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Query: UMLS:C0008031 (chest pain)
 17,248 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Five cases of cardiac rupture (CR) in acute myocardial infarction (AMI) (four men and one woman aged between 49 and 86 years, mean 64) are described. The incidence of CR was 4,7% of 106 cases of AMI and 20,8% of causes of death. In all cases, pathologic observations well agreed with electrocardiographic site of infarction. All patients had ECG pattern of transmural AMI: postero-inferior (2 cases), anterior (1 case); none of them had myocardial infarction in the past. Two patients had systolic hypertension on admission, during and immediately before death, and 3 patients were normotensive during the whole course of illness. All patients had severe, prolonged and resistant to opiate therapy chest pain, which reexacerbated immediately before death in two cases. 4 patients died within 24 hours after the onset of symptoms. Terminal ECG pattern was similar in these four cases: sudden sinus bradycardia and/or idio-ventricular rhythm, with a progressive slowing of heart rate and changes of QRS patterns of "agonic" type, preceded electrical activity cessation. In one patient, who died at the seventh day of illness, ventricular fibrillation was observed. The AA. stress the importance of the early recognition of clinical findings suggesting an impeding CR in order to relieve cardiac tamponade with pericardiocentesis and to perform, as soon as possible, surgical treatment.
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PMID:[Cardiac rupture: a not infrequent complication of acute myocardial infarction. Report of five cases (author's transl)]. 26 61

Malignant hyperthermia is a disease resulting from defective cellular membranes, usually presenting as drug-induced pyrexic crises. We describe four patients with life threatening ventricular arrhythmias or chest pain in the absence of pyrexic crises. Three presented with life threatening arrhythmias and the fourth with severe atypical chest pain. Two patients had a family history of multiple sudden deaths. Resting CKs were elevated in three patients while CK-MB was elevated in one. Resting ECGs were abnormal in three. Three patients had recurrent ventricular tachycardia, two had recurrent ventricular fibrillation and multiple cardiac arrests. Cardiac catheterization showed abnormal left ventricular wall motion in two and minimal mitral valve prolapse in one while all had normal coronary arteries. Thallium-201 myocardial imaging demonstrated large perfusion defects in the patient with electrocardiographic Q waves and normal coronary arteries. Myocardial involvement has been demonstrated by clinical, electrocardiographic, hemodynamic, angiographic and myocardial imaging abnormalities. Malignant arrhythmias occurred in these patients in the absence of pyrexic crises or drug admininstration. Abnormal calcium release in the myocardium, as documented in skeletal muscle membranes, may be a unifying concept for the various manifestations described.
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PMID:Cardiac manifestations of malignant hyperthermia susceptibility. 69 60

The out-of-hospital reports of 2152 consecutive paramedic fire rescue responses were reviewed. Examination of emergency department records and outcome was conducted in all cardiopulmonary arrests (120), major trauma (59) or nontraumatic hemorrhage (9) and one half (95 of 199 patients) with chest pain or possible myocardial infarction. Predominant age was 50 to 70 (66%) and men outnumbered women by four to one. At the scene arrival was under five minutes in over 70% of the cases. Thirty of the 120 patients with cardiopulmonary arrest (12 occurred after paramedic arrival) responded to initial cardiopulmonary resuscitation, 24 patients entered the coronary care unit, and 16 were discharged alive. Ventricular fibrillation (50) and asystole (40) were the documented rhythms. All survivors had ventricular fibrillation. Evaluation of the trauma and nontraumatic blood loss victims indicated that, after the paramedic places an intravenous line, the paramedic role is less well defined. Mean transportation time was 36 (trauma) and 38 (hemorrhage) minutes to the hospital.
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PMID:Factors in successful resuscitation by paramedics. 83 90

Ventricular tachycardia associated with myxoedema is rare. Only two cases have so far been documented. In the report by Hansen, the patient had recurrent chest pain which suggested coexisting coronary heart disease. In the second case, the patient developed recurrent ventricular tachycardia only after intravenous triiodothyronine was given. This paper reports a further case of hypothyroidism with recurrent episodes of ventricular tachycardia and ventricular fibrillation which was not associated with any of the established causes of this arrhythmia.
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PMID:Recurrent ventricular tachycardia in hypothyroidism. 106 4

Two patients with Prinzmetal's variant angina had recurrent episodes of resting chest pain, ST segment elevation, QRS widening, ventricular tachycardia, and ventricular fibrillation. These eqisodes were unresponsive to medical therapy including lidocaine, procaine amide, and quinidine sulfate. Coronary arteriography revealed severe obstructive coronary artery disease, involving more than one coronary artery, in both patients. Aorticocoronary saphenous vein grafts were utilized to bypass significant disease in each patient. In one patient blood flow through the grafts was measured at 90 and 65 ml per minute, respectively, at operation and patent grafts were demonstrated six months postoperatively. Neither patient has had recurrence of chest pain or evidence of ventricular tachycardia at one year or 2 1/2 years postoperatively. Postoperative resting and maximal exercise ECG's are normal. Coronary artery surgery may be an effective method of therapy for ischemic ventricular tachycardia when medical therapy fails.
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PMID:Coronary artery surgery for recurrent ventricular arrhythmias in patients with variant angina. 107 46

Cardiac arrest developed in two patients after the administration of oral potassium. Neither patient had renal insufficiency, but both had underlying heart disease. In one patient fatal ventricular fibrillation developed 4 days after he received an aortic valve replacement for aortic stenosis and while he was receiving oral potassium supplements. The serum potassium level before cardiac arrest was 8.1 meq. The second patient had angina and was given 40 meq of potassium orally 15 minutes after an exercise test which produced chest pain and S-T segment depression. One hour later, ventricular fibrillation developed. Resuscitation was successful. Both patients had electrocardiographic evidence of hyperkalemia. Oral administration of potassium may produce severe cardiac toxicity in patients with heart disease even when renal function is clinically normal.
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PMID:Cardiac arrest due to oral potassium administration. 111 63

Initiation of quick prehospital cardiopulmonary resuscitation and emergency cardiac care completed the total system needed to provide emergency and convalescent coronary care for a community. Subsequently, annual community rates for coronary death during ambulance transport fell by 62 per cent and for prehospital coronary death by 26 per cent in people under 70 years of age. In cardiac arrest due to acute myocardial infarction, prompt successful prehospital correction of ventricular fibrillation and asystole yielded long-term survival in two thirds of cases. This 66 per cent success rate of prehospital cardiopulmonary resuscitation and emergency cardiac care is identical to contemporary international experience. Precordial thump-version with the fist and precordial fist pacing appeared logical additions to prehospital cardiopulmonary resuscitation and emergency cardiac care technics. Community lives saved yearly were 15.2/100,000 people aged 30 to 69 years and 6.4/100,000 total population. Simultaneously, annual community rates for coronary death as a cause of death and coronary death per 1,000 people fell significantly by 15 and 17 per cent, respectively. Unquantifiable influences included prehospital relief of ischemic chest pain; prehospital correction of acute dysautonomia; prehospital abolition of otherwise prefatal dysrhythmias; similar treatment for acute myocardial infarction in the emergency department, in the inhospital mobile coronary care unit and in the progressive intermediate coronary convalescent unit; and general community education through the media of newspapers, radio and television. The present frequency of coronary death during ambulance transport, 9 to 22 per cent of prehospital coronary deaths in this and other surveys, suggests that the prehospital cardiopulmonary resuscitation and emergency cardiac care component needs improvement in many communities. By reducing prehospital and ambulance coronary death rates, prehospital cardiopulmonary resuscitation and emergency cardiac care for acute myocardial infarction constitutes an essential component of the total system approach to emergency coronary care. Since prehospital cardiopulmonary resuscitation and emergency cardiac care have cheaply and effectively expedited and abbreviated hospitalization for acute myocardial infarction, and lowered community death rates from coronary artery disease, its adoption throughout the United States and the western world seems justified.
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PMID:Reduction of prehospital, ambulance and community coronary death rates by the community-wide emergency cardiac care system. 111 65

Epidemiologic investigations have provided a portrait of the potential candidate for coronary heart disease. This is important because studies of the evolution of coronary disease in the general population reveal that it is a common disease that frequently attacks without warning, can be silent in its most dangerous form and can present with sudden death as the first symptom. Progress in identifyin- persons in jeopardy and the factors needing correction makes it theoretically possible to interrupt the chain of factors that eventuate in this disease. Coronary disease does not really begin with crushing chest pain, pulmonary edema, shock, angina or ventricular fibrillation, but rather with more subtle signs like a poor coronary risk profile. The risk factors can be treated quantitatively as ingredients of a cardiovascular risk profile and their joint effect estimated. An efficient practicable set of variables for this purpose is a casual blood test for cholesterol and sugar, a blood pressure determination, an electrocardiogram and a cigarette smoking history. With this set of variables the risk of coronary heart diseases can be estimated over a 30-fold range and 10 percent of the asymptomatic population identified in whom 25 percent of the coronary disease, 40 percent of the occlusive peripheral arterial disease and 50 percent of the strokes and congestive heart failure will evolve. The periodic use of the electrocardiogram at rest and after exercise in persons with a poor risk profile can demonstrate persons with asymptomatic ischemic cardiomyopathy due to advanced coronary artery disease. Most cases of angina pectoris or myocardial infarction represent medical failures; the conditions should have been detected years earlier for preventive management. About 30 percent of patients with infraction will shortly experience new angina, have an annual death rate of 4 percent and a fourfold increased risk of sudden death. Reinfarction will occur at an annual rate of 6 percent, and half the recurrences will be fatal. Congestive heart failure must be expected at 10 times and strokes at 5 times the rate found in the general population. Although no major innovations are required to identify candidates for coronary disease and to estimate their risk, we have much to learn about motivating changes in behavior to control risk factors. Approaches to prevention of coronary heart disease include public health measures to alter the ecology in favor of cardiovascular health, preventive medicine directed at highly vulnerable candidates and hygienic measures initiated by an informed public in its own behalf.
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PMID:Some lessons in cardiovascular epidemiology from Framingham. 124 56

Short-term results of aggressive surgical management were compared with results of medical management in forty-three patients with preinfarction angina admitted to the coronary-care unit (CCU) over an 18 month period. These patients were selected from 1,609 consecutive admissions to the CCU because they met strict criteria for preinfarction angina: severe chest pain at rest, ST-segment elevation or depression during pain which subsided rapidly after cessation of pain, and normal serum enzymes (CPK, SGOT, and LDH). Twenty-three patients had coronary angiography, done with operating room and pump standby. One patient, who had total occlusion of the left main coronary artery, died during the study. Twenty-one of the remaining patients were considered surgical candidates, and were treated immediately after angiography with 1 to 3 vein bypass grafts. There was one late postoperative death and, of the 20 survivors, 2 had ECG evidence of acute myocardial infarction and one had mild angina at time of discharge. In contrast, of the 21 patients treated medically, 13 sustained acute MI, resulting in 8 instances of congestive heart failure and 4 cases of ventricular fibrillation. Four patients died in cardiogenic shock. With the use of rigid criteria, a small subgroup of patients with variant angina at high risk of developing AMI has been identified and categorized as having preinfarction angina. Our experience suggests that aggressive surgery immediately following coronary angiography offers a lower incidence of MI, morbidity, and death than does medical management.
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PMID:Management of preinfarction angina. Evaluation and comparison of medical versus surgical therapy in 43 patients. 124 46

The pathogenesis of cardiac arrest in the absence of any apparent heart disease remains unclear. Based on the hypothesis that coronary spasm may be a cause of cardiac arrest in the absence of apparent heart disease, ergonovine testing and/or electrophysiologic studies (EPS) were performed to evaluate the cause of cardiac arrest. Fourteen patients resuscitated from cardiac arrest had no apparent heart disease. A spontaneous episode of angina with ST-segment elevation occurred in 4 patients while under observation. Ergonovine testing was performed in 9 patients, and coronary spasm was induced in 5. EPS were performed in 8 patients, including 3 patients with coronary spasm. No electrophysiologic abnormalities were found in the 3 patients with coronary spasm. Ventricular fibrillation was induced by programmed ventricular stimulation in 2 patients with documented ventricular fibrillation at the time of resuscitation. All but one of the patients with coronary spasm had chest pain preceding cardiac arrest or at least a history of chest pain at rest, while 4 of 5 patients without coronary spasm had no prodromal symptoms. Patients with coronary spasm had a good prognosis when treated with a Ca-antagonist and/or long-acting nitrate. In conclusion, coronary spasm is the most frequent cause of cardiac arrest in cardiac arrest survivors with no apparent heart disease. Ergonovine testing should be performed to evaluate the cause of cardiac arrest when patients have no apparent heart disease.
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PMID:High prevalence of coronary artery spasm in survivors of cardiac arrest with no apparent heart disease. 841 43


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