, the frequency of divorce was higher in the NCA group (10.2%) than in the CAD group (1.3%) (p < 0.05).
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PMID:[Syndrome X. Somatic and social prognosis of patients with angina pectoris and normal coronary arteriography]. 806 3

Atherosclerosis is a systemic vascular disease that can produce pathologies in any organ. The aim of this study was to evaluate the incidence of asymptomatic peripheral atherosclerosis (PA) in patients symptomatic for angina and myocardial infarction affected by coronary atherosclerosis (CAD). 315 patients (268 male and 47 female) aged between 36 and 69 years, asymptomatic for claudicatio and cerebral ischaemic disease, underwent selective coronary angiography to detect coronary stenosis > or = 50% and Echo-Color-Doppler examination of the epiaortic trunks and upper and lower limb arteries to detect peripheral stenosis > or = 30%. In the total population the incidence of PA in patients with CAD was 23% but in patients with trivascular CAD it was 32%. These data suggest that in patients with trivascular CAD it is necessary to investigate peripheral circulation as, also in asymptomatic patients, polydistrictual atherosclerosis was frequent.
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PMID:The incidence of asymptomatic extracoronary atherosclerosis in patients with coronary atherosclerosis. 837 7

A follow-up over a 7-year period demonstrated that 8.6% of all patients subjected to coronary arteriography because of angina pectoris had normal coronary arteries (NCA). The somatic and social prognosis of these patients were evaluated and these were compared to that of an age- and sex-matched group of patients with arteriographically verified coronary atherosclerosis (CAD). On average 44 months after coronary arteriography, 2.4% with NCA had died versus 20.5% with CAD (P < 0.001). Myocardial infarction occurred in 0% (NCA) versus 12.8% (CAD) among survivors (P < 0.001). Coronary revascularization was carried out in 0% (NCA) versus 76.9% (CAD). Chest pain was unchanged or had worsened in 58.2% (NCA) versus 21.1% (CAD) (P < 0.001) and this in the NCA patients was correlated to the occurrence of minimal lesions of the coronary arteries. Of the NCA patients, 33.3% had ischaemia during exercise-ECG. Normalization was seen in 12 patients and newly developed ischaemia in seven patients. Three patients developed ischaemia during hyperventilation test. Eighty percent (NCA) versus 63.9% (CAD) gave up work due to chest pain (P < 0.001). Further, 55.7% (NCA) versus 34.6% (CAD) had reduced daily activities (P < 0.001); similarly, the frequency of divorce was higher in the NCA group (10.2%) than in the CAD group (1.3%) (P < 0.05).
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PMID:Somatic and social prognosis of patients with angina pectoris and normal coronary arteriography: a follow-up study. 840 7

Coronary angiographic profile of 75 patients (63 males and 12 females) with noninsulin dependent diabetes mellitus (NIDDM) and CAD was compared with 75 nondiabetic patients (63 males and 12 females) with CAD. No difference was present between the mean age (56.2 +/- 7.4 vs 56.1 +/- 7.7 years; p = NS), presenting complaints (67 unstable angina and 8 stable angina with positive TMT in both the groups) and other coronary risk factors between the two groups. Severity and diffuseness of coronary artery involvement was assessed by a coronary artery score (CAS) using the segmental distribution method for coronary artery lesions. Diabetic patients with CAD had a higher CAS (18.7 +/- 10.3) as compared to the nondiabetic patients with CAD (12.7 +/- 9.6) (p < 0.01). Diabetic patients with CAD had a higher number of TVD [43 (57.3%) vs 31 (41.3%); p < 0.01] while the DVD and SVD was not significantly different. As compared to the nondiabetic group, diabetics had a higher total number of coronary artery lesions (300 vs 200; p < 0.001), a higher lesion per patient ratio (4.0 lesions/patient vs 2.6 lesions/patient; p < 0.001), a higher number of concentric lesions, [151 (50.3%) vs 90 (45%); p < 0.01] and a higher number of multiple irregularity lesions, [36 (21%) vs 27 (9%); p < 0.05]. The diffuse involvement of vessels was not significantly different between the two groups in LAD (12.1% vs 5.3%; p = NS), LCx (14.2% vs 5.8%; p = NS) and RCA (10.5% vs 5.0%; p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Angiographic severity and morphological spectrum of coronary artery disease in non insulin dependent diabetes mellitus. 855 76

Ischemia is suspected to occur frequently in patients with HCM and may result from various mechanisms, for example decreased coronary flow reserve, disease of small intramuscular arteries, "inadequate' size of coronary arteries relative to hypertrophied myocardium, diminution of coronary flow during systole, compression of septal perforator arteries during systole, coronary artery spasm, and co-existent atherosclerotic CAD, which can be present in up to a quarter of HCM patients above 45 years of age. The diagnosis of CAD in patients with HCM is difficult to make on clinical grounds, secondary to the high frequency of angina in patients with HCM without CAD. Pharmacological stress echocardiography is promising but needs to be further studied; stress thallium imaging is beset with frequent false positive results. At this time, coronary angiography remains the only reliable test for the definitive diagnosis of co-existent CAD in HCM. Beta-blockers and verapamil may help in relieving symptoms and silent ischemia in patients with HCM; in those with coexistent CAD and resistant symptoms, CABG alone or in combination with left ventricular myectomy or mitral valve replacement has been recommended.
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PMID:Ischemia and atherosclerotic coronary artery disease in patients with hypertrophic cardiomyopathy: a review of incidence, pathophysiological mechanisms, clinical implications and management strategies. 882 2

High-dose dipyridamole transesophageal stress echocardiography has recently been proposed as a useful and safe method to assess myocardial ischemia in patients with poor transthoracic acoustic window. It has also been shown that transesophageal echocardiography (TEE) allows the study of coronary blood flow reserve (CBFR) in the left anterior descending artery (LAD). The aim of our study was to assess whether the morphologic information and pathophysiologic data on CBFR and myocardial ischemia can be collected by a single stress TEE without comprimizing its feasibility, safety and accuracy. We studied, 29 patient with known or suspected CAD (previous myocardial infarction or angina) (Group A), and as a control group, we studied 11 patients with mitral disease or mitral prostheses (Group B). All patients underwent the coronary angiography. None of Group B patients showed significant coronary artery stenosis (> 70%). In baseline conditions left ventricular wall motion and LAD coronary blood flow velocity (CBFV) were also evaluated. The following CBFV parameters were measured: maximal diastolic velocity (MaxDV), mean diastolic velocity (MnDV), maximal systolic velocity (MaxSV), mean systolic velocity (MnSV). The ratios of dipyridamole to rest maximal and o mean to diastolic velocities (MaxDV-Dip/Max DV-rest; MnDv-Dip/MnDV-rest) were measured as indexes of CBFR. No side effects were observed and the test could be completed in all patients (feasibility 100%). Wall motion analysis was adequate in all patients (feasibility 100%). Comparison between wall motion analysis was obtained and angiographic findings shown that the overall sensitivity and specificity of TEE were 84% and 93% respectively. Sensitivity for one, two and three vessel disease was 60%, 70% and 100%, respectively. LAD CBFV was adequately recorded in 85% of patients. CBFR parameters showed a significant difference between the two groups (Max DV-Dip/Max DV-rest: 1.67 +/- 0.7 vs. 2.73 +/- 0.6, P < 0.001); comparison between Group B patients and those of Group A with angiographically documented LAD stenosis showed a statistically significant difference in CBFR parameters (MaxDV-Dip/MnDV-rest, 2.73 +/- 0.6 vs. 1.65 +/- 0.7, P < 0.001, MnDV-Dip/MnDV-rest, 2.56 +/- 0.5 vs. 1.69 +/- 0.6 < 0.001). We conclude that transesophageal stress echocardiography is a useful method to study CAD and that it is possible to assess both morphologic and pathophysiologic information during a single examination.
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PMID:Usefulness of dipyridamole transesophageal echocardiography in the evaluation of myocardial ischemia and coronary artery flow. 891 17

Endothelin (ET), the most potent endogenous vasoconstrictor with mitogenic potency, is generated from its precursor big-endothelin (BET) in a proteolytic process and discussed as a pathogenetic factor in coronary artery disease and in the acute coronary syndromes. Several studies documented elevated plasma endothelin concentrations in acute myocardial infarction, but conflicting results were reported in patients with stable and unstable angina. Only few studies determined big endothelin, although it half-life and plasma concentrations are higher in comparison to endothelin. ET and BET levels (Radioimmunoassay, Biomedica GmbH, Vienna) were determined in patients with stable angina (SAP, n = 20), unstable angina (IAP, n = 12), acute myocardial infarction (AMI, n = 12) and healthy subjects (NP, n = 11). The concentrations of ET and BET (median (minimum-maximum) in fmol/ml) of the patients with stable angina (SAP: ET 0.7 (0.3-1.1); BET 1.7 (0.7-2.9)), unstable angina (IAP: ET 1.0(0.5-1.7); BET 2.5 (1.3-4.1)) and acute myocardial infarction (AMI: ET 1.2 (0.6-2.3); BET 3.6 (3.2-5.3)) showed a significant difference compared to controls (NP: ET 0.5 (0.4-0.7); BET 1.4 (1.1-1.7)) (SAP vs. NP: ET p < 0.01; BET p < 0.05; IAP and AMI vs. NP: ET and BET p < 0.001). Also, the concentrations of the peptides differed significantly dependent on the clinical severity of coronary artery disease (AMI vs. SAP: ET and BET p < 0.001; AMI vs. IAP: BET p < 0.05; IAP vs. SAP: ET p < 0.05; BET p < 0.01). Twelve of 15 patients with big endothelin concentrations over 3 fmol/ml suffered acute myocardial infarction. Seven of 12 patients with AMI showed elevated ET and BET concentrations before the increase of creatinecinase. There was no correlation between number of risk factors per patient, cholesterin and subfractions, severity of CAD classified in one-two-three-vessel disease or coronary score according to modified criteria of the American Heart Association (AHA). We conclude that in patients with coronary artery disease endothelin and big endothelin levels are elevated and related to the clinical and not to the morphological severity of coronary artery disease. Big endothelin is the more sensitive parameter in comparison to endothelin and indicates a severe course of myocardial ischemia in patients with unstable angina. The development of assays with the possibility of a quick determination of the peptides may be valuable for risk stratification of acute coronary events.
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PMID:[Endothelin and big endothelin in coronary heart disease and acute coronary syndromes]. 903 1

Tests to evaluate haemostatic function bleeding time (BT), prothrombin time (PT) partial thromboplastin time with kaolin (PTTK), thrombin time (TT), platelet count, platelet function tests (platelet adhesiveness and microthrombus index) and plasma fibrinogen levels were performed in 30 patients of coronary artery disease (14 myocardial infarction, 16 angina pectoris) and 20 age and sex matched controls. There was no statistically significant difference in platelet adhesiveness and mean microthrombus index in patients and controls. The BT, PT, PTTK and TT were normal in all patients and controls. Stepwise logistic regression analysis showed that plasma fibrinogen was an independent risk factor in the production of CAD.
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PMID:Haemostatic function in coronary artery disease (CAD). 925 98

This study was undertaken to assess the diagnostic value of resting 123I-BMIPP scintigraphy in patients with effort angina pectoris. One hundred and four patients underwent scintigraphic and angiographic examinations. The subsets of the patients were stable effort angina pectoris (stable type) in 27 cases, new onset of effort angina pectoris (new onset type) in 21 cases, and worsening effort angina pectoris (worsening type) in 35 cases. The remaining 21 cases were subjects without evidences of coronary artery disease (non-CAD). 123I-BMIPP was injected under resting and pain free condition, then data for single photon emission tomography (SPECT) were acquired. The positive regional 123I-BMIPP defects in three coronary territories were visually judged on the tomographic images. The overall sensitivity to diagnose the patients was 62.6% (52/83) and the overall specificity to exclude non-CAD subjects was 95.2% (20/21). The detection rate in each subset of the disease was 48.1% (13/27) in stable type, 47.6% (10/21) in new onset type and 77.1% (27/35) in worsening type (p < 0.05 versus two other types). For detection of stenosed vessels, the overall sensitivity was 41.4% (56/148) and the overall specificity was 93.8% (152/164). The rate of detection of stenosed vessels was 31.7% (13/41) in stable type, 31.4% (11/35) in new onset type, and 55.6% (40/72) in worsening type (p < 0.05 versus two other types). Vessels with 75% stenosis were more sensitively detected in the worsening type (33.3%; 4/12) compared to the remaining two types (8.3%; 1/12) even though the difference was not significant. The resting 123I-BMIPP scintigraphy was therefore valuable in diagnosing patients with effort angina pectoris and involved coronary arteries especially in the subset of patients with worsening type.
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PMID:Resting 123I-BMIPP scintigraphy in diagnosis of effort angina pectoris with reference to subsets of the disease. 967 14


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