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 15,891 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The elective simple coronary revascularization in the last consecutive 200 patients were analyzed in this study. Despite of the increase in older patients who have more high risk factors, including low left ventricular ejection fraction (LVEF) and multiple vessel disease, there were no operative deaths in the second 100 patients. The use of calcium antagonist in patients with a history of spastic angina eliminated episodes of spastic angina in the perioperative period. In the late postoperative period, there were no cardiac deaths during the 7-year follow-up period. Angina remained in two of three patients with the patent grafts, who had a history of spastic angina. Hyperlipidemia and diabetes mellitus influenced occlusion of the grafts and progression of atherosclerosis of native coronary arteries and then four of five reoperations. Exercise tolerance in patients, even those with preoperative low LVEF, has been improved although their was some increment of left ventricular end-diastolic pressure during exercise. Patency rate in sequential grafting with saphenous vein grafts or internal mammary artery grafts were 92% in the average follow-up period of 11 months. The increase of flow rate with nitroglycerine and atrial pacing in internal mammary artery grafts (IMAG) were comparable with saphenous vein grafts.
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PMID:Evaluation of coronary revascularization for ischemic heart disease: in the consecutive 200 cases. 369 68

To evaluate whether a significant statistical correlation exists between earlobe crease (EC) and coronary heart disease (CHD), 1000 Japanese adult patients (573 males, 427 females) were examined for the presence or absence of EC, clinical or angiographic evidence of CHD, and the following coronary risk factors: male sex, age over 50 years, obesity, hypertension, diabetes mellitus, cigarette smoking, and hyperlipidemia. Patients were divided into two groups according to clinical evidence of CHD: 237 patients with angina pectoris and/or myocardial infarction (CHD+ group); 720 patients without evidence of CHD (CHD- group). Coronary angiography was performed on 200 patients from this sample population; these patients were also divided into two groups: 119 patients with greater than 50% luminal narrowing of at least one major coronary artery (stenosis+ group); 81 patients with no significant atherosclerotic changes in the coronary arteries (stenosis- group). EC was present in 58 of 237 CHD+ patients (24.5%) but in only 35 of 720 CHD- patients (4.8%; P less than 0.001); it was present in 31 of 199 stenosis+ patients (26.1%) but in only 3 of 81 stenosis- patients (3.7%; P less than 0.01). EC was also found to correlate significantly with some coronary risk factors; the correlations between the presence of EC and the presence of CHD and coronary risk factors were investigated by multivariate analysis. In a multivariate setting, the existence of CHD and an age of over 50 years was significantly related to the presence of EC. To investigate the relationship between EC and advancing age, all patients were separated into age-groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Earlobe crease and coronary heart disease in Japanese. 379 68

In an attempt to identify angiographic and clinical predictors of reperfusion, 42 patients who received intracoronary streptokinase during the early phase of myocardial infarction were analyzed. The different morphologies (regular and irregular) of the occlusive lesions did not show a significant relation with the response (reperfusion vs nonreperfusion) to intracoronary streptokinase; neither did the presence of angiographically visualized thrombus in the infarct-related artery favor reperfusion. Among the clinical variables analyzed (previous myocardial infarction, previous angina, diabetes mellitus, hypertension, use of tobacco, and hyperlipidemia), a history of previous angina was significantly related to absence of reperfusion (p = 0.001). Although the presence of thrombus showed a trend toward reperfusion (p = 0.1), overall, our angiographic observations did not contribute to predicting the response to streptokinase. Further studies are needed to identify morphologic criteria favoring reperfusion and select groups of patients most likely to benefit from it.
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PMID:Morphology of occlusive coronary lesions during acute myocardial infarction: an angiographic and clinical analysis. 379 46

The clinical features and course of 30 patients (26 men and 4 women) under 30 years of age (mean age 27.3 years) with an acute myocardial infarction (MI) are described. The most common risk factor among this group of patients was smoking in 20 patients (66%). The prevalence of the other risk factors was low: hyperlipidemia in four patients and family history of ischemic disease in another four patients, diabetes mellitus, hypertension, and obesity each in one patient. Seven patients (23%) had none of the conventional risk factors. Three patients were exerting themselves prior to the onset of their MI pain; all of them had normal coronaries. Five patients experienced chest pain prior to MI, among them only two experienced classical angina pectoris. Eighteen patients underwent uncomplicated MI. The complications in the other 12 during the acute MI were rhythm disturbances in eight and congestive heart failure in four. Cardiac catheterization was performed in 25 patients. The occurrence of zero, one, or multivessel disease was equal. The 30 patients were followed up from six months to 15 years (mean 7 years). In 18 patients circulating aggregated platelets were measured one year after the MI. Elevated values were found in all of them (mean +/- SD 34.9 +/- 9.1%). In 6 of the 18, all heavy smokers, extreme values were found in the range of 39-55%. Three out of the 30 patients died within five years after their first MI. The other 15 patients developed complications, most of them angina pectoris. Five patients were hospitalized for reinfarction. None of the 30 underwent aortocoronary bypass operation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Myocardial infarction in young adults under 30 years: risk factors and clinical course. 381 21

Isolated coronary ostial stenosis is a rare condition of unknown etiology previously reported in only 22 patients. Of 2,105 consecutive patients with angiographically defined coronary disease, 27 (1.3%) had 50% or greater stenosis of one or both coronary ostia. Serious complications occurred during angiography in three patients (11%) with one death. Coronary bypass surgery was performed in 25 patients with 1 early death (4.0%) and 1 late death (mean follow-up 28 months). Twenty-two patients (Group 1) had associated multivessel coronary disease, of whom 18 (82%) presented with stable angina of variable duration (43 +/- 53 months) and 10 (46%) were in the New York Heart Association functional class II. The prevalence of risk factors was high, especially among the eight women (3.0 +/- 0.8 per patient), seven of whom had hyperlipidemia. Five patients (Group 2) representing 0.2% of the total had isolated coronary ostial stenosis. All were women (age 41 +/- 6 years). In contrast to patients in Group 1, this group presented with a short history (2.0 +/- 1.7 months) of severe angina and had a low incidence of risk factors (0.8 +/- 0.6 per patient). Histopathologic study in one case showed typical atheroma. Isolated coronary ostial stenosis is a rare lesion occurring predominantly in young or middle-aged women. The clinical and angiographic profile appears unique and, despite the histopathologic findings, suggests a natural history distinct from that usually seen in atherosclerotic coronary disease.
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PMID:Isolated coronary ostial stenosis in women. 395 82

The purpose of this study was to investigate the degree of platelet activation and thrombin generation in 40 patients with stable angina pectoris and in 20 patients with acute myocardial infarction (AMI) by determining the plasma beta thromboglobulin (BTG) and fibrinopeptide A (FPA) concentrations. In patients with angina pectoris increased platelet activation correlated with extensive coronary pathology; the activation, however, was not influenced by a previous myocardial infarction, use of oral anticoagulants, beta-blocking agents, or hyperlipidemia. The plasma beta thromboglobulin concentration predicted more accurately the extent of the coronary artery disease than the functional angina pectoris classification. Thrombin generation was within the normal range. In patients with acute myocardial infarction increased platelet activation and enhanced thrombin generation were found, which were not related to the infarct localization, infarct size, or the presence of complications. Consequently, in these patients determination of plasma beta thromboglobulin and fibrinopeptide A concentrations is useless for the diagnosis of venous thromboembolism.
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PMID:Fibrinopeptide A and beta thromboglobulin in patients with angina pectoris and acute myocardial infarction. 619 72

Vitamins are a group of organic compounds occurring naturally in food and are necessary for good health. Lack of a vitamin may lead to a specific deficiency syndrome, which may be primary (due to inadequate diet) or secondary (due to malabsorption or to increased metabolic need), and it is rational to use high-dose vitamin supplementation in situations where these clinical conditions exist. However, pharmacological doses of vitamins are claimed to be of value in a wide variety of conditions which have no, or only a superficial, resemblance to the classic vitamin deficiency syndromes. The enormous literature on which these claims are based consists mainly of uncontrolled clinical trials or anecdotal reports. Only a few studies have made use of the techniques of randomisation and double-blinding. Evidence from such studies reveals a beneficial therapeutic effect of vitamin E in intermittent claudication and fibrocystic breast disease and of vitamin C in pressure sores, but the use of vitamin A in acne vulgaris, vitamin E in angina pectoris, hyperlipidaemia and enhancement of athletic capacity, of vitamin C in advanced cancer, and niacin in schizophrenia has been rejected. Evidence is conflicting or inconclusive as to the use of vitamin C in the common cold, asthma and enhancement of athletic capacity, of pantothenic acid in osteoarthritis, and folic acid (folacin) in neural tube defects. Most of the vitamins have been reported to cause adverse effects when ingested in excessive doses. It is therefore worthwhile to consider the risk-benefit ratio before embarking upon the use of high-dose vitamin supplementation for disorders were proof of efficacy is lacking.
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PMID:Vitamin therapy in the absence of obvious deficiency. What is the evidence? 623 Feb 19

The major premise by which weight reduction is used as a medical therapy is the fact that obesity is a primary risk factor in the onset and severity of many medical diseases. Hypertension, coronary artery disease, adult onset diabetes mellitus, complications of major abdominal and thoracic surgery, cancer of the breast and colon, and degenerative joint disease are prevalent diagnoses. The data to support weight reduction use as a medical therapy derive primarily from studies of cardiovascular disease. These studies show lowering of blood pressure and reduction of risk factors for glucose intolerance, angina, and hyperlipidaemia. The magnitude of weight loss (percent reduction in excess body weight) is important; 10 per cent reduction is a firm threshold in obese patients (greater than 130%- less than 200% ideal body weight). Success at achieving this medical therapy is most frequent using very low calorie diets which average 30-40% reduction of excess body weight. Mild and moderate hypertension will respond in 90% of patients. Type II diabetes mellitus patients can become free of exogenous insulin requirement. Response to general anaesthesia and control of respiratory distress syndrome will improve if preoperative weight loss is achieved. Improved cardiovascular fitness and relief of exertional dyspnoea are other clinically important outcomes of very low calorie diet therapy. A high priority exists to investigate the use of comprehensive professional weight control therapy as medical treatment.
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PMID:Benefits of reducing--revisited. 624 29

In the industrialized countries, the incidence and mortality of myocardial infarction (MI) in young women is much lower than in men of equal ages. This difference decreases with advancing age without any abrupt change at menopause. Scotland and Northern Ireland have the highest mortality rates from coronary heart disease in women, and Scotland the highest in men. Studies on the age variation of the sex ratio based on vital statistics have suggested that male behavior may make a contribution to the elevated mortality in males compared to females regarding not only coronary heart disease but also other causes of death. Studies have shown that uncomplicated angina pectoris has the highest incidence of the various coronary disease manifestations in women. Risk factors include hypertension, serum lipids, smoking, diabetes, obesity, oral contraceptive (OC) use, noncontraceptive estrogen use, and menopause. In a series of 145 women with MI and angina pectoris only 8% had been taking OCs at the time of onset of coronary heart disease. Evidence has been accumulating recently that women using OCs run a higher risk of coronary heart disease with the relative risk increasing with an increasing number of other factors, such as hyperlipemia, hypertension, and cigarette smoking. In 1 study the death rate from circulatory diseases in women who had used OCs was 5 times greater than that of controls who had never used OCs. These findings relate mainly to preparations containing 50 mcg of estrogen. The excess death rate increased with age up to 50 years and with smoking. OCs influence carbohydrate and lipid metabolism in ways similar to those induced by glucocorticoids such as impairment of oral glucose tolerance with hyperinsulinemia and elevated serum pyruvate levels. Serum cholesterol and serum triglyceride levels seem to remain relatively unchanged in OC users with a low estrogen content. In 1 study HDL cholesterol levels appeared to be directly related to the estrogen and conversely related to the progestogen content. OCs with both estrogens and progestogens have an intermediate effect on the level of HDL cholesterol. After menopause, estrogen use has not been conclusively linked with an increased risk, but the importance of estrogen in the causation of the disease should not be ignored. There is support for familial aggregation of coronary heart disease in women but the role of environmental and genetic contributions to this is unclear. Further studies are needed of the sex-related differences in coronary heart disease among men and women of various age groups so that understanding of basic disease factors may be gained.
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PMID:Myocardial infarction in women. 635 23

Vitamin E, cholesterol and triglycerides were measured in blood sera of 167 patients (40-59 years old) with angina pectoris. An increase in concentration of vitamin E was observed only in patients with hyperlipidemia, whereas the vitamin content was similar to the control values in patients with hypertension, in smokers and in the persons free of risk factor. Distinct correlation was found only between vitamin E and the triglycerides contents (r = 0.42). These data corresponded to the results of a previous examination of 224 men and 435 women without ischemic heart disease: in men the content of vitamin E correlated with triglycerides (r = 0.50) and in women--with cholesterol (r = 0.34). The ratio of vitamin E/triglycerides appears to be a more adequate index of the vitamin content in men.
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PMID:[Vitamin E and serum lipids in ischemic heart disease]. 647 33


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