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

Exercise myocardial-thallium scintigraphy plays a fundamental role in the diagnosis of coronary artery disease. Once exercise is not always feasible, pharmacological stress became a possible alternative. The authors review the mechanism of action, administrations protocols, indications and side effects of the drugs used for this purpose: dipyridamole, adenosine and dobutamine. Dipyridamole causes coronary hyperemia by increasing the interstitial levels of endogenous adenosine. Perfusion defects result from the mismatch of coronary reserve in different coronary territories. The drug administration is classically performed with a 0.142 mg/kg/min dosage e.v. for 4 minutes, total of 0.56 mg/kg. It is possible to use a greater dose of 0.84 mg/kg e.v. for 10 minutes, increasing sensitivity without loss of specificity for diagnosis of coronary artery disease. Oral dipyridamole protocols with 300 and 400 mg were used with similar results for sensitivity and specificity. The oral protocol has the disadvantage of delayed onset and longer action. Including several dipyridamole studies, 87% was obtained for sensitivity and 84% for specificity, in the diagnosis of CAD. Dipyridamole scintigraphy has been applied to myocardial infarction risk stratification, cardiac risk evaluation of patients proposed to noncardiac surgery and therapeutic efficacy evaluation of reperfusion techniques (angioplasty and surgery). The secondary effects of dipyridamole are frequent, however mild and well tolerated. They occur in half the patients, the most frequent, facial flushing (2%), dizziness (5%), nausea (4%), vomiting (1%), headaches (11%) and chest pain (26%). Some important complications were reported although rare: myocardial infarction, ventricular fibrillation and bronchospasm.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Role of pharmacologic stimulation with myocardial perfusion scintigraphy in the evaluation of patients with ischemic cardiopathy]. 129 Jun 55

In all 4,232 patients admitted to a single hospital during a 21-month period due to initially suspected acute myocardial infarction (AMI), the prognosis and risk factor pattern were related to whether patients had chest pain or not. Symptoms other than chest pain that raised a suspicion of AMI were mainly acute heart failure, arrhythmia, and loss of consciousness. In 377 patients (9%) symptoms other than chest pain raised an initial suspicion of AMI. These patients developed a confirmed infarction during the first three days in hospital with a similar frequency (22%) as compared with patients having chest pain (22%). However, patients with "other symptoms" had a one-year mortality of 28% versus 15% for chest pain patients (p less than 0.001). Patients with "other symptoms" more often died in association with ventricular fibrillation and less often in association with cardiogenic shock as compared with chest pain patients. Among the 921 patients who developed early AMI, 64 (7%) had symptoms other than chest pain. They had a one-year mortality of 48% versus 27% for chest pain patients (p less than 0.001). We conclude that in a nonselected group of patients hospitalized due to suspected AMI, those with symptoms other than chest pain have a one-year mortality, which is nearly twice that of patients with chest pain.
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PMID:Prognosis for patients with initially suspected acute myocardial infarction in relation to presence of chest pain. 149 85

The literature on isolated right ventricular infarction is reviewed and local experience is reported. Chronic lung disease is an important risk factor. Chest pain and breathlessness are common. Syncope and sudden collapse can also occur. Rhythm disorders include sinus bradycardia, atrial fibrillation and ventricular tachycardia or fibrillation. Atrioventricular block is rare. Hypotension and a right-sided fourth heart sound are common. Cautious use of slow-release nitroglycerin is not hazardous in the absence of hypotension. High doses of steroids and anticoagulants can be helpful. The prognosis is usually good, although sudden collapse can occur due to ventricular fibrillation, rupture of the right ventricular free wall or massive pulmonary embolism.
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PMID:Isolated right ventricular infarction. 151 57

Age is one of the important prognostic factors for acute myocardial infarction. This study was performed to clarify the clinical characteristics and outcome of acute myocardial infarction in Chinese geriatric patients. The study subjects included 742 patients, divided by age into 2 groups: Group A greater than or equal to 65 years, 321 cases; and Group B less than 65 years, 421 cases. The following characteristics were compared between these 2 groups: sex composition; presence of chest pain, heart failure or shock at presentation; cardiac functional status; occurrence of various complications, and follow-up data. Males were less prominent in the older group: 229 patients (71.3%) in Group A, and 371 patients (88.1%) in Group B. At onset, the older patients presented with less chest pain (72% vs 86.5%) and more heart failure (35.2% vs 20.2%), but the occurrence of shock was similar (5.9% vs 4.5%, for Groups A and B, respectively). During hospitalization, more patients in Group A showed impaired cardiac function, as evidenced by a higher percentage of patients identified as in Killip class III or IV (35.4% vs 21.1%). Concerning complications, the older group showed a higher incidence of hypotension, low cardiac output, lung edema, frequent premature ventricular beats, atrial flutter and/or fibrillation, complete heart block and intraventricular conduction defects, but ventricular septal defects, ventricular tachycardia and ventricular fibrillation did not show any difference in occurrence. Life table analysis showed that the survival rate was significantly lower for Group A during the follow-up period of 5 years.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The clinical characteristics of acute myocardial infarction in aged patients. 167 3

Frequency of emergency calls for ambulance help to patients with acute myocardial infarction (MI) as well as a number of infarct complications and the influence of immediate professional help on survival of prehospital phase of acute MI is reviewed. The diagnosis of acute MI was based on a typical history of chest pain and electrocardiographic findings. Acute MI was also diagnosed in all cases of sudden cardiac death. Out of 3674 calls for ambulance help, MI was diagnosed in 379 patients what amounts for 10.1% of all interventions in life-threatening cases and for 61% of patients with acute MI in the analysed period of time. Complicated MI was observed in 61.7% of all patients, including 70.5% of men and 49.3% of women. Arrhythmic complications occurred in 54.5% of patients. Ventricular ectopic activity was the most frequent arrhythmia and amounted to 46.6%. The II0 or III0 atrioventricular block occurred in 4.5% of patients. Haemodynamic complications occurred in 12.3% of cases. Sudden cardiac death occurred in 23.6% of patients with acute MI, including 21.9% cases of ventricular fibrillation or flutter and 1.7% of asystole. 28.5% of those patients were successfully resuscitated. 61% of patients died in the prehospital phase of acute MI including 63.4% of males and 57.2% of females. Out of 61% of patients who died before admission to the hospital, 53% had died before ambulance team arrived and 7.9 died being under the care of the ambulance team. 80% of patients who survived prehospital phase of acute MI were admitted to the hospital within 60 min after the call for the ambulance.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Acute myocardial infarction. Analysis of the activities of the ambulance "R"]. 176 80

Independent trials of early administration of beta-blockers and thrombolytic agents have shown beneficial effects on both short- and long-term prognoses in acute myocardial infarction (AMI). The effects of a combination of the two strategies have not been thoroughly documented. Three hundred and fifty-two patients, of less than 75 years of age, with chest pain indicative of AMI, and onset less than 2 h and 45 min before first examination, were randomized to treatment with rt-PA or placebo. All patients without contraindication were given intravenous metoprolol 15 mg acutely and then 200 mg orally daily. Treatment was started either at the prehospital stage or in hospital. Thirty-seven per cent of patients had contraindications to beta-blockade, the most frequent of which were heart rate less than 60 beats min-1 and hypotension. The remaining 63% were given intravenous beta-blockade. No side-effects of metoprolol, alone or in combination with rt-PA, were observed during the prehospital phase. Overall, toleration of the treatment was good. Reduction in enzymatically estimated infarct size by rt-PA was more pronounced in patients who were also treated with metoprolol (41%, P less than 0.001) than in those with contraindications to beta-blockade (15%, NS). Patients who were also treated with metoprolol also had a lower incidence of Q-wave infarctions, congestive heart failure and ventricular fibrillation than those who were not given intravenous beta-blockade. In conclusion, toleration of intravenous administration of rt-PA and metoprolol was good, and this was also the case in the prehospital phase.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Early treatment with thrombolysis and beta-blockade in suspected acute myocardial infarction: results from the TEAHAT Study. 190 11

We report 2 fatal cases of angina pectoris in patients who complained primarily of headache during the ischemic attack. The first patient, who was hospitalized because of headache and chest pain, demonstrated repeated ST-segment elevation and fatal ventricular fibrillation on ambulatory ECG monitoring. The second patient had post-infarction angina preceded by headache and by ST-segment elevation in the precordial leads. She eventually died of reinfarction. The mechanism of the headache in relation to the angina pectoris is discussed.
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PMID:Headache angina with fatal outcome. 212 45

In the anistreplase, or anisoylated plasminogen streptokinase activator complex (APSAC) Intervention Mortality Study (AIMS), 1,258 patients with acute myocardial infarction were randomized in a parallel, double-blind, placebo-controlled mortality study in which they received either anistreplase or placebo, followed by anticoagulation therapy. Data on all adverse clinical events were recorded, regardless of their clinical significance or possible relation to therapy. There was a similar frequency of such events in both groups (anistreplase 80.4%, placebo 76.0%, difference not significant). Cardiovascular events included more reports of bradycardia, idioventricular rhythm, and hypotension in the anistreplase group, and a higher incidence of cardiac arrest, ventricular fibrillation, complete heart block, and pericarditis in the placebo group. Hemorrhagic events occurred in 13.8% of patients in the anistreplase group compared with 4.1% of patients in the placebo group. Most of these events consisted of bleeding or bruising around the puncture sites. There was a low incidence of allergic events after administration of both anistreplase and placebo. Thirteen cerebrovascular events (8 strokes and 5 transient ischemic episodes) were reported in the anistreplase group, compared with 5 in the placebo group (5 and 0, respectively). The mean systolic and diastolic pressures were significantly lower (by 5-10 mmHg) in patients in the anistreplase group during the first 24 hours after dosing. There were no significant differences in temperature and pulse rate between the two groups. The incidence of chest pain during the first 4- to 24-h period was lower in the anistreplase-treated patients than in the placebo group. The frequency of in-hospital reinfarction was higher in anistreplase-treated patients compared with patients given placebo.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The safety of anistreplase from the placebo-controlled AIMS study (anistreplase Intervention Mortality Study). The AIMS Study Group. 218 37

In a retrospective 6 year follow up data were obtained for 536 of 566 (95%) consecutive patients admitted to a coronary care unit with acute chest pain. Their diagnoses were acute myocardial infarction in 290 (54%), myocardial ischaemia in 164 (31%), pericarditis in 16 (3%), and non-cardiac in 66 (12%). Six year mortality was 36%, 24%, 0%, and 16% respectively. In patients with acute myocardial infarction a higher mortality rate during follow up was associated with a higher than average age, a higher than average creatine kinase, previous myocardial infarction, Q wave infarction, and the presence of reciprocal changes. The presence of reciprocal changes was associated with higher than average concentration of serum creatine kinase, indicating more extensive infarction. Infarction complicated by ventricular fibrillation or left bundle branch block was associated with a higher death rate. The electrocardiogram recorded at the time of acute myocardial infarction contains much useful prognostic information.
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PMID:Six year follow up of a consecutive series of patients presenting to the coronary care unit with acute chest pain: prognostic importance of the electrocardiogram. 227 53

One hundred and seventy-two consecutive cases of acute myocardial infarction (MI) admitted to a coronary care unit were studied with regard to ventricular arrhythmias--pre-mature ventricular contractions (PVC), ventricular tachycardia (VT) and ventricular fibrillation (VF). Sixty-seven (39%) patients had ventricular arrhythmias (PCC-VT-VF), of whom 17 (9.8%) had VT and 11 (6.4%) VF. VT and VF, but not total arrhythmias, were more common in anterior infarctions. Fifty-six out of 67 (83.5%) of these patients arrived at Accident & Emergency (A&E) within the first six hours of onset of chest pain. Ten out of 11 (91%) patients who had VF did so in the first six hours. PVCs were poor predictors of the occurrence of VF (positive predictive value 5.9%). Forty-three patients (84%) who had PVCs did not develop any further arrhythmias. Spontaneous heart rate had no influence on the occurrence of ventricular arrhythmias. Frequent PVCs were more commonly associated with progression to VT and VF. In 30 cases (88%) lignocaine was effective. There was no death due to VT/VF and all responded to drugs and/or cardioversion.
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PMID:The prevalence and outcome of ventricular arrhythmias in acute myocardial infarction. 236 79


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