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

Thirty-five patients with atypical chest pain were given ergonovine maleate as a provocative test for coronary spasm. None of the patients had significant coronary atherosclerosis. The patients were divided into two groups based on clinical information available before ergonovine testing. Group 1 patients (n=13) had objective evidence of cardiac disease manifested by episodes of syncope, ventricular tachyarrhythmias, myocardial infarction, or transient ST segment shifts with chest pain. Group 2 patients had chest pain but no objective evidence of cardiac disease. The ergonovine test was positive in 11 of 13 patients in group 1. None of the 22 group 2 patients had a positive response to ergonovine. These data suggest that ergonovine testing does not allow for any more precise recognition of patients with atypical chest pain who have coronary artery spasm than do clinical data alone.
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PMID:Predictability of the response to the ergonovine test. Value in the diagnosis of coronary spasm. 51 54

This chapter has demonstrated the diagnostic capability and feasibility of documenting functional abnormalities during dynamic stress in a pediatric population. The overview confirms that a controlled exercise procedure can be performed routinely in ambulatory children with or without cardiovascular disease and should be included in the clinical evaluation of specific lesions. It now appears that the primary indications for noninvasive exercise testing in the pediatric population include the following disorders: 1. Left ventricular outflow obstructions, a. Subvalvar obstructions, b. Valvar obstructions, c. Supravalvar obstructions, d. Idiopathic hypertrophic subaortic stenosis, e. Coarctation of the aorta; 2. Chronic left or right ventricular volume overload, a. Atrioventricular or semilunar valve incompetence, b. Left-to-right shunts; 3. Rhythm and conduction disturbances, a. Postoperative ventriculotomy, b. Bradytachyarrhythmias, c. Arrhythmias in patients with or without symptoms. The role of the exercise procedure is not yet established in the following areas: 1. Patients with family history of premature atherosclerosis or Type II hyperlipoproteinemia; 2. Patients with elevated blood pressure; 3. The evaluation of syncope, chest pain, or atypical findings on physical examinations (especially in athletes). Consequent upon increased interest and improved technology, the role of this technique will soon be established in the invasive and noninvasive evaluation of pediatric patients with or without overt cardiovascular disease.
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PMID:Exercise testing in children and young adults: an overview. 70 68

1. 46 cases of Prinzmetal's angina have been studied: there were 36 males and 10 females, with an average age of 54.6 years. 19 patients (group A) were treated medically, and 12 of these were followed up for more than 6 months (average follow-up period 45.1 months). 27 patients (group B) underwent a coronary by-pass procedure: 22 of these were followed up for more than 6 months after surgery (average postoperative follow-up period 21.6 months). 2. One patient from group A and two patients from group B died, one of them from postoperative renal failure. None of the three deaths could be attributed directly to the coronary artery disease. 2 patients from group A and 5 patients from group B had a myocardial infarction without fatal outcome. 5 of the 12 patients in group A and 16 of the 22 patients in group B were asymptomatic after more than 6 months of follow-up. 3. The treatment policy should take account: - of the prognosis of Prinzmetal's angina, which is on the whole better than that of an unstable angina pectoris of the common type; - of an assessment of the risks in each individual case; these are increased when there is a combination of risk factors for atherosclerosis, and/or severe arrhythmia with syncope, and/or persistant electrical changes in the territory of the anterior descending artery, and/or coronary artery lesions involving two or three major vessels. 4. Surgery is used if there is a failure of treatment with beta-blockers, which are used under cover of a pacemaker when there is a paroxysmal block. If medical treatment is successful, surgery is indicated in high-risk cases.
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PMID:[Discussion on therapeutic attitude in Prinzmetal's angina. Apropos of 6 cases]. 81 80

The clinical, roentgenologic and laboratory findings in 124 patients with dissecting aneurysm of the aorta are reported. In 53 patients the dissection occurred in the ascending aorta ("proximal" dissection), and in 71 patients the site of origin was the descending thoracic aorta ("distal" dissection). Certain distinct clinical differences between the groups were apparent. Although hypertension was an important predisposing factor, it was significantly more common in distal dissection, as was atherosclerosis. Back pain and hypertension on hospital presentation characterized patients with distal dissection. Conversely patients with proximal dissection were younger and had a significantly higher incidence of Marfan's syndrome, cystic medial necrosis, anterior chest pain, pulse deficits, neurologic compromise, aortic insufficiency and congestive heart failure. In both groups, syncope appeared to correlate well with the occurrence of cardiac tamponade. Chest roentgenograms almost always showed an abnormal aortic contour. Aortic angiography, when performed, was usually confirmatory of the diagnosis.
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PMID:The clinical recognition of dissecting aortic aneurysm. 102 Jul 50

Two cases of coronary spasm in cardiac transplant recipients in which the presenting symptom was syncope without chest pain are reported. Diagnosing coronary spasm in transplant patients appears to be important because, based upon the few cases in the literature, prognosis is very poor. Coronary spasm may be related to accelerated atherosclerosis occurring in the transplanted heart.
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PMID:Syncope: a symptom of coronary artery spasm after cardiac transplantation. 157 64

Heart muscle perfusion was studied by exertion scintigraphy Tal-201 in 24 patients, 16M and 8F, aged 16-45 years, means--28 +/- 7.4 years with hypertrophic cardiomyopathy. The relationship between perfusion disturbances and sudden death risk factors occurring in this group of patients was evaluated. Disturbances of heart muscle perfusion were found in 20 pts (83%); 2 pts had permanent perfusion defects, in 18 pts these defects were completely or partially reversible at rest. Only 4 pts (17%) had normal heart muscle perfusion. In patients with perfusion disturbances there was found a significantly more frequent occurrence of the following sudden death risk factors: 1. syncope (p less than .01) 2. ventricular arrhythmia of IV b class according to Lown (p less than .01) 3. advanced hypertrophy of intraventricular septum (p less than .01) 4. sudden death in patients families (p less than .05) The evaluation of the heart muscle perfusion confirmed the occurrence of myocardial ischemia in most of the examined patients. Normal coronaro-angiography in all the patients over 35 years as well as the young age of the other patients exclude atherosclerosis as the cause of myocardiac ischemia in the group under study. This is a confirmation of nonatherosclerotic etiology of myocardiac ischemia in hypertrophic cardiomyopathy patients. The correlation between perfusion disturbances and sudden death risk factors points to the role of ischemia in the natural course of disease and the value of exertion scintigraphy TI-201 in prognosing patients with hypertrophic cardiomyopathy.
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PMID:[Disturbances of myocardial perfusion by exertion scintigraphy in patients with hypertrophic cardiomyopathy and their relationship with sudden death risk factors]. 194 60

Clinical, laboratory and electrocardiographic data from 608 patients with permanent pacemakers implanted over a period of 8 years, were evaluated retrospectively. The number of implants was greater in males (56.5%) and in patients over 60 years of age (77.5%). Atherosclerosis was the most common disease found in this group (50%). Syncope occurred in 96.2% of the cases; and complete AV block was the most common electrocardiographic alteration (50.5%). Electrode displacement occurred in 32 patients (5.2%) and was the most commonly found early complication. Among the late complications, 10.3% of the patients had infections in the area of the generator. The total mortality was 7.7% due to the heart disease rather than pacemaker-related complication.
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PMID:[Permanent pacemaker implantation. Indications and results]. 234 27

Coronary artery disease (CAD) developed in 15 patients at a mean of 16 years (range 3 to 29) after chest irradiation. The mean dose of radiation was 42 +/- 7 grays; irradiation was performed for Hodgkin's disease in 9 patients, lymphoma in 2, breast carcinoma in 3 and cystic hygroma in 1 patient. Mean age was 48 years (range 26 to 63) at diagnosis of CAD; 4 patients were younger than 35 years. Nine were women. Ten presented with angina, 3 with acute myocardial infarction, 1 patient with syncope and 1 with dyspnea. Twelve had no more than 2 risk factors of atherosclerosis. At coronary angiography, 8 had at least 50% diameter narrowing of the left main coronary artery and 4 had severe ostial stenosis of the right coronary artery. Eight patients also had valvular heart disease, 4 pericardial disease and 4 complete heart block. Mean left ventricular ejection fraction was 67 +/- 11% (range 53 to 80%). Nine had undergone coronary artery bypass grafting, but surgery was difficult or impossible in 3 because of severe mediastinal and pericardial fibrosis. Radiation-associated CAD is characterized by a high incidence of left main and right ostial coronary disease and often occurs in women with relatively few conventional risk factors for CAD.
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PMID:Clinical and angiographic features of coronary artery disease after chest irradiation. 367 2

Findings are described in five patients who at necropsy were found to have origin of the left main coronary artery from the right sinus of Valsalva and coursing of the anomalously arising artery between aorta and pulmonary trunk to reach the left side of the heart. Three of the five patients were boys and died suddenly at ages 13, 14 and 19 years, respectively: two of them had had one or more episodes of syncope and the third had an abnormal electrocardiogram. The fourth patient, a 64 year old woman, died of chronic congestive heart failure 1 year after an acute myocardial infarction. She had insignificant coronary atherosclerosis. The fifth patient, an 81 year old man, died of chronic alcoholism, having been free of symptoms of cardiac dysfunction during life. Additionally, clinical and necropsy findings are summarized in 38 previously reported necropsy patients with the coronary anomaly. Of these 38 (34 male [89%]), 23 (61%) died suddenly in the first two decades of life; death in 6 others (16%) appears to have been related to coronary atherosclerosis and 9 patients (24%) died from noncoronary causes. Thus, this anomaly is life-threatening. Why it frequently causes fatal cardiac arrest in some young individuals and allows a normal life span in others remains unclear.
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PMID:Left main coronary artery originating from the right sinus of Valsalva and coursing between the aorta and pulmonary trunk. 394 56

Thirty-seven patients with coronary artery spasm and minor coronary atherosclerosis (34) or normal coronary arteries (3) were followed up long-term. All had angina at rest, 32 had nocturnal angina, and 13 had a positive exercise test with S-T elevation. Three had a previous subendocardial infarction; 10 had had serious arrhythmias, which caused syncope in 7. At last review, 21 months (range 1 to 61) after starting therapy, 27 patients continued on verapamil, 314 (120 to 600) mg/day; 4 who did not respond to verapamil were taking nifedipine, 58 (30 to 80) mg/day; and 16 were also taking isosorbide dinitrate, 41 (20 to 80) mg/day. Of the 31 patients on therapy, 21 were asymptomatic, 9 were improved (1 to 4 attacks/month), and 1 had an average of 8 anginal attacks/month; the remaining 6 had stopped therapy and 5 were asymptomatic a mean of 10 (3 to 18) months after stopping. The exercise test became negative in all 12 patients tested on therapy, although 3 required nitrates in addition to verapamil or nifedipine. In 26 supervised treatment withdrawals in the hospital, a mean of 15 (1 to 55) months on therapy, 10 developed angina in less than 48 hours. Angina recurred in all 6 unsupervised, patient-initiated withdrawals. Failure to stop smoking was positively associated with recurrence of angina on treatment withdrawal (p less than 0.02). Long-term treatment of coronary artery spasm with verapamil or nifedipine together with isosorbide dinitrate was well tolerated and effectively relieved angina. No documented serious arrhythmias, syncopal episodes, myocardial infarction, or death occurred during follow-up.
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PMID:Long-term follow-up of verapamil and nitrate treatment for coronary artery spasm. 681 5


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