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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

One hundred forty-four patients underwent a Bruce protocol treadmill exercise test during which an electrocardiogram (ECG) was recorded simultaneously with a 2-channel Holter recorder with bipolar V3- and V5-like leads and by a conventional 12-lead system. Sixty-eight patients had no ST depression on either the Holter or on the 12-lead ECG during the exercise test, whereas in 70 patients ischemic changes were recorded by both methods; thus, in 138 of the 144 patients (96%), the results of the 2 tests were concordant. The severity of ST depression, as judged by the heart rate at which ischemic changes were first noted and the maximal ST depression observed, were similar on both recording systems. The Holter system identified 6 of the 7 patients whose ischemic changes were confined to the inferior wall on the 12-lead ECG. The addition of the V3 lead as a second ischemic lead increased the ischemia detection by 10%. Ninety-five patients also underwent coronary arteriography. In these patients the sensitivity of the Holter system during exercise in detecting significant coronary artery disease was 81% and that of 12-lead ECG was 84%, the specificity was 85% and 85%, respectively, and the positive predictive value 91% and 91%, respectively. Thus, the 2-channel Holter recording system with bipolar V3- and V5-like leads was as accurate as the 12-lead system in detecting ischemic changes during exercise and proved that ambulatory monitoring system can reliably reproduce ST segment.
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PMID:Holter recording during treadmill testing in assessing myocardial ischemic changes. 398

The functional state and coronary anatomy of 120 patients evaluated primarily because of a markedly positive ischemic exercise stress test (greater than 2 mm ST depression) is presented. Twenty-seven patients were asymptomatic (group A), 36 patients (group B) had type I angina (Canadian classification) and 57 patients (group C) had angina with only minor limitations (type II angina). All patients underwent exercise stress testing (Bruce protocol) within 2 months of cardiac catheterization. No significant intergroup differences were observed in exercise variables including time of onset of ischemia, maximal heart rate achieved, rate-pressure product, duration of exercise or mean change in blood pressure. Two patients in group A had normal coronary arteriograms. Comparison of the remaining asymptomatic patients in group A with patients in groups B and C revealed no significant differences in the number of coronary arteries involved, main left coronary artery disease, coronary score or the frequency of collateral circulation. In group A, 18% of collateral vessels were in jeopardy compared with 52% in groups B and C (p less than 0.05). Triple vessel disease was present in 57% and left main coronary artery disease in 16% of the total group. The only exercise variable useful in identifying patients with severe coronary disease was an abnormal exercise blood pressure response. This study indicates that a markedly ischemic stress test, regardless of the functional state of the patient, identifies patients, including those without symptoms, who have severe coronary disease.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Functional and anatomic correlates of markedly abnormal stress tests. 671 99

Nineteen patients survived a cardiac arrest not associated with an acute myocardial infarction, and had a normal electrophysiologic study with no inducible ventricular tachycardia despite programmed stimulation with one to three extrastimuli at two or more ventricular sites. Among 14 patients who had obstructive coronary artery disease, cardiac arrest occurred during exertion or an episode of angina pectoris in 11; 24 hour ambulatory electrocardiographic recordings demonstrated infrequent or no premature ventricular complexes in 10 and an ischemic response occurred during stage I or II (Bruce protocol) in 6 of 9 patients who underwent exercise testing. Treatment of these patients consisted of myocardial revascularization (eight patients) or antianginal medications (six patients). Only three patients were also treated with an antiarrhythmic drug. Over a follow-up period of 26 +/- 15 months (mean +/- standard deviation), only one patient died suddenly. Two patients who had coronary artery spasm were treated with coronary vasodilator medications and had no recurrence of cardiac arrest over 7 and 36 months of follow-up, respectively. Three patients who had cardiomyopathy or no identifiable structural heart disease were treated with nadolol or amiodarone and had no recurrence of cardiac arrest over 3 to 27 months of follow-up. Among patients who survive a cardiac arrest and have a normal electrophysiologic study, those with obstructive coronary artery disease or coronary artery spasm generally have an excellent prognosis with treatment directed primarily at the underlying heart disease. The clinical features of these patients suggest that cardiac arrest was related to ischemia rather than a primary arrhythmia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Clinical features and prognosis of patients with out of hospital cardiac arrest and a normal electrophysiologic study. 673 52

Twelve patients 8 females and 4 males, whose ages varied from 33 to 60 years (median 50.6 years), were seen at the Hospital for Cardiology and Neurology of the Mexican Institute for Social Security. All were diagnosed as having angor pectoris, through the clinical history and physical exam. Three patients had stable angor and in nine it was of an unstable type. The resting ECG showed signs of subepicardial ischemia in five cases. In eight the stress ECG according to the Bruce technic showed depression of the ST segment over 1 mm. In one patient atrial stimulation was performed with a pacemaker and ischemic changes of the ST segment were normal in all cases; in two however, coronary spasm that reversed with nitroglycerin appeared. The left ventriculogram was normal in all but one that revealed diaphragmatic hypokinesia associated with right coronary spasm. All patients were followed from two to fifty six months (median 19.4), and only in one case the angor pectoris remained unchanged. In all others it decreased or disappeared. During this time there were no deaths, myocardial infarctions or severe arrhythmias.
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PMID:[Angina pectoris with normal coronary arteries]. 680 91

Dipyridamole-echocardiography may be considered, at this time, an useful test not only in post-infarction risk stratification, but also in diagnosis and functional evaluation of coronary artery disease, having a satisfying sensibility (67%) and a very high specificity (96%). We report a particular case of "false positive" with a review of the literature. The patient, male, aged 45, without important risk factors for coronary artery disease, experimented recurrent events of spontaneous chest pain, typical per angina pectoris. Physical examination, chest roentgenogram and blood samples were normal. Slight signs of subendocardial ischemia, lateral, were present at ECG. Forced hyperpnea resulted in onset of chest pain, with increase of ECgraphic signs of ischemia; resolution of both was obtained with sublingual nitrate administration. A stress test with myocardial flow scintigraphic assessment using sestaMIBI, was performed: ECG showed significant ST downsloping at low workload (1-11 steps of Bruce protocol) and radionuclide tomography showed reversible hypoperfusion in anterior and septal regions. High dose dipyridamole-echocardiography test (a first bolus of 0.56 mg/kg in 4', followed after 4' by a second bolus of 0.28 mg/kg) gave these results: basal echocardiogram was normal; after first bolus of dipyridamole apical hypokinesia appeared; after second bolus complete akinesia was observed. ECG showed subendocardial injury wave and the patient experimented typical anginal pain. Clinical, electrocardiographic and echocardiographic changes were immediately reversed after intravenous bolus of aminophylline, 240 mgs. Coronary arteriography was performed: coronary arteries were angiographically normal, without even any marginal irregularity: left ventricle was normal in volume, wall kinesis and ejection fraction. Dipyridamole is a powerful ischemic stressor.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Problem of false positives in dipyridamole-echocardiography test. Description of a case and review of the literature]. 770 May 41

Myocardial ischemia is an indicator of adverse prognosis. In patients with stable angina and positive exercise tests, prolonged cumulative ischemia on ambulatory electrocardiographic monitoring identifies a high-risk group with severe coronary artery disease and poor survival. To determine whether features of the exercise test can accurately (1) predict the occurrence of ambulatory ischemia, and (2) classify patients into subgroups at varying levels of risk for ambulatory ischemia, we studied 48 patients with a history of angina and documented coronary disease who underwent the standard Bruce protocol and ambulatory monitoring. All patients had a positive exercise treadmill test, and 26 had ischemia on Holter monitoring (total of 2,922 minutes, 173 episodes, 94% with silent ischemia). The remaining 22 patients did not have ischemia. The exercise test parameters showing significant differences between the 2 groups were (1) time to > or = 1 mm ST-segment depression (p < 0.0003), (2) maximal ST-segment depression (p < 0.004), and (3) exercise capacity (p < 0.037). These data were used to develop a model for predicting the presence and the severity of ambulatory ischemia. Time to onset of > or = 1 mm ST-segment depression and maximal ST-segment depression on exercise treadmill testing can be used to determine the likelihood of mild (1 to 5 episodes or lasting < or = 60 minutes) or severe prolonged (> 5 episodes or lasting > 60 minutes) ambulatory ischemia. Patients with a very high or very low probability of ischemia on Holter monitoring can be identified by certain exercise test parameters and may not need to undergo monitoring.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Use of exercise test parameters to predict presence and duration of ambulatory ischemia in patients with coronary artery disease. 797 60

A 41-year-old man was admitted because of chest pain at rest. The exercise test and coronary angiography were performed after all antianginal medication was discontinued for 24 hours. During the graded treadmill exercise stress test using the Bruce protocol, the patient had anginal pain with the electrocardiogram (ECG) showing ST segment elevation in leads V1 and V2. A baseline coronary angiogram disclosed 50% stenosis of the first septal branch of the left coronary artery. After a bolus of 0.1 mg ergonovine was administered into the coronary artery, the patient complained of typical anginal pain. Complete occlusion of the first septal branch was demonstrated, associated with significant ST segment elevation in leads V1-V3, right bundle branch block, and electrical axis deviation to the left on the ECG. The coronary occlusion reversed soon after nitroglycerin administration into the coronary artery. We diagnosed a rare case of angina pectoris caused by spasm of the minor branch of coronary artery, and that serial ECG changes might demonstrate ventricular septal ischemia including the cardiac conduction system. ST segment elevation in leads V1-V3 indicated ischemia of the ventricular septum, and right bundle branch block, axis deviation to the left, and increased amplitude of the precordial R wave might be induced by ischemia of the right bundle branch, left anterior bundle branch and septal branch in the cardiac conduction system supplied by the septal branches of the left anterior descending coronary artery.
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PMID:[Rest angina induced by coronary artery spasm at the first septal artery: a case report]. 816 49

In the setting of stable effort angina a single-blind, randomized, cross-over study to evaluate the effects of gallopamil (GAL) and amlodipine (AML) on exercise tolerance and ischemic ST depression was conducted. Fifteen outpatients, 12 males and 3 females, aged 40-65 years (57 +/- 9), with documented coronary atherosclerosis and reproducible ST-segment depression on 2 consecutive baseline exercise stress tests, completed the study, which consisted of 4 periods: 1 and 3 placebo, 2 and 4 at random GAL (50 mg tid) and AML (10 mg/daily). At the end of each period a multistage treadmill exercise stress test (Bruce protocol) was performed. Both drugs significantly (p = 0.0001) increased the ischemia time (IT) (0.1 mV ST depression) as compared to placebo, from 416 +/- 165 s to 635 +/- 161 s (GAL) and 607 +/- 152 s (AML) with significant difference (p = 0.2) between the 2 drugs, and reduced significantly (p = 0.001) the maximal ST depression from -0.25 +/- 0.09 mV to -0.11 +/- 0.08 mV (GAL) and -0.12 +/- 0.09 mV (AML). At the IT, the systolic blood pressure increased from 178 +/- 23 mmHg to 185 +/- 20 mmHg (GAL) and remained unchanged during AML treatment (178 +/- 15 mmHg); similarly, the heart rate increased from 126 +/- 22 b/min to 139 +/- 21 b/min (GAL) and 138 +/- 19 b/min (AML). In conclusion, both GAL and AML showed a good anti-ischemic effect (IT = +52.6% during GAL and +45.9% during AML), even if GAL proved to be significantly more effective than AML.
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PMID:[An ergometric cross-over evaluation of the anti-ischemic efficacy of amlodipine and gallopamil in stable angina of effort]. 822 40

The Asymptomatic Cardiac Ischemia Pilot (ACIP) and modified ACIP treadmill exercise protocols were developed to test patients with coronary artery disease and to linearly increase work load between stages. The physiologic changes that occurred with ACIP and modified ACIP were compared to those with the Bruce and Cornell protocols in 28 normal subjects and 16 men with coronary artery disease. The exercise protocols were randomly assigned over 2 days, and gas exchange data were obtained continuously with each test. In normal subjects, the peak heart rate, systolic blood pressure, peak oxygen consumption rate (VO2) and minute ventilation were similar for the 4 protocols tested, with exercise time shortest for the Bruce protocol in comparison with the ACIP, modified ACIP and Cornell protocols (10.2 +/- 3.1 vs 13.4 +/- 4.9, 13.9 +/- 4.5, and 15.0 +/- 4.2 minutes, respectively; p < 0.001). The difference between predicted and observed VO2 was smallest for the ACIP protocol (37.0 +/- 11.0 vs 35.8 +/- 13.5 ml/kg/min) and greatest for the Bruce protocol (41.1 +/- 11.8 vs 36.7 +/- 15.0 ml/kg/min) in normal subjects, as well as in patients with coronary artery disease (ACIP protocol 26.9 +/- 7.1 vs 22.5 +/- 6.7, and Bruce protocol 29.1 +/- 7 vs 22.6 +/- 5.7 ml/kg/min, respectively). The ratio of VO2 to work rate, expressed as a slope, was similar in normal subjects for the 4 protocols tested. However, in patients with coronary artery disease, the slope was 0.84 and 0.83 for the ACIP and modified ACIP protocols, respectively, versus 0.61 and 0.71 for the Bruce and Cornell protocols, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparison of the Asymptomatic Cardiac Ischemia Pilot and modified Asymptomatic Cardiac Ischemia Pilot versus Bruce and Cornell exercise protocols. 809 59

A 62-year-old woman with exertional angina underwent an exercise thallium-201 stress test. She exercised for 4 minutes on the treadmill using a modified Bruce protocol, reaching 94% of her predicted maximal heart rate, and stopped because of chest pain and fatigue. No ST-segment depression was detected at peak exercise or in the recovery period. In contrast, the thallium-201 myocardial single-photon emission computed tomography images in the short-axis, vertical long-axis, and horizontal long-axis views revealed severe myocardial ischemia involving the anterior, septal, posteroinferior, and posterolateral planes of the heart. Coronary arteriography showed severe stenosis of the left anterior descending and right coronary arteries. The information from the exercise electrocardiogram (ECG), thallium-201 myocardial scintigraphy, and a coronary angiogram suggested that the false negative ECG response was due to ischemic ST-segment counterpoise (i.e., cancellation of ischemic ST-segment vectors, generated by equally extensive and severe ischemia involving myocardial planes opposite each other.
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PMID:The paradox of negative exercise stress ECG/positive thallium scintigram. Ischemic ST-segment counterpoise as the underlying mechanism. 885 35


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