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

Exercise-induced Q-waves were encountered in four Caucasian males presenting to the Cardiac Clinic, Tygerberg Hospital, with chest pain suggestive of angina pectoris. This phenomenon occurred in four out of a total of 1943 patients undergoing treadmill stress testing (Bruce Protocol) during a two-year period, giving an incidence of 0.21 percent of this ECG response. Two of the four patients (cases 1 and 2) were documented to have coronary atherosclerosis by selective coronary arteriography. One of these patients may well have been experiencing coronary vasospasm. One of the remaining two patients was a teenager whose exercise response was probably normal, whilst the last patient could have had ischemic heart disease (IHD). This most interesting and rare response to exercise (stress) testing is discussed, emphasis being placed on its incidence, mechanism and clinical significance in IHD and other conditions in clinical practice. Awareness of the occasional transient nature of "pathological" Q-waves, whether these occur at rest or during exercise, has an important bearing on such acute therapeutic interventions as intracoronary thrombolysis and percutaneous transluminal coronary angioplasty.
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PMID:Transient "pathological" Q-waves occurring during exercise testing: assessment of their clinical significance in a presentation of a series of patients. 359 53

The pathophysiology of ischemic heart disease is multifaceted. Atherosclerosis, spasm, thrombosis, and embolism, alone and in combination, play a role in the pathogenesis of myocardial ischemia. The effect of coronary occlusive disease may vary from patient to patient, producing stable or unstable angina, or myocardial infarction. Myocardial ischemia occurs when there has been an acute imbalance between oxygen demand and supply. A number of variables alter the relationship between the presence of myocardial ischemia and the degree of coronary stenosis. These include the length, location, and geometry of the stenosis; the presence or absence of collateral vessels; and the coronary arterial tone. Coronary arteriography has shown the same general extent and distribution of coronary artery disease in patients with stable and unstable angina. Differences in the severity of coronary artery disease emerge when the various forms of unstable angina pectoris are considered separately. More severe coronary disease is present in patients who present with a crescendo pattern of angina and in those who display either ST-segment deviations or T-wave inversions during chest pain. The precise mechanism for the production of unstable angina in any individual patient is unknown but may be related to several factors, including the rapid progression of coronary artery disease just before or during the onset of unstable angina; or intermittent transient coronary artery occlusion resulting from spasm, platelet aggregation, or thrombosis.
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PMID:Presence and evolution of coronary atherosclerosis in relation to clinical and electrocardiographic patterns of myocardial ischemia. 375 84

The results of a consecutive series of 24 patients reoperated for coronary bypass grafting between May 1977 and February 1983 are reported. The overall incidence of reoperation was 1.4 p. 100 (24 out of 1 716 cases); the incidence is tending to increase (2.3 p. 100 in 1982). Preoperative assessment revealed the persistence of cardiovascular risk factors: 75 p. 100 of patients had continued to smoke; 61 p. 100 had persistent hyperlipidaemia. The usual presenting syndrome was recurrence of chest pain (21 out of 24 cases) leading to control coronary arteriography on the results of which the surgical indication was based. The average time between the two operations was 38.7 months. The patients were classified into two groups; early reoperation (6 cases) for a technical problem or incomplete revascularisation, and late reoperation (8 cases) for disease of the graft and atherosclerosis. Progression of coronary atherosclerosis was the major long-term cause of occlusion of the saphenous graft (10-14 cases). The arteries most commonly bypassed at reoperation were the left anterior descending and right coronary arteries (12 times each). Reoperation comprised single bypass (13 cases), double bypass (10 cases) and triple bypass (1 case) with an average of 1.5 grafts per patient. The most commonly used vein was the internal saphenous vein (32 out of 36 grafts). Myocardial protection was insured by cardioplegia (13 cases) and intermittent clamping (10 cases) after cooling (general hypothermia at 22 degrees C). Global reoperative mortality (4 p. 100) was higher than for elective primary coronary surgery (2.3 p. 100). The incidence of perioperative infarction was 8 p. 100.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Reoperation after saphenous aortocoronary bypass]. 391 77

At a follow-up 7-10 years after a health survey of men born in 1920-1924 in the municipality of Uppsala, 31 of the participants (n = 2322) had died from ischaemic heart disease (IHD). In response to a letter to all men alive in 1980, 106 men declared that they had had a myocardial infarction (MI) (verified or suspected). In 58 cases MI was verified from the hospital records. 28 other men had had typical central chest pain (angina pectoris) only. In another 20 men other diagnoses explained the chest pain for which they were treated in hospital. The health screening values for S-cholesterol and S-triglycerides, blood pressure and smoking habits were analysed in relation to the occurrence of IHD. In this prospective study, smoking, hypertension, S-cholesterol and S-triglycerides were identified as risk factors for fatal and non-fatal MI. The risk factor values were similar in subjects suffering from angina pectoris only to those in subjects who also developed ECG and/or transferase changes, with the exception of S-triglyceride concentration, which was normal in the group with angina pectoris. The subjects who had a fatal MI had a significantly higher blood pressure than those with non-fatal MIs, but otherwise these two groups did not differ. The results emphasize the importance of scrutinizing questionnaire data with regard to chest pain and of selection of end-points when risk factor patterns are described for cardiovascular diseases.
Atherosclerosis 1985 Jan
PMID:Serum triglycerides are a risk factor for myocardial infarction but not for angina pectoris. Results from a 10-year follow-up of Uppsala primary preventive study. 399 81

Cardiac rupture occurs in 10 per cent of patients who die with acute myocardial infarction, but the pathogenesis remains unclear. Twenty randomly selected patients with cardiac rupture were reviewed retrospectively at autopsy, and the findings were compared with those of 20 age- and sex-matched control subjects who had died of acute transmural myocardial infarction without rupture. The times from the onset of chest pain to death were similar in the two groups (5.7 +/- 5.8 days for patients with rupture versus 4.2 +/- 4.9 days for control subjects), and there were no differences in the incidences of systemic hypertension, diabetes mellitus, hypercholesterolemia, history of myocardial infarction, or angina pectoris. The severity of coronary atherosclerosis was different in the two groups, with 55 per cent of the patients with cardiac rupture having single-vessel disease and 70 per cent of the patients without cardiac rupture having disease in three vessels. Additionally, the incidence of thrombosis was greater in patients with cardiac rupture than in those without. The inflammatory cell response in each patient was quantitated microscopically (number and type of leukocytes) in ten high-power fields. The inflammatory response was greater in patients with cardiac rupture. The number of eosinophils in the inflammatory response was significantly (P less than 0.01) greater in hearts associated with cardiac rupture (29.5 +/- 4 per cent) than in control hearts (11.7 +/- 3.1 per cent). It is postulated that eosinophils rich in arylsulfatase B, peroxidase, glucuronidase, beta-glycerophosphatase, major basic protein, and eosinophilic cationic protein may further weaken the necrotic myocardium and, in part, determine whether acute myocardial infarction will eventually result in cardiac rupture.
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PMID:Association of eosinophils with cardiac rupture. 399 34

Five patients with lymphoma and Vincristine induced myocardial infarction are described in the medical literature. We report two new cases, in whom an anterior myocardial infarction developed few hours after the second administration of the drug. In the reported cases a strict cause-to-effect relationship between the drug and acute myocardial infarction seems indicated by: the striking temporal coincidence between Vincristine administration and onset of chest pain; the additional myocardial infarctions in patients in whom the treatment was continued after the first event; the nearly constant absence of important coronary risk factors and the young age of the patients, making preexisting coronary atherosclerosis unlikely. The mechanism for the described association is still unknown: the possible causes are discussed.
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PMID:[Myocardial infarction induced by vincristine in patients with Hodgkin's lymphoma. Description of 2 cases and review of the literature]. 400 46

Prognosis for the patient recovery from an acute myocardial infarction is related mainly to electrical instability, left ventricular function, residual ischemia, and extent of coronary atherosclerosis. Many procedures now exist that allow investigation of these various aspects of cardiovascular function and stratification of risk. No ideal marker of prognosis exists because prognosis is not related to a single factor, because the various determinants are often interdependent, and also because they are time dependent. Thus, the presence of ischemia may be particularly important in the first year when the risk is greater, whereas left ventricular function may be the most important factor thereafter. For this reason, an active strategy for detecting ischemia, by exercise testing or other means, may add to clinical observation. Exercise testing is a safe and noninvasive method that can provide information not only on residual ischemia but also on other aspects of cardiovascular function. Many parameters can be studied, such as ST segment elevation or depression, chest pain, ventricular arrhythmias, tolerance to exercise, completion or not of the test, and the heart rate and blood pressure responses. Some of these data are not specific and must be complemented by further investigation. Such as approach should allow an overall evaluation of the cardiovascular function of the patient and an assessment of risk, and help institute an optimal treatment.
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PMID:Exercise testing in the early period after myocardial infarction in the evaluation of prognosis. 640 5

The effectiveness of exercise-treadmill testing in diagnosing coronary-artery disease in hypertensive patients is limited by a high rate of false positivity. Exercise radionuclide ventriculography, however, relies on different criteria (ejection fraction and wall motion), and we have evaluated this procedure in 37 hypertensive and 109 normotensive patients with chest pain, using coronary arteriography as an indicator of coronary disease. In the hypertensive cohort there was no difference in the ejection fraction at rest between the 17 patients with coronary disease and the 20 without it. Neither group had a significant mean (+/- S.E.M.) change in ejection fraction from rest to exercise (-1.9 +/- 2 and - 1.4 +/- 1 per cent, respectively). A wall-motion abnormality developed during exercise in 5 of the 17 hypertensive patients with coronary disease (29 per cent) and in 4 of the 20 without it (20 per cent) (P = not significant). In the normotensive cohort, however, the peak-exercise ejection fractions were significantly different. The 71 patients with coronary disease had a mean decrease of 3.6 +/- 1 per cent, in contrast to the patients without coronary disease, who had an increase of 6 +/- 1 per cent (P less than 0.001). An exercise-induced wall-motion abnormality was seen in 35 of the 71 patients with coronary disease (48 per cent), as compared with 3 of the 38 without it, (8 per cent) (P less than 0.001). We conclude that exercise radionuclide ventriculography is inadequate as a screening test for coronary atherosclerosis in hypertensive patients with chest pain.
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PMID:Exercise radionuclide ventriculographic responses in hypertensive patients with chest pain. 649 84

We evaluated left ventricular function in 10 scleroderma patients with signs and symptoms suggestive of congestive heart failure. M-mode and two-dimensional echocardiography demonstrated normal to increased systolic function in all patients. The presence of pulmonary venous congestion on the chest radiograph was not useful in assessing left ventricular systolic function. Five of nine patients with normal to increased left ventricular ejection fraction (LVEF) had increased cardiothoracic ratios and increased pulmonary vascular markings. Left ventricular hypertrophy was associated with a worse New York Heart Association functional class, more pulmonary vascular congestion, and greater left atrial size. In the presence of normal systolic function and ventricular hypertrophy, diminished left ventricular diastolic compliance may account for the cardiac dysfunction in these patients. Cold pressor testing induced peripheral Raynaud's phenomenon in nine of nine patients; however, no ST segment changes or chest pain was provoked. In seven of nine patients there was no abnormal fall in LVEF. The mechanism for the fall in ejection fraction seen in two patients may be related to an increase in afterload or myocardial ischemia secondary to coronary atherosclerosis. We found little to suggest that a myocardial Raynaud's phenomenon affects left ventricular perfusion or systolic function. Clinical signs and symptoms of congestive failure as well as chest radiographs are poor indicators of impaired systolic function in scleroderma patients. Based on these findings, it appears that evaluation of left ventricular systolic function should include echocardiographic or angiographic study before such patients are treated for heart failure with inotropic agents.
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PMID:Left ventricular function at rest and during Raynaud's phenomenon in patients with scleroderma. 650 43

Twenty-six patients with arterial hypertension and chest pain were examined using echocardiography, bicycle ergometry, pharmacological tests with the intravenous administration of dipiridamol and isoproterenol, coronary angiography and left ventriculography. With regard to the painful syndrome the patients were divided into 2 groups: Group 1 with angina, Group 2 with cardialgia. The majority of the group 1 patients showed extensive atherosclerosis of the coronary arteries. The results of bicycle ergometry and pharmacological tests in this group were positive in the majority of cases. The group 2 patients displayed minor atherosclerosis of the coronary arteries or intact arteries which correlated with negative results of the bicycle ergometry and pharmacological tests. Echocardiographic and ventriculographic examinations of the functional state of the left ventricle revealed circulation insufficiency in none of the patients.
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PMID:[Clinical aspects and diagnosis of ischemic heart disease in patients with arterial hypertension]. 652 Dec 11


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