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

To define the risk factors and clinical presentation of patients under age 40 who present to the emergency department (ED) of a community hospital with an acute myocardial infarction (MI), a retrospective cross-sectional study was conducted over a 7-year period. Two hundred and nine consecutive cases of initial MI who met World Health Organization criteria (chest pain, ECG changes, and serum enzyme rises) and were admitted to one of five participating hospitals were reviewed. The mean age of patients was 34.8 years (range, 17-39); 81% were male. The major risk factor was tobacco use (81%), followed by family history (40%), hypertension (26%), and hyperlipidemia (20%). One hundred and eighty-three patients (87.6%) had ECG evidence of cardiac ischemia, injury, or infarction in the ED. Approximately 24% of patients had multi-vessel coronary atherosclerosis as documented by angiography; 62% had single vessel disease; and 14% had normal coronary arteries. The most common anatomical location for the MI was the inferior wall. This study characterized the epidemiology of acute MI in young adults: 1) smoking emerged as the main coronary risk factor; 2) atherosclerosis continues to be the major etiology; 3) a common finding on angiography was single-vessel disease causing infarction of the inferior wall; and 4) the complication rate was comparable to older populations, but the in-hospital mortality was only 1.9%.
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PMID:Myocardial infarction in young adults: risk factors and clinical features. 874 Jul 43

We report the case of a 60-year-old man with recent onset of poorly controlled diabetes mellitus, frequent anginal chest pains, paroxysmal hypertension, hyperlipidemia, and mild renal insufficiency. The patient was found to have pheochromocytoma of the left adrenal gland, resection of which resulted in total resolution of diabetes, hypertension, chest pain, hyperlipidemia and renal failure.
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PMID:Insulin-requiring diabetes mellitus, hyperlipidemia, and anginal chest pains as prominent features of pheochromocytoma. 938 71

The clinical significance of coronary arteriosclerosis and coronary risk factors was investigated in patients with coronary spasm. Coronary spasm induction test with acetylcholine was performed in 140 consecutive patients (85 males and 55 females) with chest pain in our hospital. The patients were divided into positive, borderline, and negative groups according to the results of the test. The positive and borderline groups were categorized as the coronary contractive group. The coronary sclerosis index was used to evaluate the degree of coronary arteriosclerosis. Coronary risk factors were evaluated in terms of hypertension, diabetes mellitus, hyperlipidemia, obesity, history of smoking and drinking, and family history of cardiovascular events. Patients could be divided into 34.3% in the positive group and 23.6% in the borderline group, i.e. 57.9% in the coronary contractive group, and 42.1% in the negative group. There were more males than females in both positive and coronary contractive groups. The proportion of males in the coronary contractive group was higher in patients over 60 years of age than in patients under 60. In contrast, the proportion of females was higher in patients under 60 than in patients over 60. In male patients, the coronary sclerosis indices in the positive, borderline, and coronary contractive groups were higher than those in the negative group. The indices in female patients in the positive and coronary contractive groups were higher than the index in the negative group. There were no differences in terms of the presence or absence, or the degree of organic stenosis between spastic sites and nonspastic branches in the positive group. The history of smoking in male patients was significantly more common in the positive group than in the negative group. The family history was more relevant in female patients in the positive or coronary contractive group compared to the negative group. Moreover, the history of smoking in the coronary contractive group was significantly more common than that in the negative group. The development of coronary spasm may be determined, at least in part, by the degree of coronary sclerosis as well as by gender and age. Smoking habits in both sexes and family history in females are proposed as the most important risk factors for coronary spasm.
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PMID:[Significance of coronary risk factors and coronary arteriosclerosis for coronary vasospasm]. 955 76

There are only a few reports concerning coexistent hypertrophic cardiomyopathy (HCM) and vasospastic angina. Clinical characteristics in patients with both diseases have not been clarified yet. This study was designed to elucidate the relationship between chest pain and coronary vasospasm in HCM patients and to delineate clinical characteristics in patients with both HCM and coronary vasospasm. First, 36 patients with HCM underwent acetylcholine provocation test for coronary vasospasm and were divided into two groups on the basis of presence or absence of coronary vasospasm. Next, the following risk factors for coronary artery disease were compared between the two groups: hypertension, smoking, hyperlipidemia, diabetes mellitus, and hyperuricemia. Coronary vasospasm was induced in 10 (28%) of 36 patients with HCM. There were no significant differences in age and male gender between the two groups. Smoking was more prominent in HCM patients with than without coronary vasospasm (80% vs 35%, p<0.05), but there were no differences in the prevalence of other risk factors between the two groups. In conclusion, coronary vasospasm appears to play a significant role in the etiology of myocardial ischemia in Japanese patients with HCM, and smoking might be a major risk factor for coexistence of HCM and coronary vasospasm.
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PMID:Clinical characteristics in Japanese patients with coexistent hypertrophic cardiomyopathy and coronary vasospasm. 978 50

We experienced 23 cases of venous thrombosis after gynecological surgery for the past 12 years at Tokyo Women's Medical University Hospital, representing 0.345 % of all patients. Eighteen of the 23 cases had deep venous thrombosis (DVT) including five cases followed by pulmonary embolism (PE), and five cases had PE without any symptoms of DVT. The main risk factors for thrombosis in these 23 patients were (1) obesity, DM, hyperlipidemia; (2) huge abdominal tumor, severe adhesion; and (3) hemoconcentration, post-treatment of severe anemia. The onset of PE varied from 1 to 3 postoperative days, when the patients started to walk. Five cases had dyspnea, chest pain, and decreased PaO2 levels without leg pain, while five cases showed only calf pain and tenderness with decreased PaO2 levels. PE was confirmed by immediate diagnostic images such as RI venography with ventilation and perfusion lung scan, pulmonary arterial CT, or pulmonary arteriography. Two patients died and eight patients recovered. The best way of managing venous thrombosis might be as follows: (1) identify the risk factors of thrombosis before surgery; (2) perform prophylactic leg exercises in bed and/or active anticoagulant therapy depending on the degree of risk factors; (3) rapid diagnosis with the images; and (4) proper treatment.
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PMID:Management of venous thrombosis and pulmonary embolism after gynecological surgery. 983 10

A significant lack of information exists regarding risk factors, preventive strategies, diagnostic testing, and treatment of women with coronary artery disease (CAD), especially in the young age group. We studied the clinical profile, angiographic results, and long-term follow-up of 135 women aged < or =50 years referred for coronary angiography because of chest pain. The most prominent risk factor was hyperlipidemia (60%), followed by a family history of coronary disease (44%), systemic hypertension (40%), cigarette smoking (31%), postmenopausal state (23%), and diabetes mellitus (21%). Angiographically significant CAD was demonstrated in 79 of 135 patients (58%), most of whom (61%) had 1-vessel CAD. Women with compared to those without significant CAD had a higher prevalence of hyperlipidemia (71% vs 45%; p = 0.002) and of the post-menopausal state (30% vs 16%; p = 0.028). There was no difference in the incidence of positive noninvasive evaluation (ergometry or thallium scan) before catheterization between women with or without significant coronary lesions. At a follow-up period of 2 to 7 years, 3 women had acute myocardial infarction, all of whom demonstrated coronary lesions on prior angiography. No difference was found regarding the recurrence of chest pain on follow-up between women with or without significant CAD. Mortality and congestive heart failure were observed more frequently in women with CAD (6% vs 0%; p = 0.0516 and 12% vs 2%; p = 0.047, respectively).
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PMID:Clinical profile and long-term prognosis of women < or = 50 years of age referred for coronary angiography for evaluation of chest pain. 1075 17

Because hyperlipidemia may present as xanthomas, a dermatologist may be the first to diagnose these skin lesions and associated lipid abnormalities. Xanthomas are of concern because of their association with coronary artery disease and pancreatitis. We describe the case of a 40-year-old white male with chest pain and eruptive xanthomas. Laboratory tests revealed severe hypercholesterolemia, hypertriglyceridemia, and diabetes mellitus, and the histopathology of the skin lesions was consistent with eruptive xanthomas. Surprisingly, even with overwhelming risk factors for both atherosclerosis and pancreatitis, this patient did not show evidence of either disease process. After initiating therapy for the diabetes and hyperlipidemia, the patient has had no recurrence of chest pain, and the skin lesions have gradually resolved. The most likely explanation for this patient's pattern of symptoms and laboratory results is the chylomicronemia syndrome, which can be seen in patients with type I or type V hyperlipoproteinemia.
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PMID:Eruptive xanthomas and chest pain in the absence of coronary artery disease. 1132 91

C-reactive protein (CRP) is a protein whose concentration in serum is increased in response to inflammatory stimuli. Increased levels serve to identify organic disease, monitor disease activity and assist differential diagnosis. High values are observed early in bacterial infections, active rheumatoid disease, Crohn's disease, acute myocardial infarction and after major trauma. In patients with ischaemic chest pain, a raised CRP value on hospital admission is associated with an adverse prognosis. In apparently healthy individuals, a raised CRP value indicates an increased risk of developing atherosclerotic vascular disease, but also increased benefit from aspirin prophylaxis and treatment of hyperlipidaemia.
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PMID:C-reactive protein. 1140 13

The pathophysiology and prognosis of coronary heart disease in women are the subject of intensive epidemiological and clinical investigations due to sex specific considerations. We have estimated the prevalence of modifiable coronary risk factors in 36 consecutive women (mean age 59.7 years) with suspected coronary heart disease in whom coronary angiography was performed due to unclear chest pain. Seventeen women revealed angiographically normal coronary arteries (gr. I) and 19 women showed coronary vessels with initial arteriosclerosis (luminal diameter reduction < 35%) (gr. II). Mean age was 59.1 years in gr. I and 60.3 years in gr. II (p = ns). No woman received lipid lowering drugs within the last 6 months. A hormone replacement therapy was not performed in any case. Women in gr. I showed significantly higher total and LDL cholesterol levels (271.6 +/- 34.3 vs 243.5 +/- 44.8 mg/dl; p < 0.005 and 190.5 +/- 36.8 vs 149.7 +/- 45.1 mg/dl; p < 0.025, respectively) and significantly lower HDL cholesterol values (57.8 +/- 16.5 vs 72.8 +/- 19.1 mg/dl; p < 0.0125) compared to women in gr. II. The total/HDL cholesterol ratio was 3.6 +/- 1.2 in gr. I and 5.1 +/- 1.7 in gr. II (p < 0.005). The positive predictive value for the existence of initial coronary atherosclerosis and a total cholesterol/HDL ratio > 4 was 76.5%. The negative predictive value and a ratio < 4 was 81.3%. Women in gr. I revealed 1.2 +/- 0.9 and in gr. II 1.6 +/- 0.8 risk factors (smoking, hypertension, body mass index > 30 kg/m2, diabetes mellitus, hyperlipidemia) (p < 0.10). The 10-year risk for the occurrence of a coronary event was 9.1 +/- 3.7% in gr. I and 14.2 +/- 5.8% in gr. II (p < 0.005). The positive predictive value for the existence of initial coronary atherosclerosis and a 10-year risk > 10% was 90%. The negative predictive value and a 10-year risk < 10% was 64.0%. Our investigation indicates that women with a mean age of 60 years, unclear chest pain and without exercise induced ischemia are highly suspected to have initial coronary arteriosclerosis, when a distinct risk factor profile and a 10-year cardiac event risk > 10% are present. For this high risk group of women, intensive secondary prevention measures are necessary.
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PMID:[Coronary risk profile in women with angiographically normal coronary arteries or initial coronary arteriosclerosis]. 1145 97

Patients with suspected chronic stable angina can be evaluated in three stages. In stage one, the clinician uses information from the history, physical examination, laboratory tests for diabetes and hyperlipidemia, and resting electrocardiography to estimate the patient's probability of coronary artery disease (CAD). In stage two, additional testing for patients with a low probability of CAD focuses on diagnosing noncoronary causes of chest pain. Patients with a high probability of CAD have stress tests to assess their risk from CAD, and patients with an intermediate probability of CAD have stress tests to estimate the probability of CAD and assess their risk from CAD. Most patients with new-onset angina can start stress testing with exercise electrocardiography. The initial stress test should be a stress imaging procedure for patients with rest ST-segment depression greater than 1 mm, complete left bundle-branch block, ventricular paced rhythm, preexcitation syndrome, or previous revascularization with percutaneous coronary angioplasty or coronary artery bypass grafting. Patients who cannot exercise can have an imaging procedure with stress induced by pharmacologic agents. In stage three, patients with a predicted average annual cardiac mortality rate between 1% and 3% should have a stress imaging study or coronary angiography with left ventriculography. Those with a known left ventricular dysfunction should have cardiac catheterization. Patients with CAD who have an estimated annual mortality rate greater than 3% should have cardiac catheterization to determine whether their anatomy is suitable for revascularization. Patients with an estimated annual mortality rate less than 1% can begin to receive medical therapy.
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PMID:Guidelines for the management of patients with chronic stable angina: diagnosis and risk stratification. 1157 57


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