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)

In patients affected by high degree AV block without preexisting congestive heart failure there is no definite demonstration that DDD pacing gives real clinical advantages in respect to VVIR pacing. We performed an intrapatient, long-term study between the two pacing modes in 14 high degree AV block patients, using the Medtronic Synergyst 7027 dual chamber pacemaker, who could be programmed alternatively in DDD or VVIR mode. After a 4-week run-in period following the pacemaker implant, patients completed a randomized, double-blind, cross-over study to compare the effect of 6-week period VVIR and DDD pacing on symptoms and cardiovascular parameters. A semiquantitative score scale was used to quantify the symptoms of general well-being, palpitations, dizziness, pulsating sensation in the neck or abdomen, shortness of breath at rest and during effort, chest pain, and NYHA classification. The sum of symptom scores was 10.4 +/- 6.7 in VVIR period and 4.6 +/- 2.7 in DDD period (P less than 0.001); five patients (36%) crossed over early from VVIR to DDD because of intolerable symptoms; overall, eight patients preferred the DDD mode and no one preferred the VVIR. Cardiac output at rest (echo-Doppler method) was 4.7 +/- 1.4 versus 5.7 +/- 1.6 liter/min (P less than 0.01), body weight was 65.9 +/- 6.6 versus 64.9 +/- 6.1 kg (P less than 0.02), atrial natriuretic peptide was 236 +/- 112 versus 198 +/- 110 pg/mL (P less than 0.01), respectively, during VVIR and DDD modes. Effort tolerance was similar with the two modes of pacing (68 +/- 15 vs 70 +/- 18 watts/min).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Intrapatient comparison between chronic VVIR and DDD pacing in patients affected by high degree AV block without heart failure. 170 47

A within patient double blind prospective study of symptoms and exercise tolerance was designed to determine the preferred pacing mode in 10 patients with programmable dual chamber pacemakers who also had angina pectoris. Patients were randomly allocated to one month in each of the following modes: ventricular pacing at 70 beats/min (VVI) or atrioventricular synchronous upper rate 150 beats/min (DDD 150) or 100 beats/min (DDD 100). Medications were unchanged throughout the study; none was taking beta blockers. At the end of each month patients underwent an exercise test. During each month patients recorded symptoms and their preferred pacing mode. DDD 100 was the preferred mode (seven patients). There was significantly less chest pain with this mode than with either of the other modes. There were significantly more episodes of dizziness in VVI, and two patients who developed pacemaker syndrome were unable to complete the pacing period. Three patients developed angina during exercise testing in DDD 150. Atrial synchronous ventricular pacing is better than ventricular pacing for the control of symptoms in patients with angina pectoris provided that the upper atrial tracking rate is limited.
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PMID:Optimum pacing mode for patients with angina pectoris. 379 Mar 82

Optimal pacing in patients with paroxysmal atrial fibrillation/flutter following AV node ablation remains to be determined because VVIR pacing cannot restore AV synchronization and conventional DDD(R) pacing cannot properly cope with atrial tachyarrhythmias. The objective of the present investigation was to study the clinical outcome of 16 of these patients who received a new DDDR pacemaker with an automatic mode switch (Thera DR; Medtronic) immediately after AV node ablation. Arrhythmia-related symptoms before ablation were palpitations in 12, dizziness in 10, exercise intolerance in 8, and syncope in 6 patients. Pacing modes at hospital discharge were DDDR (n = 14) and DDD (n = 2) with an activated mode switch in all patients. After 1 month 12 patients were symptom free. Clinical events occurred in 4 patients (palpitations in 2, dizziness in 1, chest pain in 1, and fatigue in 1), which could be relieved in 3 patients. At discharge as well as at the 1-month follow-up, Holter ECG recorded a total of 12 episodes of atrial fibrillation in 5 patients, which were correctly detected by the pacemaker and followed by mode switching. At the 3-month follow-up (n = 14), 12 patients were symptom free and 2 continued to report symptoms which could not be resolved. All patients remained on an automatic mode switch in either the DDDR (n = 12) or DDD (n = 2) mode. There were no hints of inappropriate mode switching or reports of pacemaker syndrome, and there were no new symptoms related to automatic mode switching. The patients studied were highly symptomatic before implantation due to paroxysmal atrial fibrillation/flutter. After the first follow-up, 81% of the patients reported no symptoms. Paroxysmal atrial fibrillation/flutter combined with a high-degree AV-block seems no longer to be a contraindication for AV-synchronous pacing.
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PMID:DDD(R) pacing with automatic mode switch in patients with paroxysmal atrial fibrillation following AV nodal ablation. 919 25

Nonsurgical septal reduction has been proposed as a means of treating patients with hypertrophic cardiomyopathy whose symptoms of exercise limitation by chest pain or breathlessness are inadequately controlled with standard medical therapy (i.e., beta blockers, calcium antagonists, or even DDD pacing).
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PMID:Nonsurgical Treatment of Hypertrophic Cardiomyopathy. 1117 99

This report describes two cases of diffuse biphasic malignant mesothelioma with osseous differentiation and long survival. Two male patients aged 66 and 54 years presented with chest pain, bloody pleural effusions, and diffuse and nodular pleural thickening. They both had a history of prolonged asbestos exposure. Sarcomatoid and epithelioid areas were identified on histopathological examination. In addition, there were foci of ossification. Epithelioid tumor cells as well as benign osteoclasts within the ossification reacted positively for cytokeratin 5/6, whereas sarcomatoid areas were negative. Both patients survived 39 and 69 months, respectively. To our knowledge, these two cases with biphasic malignant mesothelioma and osseous differentiation with long survival are the first to be described from Central Anatolia.
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PMID:Biphasic malignant mesothelioma cases with osseous differentiation and long survival: a review of the literature. 1736 4

The aim of the study was to assess the situation with implantation of cardiac pacemakers and to critically evaluate the possibility of this method of treatment. The study was conducted from 2001 to 2007. Data on a total of 211 operations were included in the study. There were 121 (57.3%) male patients, mean age 69.7 years, and 90 (42.7%) female patients, mean age 74.5 years. Total number of operations increased from 18 in 2001 to 24 in 2002, 28 in 2003, 38 in 2004, 38 in 2005, 30 in 2006 and 35 in 2007. Primo implantation was carried out in 196 (92.9%) cases. The following types of pacemakers were used: VVI in 79 (40.3%), VVIR in 73 (37.2%), DDD in 7 (3.6%), DDDR in 18 (9.2%), VDD in 17 (8.7%) and AAIR in 2 (1.0%) cases. ECG indication was second degree heart block in 40, third degree heart block in 86, chronic atrial fibrillation with bradyarrhythmia in 57, sick sinus syndrome in 27 cases and trifascicular block in one case. The symptoms included dizziness in 126, syncope in 52, dyspnea in 45, bradycardia in 12, chest pain in 3 and cerebral dysfunction in 2 cases. In conclusion, our patients now receive appropriate treatment within a shorter time, thus reducing pressure upon large cardiac surgery centers. However, efforts should be continuously invested in approaching European standards of artificial pacemaker implantation.
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PMID:The first seven years of implantation of permanent cardiac pacemakers in a small urban community in central Croatia. 1938 70

Prinzmetal's angina is a distinct syndrome characterized by episodes of chest pain and transient ST-segment elevation caused by coronary vasospasm. This variant form of angina is sometimes associated with complete atrioventricular block and ventricular arrhythmias. We report here a case of variant angina with documented severe heart rhythm disturbances and syncope in a 66 year-old woman. Due to recurrent episodes of high-degree atrioventricular block, a DDD pacemaker was implanted. No further symptoms of angina or cardiac arrhythmias were detected on optimal therapy.
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PMID:Prinzmetal's variant angina associated with severe heart rhythm disturbances and syncope: a therapeutic dilemma. 1943 4

Venticular paced rhythm makes diagnosis of acute myocardial infarction difficult. We present a case of a 77-year-old woman with cardiac DDD pacemaker, suffering from diabetes, arterial hypertension and renal insufficiency. She was admitted to hospital due to heavy chest pain, radiated to neck and jaw and shortness of breath. The electrocardiogram recorded on admission showed ventricular paced rhythm and ST segment elevation > 0.5 mV, which fulfilled Sgarbossa's criteria for indetermined acute coronary syndrome in a patient with pacemaker. Troponin levels were not increased. Severe stenosis of left anterior descendent coronary artery was revealed in coronarography and percutaneus coronary angioplasty with stent implantation was performed immediately.
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PMID:[Undetermined type of acute coronary syndrome in a patient with a pacemaker]. 1952 44

Synovial sarcomas arising in unexpected locations may lead to diagnostic challenges. In this report, we describe 3 cases of synovial sarcoma that manifested clinically as primary pericardial lesions. All 3 cases occurred in men in their fourth decade. Fever, cough, chest pain, and chest distress were the most common symptoms. Histologically, 2 of the tumors were spindle cell monophasic, and 1 tumor was biphasic. By immunohistochemical studies, the tumor cells were positive for cytokeratins and epithelial membrane antigen. In addition, the tumor cells displayed focal immunoreactivity for calretinin, cytokeratin 5/6, and HBME-1, resulting in the initial interpretations of malignant mesotheliomas. None of the 3 cases were diagnosed correctly until subsequent molecular cytogenetic assays demonstrated the presence of SYT gene rearrangements. As there are overlapping morphologic features between pericardial synovial sarcoma and mesothelioma, molecular analysis is essential for differential diagnoses.
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PMID:Pericardial synovial sarcoma, a potential for misdiagnosis: clinicopathologic and molecular cytogenetic analysis of three cases with literature review. 2218 Apr 88

We present the case of a 46-year-old woman with episodes of chest pain with ST-T segment elevation and paroxysmal high-degree atrioventricular block and syncopal episodes. Coronary angiography revealed no significant atheromatous lesions. The patient was treated with nitrates and calcium channel blockers but syncopal episodes with atrioventricular block persisted. A DDD-R pacemaker was implanted and four-month follow-up was uneventful.
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PMID:[High-degree atrioventricular block induced by Prinzmetal angina]. 2233 70


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