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

The study was designed to assess the influences of antiarrhythmic therapy on exercise tolerance in patients with coronary artery disease and ventricular arrhythmias. Subjects for this study were subdivided into 3 groups: group I - 46 patients treated with amiodarone 1,200 mg daily during 10 days and 200-600 mg daily within next days, group II - 79 patients receiving disopyramide 300-600 mg daily, group III - 129 patients with combined administration of disopyramide 300-600 mg daily and propranolol 30-240 mg daily. propranolol 30-240 mg daily. Submaximal exercise stress testing was performed in each patient before treatment and after the medication for 4 weeks (group I) and for 2 weeks (groups II, III). The following parameters have been evaluated: maximal archived workload, maximal heart rate blood pressure response, double product (maximal heart rate x maximal systolic blood pressure), reasons for ending the test (target heart rate, typical angina, exhaustion, ST-segment depression greater than or equal to 2 mm, occurrence of ventricular arrhythmia, blood pressure greater than 250/120 mm Hg, significant drop in systolic pressure). Positive result of exercise ECG was defined: horizontal or down-sloping ST-segment depression greater than or equal to 1 mm and/or typical chest pain. The data from the first and second tests were estimated for significance of differences between the mean values with following results: 1) maximal achieved workload, 86 +/- 46 and 103 +/- 49 W (p less than 0.02) in group I; 101 +/- 64 and 106 +/- 50 W (NS) in group II; 107 +/- 55 and 119 +/- 54 W, W (p less than 0.01) in group III.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Effect of amiodarone and disopyramide on the results of electrocardiographic exercise stress testing in patients with coronary disease]. 208 70

Exercise test on cycle ergometer and coronary angiography were performed on 190 patients with chest pain. Volunteers with a normal thallium scintigraphy (n = 47) served as controls. The load started at 20 W and increased at a rate of 10 W min-1 until exhaustion or symptoms. Conventional 12-lead ECGs were recorded by means of computer before, during and after exercise. Minimum ST amplitude 60 ms after the STJ point (ST60) at end of work with a cut-off level of -1.10 mm had a sensitivity of 69% (52/75) and a specificity of 89% (37/42) when individuals with a normal resting ECG were considered. ST80 and sum of ST60 in left ventricular leads had slightly lower values of sensitivity and specificity. Changes in ST60 during exercise discriminated less well between the groups. Final heart rate during exercise (less than 148 min-1) had a sensitivity of 88% (53/60) and a specificity of 89% (42/47). The change in heart rate during exercise (less than 66 min-1) had a sensitivity of 50/60 (only patients without beta-blockers were considered). The best discrimination was obtained by defining a test score (TS) according to the linear equation TS = 2.95-0.23 x HRE-0.301 X ST60 where a positive value indicates a positive test and a negative value a negative test. Sensitivity and specificity were 21/23 (91%) and 40/42 (95%), respectively. The test score was also calculated in those patients having significant coronary disease and an abnormal resting ECG (no bundle branch block, no beta-blockers) and this yielded a sensitivity of 30/34.
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PMID:ST changes in relation to heart rate during bicycle exercise in patients with coronary artery disease. 208 84

Surveys of athletes, primarily runners, have shown that digestive disorders are common, associated both with training and racing. Women, in particular, seem to suffer most commonly. Nearly half have loose stools and nausea and vomiting occur frequently after hard runs. Diarrhoea, incontinence and rectal bleeding occur with surprising frequency. Runners may use medications prophylactically to minimise some of these symptoms. Upper digestive symptoms seem to occur more commonly in multisport events such as triathlons or enduro. The published literature is difficult to analyse and the basic intestinal physiology not well studied. Most gastroenterologists are accustomed to evaluating the fasting patient at rest and exercise physiologists are seldom experienced with digestive techniques. Digestive symptoms occurring with exercise referable to the oesophagus include chest pain, gastro-oesophageal reflux symptoms, or symptoms related to alterations in motility. While little is known of the oesophageal physiology during exercise, it is believed that only minimal changes occur in most subjects. Gastro-oesophageal reflux occurs more frequently with exercise than at rest and may produce symptoms of chest pain suggestive of ischaemic disease. Acid exposure may be reduced by pretreatment with histamine H2-receptor antagonists. Oesophageal symptoms, though common, are rarely disabling to the athlete, and the clinical importance lies in confusion with ischaemic disease. Cases of acute gastric stasis following running have been reported and gastric physiology during exercise, particularly bicycling, has been more actively investigated. Gastric emptying during exercise is subject to a number of factors including calorie count, meal osmolality, meal temperature and exercise conditions. However, it is generally accepted that light exercise accelerates liquid emptying, vigorous exercise delays solid emptying and has little effect upon liquid emptying until near exhaustion. Gastric acid secretion probably changes little with exercise although some have postulated that ulcer patients may increase secretion with exercise. Some exercise-associated digestive symptoms, such as diarrhoea and abdominal pain, have been attributed to changes in intestine function. Small bowel transit is delayed by exercise when measured by breath hydrogen oral caecal transit times and motility may be reduced as well. Intestinal absorption during exercise has not been well evaluated but probably changes little in ordinary circumstances. Passive absorption of water, electrolytes and xylose are not affected by submaximal effort. Colonic transit and function is even more difficult to evaluate and published results have been conflicting. However, it is likely that many of the lower digestive complaints of runners such as diarrhoea and lower abdominal cramps are due to direct effects of exercise upon the colon.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The effect of exercise on the gastrointestinal tract. 218 30

Simple cardiopulmonary functions were studied serially in 26 mountaineers between sea level and an altitude of 25,200 ft. Up to 12,000 ft there was no altitude sickness, though there were complaints of leech bite (26.9%) and blisters (3.8%). One member died of exhaustion, two developed pulmonary oedema, one "flu" (at 15,600 ft) and one pleural rub (at 21,000 ft). Up to 16,000 ft altitude, 4 to 7.7% developed diarrhoea or epistaxis only, but at higher levels 25 to 50% subjects developed several symptoms, besides excessive dyspnea. These included diarrhoea (35-60%), vomiting (30%) abdominal pain (35-60%), rectal bleeding (15%), chest pain (10-40%), dry cough (40-60%), giddiness (30%) and poor memory (7.7%). A small rise in blood pressure was seen (for systolic at lower and diastolic at greater altitudes). After 18,200 ft the steady increase seen in VE slowed and the rise in heart rate and respiratory rate (f) became steeper. After a small rise at 7,800 ft, FVC and FEV1 showed a gradual decline at higher altitudes. After a large initial increase in PEFR up to 12,000 ft, a gradual decline was seen. The mean weight loss during the expedition was 8 +/- 2.7 kg. These changes seem to be due to an incomplete acclimatisation, which future mountaineering teams should take into consideration to avoid health problems and improve performance.
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PMID:Cardiopulmonary functional changes in acute acclimatisation to high altitude in mountaineers. 225 31

Personality and life events were measured in 69 consecutive patients (36 men and 33 women) below age 40 attending the emergency care unit because of chest pain without obvious organic cause (91% participation rate). The results were compared with 32 randomly sampled healthy subjects matched with regard to age and sex (86% participation rate). The patient group had significantly higher scores for "neuroticism', 'Type A behaviour' and 'vital exhaustion'. Further more the patients had experienced significantly more life events, in particular uncontrollable ones, during the last year. We conclude that 'Type A behaviour', 'neuroticism', 'vital exhaustion' and critical recent life events are linked with emergency consultation for chest pain of non-cardiac origin. Possible explanations of the link between the psychological reaction and the chest pain are enhanced tension in the thoracic muscles producing chest pain and oesophageal disorders. This study stresses the importance of careful medical and psychosocial examination of each case of unexplained chest pain at the emergency care unit.
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PMID:Acute chest pain without obvious organic cause before age 40--personality and recent life events. 358 23

In a double-blind, randomized, placebo controlled trial 74 patients surviving a myocardial infarction (MI) were stress tested three and twelve months following MI. Thirty-eight patients received the beta blocking agent timolol and 36 patients received placebo. There was no significant difference in the mean total exercise capacity of the two groups. Most of the patients treated with timolol discontinued the exercise test because of exhaustion, but the placebo treated patients usually stopped the test because of chest pain, exhaustion or a fall in blood pressure. Patients treated with timolol had significantly less increase in heart rate, systolic blood pressure and rate-pressure product during exercise compared to placebo. We conclude that beta-blockade with timolol after MI does not affect work capacity, but timolol-treated patients perform the same work with a lower rate-pressure product.
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PMID:Long-term effect of beta-blockade with timolol on maximal work capacity following myocardial infarction. 636 Jun 89

A 33-year-old man with heat exhaustion was admitted to our hospital suffering from severe chest pain. Serum creatine kinase elevation and new Q waves revealed myocardial infarction of the inferior wall. Technetium-99m-pyrophosphate suggested diffuse myocardial damage, although the left ventricular function was normal by echocardiography. This case highlights the importance of early recognition of heat stroke and heat exhaustion, as they are associated with widespread tissue injury.
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PMID:Acute myocardial infarction in a young man after heat exhaustion. 772 9

Patients with chest pain and normal epicardial coronary arteries are characterized by an impairment of myocardial perfusion reserve. Functional and morphological abnormalities of the intramyocardial arterioles are suggested to be responsible for this, possibly as a consequence of hypertension and/or left ventricular hypertrophy. In an attempt to isolate predisposing factors of microvascular angina we investigated 34 patients (15 f, 19 m) with a mean age of 53 +/- 7 years. They were diagnosed as microvascular angina without hypertension or left ventricular hypertrophy. Parameters such as plasma insulin, glucose, cholesterol, LDL-cholesterol, triglycerides, (VLDL-cholesterol) and fibrinogen were determined for a metabolic profile. Furthermore, insulin and glucose were measured after an oral glucose load of 100 g glucose (OGTT) over 3 h. All parameters were compared to a control group of 15 healthy people matched for age and body mass index. In the study population systolic blood pressure was within normal limits at 137 +/- 17 mm Hg and thus higher than control at 124 +/- 11 mm Hg (p < 0.02). Furthermore, diastolic blood pressure was 85 +/- 7 mm Hg compared to 78 +/- 9 mm Hg in controls (p < 0.02). Insulin was significantly elevated in patients with microvascular angina 90 min (median: 101 vs 54 microU/ml; p < 0.01) and 120 min (median: 88 vs 51 microU/ml; p < 0.05) after ingestion of 100 g glucose. The fasting glucose was elevated at 98 +/- 12 compared to 87 +/- 7 mg/dl in controls (p < 0.01). Glucose concentration was also elevated after 30 min at 176 +/- 28 compared to 148 +/- 32 mg/dl (p < 0.02), after 45 minutes (198 +/- 35 compared to 152 +/- 53 mg/dl) (p < 0.01) and 60 minutes (193 +/- 44 compared to 145 +/- 54 mg/dl) (p < 0.01). In microvascular angina parameters such as total cholesterol: (244 +/- 46 vs 199 +/- 29 mg/dl (p < 0.01)), LDL-cholesterol (157 +/- 41 vs 122 +/- 18 mg/dl (p < 0.01)) and fibrinogen: (377 +/- 150 vs to 285 +/- 69 mg/dl (p < 0.03)) were elevated. These findings suggest a pathogenetic role of insulin resistance, hyperlipoproteinemia and elevated levels of fibrinogen for impaired myocardial coronary reserve. This metabolic constellation as well as exhaustion of coronary reserve is often found in hypertensive patients and may identify microvascular angina as an early stage of hypertensive heart disease before manifest hypertension has developed.
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PMID:[The significance of insulin resistance and hyperlipidemia in microvascular angina (syndrome X)]. 773 10

We assessed the effects of L-arginine (an endogenous precursor of nitric oxide) on the magnitude of exercise-induced QT dispersion in patients with coronary artery disease. The study had a randomized double-blind cross-over design. Twenty-five patients with stable coronary artery disease underwent two separate exercise tests: after oral administration of L-arginine (6 g/24 h for 3 days) or placebo. Indications for cessation of exercise included: pulse limit, exhaustion, chest pain, ST segment depression >2 mm. We found that arginine significantly increased exercise duration from 604+/-146 to 647+/-159 s (P<0.03). However, it had no effect on the sum of exercise-induced ST segment depressions (1.9+/-2.3 and 2.4+/-3.3 on and off arginine, respectively, NS). Exercise shortened QT interval to a similar extent in patients treated with placebo or arginine. QT dispersion changed during exercise from 55+/-21 to 60+/-19 ms (NS) and from 60+/-21 to 53+/-17 ms (NS), respectively. We conclude that, in patients with coronary artery disease, oral supplementation of L-arginine does not affect exercise-induced changes in QT interval duration, QT dispersion or the magnitude of ST segment depression. However, it significantly increases exercise tolerance, most likely due to improved peripheral vasomotion. These results may be of clinical and therapeutic importance.
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PMID:Effects of oral L-arginine supplementation on exercise-induced QT dispersion and exercise tolerance in stable angina pectoris. 1107 35

The purpose of this descriptive study was to explore the experiences of women with cardiac disease in regard to cardiac risk factors, symptoms, and symptom interpretation. Interviews with a convenience sample of 21 African American and Caucasian female patients, aged 40-81 years with cardiac diagnoses, were taped and transcribed. Three advanced practice nurses with experience in cardiovascular nursing were interviewed individually for background. Analyses of symptoms indicated that women experienced a range of prodromal symptoms other than chest pain prior to hospitalization such as: edema, shortness of breath, lightheadedness, dry cough, and exhaustion. Atypical symptoms delayed recognition of a cardiac problem for some women. The lack of symptom consistency underscores the need for thorough assessment and screening of women at risk for cardiac problems. Advanced practice nurses are aware of current cardiac disease research in women but they must continue to be vigilant for atypical symptoms.
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PMID:Symptom reflections of women with cardiac disease and advanced practice nurses: a descriptive study. 1273 99


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