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Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Spasm of coronary arteries can cause chest pain indistinguishable from classic angina pectoris in patients without atherosclerosis of these vessels or recognizable heart disease. Associated electrocardiographic changes usually correspond to the coronary artery affected and disappear when the attack of pain ends. Sublingual nitrates are excellent agents for the control of the episodic anginal symptoms. There have been scattered reports of myocardial infarction occurring in patients with normal coronary arteries; a role of arterial spasm in these cases in speculative.
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PMID:Myocardial ischemia from coronary arterial spasm. 0 82

The physician who understands the pathophysiology of angina pectoris can apply rational therapeutic measures based on an appreciation of the determinants of myocardial oxygen supply and demand. Most patients with angina secondary to coronary atherosclerosis can be treated conservatively using a systematic approach that includes correction or removal of underlying causes or precipitating factors and the judicious use of sublingual nitroglycerin. In patients with more resistant angina, use of oral or topical nitroglycerin or sublingual isosorbide dinitrite as well as propranolol can be advised. Aortocoronary bypass surgery can offer significant improvement in carefully selected patients with frequent angina poorly controlled by medical therapy. The most important consideration in the treatment of angina is protection of coronary blood flow reserve by primary prevention of the atherosclerotic process itself. All individuals from families prone to coronary artery disease should be evaluated for alterable risk factors, the most important being cigarette smoking, hypertension, and hypercholesterolemia. Considering the high risk of unheralded sudden death in previously asymptomatic patients with coronary atherosclerosis, angina can, in a sense, be considered a fortunate harbinger of coronary stenosis, identifying candidates for secondary preventive measures aimed at retarding the progression of vascular disease. More importantly, angina serves as an index for detecting families at high risk of coronary artery disease, in whom early application of primary prevention may afford a more promising outlook.
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PMID:Angina pectoris. Diagnosis and treatment. 0 83

The opinion is emerging that beta-blocking drugs have an important role in management of patients following acute myocardial infarction. Already beta-blocking drugs are accepted as the treatment of choice in hypertension and in angina pectoris--in the major risk factor and consequence respectively of coronary atherosclerosis, and both commonly recognized in patients who survive acute myocardial infarction. But beta-blocking drugs also may be of benefit in reducing the incidence and risk of subsequent infarction, and so may be of value for long term treatment of patients who have no symptoms whatever following acute infarction.
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PMID:The role of long term beta-blockade after myocardial infarction: Paper 1. 3 Apr 41

In patients with coronary atherosclerosis in I and III stages content of histamine in blood, excretion of free histamine with urine, activities of serum histidine decarboxylase and diaminooxidase, histaminopexy of blood serum and content of antihistamine factor were studied. In patients with the disease of the I stage during the attacks of stenocardia content of histamine in blood, the activity of diaminooxidase and content of degranulated basophils were increased, but the histidine decarboxylase activity, histaminopexy, content of antihistamine factor and excretion of free histamine with urine were normal. During the stenocardia attacks in patients with coronary atherosclerosis of the III stage content of degranulated basophils, the histidine decarboxylase activity were increased, histaminopexy and titres of antihistamine factor were decreased. Between the content of histamine in blood and the diaminooxidase activity no correlation was observed. This lack of correlation could cause development of hyperhistaminaemia and increased excretion of free histamine with urine. Antihistamine and desensitizing preparations (pipolphen, heparin, amidopyrine and ascorbic acid) increased the therapeutic efficiency of vasodilating drugs, decreased stenocardia attacks, accelerated both clinical improvement and normalization of histamine metabolism.
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PMID:[Metabolism of histamine in patients with coronary atherosclerosis]. 5 86

Not every case of angina pectoris occurring in a hypertensive patient is indicative of coronary atherosclerosis. Nine patients with essential hypertension of moderate degree had attacks of angina of sufficient severity to require investigation by arteriography. In these patients, the coronary arteriogram was normal but ventriculography showed hypertrophy of the walls of the left ventricle of restrictive or obstructive type. These appearances were confirmed by echocardiography which also showed hypertrophy of the septum and, in certain cases, confirmed the involvement of the ventricle, while by contrast the electrocardiogram and radiological appearances of the heart were essentially normal. The beta-blockers may have an important part to play in such conditions, and echocardiography is suggested as part of the routine investigation in cases of hypertension.
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PMID:[Angina pectoris in a hypertensive patient with left ventricle hypertrophy: echo-angiographic comparisons]. 10 Nov 81

Three years after radiotherapy to the mediastinum for Hodgkin's disease, a 28 year old female presented with incapacititating angina. The presence of severe disease in the proximal arteries on coronary arteriography, with obliteration of the anterior descending artery and, of the right coronary artery, together with an unstable collateral circulation, constituted an indication for a double aorto-coronary bypass graft. A review of the literature suggests that early development of atherosclerosis may be produced by the synergistic action of radiotherapy and lipid disorders. Fifteen similar cases have been described, eight of them in patients of less than 40 years of age; three were discovered at post-mortem examination in patients aged under 21.
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PMID:[Severe coronary insufficiency in a young woman after mediastinal radiotherapy]. 10 86

Certain clinical and morphologic observations are described in 27 patients with severe isolated angina pectoris of either the stable (five patients) or the unstable form (22 patients). Twenty-four patients died during or shortly after cardiac operations designed to relieve angina pectoris and three died during cardiac catheterization. During life none had had clinical evidence of acute myocardial infarction or congestive cardiac failure. At necropsy, each had diffuse, extensive coronary atherosclerosis with severe luminal narrowing: the lumens of at least two, an average of three, of the four major epicardial coronary arteries were narrowed greater than 75% in cross-sectional area by old atherosclerotic plaques. Despite the severe coronary narrowing, there was little myocardial damage. Left ventricular scarring (excluding papillary muscle) was observed grossly in only 14 (52%) of the 27 patients and in each it involved only a small portion of myocardial wall. The left ventricular cavity was of normal size in all except two patients. The hearts were of normal weight in 15 (56%) patients, and the average increase above the upper range of normal for the other 12 hearts was 19%. Thus, clinically isolated, severe angina pectoris is associated with severe, diffuse luminal narrowing but relatively little myocardial damage.
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PMID:The coronary arteries and left ventricle in clinically isolated angina pectoris: a necropsy analysis. 13

Marked hypertriglyceridemia and hypercholesterolemia accompanied by angina and a left cerebral thrombosis occurred in a long-term hemodialysis patient following 5 1/2 weeks of oral treatment with oxymetholone, 100 mg/day, a synthetic androgen. After androgen therapy was discontinued, over a three-month period, plasma lipid values progressively decreased below pretreatment values, and clinical symptoms disappeared. During rechallenge with oxymetholone, serum lipid values increased substantially, and the lipoprotein pattern changed from a type IV to a type V. Detailed lipid studies showed subnormal postheparin lipolytic activity and a fast-migrating pre-beta-lipoprotein in a very-low-density lipoproteins (VLDL) fraction. Because of the data linking lipid abnormalities to atherosclerosis and the acceleration of atherosclerosis in long-term hemodialysis patients, great caution should be exercised in administering androgenic steroids to these patients.
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PMID:Hyperlipidemia due to oxymetholone therapy. Occurrence in a long-term hemodialysis patient. 18 Mar 4

Epidemiologic studies have found associations between low levels of high density lipoprotein (HDL) cholesterol and increased risk of coronary artery disease, using myocardial infarction or angina pectoris as endpoints. However, since most studies have not correlated HDL cholesterol with the presence, severity, or location of anatomically proven coronary disease, the present study measured HDL cholesterol levels in 483 men and women undergoing coronary arteriography. Consistent and statistically significant trends of decreasing mean HDL cholesterol levels with increasing numbers of diseased coronary arteries were observed in both men and women and in younger and older age groups. Although women without coronary disease had much higher levels of HDL cholesterol than men without coronary disease, the differences between men and women with similar degrees of coronary disease were small. Low levels of HDL cholesterol were associated with left main coronary disease; patients with both triple vessel disease and left main disease had lower levels of HDL cholesterol than did patients with triple vessel disease without left main disease. These results were not explained by the possible associations of low density lipoprotein cholesterol or triglycerides with HDL cholesterol. These findings suggest that low levels of HDL cholesterol are important risk factors for the development of atherosclerosis and that they may be useful for identifying patients at high risk of certain anatomic patterns of coronary artery disease.
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PMID:The association of low levels of HDL cholesterol and arteriographically defined coronary artery disease. 22 34

Forty-six patients with xanthomatosis and elevated very low density lipoproteins (VLDL) levels (in different types of hyperlipoproteinaemia) were classified on the basis of the WHO criteria and the cholesterol/triglyceride ratio in VLDL. A large majority (31/46) of the patients referred to the Department of Dermatology could be classified as hyperlipoproteinaemia type III, only 8/46 as type IIB and 7/46 as type IV/V. This distinction seems to be relevant as the xanthomatous lesions differed distinctly between these three types of hyperlipoproteinaemia. Xanthochromia striata palmaris was present in 29/31 cases of hyperlipoproteinaemia type III and was not found in type IV/V patients, who had distinctive papuloeruptive xanthomas. During a follow-up in 35/46 patients all xanthomas disappeared within 2 years except the xanthelasma palpebrarum and tendinous xanthomas. All type IV/V patients (7/7) but only one type III patient (1/31) had abnormal glucose tolerance. Only 2/18 type III patients less than 45 years showed claudication and none of the young type III patients had angina pectoris. In contrast, all four type IIB patients less than 45 years had clinical signs of atherosclerosis. However, angina pectoris and/or claudication were present in 5/13 type III patients over 45 years old. The mean serum cholesterol level was equally elevated in both groups but the cholesterol was mainly present in VLDL in type III and in low density lipoproteins (LDL) in type IIB. In 9/31 type III patients the LDL level was also elevated but was easily normalized by a diet low in carbohydrate, whereas the elevated LDL level in type IIB was therapy-resistant. The recognition of xanthomatous lesions, specifically xanthochromia striata palmaris, as an early sign of type III hyperlipoproteinaemia, can lead to the early diagnosis and successful treatment of these patients, and thus possibly prevent the development of premature atherosclerosis.
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PMID:Xanthomatosis and other clinical findings in patients with elevated levels of very low density lipoproteins. 22 20


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