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Query: UMLS:C0027497 (nausea)
 23,468 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Histamine, the main amine released during allergic reactions, can provoke coronary arterial spasm manifested as angina pectoris. This has been shown during clinical and laboratory studies. The effects of histamine on cardiac function are mediated via H1- and H2- receptors situated on the four cardiac chambers and coronary arteries. Coronary arteries of cardiac patients are hyperactive and contain stores of histamine which can initiate coronary artery spasm. Clinical observations indicate that angina pectoris or acute myocardial infarction can be provoked by acute allergic reaction. The coincidental occurrence of chest pain and allergic reaction accompanied by clinical and laboratory findings of classical angina pectoris seems to constitute the syndrome of allergic angina. The clinical symptoms of allergic angina include chest discomfort, dyspnoea, faintness, nausea, pruritus and urticaria. They are accompanied by signs such as hypotension, diaphoresis, pallor and bradycardia. There are also electrocardiographic findings indicating myocardial ischaemia, arrhythmias and conduction defects. Thus, in patients undergoing acute allergic reaction, the development of chest pain could be explained by the mechanism of coronary arterial spasm provoked by the release of histamine, which constitutes the syndrome of allergic angina.
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PMID:Histamine-induced coronary artery spasm: the concept of allergic angina. 179 97

Domperidone has been used as a gastrokinetic and anti-emetic drug within the frames of an intensive care programme in 57 patients with a history of 3-4 days of acute myocardial infarction. According to the observations, Motilium prevents the development of gastroduodenal complaints and nausea, vomiting in a period following the first days of acute therapy and promotes the start of bowel movement and defecation. It has no cardiac or other toxic effects and does not influence the action of other drugs.
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PMID:Role of domperidone in improving intestinal activity in acute myocardial infarction patients. 181 29

A 59 year-old housewife was admitted to the emergency service with a sudden onset of chest pain and nausea. Initially she was treated as an acute myocardial infarction, but conventional treatments were not effective, and she was sent to our hospital for further evaluation. Her ECG showed several abnormal findings including T-wave inversion, atrial flutter, QT-time prolongation, ST-segment depression or elevation, and frequent ventricular ectopic beats. The echocardiogram, 201thallium scintigram and coronary angiography were almost normal. Both urinary and plasma levels of catecholamines were remarkably increased, and the plasma epinephrine was extremely high during attacks. Abdominal echotomography and CT-scanning showed a large left adrenal tumor. The 131MIBG scintiscan revealed a high accumulation in this tumor. Then the patient was diagnosed as having pheochromocytoma and catecholamine-induced myocarditis. The administration of phentolamine (10 mg) normalized the inversion of T-wave and the high blood pressure. But when propranolol (2 mg) was administrated in addition to phentolamine, the ECG showed a biphasic low T-wave change. According to these phenomena, we supposed that the alpha-adrenergic receptor was involved in the development of the ST-T changes of the ECG, and the alpha-adrenergic receptor of this patient might be sensitive under excessive catecholamines, according to the inhibition of the beta-receptor by propranolol.
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PMID:[A case of pheochromocytoma with an AMI-like ECG change corrected by an alpha-blocking agent]. 196 1

Within the health care of the elderly with prevention, diagnosis, therapy, rehabilitation, nursing care and social service, diagnostic procedures are of great importance to avoid under- and over-diagnosis. Many diagnostic difficulties exist in elderly patients such as changed reference values, changed normal values and changed signs and symptoms. Well-known examples of conditions which are likely to be under-diagnosed include depression and urinary incontinence. Examples are given from the cardiopulmonary field where e.g. dyspnoea showed to be very common, but in only 36% of males and 52% in females related to cardiac failure or pulmonary disease. The most common symptom of acute myocardial infarction in elderly patients was shown to be dyspnoea, whereas chest pain occurred in only one fifth of the cases. In another study of patients with ulcer disease loss of appetite and weight, nausea and anemia were more common than abdominal pain and heartburn. In peritonitis patients, abdominal pain was observed in only just more than half of the cases and guarding and/or abdominal rigidity in about one third. In patients with suspect age dementia a detailed investigation showed the prevalence of organic dementia to be 89% whereas 3% had treatable dementia and 8% non-dementia conditions. In geriatric long-term patients the mean hearing loss in the speech area was about 50 dB, in spite of the fact that only about 10% of the patients had hearing aids. The need for nursing diagnosis is also obvious. It is concluded that a detailed multidisciplinary diagnostic investigation procedure is very important in geriatric medicine.
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PMID:The importance of diagnostic procedures to ensure quality of health care in geriatric medicine. Examples from recent studies. 198 60

We describe a girl aged 17 y who died after a cardiac arrest secondary to septic shock. At autopsy, the enlarged, soft, and flabby heart showed microscopic evidence of acute myocardial infarction, myocardial edema, myocardiocyte loss, replacement fibrosis in the interventricular septum, and right and left ventricular hypertrophic nucleomegaly. The pathological diagnosis was that of cardiomyopathy due to prolonged selenium deficiency. The patient had been on total parenteral nutrition for 17 mo, following extensive bowel resection for intractable pain, nausea, and vomiting caused by chronic idiopathic intestinal pseudoobstruction. Seven months before death, when severe biochemical selenium deficiency was diagnosed, supplemental selenium was added to the infusion, and plasma selenium concentrations increased. In long-standing selenium deficiency, sepsis may contribute the final insult to a damaged myocardium, triggering symptomatic cardiac failure and sudden death.
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PMID:Cardiomyopathy associated with nonendemic selenium deficiency in a Caucasian adolescent. 216 25

In 14 patients with acute myocardial infarction, a 24-hour Iloprost infusion was started with a mean delay of 309 +/- 22 minutes from onset of symptoms. Patients were haemodynamically monitored with a pulmonary artery catheter and an arterial cannula. The dose of Iloprost was 1-4 ng kg-1 min-1 and titrated according to blood pressure and systemic vascular resistance. When 2.0-4.0 ng kg-1 min-1 of Iloprost were infused, 5 out of 10 patients required dose reduction due to hypotension, nausea or both. However, in all patients the infusion period was completed as planned. Acute reductions of systolic blood pressure and vascular resistance were seen, whereas stroke volume increased and heart rate remained unchanged. The infusion of Iloprost caused profound inhibition of ADP-induced platelet aggregation but no significant changes in plasma values for platelet-specific proteins or thromboxane B2 were recorded. It is concluded that it was possible to safely administer Iloprost over 24 hours in the early phase of acute myocardial infarction and profound anti-aggregatory effects were observed. These findings should be evaluated in a controlled study.
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PMID:Central haemodynamic and antiplatelet effects of iloprost--a new prostacyclin analogue--in acute myocardial infarction in man. 244 Jun 82

619 patients with suspected acute myocardial infarction (MI) were randomized to receive either a high-dose short-term intravenous infusion of streptokinase (1.5 MU over one hour) or placebo. Using a '2 X 2 X 2 factorial' design, patients were also randomized to receive either oral aspirin (325 mg on alternate days for 28 days) or placebo, and separately randomized to receive either intravenous heparin (1000 IU h-1 for 48 hours) or no heparin. Streptokinase (SK) was associated with a nonsignificant (NS) increase in non-fatal reinfarction (3.9% SK vs 2.9% placebo) and decrease in mortality (7.5% vs 9.7% in hospital plus 6.1% vs 8.7% after discharge). After SK, there were significantly fewer strokes (0.5% vs 2.4%; 2P less than 0.05), but significantly more minor adverse events (e.g. hypotension and bradycardia, allergies, bruises or minor bleeds, nausea). Aspirin was associated with fewer non-fatal reinfarctions (3.2% aspirin vs 3.9% placebo; NS), deaths (in hospital: 6.1% vs 10.5%; 2P less than 0.05, and after discharge: 7.0% vs 6.9%; NS), and strokes (0.3% vs 2.0%; NS). Heparin was associated with a decrease in reinfarction (2.2% heparin vs 4.9% no heparin; NS), though not in mortality (in hospital: 8.0% vs 8.5%; NS, and after discharge: 7.0% vs 6.9%; NS), and with a trend towards more strokes (1.6% vs 0.7%; NS) and more bruising and bleeding (14% vs 12%; NS). To assess more reliably the effects of aspirin and of this SK regimen on mortality, about 400 hospitals worldwide are now collaborating in a large (about 20,000 patients planned) randomized trial (ISIS-2), for which the present study was a pilot.
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PMID:Randomized factorial trial of high-dose intravenous streptokinase, of oral aspirin and of intravenous heparin in acute myocardial infarction. ISIS (International Studies of Infarct Survival) pilot study. 288 30

The analgesic effect of ketobemidone hydrochloride + the spasmolytic component A29 (Ketogan) and morphine hydrochloride was compared double-blindly in patients with suspect acute myocardial infarction. The test drugs were administered i.v. in an initial dose of 0.5 ml (2.5 mg Ketogan, 5 mg morphine) followed, if necessary, by additional injections of 0.25 ml. Altogether, 309 patients participated in the trial. The total consumption of the test drugs showed that 5 mg Ketogan was equipotent with 10 mg of morphine. Treatment with Ketogan resulted in a significantly higher proportion of patients who were completely free of pain 15 and 30 min after the initial injection: 16% and 15% more, respectively, compared to morphine. Within 2 hours after the initial injection, approximately 15% of the patients in both treatment groups had reported nausea and about 7% had vomited (patients who vomited or were nauseated before treatment were not included in this analysis). The frequency of other side-effects was low, with no differences between the two treatment groups. Morphine caused a greater reduction of the systolic blood pressure than Ketogan. The effect of both drugs on pulse rate and respiration was the same.
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PMID:Analgesic treatment in acute myocardial infarction. A double-blind comparison of ketobemidone + the spasmolytic A29 (Ketogan) and morphine. 289 63

A 55-year-old Caucasian woman suddenly developed substernal chest pain at rest accompanied by pallor, diaphoresis, nausea, and vomiting. Physical examination was otherwise unremarkable. The resting ECG showed T-wave inversion in all anterior leads which returned to normal 24 h after the onset of the symptoms. The pain was eliminated promptly by sublingual isosorbide dinitrate. "Impending" acute myocardial infarction was diagnosed. Coronary arteriography, however, failed to reveal any change in any major coronary artery but an apical aneurysm of the left ventricle was detected. As the complement-fixation test for Chagas' disease was positive, the diagnosis of chronic Chagas' heart disease was then established. This unusual clinical manifestation of Chagas' disease is thought to be the consequence of a transient imbalance in the cardiac autonomic nervous system, which is considered to play a central role in the pathogenesis of chronic Chagas' heart disease. In addition, the present case may alert clinicians to the thus far neglected atypical chest pain, which is frequently seen in chagasic patients but whose etiology remains obscure.
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PMID:Chronic Chagas' heart disease presenting as an impending myocardial infarction: a case favoring the neurogenic pathogenesis concept. 359 60

Studies have attempted to define predictive indicators of diagnosis and/or prognosis for acute myocardial infarction (AMI) in the emergency department and to identify the need for hospital admission in patients with chest pain. Because prehospital predictors have not been defined, dispatchers, paramedics, and base station physicians continue to triage based on patient history. We reviewed 401 patients presenting in one year to an urban paramedic system with chest pain, normal vital signs, and stable rhythms to identify predictors of AMI and unstable angina. Thirty-one percent (123) had a diagnosis of AMI, 26% (105) unstable angina, and 43% (173) "other" diagnoses. Two-hundred seventy-eight patients required nitroglycerin administration, 182 required IV morphine, 14 developed arrhythmias requiring lidocaine, and two suffered cardiac arrest in the field. Nine other patients had a cardiac arrest after arrival in the ED. When comparing AMI and unstable angina patients to the "others," 64% (132) versus 36% (74) had radiation of pain (P less than .003), 72% (95) versus 28% (37) had diaphoresis (P less than .0001). Neither difficulty breathing, nausea/vomiting, vital signs, initial rhythm, nor past history of myocardial infarction were helpful in discriminating AMI and unstable angina from others. Comparing AMI alone versus others, the presence of ST segment elevation on lead II was present in 15% (18) AMIs, 3% (3) unstable angina, and 8% (14) others (P = .005). Diaphoresis also was a predictor of diagnosis with 51% (63) of the AMIs and 25% (69) of others exhibiting this sign (P less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Limitations of prehospital predictors of acute myocardial infarction and unstable angina. 368 92


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