Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0008031 (chest pain)
 17,248 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The association of idiopathic hypertrophic subaortic stenosis (IHSS) with significant coronary atherosclerosis is little known, only 43 cases being available in the literature, 2 of which are personal ones. But the incidence of this association has certainly been underestimated. It is especially found from the sixth decade onwards, and at least 20% of patients with IHSS in and above the age group have stenosing lesions of the coronary artery. It is almost impossible to establish the presence of associated coronary abnormalities from the clinical features of from electrocardiogram. It does however seem worthwhile looking for this condition in IHSS when there is refractory chest pain, especially to beta-blockers, particularly if the patient is aged over 50 and has risk factors for ischaemic heart disease. It is also good to find IHSS associated with known coronary artery disease by using simple non-invasive techniques such as phonomechanocardiography and especially echo-cardiography; it is important not to miss the myocardial lesion and to treat concurrently if there is likely to be an indication for dealing with the coronary arteries surgically. The beta-blockers are the treatment of choice for both conditions, together with anticoagulents. If they fail, myectomy or myotomy together with aorto-coronary bypass graft should be considered.
Arch Mal Coeur Vaiss 1978 Sep
PMID:[Obstructive cardiomyopathy and associated coronary atherosclerosis. Review of the literature and report of 2 personal cases]. 10 92

The unusual occurrence of situs inversus totalis, ventricular septal defect, hypertrophic subaortic and subpulmonic stenosis, and single coronary artery in a 38-year-old man is presented. The clinical course was remarkably mild, as documented by data from 23 years of study including four cardiac catheterizations. At age 35 years, however, syncope, chest pain, and marked elevation of right ventricular pressure prompted complete surgical repair of the left and right ventricular outflow tract obstructions and closure of the septal defect. Three years after surgery the patient continues to lead an active life without symptoms. The unusually mild course can be attributed to the natural banding effects of the subpulmonic stenosis which prevented irreversible pulmonary hypertension.
Chest 1976 Sep
PMID:Situs inversus, subaortic and subpulmonic stenosis, ventricular septal defect, and single coronary artery. 13 89

Thirteen patients with idiopathic hypertrophic subaortic stenosis were compared with two groups of subjects: 10 patients with chest pain, normal coronary arteries and a normal left ventricle, and 10 patients with left ventricular hypertrophy. Five of the latter had aortic stenosis and five had idiopathic left ventricular hypertrophy. Coronary arteriography revealed that the septal branches of the left anterior descending artery closed or narrowed during systole in patients with idiopathic hypertrophic subaortic stenosis and did not do so in the other patient groups. This narrowing is possibly related to an abnormal position of the septal arteries within the septum in idiopathic hypertrophic subaortic stenosis. Systolic compression of the septal perforator arteries is not a pathognomonic sign of idiopathic hypertrophic subaortic stenosis.
Am J Cardiol 1977 Sep
PMID:Septal perforator compression (narrowing) in idiopathic hypertrophic subaortic stenosis. 14 7

Forty-three patients (mean age 62 +/- 1 years) were treated for ventricular septal defect (VSD) secondary to myocardial infarction. Whenever possible, operation was postponed until six weeks post-onset chest pain. However, hemodynamic instability, evidenced by cardiogenic shock, refractory pulmonary edema, or a rising blood urea nitrogen (BUN) forced operation in 21 patients within 21 days post-infarct (Group I). In seven patients operation was performed three to six weeks post-infarct (Group II). In only eight patients could operation be delayed beyond six weeks post-infarct (Group III). Clinical deterioration, once begun, progressed rapidly, and could be reversed only temporarily by intra-aortic balloon pumping, used in 26 patients for safe conduct of cardiac catheterization and for peri-operative hemodynamic support. Hospital survival was achieved in 24 of the 36 operated patients (66%). In Group I patients, ten of 21 survived. In Group II, six of seven survived. In Group III, eight of eight patients survived. There have been five late deaths with a mean follow-up of 41 months in survivors. Improved survival has been achieved recently by the greater use of prosthetic material to replace necrotic muscle and by a transinfarct incision regardless of infarct location. Operative mortality before 1973 was 47%; mortality after 1973 was only 18%, with a concomitant reduction of mortality (30%) even in Group I patients.
Ann Surg 1977 Sep
PMID:Surgery for post-myocardial infarct ventricular septal defect. 30 10

The clinical effects of a new cardioselective beta-adrenergic blocking drug, acebutolol hydrochloride (SECTRAL), were studied in 18 patients with angina pectoris, using graded treadmill testing according to a modified Bruce protocol. Measurements were made in the control state, after two weeks' treatment with placebo and after two more weeks of constant oral dose of the drug. Acebutolol produced a significant increase in the treadmill work performed before the onset of ischemic ECG changes and chest pain. The heart rate and blood pressure responses to exercise were depressed, so that the greater work load was achieved at a lower double product. Graded treadmill testing is a useful method for assessing the efficacy of treatment with a beta-blocking drug.
Isr J Med Sci 1978 Sep
PMID:Acebutolol in angina pectoris: objective assessment using graded treadmill testing. 36 42

To assess the clinical usefulness of radionuclide-determined changes in pulmonary blood volume in patients with or without substantial coronary-artery disease, we determined the ratio of pulmonary blood volume at rest as compared with that during exercise. We used multigated blood-pool images obtained at rest and during supine exercise to determine the blood-volume ratio in patients subsequently undergoing coronary arteriography for evaluation of chest pain. Exercise tests were performed by use of a submaximal-workload protocol, although all tests were limited according to each patient's symptoms. The mean exercise/rest pulmonary-blood-volume ratios were lower for persons without coronary-artery disease (0.94 +/- 0.06 [S.D.], 10 patients) and for those with disease confined to the right coronary artery (0.99 +/- 0.12, five patients), as compared with all others with coronary-artery disease (1.14 +/- 0.15, 37 patients) (P less than 0.01). A pulmonary-blood-volume ratio equal to or greater than 1.06 had a sensitivity of 79 per cent. Patients with coronary-artery disease not confined to the right coronary artery usually show an increase in pulmonary blood volume during supine exercise. No such change occurs in persons without coronary-artery disease.
N Engl J Med 1979 Sep 13
PMID:Radionuclide-determined change in pulmonary blood volume with exercise. Improved sensitivity of multigated blood-pool scanning in detecting coronary-artery disease. 38 22

Coronary artery spasm is an important pathogenetic mechanism in some forms of myocardial ischemic disease. Factors that may be important in the genesis of spasm include the autonomic nervous system, prostaglandins, endoperoxides, thromboxanes, and the calcium availability to the contractile apparatus. Spasm results in myocardial ischemia with attendant chest pain and electrocardiographic and hemodynamic changes; it is the primary pathogenetic mechanism in Prinzmetal's variant angina and has been found in association with classic angina pectoris and acute myocardial infarction. Diagnosis of coronary artery spasm is firmly made only by coronary angiography. Treatment includes the use of both short- and long-acting nitrates and the slow-channel blocking agents such as verapamil, nifedipine, and perhexiline.
Ann Intern Med 1979 Sep
PMID:Coronary artery spasm. 38 40

The effects of subcutaneous pentagastrin (6 microgram/kg) on esophageal motility were recorded in patients with achalasia, in patients with idiopathic diffuse esophageal spasm (IDES), and in healthy subjects. In achalasia and IDES, pentagastrin produced an increase in mean lower esophageal sphincter pressure, amplitude of contractions, esophageal pressure, and repetitive wave activity. Also, chest pain or dysphagia occurred after pentagastrin administration in 4 of 9 patients with IDES and in 7 of 12 patients with achalasia. After comparing these observations with those of healthy subjects, we tested the potential for pentagastrin-induced motility changes to improve our ability to diagnose IDES. This was done by administering pentagastrin to 22 patients with clinically "suspected" esophageal motor disease but in whom routine radiologic and manometric studies were nondiagnostic. In none of the 22 did symptoms or manometric changes develop to help establish the diagnosis of IDES. This was true despite additional studies in 10 patients that failed to provide an alternative to IDES as the diagnosis. These results do not support the use of pentagastrin as a provocative test for IDES.
Gastroenterology 1979 Sep
PMID:The effects of pentagastrin in achalasia and diffuse esophageal spasm. 45 41

Esophageal manometric tracings obtained using low-compliance pneumohydraulic infusion systems were reviewed from patients with symptoms of chest pain and/or dysphagia. Using this sytem, we report on 7 symptomatic patients with markedly increased esophageal peristaltic amplitude. Maximal peristaltic amplitude for these 7 patients (225-430 mmHg) was greater than for normals (75-175 mmHg). Mean peristaltic amplitude for the 7 was 170 mmHg, which was greater than for normals (81 +/- 30 mmHg, mean +/- 2 SD). This finding is believed to reflect the sensitivity of currently available manometric systems. It may be possible with these techniques to define more clearly the bulk of presumed esophageal dysfunction, which is at present poorly characterized. The relationship of clinical symptoms to abnormal esophageal motility is often less than optimal and may result from an inability to define "normal" or from inadequacies of currently available techniques. Our observations of a subset of symptomatic patients having peristaltic contractions with amplitudes exceeding the normal range seem to characterize one form of esophageal motility defect. This abnormality was seen more frequently than diffuse esophageal spasm in our laboratory.
Gastroenterology 1979 Sep
PMID:High amplitude, peristaltic esophageal contractions associated with chest pain and/or dysphagia. 45 42

Mycoplasmal pneumonia, tularemic pneumonia, Q fever pneumonia, psittacosis, and Legionnaires' disease are the most frequently encountered treatable atypical pneumonias. Mycoplasmal pneumonia, the most common, is often accompanied by nonexudative pharyngitis, conjunctivitis, or otitis. The nonproductive cough is characteristic. Tularemic pneumonia is characterized by substernal chest pain, bloody pleural effusion, and bilateral hilar adenopathy. Although the clinical presentation is mild, roentgenographic findings are impressive. Q fever pneumonia resembles psittacosis but is less serious; it may be accompanied by subacute bacterial endocarditis, hepatitis, or both. Psittacosis is characterized by prominent headache, bloody sputum, and relative bradycardia. Tetracycline is the drug of choice for either. In Legionnaires' disease, pneumonia is accompanied by prominent extrapulmonary symptoms. The most important diagnostic clues include diarrhea and mental confusion. Relative bradycardia and laboratory abnormalities are also helpful. Erythromycin is the drug of choice unless doubt exists as to the diagnosis.
Postgrad Med 1979 Sep
PMID:The atypical pneumonias: a diagnostic and therapeutic approach. 47 55


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