Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

On the basis of an examination of 412 patients with myocardial infarction the efficacy of a long-term employment (for 3--4 days) of a neuroleptic Droperidol and a vasodilator Curantyl was examined. Optimum dosages of the drug and its administration techniques were worked out with due account of the data of clinical and physiological observations and blood concentrations of Curantyl. The incidence of the pain syndrome, of extrasystolic arrhythmias, of cardiogenic shock and sudden ventricular fibrillation was shown to decrease under the effect of the treatment. Without affecting the haemodynamics of the general circulation, the employed combination of drugs improved the pulmonary circulation and produced a beneficial inotropic effect upon the right ventricular myocardium, thus causing a distinct improvement of microcirculation, normalizing the ratio of diameters of the arterioles and venules, increasing the level of the tissue blood flow, and significantly reducing the intravascular aggregation of the formed elements of the blood. A long-term combined employment of the drugs for a few early days of the disease clearly favoured a positive haemodynamics in an important part of the patients, as demonstrated by the data of electro- and vectorcardiography.
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PMID:[Experience with combined use of neurolepsy and vasodilator substances in the treatment of patients with acute myocardial infarct]. 101 82

Sixty patients with chest pain, chest and epigastric pain, or predominantly epigastric pain, not explained by electrocardiographic (EKG) changes or pulmonary findings, were given 20 cc of Xylocaine Viscous orally. Thirty-seven out of 60 experienced complete or almost complete relief within 10 to 15 minutes. Of this group, none were found to have suffered a myocardial infarction. Of the 23 patients who did not experience pain relief, six had a myocardial infarction and seven were diagnosed as having cardiac angina. Determination of serum lidocaine levels after oral ingestion of 20 cc of Xylocaine Viscous in patients with normal gastric function demonstrated a maximum level of 0.55 mu/ml--a serum level unlikely to result in adverse side effects.
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PMID:Xylocaine viscous as an aid in the differential diagnosis of chest pain. 101 76

Although the atherosclerotic process does not penetrate the coronary circulation at subendocardial levesl, the hemodynamic effects of coronary arterial narrowing occur at the endocardial and myocardial cellular levels. Theee resultant deprivation of blood supply to these tissue areas eventually leads to myocardial infarction. In certain clinical situations, a sudden increase in symptoms signifies and impending acute ischemic process. Three parameters have clinically been used to evaluate the changes that lead progressively to myocardial infarction: symptoms, electrocardiogram, and serum enzyme levels. The typical preinfarction patient experiences episodes of acute angina pectoris, sometimes intense and prolonged, and often unresponsive to nitroglycerin. Physical examination is usually not remarkable, serum enzyme levels are normal if tissue damage has not occurred, and the electrocardiogram is variable with pain. Th pathologic process in the preinfarction patient is frequently confined to the proximal arterial segment of one or more of the coronary arteries, usually in the form of a high-grade (in excess of 95 per cent) atherosclerotic lesion. This pathologic condition presents a satisfactory distal arterial segment suitable for bypass, and these patients are ideal candidates for urgent myocardial revascularization.
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PMID:A symposium on surgery for coronary artery disease. Pre-infarction syndrome--surgical indications. 103 85

In isolated perfused rabbit hearts, bradykinin produced a concentration-dependent decrease in coronary resistance directly associated with biosynthesis and release of prostaglandin-E-like substance. An inhibitor of bradykinin destruction (the nonapeptide SQ-20881) markedly enhanced both the coronary vasodilation and release of prostaglandin-E-like substance produced by cardiac injection of bradykinin. Indomethacin inhibited both the myocardial prostaglandin biosynthesis and the decrease in coronary resistance induced by bradykinin. The demonstration that bradykinin is a potent stimulator of prostaglandin biosynthesis in the heart has implications as to the cause of the afferent cardiovascular reflexes and pain in myocardial infarction and angina pectoris.
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PMID:Mechanism and modification of bradykinin-induced coronary vasodilation. 105 12

The first 81 patients who underwent coronary artery bypass surgery at Stanford University Hospital for unstable angina pectoris have been followed up for an average of 18 months. The over-all surgical mortality was 8.6 per cent (seven patients). There have been no operative deaths in last 32 patients, which may be due to over 75 per cent of these patients being stabilized on intensive medical therapy from 24 to 72 hours before study or surgery. There was a 16 per cent (13 patients) perioperative and 15 per cent (12 patients) late incidence of myocardial infarction. Of 74 patients who survived the initial operation 2 died 2 and 3 months postoperatively. Good or complete relief from pain was obtained in 94 per cent (70 patients) of the survivors. Of 57 longterm survivors tested, 49 per cent (28 patients) had a definite ischemic response to treadmill exercise testing. This may reflect the severe nature of the occlusive coronary disease or mechanisms other than increased coronary flow being responsible for the relief of pain. Although coronary bypass surgery appears to be effective in relieving the pain of patients with unstable angina pectoris, the 18 month average follow-up indicates that the incidence of myocardial infarction in surgically treated patients is comparable to that in medically treated patients.
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PMID:Coronary bypass surgery for unstable angina pectoris. Clinical follow-up and results of postoperative treadmill electrocardiograms. 107 52

Since the advent of saphenous vein bypass grafting as successful means of myocardial revascularization, a variety of coronary artery disease syndrome have come under surgical attack. The proper role of surgery in many of these coronary syndromes remains ill-defined. However, clear indications for surgical revascularization exist in patients with unstable angina pectoris, i.e., progressive angina and onset of rest pain and noctural angina in spite of adequate medical therapy. An analysis has been made of 100 consecutive patients with unstable angina pectoris who underwent myocardial revascularization over the past 2 years at the Woodruff Medical Center of Emory University. Included in this group are the following subgroups: 1) Emergency cases with pre-infarction angina (including Printzmetal angina); 2) Cases of combined valvular heart disease and coronary artery disease; and 3) Advanced coronary artery disease with certain complications of previous myocardial infarction. A discussion of the relative merits of saphenous vein grafts and internal mammary artery anastomoses is presented and indicates that the technique selected should be determined by the quality of the distal native coronary circulation. Surgical mortality and morbidity figures, patency rates of saphenous vein grafts and internal mammary artery anastomoses visualized postoperatively, and the number of patients wiht dramatic relief of angina pectoris in this series support current enthusiasms for available surgical techniques for myocardial revascularization.
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PMID:The surgical treatment of unstable angina pectoris. 107 49

Ffity-five patients with recurrent severe angina pectoris at rest that was resistant to medical therapy were treated with intraaortic balloon pumping (IABP), angiography, and vein bypass surgery. There were 25 patients with typical angina with ST depression during pain, 12 with Prinzmetal's angina, and 18 patients with angina in the early recovery phase following "transmural" myocardial infarction. The severity and frequency of ischemic attacks were documented with hemodynamic and continuous electrocardiographic monitoring. A marked reduction in both frequency and intensity of attacks was produced by IABP. Temporary cessation of IABP resulted in rapid recurrence of angina in 40% of patients. All underwent selective coronary angiography and revascularization surgery. The overall mortality was 5.5% and the incidence of intraoperative myocardial infarction was under 2%. Follow-up evaluation after an average of 18 months has shown no late deaths and sustained clinical improvement.
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PMID:Refractory angina pectoris: follow-up after intraaortic balloon pumping and surgery. 108 45

Effects on anginal symptoms of sudden withdrawal of large doses of propranolol or placebo were evaluated in 20 patients in a double-blind crossover efficacy trial requiring sudden cessation of the agent. With propranolol, 160 to 320 mg per day for six and 12 weeks, no patients had increased angina or nitroglycerin use, and there were no hospitalizations or deaths. However, within two weeks of discontinuance of propranolol, untoward ischemic events developed in 10 patients. Six had serious withdrawal complications: intermediate coronary syndrome in three, and ventricular tachycardia, fatal myocardial infarction, and sudden death in one each. In four patients discontinuance of placebo increased anginal symptoms; in the remaining 10, ischemic symptoms were not provoked. The rebound phenomenon was related to degree of pre-propranolol angina and relief of pain by the agent. Thus, chronically administered propranolol should be gradually reduced, and activity restricted during its withdrawal.
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PMID:Propranolol-withdrawal rebound phenomenon. Exacerbation of coronary events after abrupt cessation of antianginal therapy. 109 25

Forty patients with acute myocardial infarction and pericarditis (AMI-P) were encountered over a three-year period. The incidence of AMI-P was 7.2 percent (40 of 554 patients). Fifty consecutive patients with acute transmural infarction without pericarditis (AMI-C) were used as a control group. There were no significant differences between the AMI-P and AMI-C groups regarding age, sex, infarct location, hospital stay or mortality. Painful symptoms of pericarditis were experienced by 37 patients (92 percent), all of whom had developed symptoms by the fourth hospital day. The pericardial friction rub lasted three days or less in 34 patients (85 percent), but an occasional rub could be heard for up to eight days. Twenty patients with AMI-P (50 percent) developed pleural effusions and/or parenchymal pulmonary infliltrates. Twenty-eight AMI-P patients (70 percent) were thought to have had congestive heart failure (CHF) on the basis of their symptoms and physical findings. Radiographic examination could confirm only 13 cases of CHF among the 28 patients in whom the diagnosis was made clinically. Glucocorticoids were given parenterally to 31 of the 37 patients (84 percent) who had symptomatic pericarditis and was felt to be effective in ameliorating painful symptoms. Followup data was obtained on 28 of the 32 surviving patients. Five patients (15 percent) had seven episodes of the postmyocardial infarction syndrome (PMIS). Pericarditis is generally a shortlived complication of acute myocardial infarction. Pleural and parenchymal pulmonary abnormalities are common and probably account for the tendency to "overdiagnose" CHF in patients with AMI-P. PMIS appears to occur more frequently in patients who have had pericarditis at the time of the acute myocardial infarction.
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PMID:Pericarditis of acute myocardial infarction. 112 19

In blood serum of healthy persons the activity of arginase (EC 3.5.3.1) is very low, whereas in patients with myocardial infarction it increases within a few hours after the first attack of coronary pain, and returns to normal values after 3-5 days. No increase of arginase activity was observed in sera of patients with angina pectoris, coronary insufficiency or cardiac failure. Determination of arginase activity in blood serum may serve as a useful test in early differential diagnosis of myocardial infarction.
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PMID:Early diagnosis of myocardial infarction by arginase activity determination. 113 81


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