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

Non-coronary ST-segment elevation during right sided chest pain has been described in subjects with episodes of ventricular fibrillation at rest. This syndrome has been attributed to functional phenomena or to structural myocardial changes. A personal case has features belonging to two categories: ST-segment elevation observed before, during and after episodes of arrhythmia was compared to 11 previously recorded ECG recordings. Right ventricular dysplasia was shown by electrocardiography, electrophysiology and echocardiography. In addition, ST-segment elevation is classified in 3 categories: triangular and dome-shaped are the most commonly observed forms during the arrhythmias: the third form with "saddle"-shaped appearances has not been previously described and would seem to be a minor equivalent observed during intercritical periods. This form is found in 30% of clinically documented cases of arrhythmogenic right ventricular dysplasia.
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PMID:[Right precordial leads and sudden death. Relation with arrhythmogenic right ventricular dysplasia]. 895 33

We examined Bortner scores for behavioral patterns and eight basic emotional dimensions named by Plutchik for patients with acute myocardial infarction who survived ventricular fibrillation and left ventricular failure. There were 70 patients, 48 men and 22 women ages 26 to 69 yr. (M = 54, SD = 8), admitted to the coronary care unit within 24 hours of the onset of a long-lasting chest pain. Six patients survived an episode of ventricular fibrillation that occurred within 24 to 48 hours after their admission. 15 patients developed left ventricular failure and were in Killip Classes II and III. Patients with acute myocardial infarction and left ventricular failure had mean Bortner scores significantly lower than others with acute myocardial infarction and were classed as Type B behavior. There was no difference in Bortner scores between patients with ventricular fibrillation and others with acute myocardial infarction. Patients with acute myocardial infarction and left ventricular failure scored significantly higher on Timid than others with acute myocardial infarction. Patients with acute myocardial infarction and ventricular fibrillation scored significantly lower on Depressed and higher on Distrust than other patients with acute myocardial infarction. Our findings suggest that patients with ventricular fibrillation and low scores on Depressed have good hospital prognosis. They are more critical and tend to reject people and ideas more than patients with acute myocardial infarction. This study suggests that the way in which patients with acute myocardial infarction react to their infarction, in terms of eight basic emotions and test patterns, is dependent on the complications of myocardial infarction.
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PMID:Bortner type A scores and eight basic emotions for survivors of ventricular fibrillation and left ventricular failure during acute myocardial infarction. 900 66

We report a case of sudden death due to variant angina during Holter electrocardiogram (ECG) monitoring. The patient, a 60-year-old man, had been aware of chest discomfort lasting less than one minute at midnight 2 days earlier. Because variant angina or arrhythmia was suspected, Holter ECG monitoring was performed. The patient spent a whole day without a recurrence of chest pain before going to bed, but at midnight he developed sudden chest pain, and died immediately after taking a sublingual tablet of isosorbide-dinitrite. Analysis of the Holter ECG revealed ventricular fibrillation after several ventricular premature beats following ST-segment elevation in both the CM5 and NASA leads. This case shows that sudden death from variant angina may occur within a few days after the first onset, and also highlights whether priority should be given to making a definite diagnosis or giving treatment when variant angina is strongly suspected.
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PMID:Sudden death during Holter electrocardiogram monitoring in a patient with variant angina. 903 Sep 96

The clinical case of a 45-year-old patient referred to us for chest pain and with clinical examination and ECG negative for ischaemic damage, is reported. The patient, hospitalised in a bed without an ECG monitor, presented heart failure due to ventricular fibrillation. He was re-examined first with ventilation and EMC and then with defibrillation. Reanimation continued for about 70 minutes. Administration of high doses of adrenalin (0.2 mg/kg) and 9 defibrillations failed to resolve the refractory VF; nor did i.v. lidocaine administration resolve the situation. Echocardiogram did not reveal cardiac tamponade. Administration of 4 g of magnesium sulphate followed by adrenalin and defibrillation, led to asystole with subsequent restoration of sinus rhythm. The patient was then transferred to Intensive Care where he was sedated and curarized for 48 hours. The clinical course was characterised from the start by positive aspects that excluded the need to carry out instrumental investigations such as evoked somatosensory potentials, in the formulation of a prognosis. The patient was transferred to the Hospital Cardiology Unit 72 hours after admission. Two weeks later the patient was discharged with a complete recovery of neurological functions and with no metabolic or thoracopulmonary changes. It can be concluded from this experience that prognosis during CPR may not be reliable. So the factors that should lead us to carry out prolonged reanimation are the age of the patient, his pre-existing clinical conditions, the speed of our actions and correct performance of reanimation.
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PMID:[Complete neurologic recovery after prolonged cardiac arrest caused by refractory ventricular fibrillation. Clinical case]. 907 13

We encountered a rare complication after Bentall's operation (Piehler's modification) with the left coronary artery occlusion. A 56-year-old man admitted to our hospital to get the aortic reconstruction operation for the chronic dissecting aortic aneurysm (DeBakey type I) with 7 cm in diameter. We performed Piehler's modification procedure using a 26 mm and 8 mm woven Dacron tubes coated with gelatin, and 23 mm prosthetic valve (St. Jude Medical). He got well after 6-day intubation until he complained anterior chest pain suddenly on 22 postoperative day. He showed ventricular fibrillation on the second attack requiring resuscitation procedures. Emergent angiogram showed total occlusion of the left coronary artery. The percutaneous transluminal coronary angioplasty was performed only with temporal success. Autopsy revealed no thrombus in the grafts and no kinking of the tubes. We might have to use more anticoagulants during the respirator assisted period when the APTT was naturally prolonged from 120 to 160 seconds.
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PMID:[A case report of sudden death after Bentall's operation (Piehler's modification) due to left coronary occlusion]. 922 64

Large numbers of patients referred for evaluation of chest pain are unable to perform adequate, diagnostic exercise testing. In these patients, dobutamine stress echocardiography (DSE) represents an alternative, exercise-independent stress modality. Apart from the approximately 5% of patients with an inadequate acoustic window, 10% of patients referred for this test have nondiagnostic (submaximal negative) test results. Serious side effects during or shortly after DSE are uncommon, with ventricular fibrillation or myocardial infarction occurring in approximately 1 of 2,000 studies. No deaths have been reported. On the basis of a total number of 2,246 patients, reported in 28 studies, the sensitivity, specificity and accuracy of the test for the detection of coronary artery disease (CAD) were 80%, 84% and 81%, respectively. Mean sensitivities for one-, two- and three-vessel disease were 74%, 86% and 92%, respectively. The sensitivity for detection of disease in the left circumflex coronary artery (55%) was lower, both compared with that for left anterior descending (72%) and right coronary artery disease (76%). The sensitivity of predicting multivessel disease by multiregion echocardiographic abnormalities varied widely, from 8% to 71%. In direct comparisons, DSE was superior to exercise electrocardiography and dipyridamole echocardiography and comparable to exercise echocardiography and radionuclide imaging. DSE is a useful, feasible and safe exercise-independent stress modality for assessing the presence, localization and extent of CAD.
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PMID:Methodology, feasibility, safety and diagnostic accuracy of dobutamine stress echocardiography. 928 14

We describe the case of a 71-year-old man with history of inferior wall myocardial infarction and abdominal aortic aneurysm surgically treated. The patient, admitted to hospital for chest pain, after 24 hours suddenly dead for ventricular fibrillation and cardiac arrest. Chest X Ray, echocardiogram and Computed Tomography had shown a very large paracardiac mass. At the autopsy, three large saccular aneurysms were found, one for each coronary artery and lumen completely filled with thrombi.
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PMID:[Multiple coronary aneurysms of an atherosclerotic nature in a patient with an abdominal aortic aneurysm: presentation of an anatomo-clinical case]. 938 Apr 24

The aim of this study was to describe mortality, mode of death and risk indicators for death during 5 years of follow-up among men and women coming to the emergency department with chest pain or other symptoms raising suspicion of acute myocardial infarction (AMI). During the 21 months of the study, all patients who came to the medical emergency department of one single hospital with chest pain or other symptoms suggestive of AMI were prospectively followed for 5 years. A total of 5362 patients came on 7157 occasions; men accounted for 55% of the admissions. The 5-year mortality rate was 25.6% for men compared with 25.7% for women. The women were older and had a higher prevalence of known congestive heart failure and hypertension, whereas the prevalence of previous myocardial infarction was higher in men. When correcting for dissimilarities in age and clinical history, male gender appeared as an independent predictor of death. In terms of mode of death men differed from women: more frequently dying at home, more frequently dying in association with ventricular fibrillation and less frequently dying in association with congestive heart failure. However, these differences were to some extent explained by differences in age. Independent risk indicators for death during 5 years of follow-up differed in men and women. It was concluded that in a consecutive series of patients with chest pain or other symptoms suggesting AMI in the emergency department, male gender was an independent risk indicator for death during a 5-year follow-up. This might be explained by a higher occurrence of coronary artery disease in men than in women in this patient population.
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PMID:Long-term prognosis in men and women coming to the emergency department with chest pain or other symptoms suggestive of acute myocardial infarction. 944 3

The aim of this study was to analyse the influence of patient characteristics on delay between onset of symptoms and hospital admission (patient delay) in acute myocardial infarction. A group of 6676 consecutive patients with AMI, admitted alive to 27 Danish hospitals from 1990 to 1992, were studied. Due to missing information on delay or in hospital acute myocardial infarction 698 patients were excluded. Mean patient delay was 9.1 hours, median delay 3.25 hours (5 to 95 percentiles: 0.67-40 hours). In multivariate logistic regression analysis patient delay was independently associated with male gender, increased age, diabetes mellitus, left ventricular systolic function (wall motion index), onset from midnight to 6 a.m., onset on a weekday, history of angina pectoris, chest pain as initial symptom, ventricular fibrillation or-tachycardia, Killip class > or = 3, presence of ST-elevation and ST-depressions. In conclusion, patient delay continues to be disappointingly long. This also applies to patients with a high risk of acute myocardial infarction (notably history of diabetes mellitus and angina pectoris).
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PMID:[Delay from start of symptoms to hospital admission among 5.978 patients with acute myocardial infarction]. 952 59

The ability of QT interval dispersion to predict the occurrence of ventricular fibrillation (VF) after acute myocardial infarction treated with thrombolytic therapy is controversial. Continuous 12-lead electrocardiographic (ECG) monitoring for 48 hours or longer provides an opportunity to detect transient changes of QT dispersion and correlate such changes with the clinical outcome. In 543 consecutive patients enrolled in the TAMI-9 and GUSTO I studies, serial changes of the QT dispersion were analyzed in an attempt to predict the occurrence of VF with a system that monitored continuously the 12-lead ECG and stored it at least every 20 minutes. Measurements of QT dispersion were made at a median time of 2.37 hours after the onset of chest pain and at 24- and 48-hour intervals. A total of 43 patients experienced VF during the acute phase of myocardial infarction; of these patients, 33 (77%) had anterior infarcts. However, despite the higher preponderance of anterior myocardial infarcts in the VF group, patients with anterior infarcts did not have longer QT dispersion than those with other infarct locations. Similarly, no significant differences in the QT dispersion were observed at any time between the group with VF and that without. Women had increased QT dispersion in the initial and 24-hour ECG as compared with men (P = .005). However, this normalized at the 48-hour measurements. Despite this difference, there was no higher incidence of VF in female patients. In conclusion, the data suggest that QT dispersion alone is not sufficient to explain the occurrence of VF in the acute phase of myocardial infarction after thrombolytic therapy.
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PMID:QT prolongation and dispersion in myocardial ischemia and infarction. 953 98


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