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

The present article examines the relations among self-reported and physician-estimated chest pain variables to angiographically determined coronary stenosis (CAD) and neuroticism scores. Six of the 48 chest pain variables were significantly related to coronary stenosis, but only one variable, chest pain elicited by walking, was positively related to stenosis. Chest pain during sleep, sighing and dizziness accompanying chest pain, right lower chest pain radiation, and infrequent rest to cope with the chest pain were significantly negatively related to stenosis. Neuroticism scores (N) were not significantly related to CAD but were significantly correlated with 13 of the 48 chest pain variables. In addition to correlating positively with the chest pain variables that were negatively correlated with CAD, N scores were significantly related to higher pain severity ratings, being angry, annoyed, tense, afraid, worried, and upset before the chest pain, breathlessness during the pain episode, and pain sensations described as stabbing. The six chest pain variables significantly correlated with CAD yielded a multiple correlation of 0.58, accounting for 34% of the variance, whereas N scores accounted for only 5% of the variance; however, N contributed less than 1% unique variation to stenosis in combination with the six chest-pain variables. That N influences chest pain reports more than actual stenosis is further confirmed by the results of physicians' ratings of their patients' typical chest pain episodes. Recognition of patients' characteristic levels of distress or neuroticism may aid physicians in evaluating symptoms more accurately and in treating their chest pains more appropriately.
 ...
PMID:The relation of chest pain symptoms to angiographic findings of coronary artery stenosis and neuroticism. 400 Dec 86

As we learn more about CAD, its presentation, clinical characteristics, and "natural" history, we have begun to realize the enormous variability of the "natural" history of this disease, depending on clinical, electrocardiographic, stress-testing, arteriographic, and ventricular function data. Therefore, it seems likely that we may not be able to be certain that CBS prolongs life in any subgroup of patients with CAD without a prospective randomized study that is properly designed and rigorously conducted. However, it has to be acknowledged that for practical purposes this goal may be extremely difficult to achieve. Left ventricular function and the number of diseased vessels are the most powerful predictors and determinants of survival. Age, functional class, type of angina, ECG, and heart size are other major determinants of survival. Progressive chest pain is a powerful predictor of total cardiac events, particularly of nonfatal myocardial infarction in patients with one- and two-vessel disease and of cardiac deaths in patients with three-vessel disease and LMCAD.
 ...
PMID:What is the role of coronary bypass surgery in patients with chronic angina? 633 72

Using digital subtraction angiography, left ventriculograms were obtained with 10 ml of iodinated contrast material in 21 patients both at rest and during atrial pacing. In 15 patients with significant coronary artery lesions (CAD) (greater than 50% diameter narrowing in at least 1 major artery), ejection fraction decreased during atrial pacing from a mean of 62 +/- 14% to 51 +/- 15% (p less than 0.001). In 14 (93%) of 15 patients, ejection fraction decreased or was unchanged during pacing. In 6 patients with chest pain but normal coronary arteries, ejection fraction increased from a mean of 66 +/- 9% at rest to 72 +/- 6% during atrial pacing (p less than 0.01). Ejection fraction increased by greater than or equal to 5% during pacing in 5 of 6 patients with normal coronary arteries. Patients with CAD also had an abnormal response in end-systolic volume during atrial pacing (50 +/- 31 ml at rest versus 47 +/- 24 ml during pacing) compared with patients with normal coronary arteries (46 +/- 16 ml at rest versus 26 +/- 9 ml during pacing; p less than 0.01). The digital ventriculograms demonstrated new or increased wall motion abnormalities during atrial pacing in 4 of 5 patients with CAD who had wall motion abnormalities at rest and in 8 of 10 patients with CAD who had normal wall motion at rest. Moreover, these wall motion abnormalities occurred in myocardial wall segments that were supplied by coronary arteries with significant lesions. Thus, because digital subtraction angiography allows multiple left ventriculograms to be obtained during routine cardiac catheterization, intervention studies such as atrial pacing can be used to obtain a functional assessment of the severity of coronary arterial lesions.
 ...
PMID:Digital angiography in assessment of ventricular function and wall motion during pacing in patients with coronary artery disease. 633 87

It is obvious that the indication and clinical applications of radionuclide stress testing have been expanded and that both techniques described in this article are useful for diagnostic and prognostic purposes. The sensitivity and specificity of noninvasive stress testing have been significantly enhanced by the introduction of these radionuclide approaches for detecting ischemia in patients with undiagnosed chest pain. As mentioned previously, these tests should be ordered with a sound understanding of the principle of Bayes' theorem and of probability analysis. High-risk patients with either stable CAD or recent myocardial infarction can be identified by the severity of the abnormal response elicited. Patients with multiple thallium defects, particularly of the redistribution type, appear to be at the highest risk for subsequent cardiac events. Similarly, patients with a greater than 10 per cent fall in ejection fraction with development of multiple wall motion abnormalities and an increase in end-systolic volume seem to be in a high risk subset. Further developments with single photon emission tomography and computer quantitation of thallium or ventriculographic images should make these tests even more reliable in obtaining useful information in patients with CAD.
 ...
PMID:Radionuclide exercise testing for coronary artery disease. 639 69

We studied 42 consecutive patients with coronary artery spasm (CS) who where treated with the Ca2+ entry blocker diltiazem for a mean period of 11 months (range 2-29 months). Patient population consisted of 26 females (age X = 52.1) and 16 males (age X = 59.1). ALl patients had diagnosis of CS confirmed by coronary arteriography (CA) with no patient having 70 per cent CAD. CS was equally distributed between LAD and RCA. 81 per cent of patients were cigarette smokers, 55 per cent had Raynaud's phenomenon, and 9 per cent had a history of migraine, 2 patients had previous MI, 2 previous bypass surgery (CABS), 1 previous angioplasty, 3 syncope with heartblock requiring pacemaker, and 2 with sudden death (VF-resuscitated). All patients were placed on diltiazem 240 or 360 mg/day to achieve pain free state. During follow-up there was no mortality. 2 patients hd uncomplicated inferior MI's. 1 patient had CABS for progressive 90 per cent LAD lesion, and 2 required hospitalization for dose adjustment due to frequent chest pain. No patient has drug-related side effects. Thus, long-term follow-up of patients with CS treated with diltiazem revealed no mortality, low morbidity (12 per cent) and no adverse drug side effects.
 ...
PMID:The short and long-term efficacy of diltiazem for the treatment of variant angina pectoris. 640 38

We obtained myocardial imaging with Tl during pharmacologic interventions. Dipyridamole-loading myocardial imaging was performed in 38 patients with CAD. The diagnostic accuracy of this method was 66%. The combination of dipyridamole-loading and exercise stress myocardial imaging increased the diagnostic sensitivity of CAD from 71% (exercise stress imaging only) to 87%. In addition, dipyridamole-loading myocardial imaging was useful for the diagnosis of CAD in patients who could not perform exercise stress test. Chest pain and ST-segment depression were induced less often during dipyridamole administration than exercise stress test. Animal experiments showed that dipyridamole caused abnormalities in myocardial blood flow and myocardial Tl uptake distal to the critical coronary stenosis. And dipyridamole increased myocardial blood flow by 142% and myocardial Tl concentration by 62% in the normally perfused myocardial segments. Ergonovine-loading myocardial imaging was performed in 8 patients with resting angina and without significant coronary stenosis. And in all of them, ergonovine induced cold-spots on myocardial imaging with or without chest pain and ST-segment shift. Ergonovine-loading myocardial imaging was useful for the diagnosis of angina induced by coronary artery spasm. The combination of initial and delayed resting myocardial imaging was useful to differentiate the underperfused but viable myocardium from the scar. And by comparing with radionuclide angiography obtained before and after NTG administration, NTG-loading myocardial imaging and ECG findings in 20 patients with CAD, we demonstrated that the transient defective myocardial segments were underperfused but viable.
 ...
PMID:Noninvasive detection of coronary artery disease by myocardial imaging with thallium-201--the significance of pharmacologic interventions. 677 29

We used the cold pressor test as provocative of myocardial ischemia in 23 subjects evaluated for chest pain on effort. Seven of them (group N) had normal coronary arteries, and 16 (group CAD) had critical stenoses along the main branches of the left coronary artery. In both groups exposure to cold induced increase in arterial pressure and double product. Left ventricular end-diastolic pressure increased +60% from baseline (P less than 0.001). Angiocardiographic parameters, unchanged in group N, showed an impairment of left ventricular function in group CAD. End-diastolic volume increased +11% (P less than 0.01), ejection fraction decreased -8% (P less than 0.0025), with a significant reduction in segmental wall motion in the area of the diseased artery (P less than 0.001). The mean Vcf was slightly and not significantly reduced, while early-systolic and end-diastolic stress and the constant of stiffness consistently increased in both groups. The appearance or extension of ventricular wall contraction abnormalities in group CAD, in the absence of demonstrable coronary spasm and in the presence of a remarkable increase in left ventricular end-diastolic pressure and stress, was interpreted as due to ischemia secondary to increased extravascular resistances to coronary flow. The cold pressor test is proposed as a useful tool for the diagnosis and evaluation of patients with ischemic heart disease.
 ...
PMID:Effects of the cold pressor test on the left ventricular function of patients with coronary artery disease. 687 44

Visualization of the lumen of the coronary arteries by angiography has greatly expanded the ability of the physician to evaluate the extent of disease in patients suspected of having an ischaemic cardiac disorder. Criteria for coronary angiography have been developed in part by reviewing the experience in the Coronary Artery Surgery Study, CASS. During a five year period at 15 participating sites 24959 consecutive patients undergoing angiography for suspicion of coronary artery disease were enrolled. Chest pain was the dominant symptom in more than 80%. Unstable angina occurred in more than 1/3 of patients classified as definite or probably angina pectoris. The majority of patients were in Canadian Class 2,3. In a study previous reported by CASS a mortality of 002 and a morbidity (myocardial infarction) of 003 was found; presence of left main disease increased mortality 6.8 times. In males, 79% had significant and 12% no CAD; left main disease occurred in 9%. In females 45% had significant and 40% no CAD; left main disease occurred in 4%. The distribution of 1,2 and 3 vessel disease will be presented. From these data and a survey of clinical experience during the past several years, 10 indications for visualization of the coronary artery anatomy by angiography have been developed. These indications are presented for discussion.
 ...
PMID:[Indications for coronary arteriography]. 706 86

A clinical evaluation of the dipyridamole in the myocardial perfusional scintigraphy (MPS) was carried out in a series of patients, comprehensive of cases of unstable angina, aiming to assess the feasibility and diagnostic validity of the test and to state its possible role in comparison with exercise stress test. On the whole, 107 subjects were examined (34 with stable angina, 23 with unstable angina, 19 with recent myocardial infarction, 15 with atypical angina, 10 with chest pain of uncertain origin and 6 healthy volunteers), performing 108 scintigraphic studies (48 after dipyridamole infusion and 37 after bicycle exercise). In the studies with physical or pharmacologic stress a redistribution scintigraphy was also performed (4 hour after the injection). The dipyridamole stress test was well tolerated by patients with unstable angina too and showed a diagnostic sensitivity equivalent to that with exercise stress, although the latter appears better as regards image quality and can give an increase of sensitivity provided electrocardiographic findings are evaluated. Post-stress redistribution of 201 Tl in delayed scans was shown either after dipyridamole or after exercise in patients with typical angina without prior infarction. The computation, by the Bayes's theorem, of the predictive value of the two tests leads the Authors to the following conclusions: in atypical angina (prevalence of CAD: about 40%) the association MPS + exercise ECG is preferable; in patients with chest pain of uncertain origin or with asymptomatic electrocardiographic alterations (prevalence of CAD: about 15%) it is better to take into account only the scintigraphic findings obtained after exercise or pharmacologic stress, to avoid an excess of false positive results.
 ...
PMID:[Clinical usefulness of thallium-201 myocardial scintigraphy with dipyridamole pharmacodynamic test in ischemic heart disease (author's transl)]. 723 8

We aimed to assess the relationship between frequent and complex ventricular ectopy by continuous electrocardigraphic 24-hours Holter monitoring in patients with coronary artery disease and inducible ischemia during exercise procedures. We investigated 609 consecutive patients. They were referred for chest pain (28% with a previous myocardial infarction, older than 6 months). In all population patients radionuclide ventriculography showed a global normal or mildly reduced left ventricular function (ejection fraction > 45%). All patients showed exercise-induced myocardial ischemia (ST depression) and exercise thallium-201 reversible defects. During Holter monitoring, in study population, divided according to incidence of premature ventricular complexes (PVC), we found a higher prevalence of complex ventricular arrhythmias (CVA) (bigeminy, couplets, ventricular tachycardia, multiformity) in patients with high incidence of PVC. The relationship between frequent and complex ventricular ectopy has been observed also during ischemic ST shifts occuring during 24-hours monitoring. In contrast, the R on T phenomenon was not related to incidence of PVC. Therefore, in patients with exercise-induced myocardial ischemia and global normal or mildly reduced left ventricular function there is a relationship between frequent and complex ventricular ectopy, as previously suggested in CAD patients with depressed left ventricular function.
 ...
PMID:Incidence and complexity of ventricular ectopy during Holter monitoring in patients with exercise-induced myocardial ischemia and normal or mildly reduced left ventricular function. 756 35


<< Previous 1 2 3 4 5 6 7 8 Next >>