Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Fifty six patients were studied while in the Coronary Care Unit: 17 with unstable angina and 39 with acute myocardial infarction. All patients underwent dobutamine stress testing (doses of 5, 10, 15 and 20 micrograms/kg/min every 5 min) and exercise testing (modified protocol to finish at an energy expenditure of approximately 5 METS): 4-5 days after the last crisis of angina or 6-8 days after the onset of noncomplicated acute myocardial infarction. The heart rate increased from 72 +/- 10 to 104 +/- 12 beat/min with dobutamine (p = 0.00001) and from 84 +/- 11 to 118 +/- 15 beat/min with exercise testing (p = 0.00001). The systolic blood pressure increased from 116 +/- 9 to 138 +/- 11 mmHg with dobutamine (p = 0.00001) and from 117 +/- 8 to 156 +/- 7 mmHg with exercise testing (p = 0.00001). Due to different reasons 33 patients did not finish the exercise protocol, while only 8 patients did not finish the dobutamine testing. The ST segment wast elevated in 22 cases with dobutamine and in 9 cases with exercise, eight of them coinciding in both tests. The ST segment was depressed in 36 cases with dobutamine and in 21 cases with exercise, 20 of them coinciding in both tests. Angina was present in 11 cases with dobutamine and in four exercise, three of them coinciding. If the unfinished tests or those with angina or ST segment depression are considered abnormal, there were 40 abnormal tests with dobutamine and 38 with exercise, 32 of them coinciding.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Usefulness of dobutamine in producing myocardial ischemia. Comparison with ergometry]. 277 72

One hundred patients with high-risk unstable and medication-resistant angina pectoris underwent coronary artery by-pass grafting. In 35 cases the angina was of early post-infarction type, in 60 it was progressive after previous stability and in five it was of recent onset. All had abnormal ECG in association with anginal attacks (ST depression in 76, ST elevation in 5, T-wave inversion in 15 and left bundle branch block in 4). The left main coronary artery was stenosed in 33 patients, and the respective figures for three-vessel, two-vessel and one-vessel disease were 53, 9 and 5. The average number of inserted peripheral grafts/patient was 4.6. The perioperative mortality rate was 1%. Seven patients had confirmed or probable perioperative myocardial infarction and two had late infarction during the hospital stay, but none had angina pectoris on discharge. Of 60 patients re-examined after 1 year, 47 were angina-free. Five had NYHA class III angina, but all were improved. In refractory unstable angina pectoris there is severe coronary artery involvement, but bypass grafting can give good results.
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PMID:Clinical characteristics and coronary anatomy in refractory unstable angina pectoris leading to coronary artery bypass grafting. The Kuopio experience. 278 48

Atrial pacing and thallium 201 scintigraphy were done in 61 patients with known or suspected coronary artery disease referred for evaluation of cardiac risk before elective vascular surgery. All patients had noncardiac limitations precluding performance of an adequate exercise stress test. Before atrial pacing all were considered to be at low risk of a postoperative cardiac event based on assessment of clinical parameters. Vascular surgery was subsequently performed in 47 patients. In these patients, pacing-induced ST segment depression greater than or equal to 1 mm occurred in 18, a fixed perfusion defect occurred in 11, and a reversible defect occurred in six. Two of the six patients with reversible perfusion defects had preoperative coronary angiography; both had significant coronary artery disease (one or more lesions greater than or equal to 50%). Two patients (one of whom had a reversible perfusion defect) underwent preoperative coronary revascularization and tolerated subsequent vascular surgery well. All other patients received only medical therapy. None of the 47 patients undergoing vascular surgery had a postoperative cardiac event (unstable angina, congestive heart failure, myocardial infarction, or cardiac death). Of the 14 patients in whom vascular surgery was deferred or canceled, surgery was canceled for noncardiac reasons in seven. Six of these seven patients had a normal perfusion scan; none had a reversible perfusion defect or marked (greater than or equal to 2 mm) ST segment depression. No cardiac event occurred during a 3-month period after atrial pacing in any of these patients. Six of the remaining seven patients had reversible perfusion defects.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Preoperative evaluation of cardiac risk by means of atrial pacing and thallium 201 scintigraphy. 279 63

Patients who undergo peripheral vascular surgery are at increased risk for postoperative cardiac events and are difficult to assess preoperatively because of limitations on their activity. We prospectively studied 176 consecutive eligible patients undergoing elective vascular surgery to determine the value in predicting a postoperative cardiac event of preoperative electrocardiographic monitoring to detect myocardial ischemia. Of the 176 patients, 32 (18 percent) had 75 episodes of monitored ischemic ST-segment depression preoperatively (of which 73 were asymptomatic), and 13 (7 percent) met strict criteria for major postoperative cardiac events, including 1 with a fatal myocardial infarction, 3 with nonfatal infarctions, 4 with unstable angina, and 5 with ischemic pulmonary edema. Of the 32 patients with ischemia before their operations, 12 had postoperative events (univariate relative risk, 54; 95 percent confidence interval, 7.2 to 400). Only 1 postoperative event occurred among 144 patients who did not have preoperative ischemia. The sensitivity of preoperative ischemia was 92 percent, the specificity 88 percent, the predictive value of a positive result 38 percent, and the predictive value of a negative result 99 percent. In multivariate analyses, preoperative ischemia was the most significant correlate of postoperative cardiac events and remained a statistically significant independent correlate even after we had controlled for all other preoperative factors (multivariate relative risk, 24.4; 95 percent confidence interval, 6.8 to 88). These preliminary data suggest that preoperative electrocardiographic monitoring to detect episodes of myocardial ischemia is a useful method for assessing cardiac risk in patients who undergo elective vascular surgery. In particular, the absence of ischemia during monitoring indicates a very low risk.
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PMID:Correlation between preoperative ischemia and major cardiac events after peripheral vascular surgery. 279 5

The effects of high thoracic epidural anesthesia (TEA) on central hemodynamics as measured by pulmonary arterial catheterization were studied in nine patients with severe coronary artery disease and unstable angina pectoris. The patients were also treated with a combination of beta-blockers, calcium antagonists, and nitrates, as well as salicylates, low-dose heparin, and nitroglycerin infusion for greater than 24 hr. Management of pain with high TEA was started with the bolus epidural injection of 4.3 +/- 0.2 mL bupivacaine (5 mg/mL), which induced a sympathetic blockade from Th. During ischemic chest pain, pulmonary artery and pulmonary capillary wedge pressures were significantly increased. TEA, while relieving the chest pain, significantly decreased systolic arterial blood pressure, heart rate, and pulmonary artery and pulmonary capillary wedge pressures, without any significant changes in coronary perfusion pressure, cardiac output, stroke volume, and systemic or pulmonary vascular resistances. In some patients, ST-segment depression was less pronounced during TEA. Thus, during ischemic chest pain, TEA has beneficial effects on the major determinants of myocardial oxygen consumption, without jeopardizing coronary perfusion pressure. TEA may therefore favorably alter the oxygen supply/demand ratio within ischemic myocardial areas.
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PMID:Thoracic epidural anesthesia and central hemodynamics in patients with unstable angina pectoris. 280 91

Thirty patients with unstable angina pectoris underwent atrial stimulation test under continuous ECG monitoring and repeat coronary ventriculography. All this made it possible to compare ST-segment dynamics with altered parameters of left ventricular contractility in induced myocardial ischemia. It was shown that ischemia that appeared as ST-segment depression caused abnormal regional myocardial contractility in the area of impaired coronary blood flow. At the same time, ischemias shown by ST-segment elevation resulted in abnormal diastolic myocardial relaxation in the left ventricle.
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PMID:[Correlations of ECG ST segment changes and indicators of left ventricular function in patients with unstable stenocardia during the atrial stimulation test]. 281 Oct 41

The value of atrial pacing and thallium-201 scintigraphy for assessing risk of subsequent cardiac events was examined in 210 patients with stable chest pain. Follow-up information was complete in 195 patients (mean age 61 years). Over an average follow-up of 19 months, cardiac events occurred in 38 patients--unstable angina in 20, nonfatal acute myocardial infarction in 6 and death from cardiac causes in 12. A history of previous myocardial infarction, diabetes mellitus, systemic hypertension or peripheral vascular disease at the time of pacing was not associated with an increased frequency of subsequent cardiac events. Six of 38 patients with later cardiac events had a history of congestive heart failure, compared with 8 of 157 without cardiac events (p less than 0.05). Neither pacing-induced angina, ST depression, nor the presence of a fixed perfusion defect was significantly more frequent in patients with cardiac events as a whole compared with patients without such events. Reversible defects and abnormal scans (reversible or fixed defects) were present, respectively, in 19 and 31 of 38 patients with cardiac events, compared with 42 and 79 patients, respectively, of the 157 patients without cardiac events (both p less than 0.01). In patients who developed unstable angina, a reversible defect was seen in 13 and an abnormal scan in 16 (both p less than 0.01 compared with patients without cardiac events). In 12 patients who died from a primary cardiac event, fixed defects were present in 8 and an abnormal scan in 11 (p less than 0.05 and p less than 0.01, respectively, compared with patients without cardiac events).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prognostic value of atrial pacing and thallium-201 scintigraphy in patients with stable chest pain. 281 58

This study is a retrospective analysis of the efficacy of percutaneous transluminal coronary angioplasty of the ischaemia-related vessel in patients with unstable angina. Forty-three patients had multivessel disease with dilatation of the ischaemia-related vessel only (group I; partial revascularization) while 111 patients had single vessel disease only (group II; total revascularization). The initial success rate in both groups was identical (88 versus 88%). The need for emergency coronary artery bypass surgery was similar in the two groups (group I 12% versus group II 9%; NS). The total post PTCA myocardial infarction rate (despite urgent CABG) was also similar in the two groups (group I 9% versus group II 10%; NS). The results of electrocardiographic exercise testing and Thallium-201 scintigraphy provide objective evidence for incomplete revascularization in group I. The maximum workload achieved was lower, and the frequency of exercise induced angina, ST-segment depression and reversible perfusion defect was higher than in group II. Moreover, at 6 months follow-up the recurrence rate of angina pectoris rate was higher in group I than in group II (29% versus 16% P less than 0.05). It is concluded that dilatation of the ischaemia related vessel only in patients with unstable angina and multivessel disease is as effective in the management of the acute phase of unstable angina as is dilatation of the ischaemia related vessel in patients with single vessel disease. However, due to only partial revascularization the recurrence rate of angina pectoris is higher.
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PMID:Coronary angioplasty of the unstable angina related vessel in patients with multivessel disease. 294 6

Out of 145 patients with unstable angina hospitalized at CCU of the Instituto de Cardiologia do Rio Grande do Sul (Brazil) in 1981, 69 were studied: group I = 23 case (33.3%) with transient ST segment depression, group II = 13 cases (18.8%) with transient ST segment elevation, group III (control) = 33 cases (47.8%) without acute EKG changes. Group I showed a higher incidence of double-triple coronary artery involvement: 71.4% VS 53.8 and 63.3% respectively (non significant). This group also showed a higher number of patients with severe angina and who suffered acute myocardial infarction during follow-up, although without statistical significance. There were 8 deaths (34.8%) in group I, 3 (23.1%) in group II and 4 (12.1%) in group III (chi 2 = 4.11, p greater than 0.05). The 36 months survival rate was lower in group I than in groups II and III: 52.9% VS. 75.2% (NS) and 89.7% (P less than 0.02) respectively. We conclude that acute EKG changes, mainly transient ST segment depression, in unstable angina, are markers of high risk patients.
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PMID:[Changes in the ST segment in unstable angina pectoris. Its prognostic value]. 294 54

Sixty-eight patients underwent percutaneous transluminal coronary angioplasty (PTCA) for multiple coronary stenoses. Lesions involved one coronary vessel in 24 patients, two in 34, and three or more vessels in 10 patients. The primary patient success rate was 96%, and we successfully dilated 162 (91%) of 179 significant (i.e., greater than 70% obstructive) coronary lesions, mean 2.4 lesions/patient. Complete coronary revascularization was achieved in 24 patients (Group 1), while major narrowings were not dilated either by intention or due to failure of dilation in 42 others (Group 2). The clinical state of the patients improved markedly after successful PTCA, and 44 (72%) of 61 were in the New York Heart Association Functional Class I or II 3 to 24 months later. In keeping with the clinical results, there was a significant improvement in treadmill exercise performance, in both groups. Patients with complete revascularization, however, tended to exercise longer (NS) to a greater heart rate (P less than 0.004) with less or no ischemic ST depression on ECG (P less than 0.04). Complications were few and limited to patients undergoing PTCA for unstable angina pectoris or following acute myocardial infarction. One patient (1%) died, two (3%) had Q-wave infarction and one patient sustained a cerebral embolus during catheterization. Restenosis was observed in 6 (29%) of 21 consecutive patients recatheterized 6 to 12 months (or sooner for symptoms) after successful PTCA. Four patients underwent a repeat PTCA, one was referred for coronary artery bypass grafting (CABG), and in one restenosis was minor and symptoms were mild. PTCA should be considered in patients with multiple coronary stenoses in whom all or most of the significant lesions can be dilated. Partial revascularization by PTCA is clinically useful and may be preferable to CABG in patients in whom the surgical risk is increased.
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PMID:Short- and long-term results of angioplasty for multiple coronary stenoses. 296 64


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