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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Three patients with thyrotoxicosis are described, in whom the presenting symptom was severe cardiac pain at rest or on effort and who were admitted to hospital with suspected or proven myocardial infarction. All patients were studied by selective coronary arteriography and left ventriculography after thyroid function tests which confirmed thyrotoxicosis. There was no demonstrable disease of the major coronary arteries in any of the patients, yet myocardial infarction and left ventricular aneurysm were shown to be present in 1, and there was definite electrocardiographic evidence of ischaemia in all 3. In addition, under stress the myocardium of all 3 patients produced lactate. It is recommended that thyrotoxicosis be seriously considered in the differential diagnosis of cardiac pain, particularly in younger women. The cause of the pain seems related to the cellular effects of thyrotoxicosis on the myocardium and current views of these effects are summarised. Of the 3 patients, 1 died suddenly 6 months after becoming euthyroid, indicating that the disease may not be as benign as expected. A guarded prognosis and continued medical follow-up are recommended when thyrotoxicosis presents with angina pectoris even when normal coronary arteries have been demonstrated.
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PMID:Thyrotoxicosis and lactate-producing angina pectoris with normal coronary arteries. 91 54

The status of 103 patients and their 113 autogenous venous femoropopliteal bypass grafts exactly 5 years after operation was presented previously. A 10 year follow-up now is possible. The mortality rate at 5 years was 48% (50 of 103) and at 10 years was 73% (75 of 103). Myocardial infarction was considered to be the cause of death of 36% of the 103 patients. The actual graft patency rate for survivors at 5 years was 59% (35 of 59) and at 10 years was 38% (11 of 29). Utilizing the same date, late graft patency rates of 45%, 58%, and 58% would have been calculated or predicted by other methods of reporting. Of 46 extremities operated on for claudication, 22 patients were alive and 45% of grafts (10 of 22) were patent 10 years later. Of patients with a total of 67 extremities operated on for rest pain or gangrene, only seven patients were alive and 14% (one of seven) of the grafts patent. Patency rates at 10 years of short grafts were 43% (nine of 21) and of long grafts 25% (two of eight). Extremities with good runoff had patency rates of 41% (nine of 22) at 10 years and those with poor runoff had patency rates of 29% (two of seven). Arteriograms demonstrated atherosclerotic changes in one of 18 grafts at 5 years and in two of eight grafts at 10 years. This study provides more facts for answering the questions of patients regarding long-term prognosis following their arterial reconstruction. It is important to analyze carefully any report in which a comparison of patency rates is suggested or invited.
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PMID:Autogenous venous grafts ten years later. 92 69

The acid perfusion test, combined with manometric studies of the oesophagus and serial electrocardiography, has been utilised to determine the incidence of ischaemic ST-segment depression and of significant arrhythmias during acid-induced oesophageal pain. Eight per cent of patients with oesophagitis and coexistent ischaemic heart disease manifest significant ECG changes during oesophageal acid perfusion. The follow-up period of 5 years indicates that these patients have a high incidence of recurrent myocardial infarction.
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PMID:The prognostic significance of the viscerocardiac reflex phenomenon. 93 52

A review of 132 consecutive patients 65 years of age and older who had a myocardial infarction showed that two-thirds of them experienced pain at onset. Pain was the only symptom leading to bedside diagnosis in one-fourth of the patients. Pain at onset combined with sudden or increased dyspnea was present in one-fifth of the patients and pain associated with other symptoms in one-sixth. Dyspnea unaccompanied by pain heralded onset of infarction in one-fifth of the patients, and in almost 7 percent, onset was marked only by other symptoms. Cerebral symptoms dominated onset in one-tenth of the patients. Preexisting coronary heart disease, hypertension, or diabetes was not predictive of painless infarction. To avoid pitfalls and facilitate bedside diagnosis of infarction, physicians should be aware of the different clinical presentations of painless infarction in the aged, which occurred in over one-third of the patients in this cohort. They also should suspect the possibility of myocardial infarction in any patient in whom symptoms are not clear, even when they are mild and unobtrusive. Questioning of the elderly patient, his family, or others around him as early as possible after the onset of an acute attack is likely to elicit a history of pain, which may lead to the correct diagnosis.
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PMID:The initial manifestations of acute myocardinal infarction. 93 23

A 30-year-old man with variant angina pectoris and ventricular arrhythmias had an angiographically demonstrable 60% obstructive lesion of the proximal left anterior descending coronary artery that was observed to progress to 100% during spasm. Control of pain and arrhythmia by pharmacologic means was unsuccessful. Aortocoronary saphenous vein-internal mammary coronary bypass was associated with an anteroseptal wall myocardial infarction and relief from both angina pectoris and arrhythmias. It is suggested that infarction of the ischemic myocardium played a role in the successful management of this case.
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PMID:Variant angina pectoris. Pain and arrhythmias controlled after postoperative myocardial infarction. 94 12

In 500 cases (379 men and 121 women) of ischemic heart disease, including 428 patients with myocardial infarction and 72 -- with imminent infarction, blood lipid levels were determined. Blood samples were taken on fasting, by the end of hospitalization, from patients with myocardial infarction on the 18th-21st day of disease, and from those with imminent infarction after cessation of pain. In 152 patients (30.4%), including 87 with infarction and 65 with imminent infarction, disturbances in the blood lipid pattern were found and classified according to Fredrickson. When expressed as percentage against the material of 152 patients with blood lipid disturbances, type II A was found in 103 cases (67.8%), type II B -- in 25 cases (16.4%), and type IV -- in 24 cases (15.8%). When calculated against the whole material of 500 patients, type II A accounted for 20.6%, type II B -- for 5%, and type IV -- 4.8% of cases.
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PMID:Hyperlipoproteinemia (acc. to Fredrickson's classification) in patients with myocardial infarction and imminent infarction. 95 45

Spontaneous adrenal haemorrhages are rare but non exceptional. They mainly occur in elderly men (mean age: 61 years). The main risk factors are: anticoagulant therapy (prescribed for myocardial infarction, occlusive vascular ou thromboembolic disease), hypertension and chronic respiratory insufficiency, as in the present case. The clinical picture is one of abdominal of lumbar pain with abdominal distension, circulatory collapse, often delayed and sometimes preceeded by an hypertensive bout, quite often fever with leucocytosis. Hyponatraemia and hyperkalaemia, are not constant features. The diagnosis is often not made until laparotomy, and it even can be missed there. In fact, plasma cortisol level or, if unavailable, urinary corticosteroid measurements are the best diagnostic procedures, permitting adequate therapy and giving best chances of survival. They must always be made in a patient with abdominal signs falling into one of the above mentioned etiologic categories.
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PMID:[Spontaneous adrenal hemorrhage. Apropos of a case]. 96 41

It is generally accepted that ST segment elevation is one of the characteristic electrocardiographic features of acute myocardial infarction. In experimental myocardial infarction the degree of ST segment elevation has been related to the degree of change in coronary flow. Surface mapping in patients of the electrocardiographic potentials gives an indirect representation of the epicardial ST segment change and in indication of the area of underlying myocardial damage. A number of patients who had sustained myocardial infar-tion within 72 hours were studied. All the patients had a history of prolonged ischaemic cardiac pain, electrocardiographic changes and a rise in serum enzymes. Electrocardiagrams were recorded from 72 points on the chest surface. Control maps were constructed from the ST segment changes measured at each of these points and plotted on a standard diagram. Electrocardiograms were recorded during a control period immediately before 20 mg of practolol was given intravenously over a period of five minutes. In all patients practolol produced a significant reduction in the area of ST segment elevation as represented by a reduction in the number of points with ST elevation of more than 2 mm. The significance of these findings is discussed.
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PMID:Electrocardiographic surface mapping of the heart following myocardial infarction and the influence of beta-blockade. 96 68

In a 27-year-old man blunt chest-wall trauma after a car accident gave rise to several retrosternal pain. Coronary angiography demonstrated severe generalised coronary arteriosclerosis. The history revealed heavy smoking (60 cigarettes daily for ten years). Although it must be assumed that there was severe generalised coronary arteriosclerosis without angina pectoris before the accident, the infarction was considered to be a direct consequence of it: it prematurely precipitated the infarction. In a second case, of a 37-year-old woman, severe precordial pressure and contusion of the thorax occurred after a collision. Cardiac symptoms developed two months later and two weeks after this acute myocardial infarction occurred. Coronary angiography demonstrated isolated sub-total occlusion of the anterior interventricular branch in the upper third of the septum without other abnormalities. Because of the two month symptom-free interval, trauma and subsequent myocardial infarction are thought not to be causally related, especially as the patient was a heavy smoker and taking oral contraceptives.
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PMID:[Myocardial infarction after accidents (author's transl)]. 97 12

The effect of intravenous administration of propranolol (3 to 10 mg) was studied in 12 patients with acute anterior transmural myocardial infarction within the first 8 hours from the onset of pain. Criteria for inclusion in the study were persistence of ischemic pain, S-T segment elevation of 0.3 or more mg in at least two standard precordial leads, heart rate of 80 or more beats/min, mean arterial pressure of 75 or more mm Hg and cardiac index of 2.5 or more liters/min per m2. Within 30 minutes of administration of propranolol, the sum of S-T segment elevations from leads V1 through V6 (sigmaST6) and the average S-T segment elevation over the left precordium recorded from multiple unipolar leads (ST) decreased significantly by 40 and 39%, respectively. At the same time, there was a significant reduction in heart rate (from 100+/-3 [standard error of the mean] to 79+/-4 beats/min), mean arterial pressure (from 112+/-6 to 95+/-5 mm Hg) and cardiac output (from 6.1+/-0.3 to 4.1+/-0.3 liters/min). Pulmonary capillary wedge pressure remained unaltered. Four hours later the hemodynamic variables had returned to control level, but the beneficial effect on myocardial injury persisted. These electrocardiographic changes were accompanied by resolution of ischemic pain and cessation of ventricular arrhythmias. The effects of propranolol were more pronounced in patients with angiographically demonstrable flow to the affected area of myocardium. Thus, administration of propranolol in the early hours of myocardial infarction can significantly reduce the signs of myocardial ischemic injury without excessively depressing myocardial function.
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PMID:Propranolol-induced reduction of signs of ischemic injury during acute myocardial infarction. 99 6


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