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

Two groups of patients with myocardial infarction in conjunction with diabetes mellitus and with myocardial infarction without diabetes mellitus, similar as regards their sex and age and not suffering from hypertensive disease (a total of 165 persons) were subjected to a clinico-statistical analysis. A number of factors characterizing the clinical course of myocardial infarction and diabetes mellitus in these two groups were compared. It was found that the nature and localization of pain showed not significant differences in the patients of the study groups. However, the duration of the algetic history was much longer in patients suffering from myocardial infarction combined with diabetes mellitus. In such patients complications develop more often and run a more severe course. In most of them the onset of myocardial infarction was attended by an exacerbation of diabetes mellitus and in some cases diabetes becomes apparent for the first time at the time of myocardial infarction.
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PMID:[Characteristics of the course of myocardial infarct in patients with diabetes mellitus]. 114 17

A review of 120 patients who had a discharge diagnosis of intermediate coronary syndrome showed 12 patients with documented transient ST elevation during spontaneous rest pain consistent with Prinzmetal's angina. Coronary arteriography showed severe proximal occlusive coronary atherosclerosis in nine of the patients, and normal or minimal disease in the other three patients. In two of these three, there was documented coronary arterial spasm with reproduction of symptoms during arteriography. Although a shorter history of chest pain, presence of an old myocardial infarction and a positive finding on electrocardiogram treadmill test tended to predict the patients with severe occlusive coronary artery disease, these methods were inadequate to select candidates for arteriography. All patients responded well to nitroglycerine while in the hospital. Five of the nine patients with coronary artery disease had coronary bypass operations, with two excellent, two fair and one poor result. One of the three patients with normal findings on coronary arteriograms died with refractory ventricular arrhythmia six months after study. The other two have had good-to-moderate relief of symptoms on long-acting vasodilators and propranolol. Current concepts of the syndrome of Prinzmetal's angina and ST elevation are reviewed. It appears that this syndrome has a wide spectrum of clinical presentations and coronary arteriographic anatomies.
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PMID:Prinzmetal's angina Clinical and anatomic aspects. 114 90

The occurrence of episodic painless ST segment elevation at rest was documented by continuous electrocardiographic monitoring in four patients with ischemic heart disease who did not conform to the classic description of Prinzmetal's variant angina. The degree of ST segment elevation in the absence of pain was generally similar to that seen with painful episodes. Clincopathological correlation was available in three of these patients: two were found to have severe coronary artery disease and one had a 70% obstructive lesion in the right coronary artery only. Three patients subsequently developed a myocardial infarction. Our observations suggest that transient painless ST segment elevation at rest is a serious finding reflecting severe ischemia and more likely to be "preinfarctional" than "variant" angina. Long term monitoring is useful in detecting silent severe ischemia that may sometimes occur with potentially lethal arrhythmias as demonstrated in one case.
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PMID:Case studies: Significance of episodic painless ST segment elevation at rest in ischemic heart disease. 115 Nov 96

In a consecutive series of 1,000 women under age 50 examined by coronary cinearteriography principally for evaluation of chest pain, 236 had at least 50 percent narrowing of one or more coronary arteries. The youngest, and the only patient who died, was 26 years old. The anterior descending coronary artery was the vessel most frequently involved; the right coronary artery was most often totally occluded. The amount of arterial involvement seemed to be related to the duration of symptoms. Only 10 percent of women with serum cholesterol levels under 200 mg/100 ml had significant coronary artery disease, whereas 44 percent of those with levels over 275 mg/100 ml had significant disease. Electrocardiographic evidence of myocardial infarction was uncommon in women with single vessel disease, but left ventriculograms disclosed that additional patients had areas of decreased contractility. Eleven of 46 women with electrocardiographically diagnosed myocardial infarction had no significant coronary artery disease. The cause of the electrocardiographic finding remained obscure in some. Although there was an excellent correlation of clinical diagnoses with arteriographic findings in women thought not to have angina pectoris, only half of those thought to have angina pectoris had significant coronary artery disease. This finding may be a major reason for recommending coronary arteriography for the evaluation of angina-like pain in women under age 50.
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PMID:Coronary arteriographic findings in 1,000 women under age 50. 116 16

A study of coronary heart disease (CHD) among Japanese migrants compared with Japanese living in Japan provided the opportunity to study factors possibly responsible for the high rates of CHD in America as compared with Japan. Comparable methods were employed in examining 11,900 men of Japanese ancestry aged 45--69 living in Japan, Hawaii and California. The age-adjusted prevalence rates for definite CHD as determined by ECG were: Japan 5.3, Hawaii 5.2 and California 10.8/1000. For definite plus possible CHD the rates were 25.4, 34.7 and 44.6. The prevalence of angina pectoris and pain of possible myocardial infarction, determined by questionnaire, showed a similar gradient. Elevated serum cholesterol showed a Japan-Hawaii-California gradient, but the prevalence of hypertension in Japan was intermediate between the prevalence in Hawaii and the higher prevalence in California. The three geographic locations were compared as to prevalence of CHD at comparable levels of blood pressure and cholesterol. At each blood pressure level and at each cholesterol level, the greater prevalence of CHD in California persisted. These facts, plus the near universality of smoking in Japan, suggest that conventional risk factors only partly explain the observed gradient in CHD.
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PMID:Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: prevalence of coronary and hypertensive heart disease and associated risk factors. 120 53

Myocardial infarct in a 37-year-old woman treated with oral contraceptives (.1 mg mestranol and 1 mg ethynodiol diacetate) for 6 years is reported. The patient had received chest bruises in an auto accident 10 weeks before the infarct, but had experienced no pain at the time and had required no medical treatment. She noted chest pain, which disappeared after a short time, some 8 weeks after the accident. 10 weeks after the accident, she presented with typical signs of myocardial infarct; treatment included digitalis, diuretics, and a anticoagulants. Except for slight overweight and smoking (15 cigarettes daily) the patient had no heart risk factors. Coronary angiography revealed isolated subtotal stenosis of the left anterior descending artery. The etiology of the infarct is discussed.
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PMID:[The aetiology of myocardial infarction in young people. With special regard to nonpenetrating chest injury, oral contraceptives, smoking (author's transl)]. 121 17

In intensive therapy units, especially in guarded wards for coronary diseases, the lethality in acute myocardial infarction could be reduced by ca. 50%. However, these favourable results are nowadays of importance for the patients concerned only then, when the diagnosis myocardial infarction or the tentative diagnosis infarction are made in a short period and already prehospitally adequate measures are begun. The following measures are in the centre of prehospital care: Immediate home visit when a suspicion of infarction is present, immediate hospitalisation into an in-patient facility, alleviation of pain, immediate treatment of complications (disturbances of cardiac rhythm, shock, pulmonary oedema, cardiac arrest), prevention of disturbances of the cardiac rhythm. According to the modern knowledge is to be assumed that about 50% of the patients with infarction undergo a premonitory stage which lasts for hours, days or weeks. It is possible that here develop concrete approaches to an infarction prophylaxis. In the first place there are an increase of frequency, intensity and duration of the attacks of angina pectoris, insufficient responsiveness to nitrangin, provocation of the attacks by slight causes and changes of the ECG as they are typical for the inner layer and outer layer ischaemia and the so-called rudimentary infarction. The treatment of the preinfarction process should immediately be begun, at best under clinical conditions.
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PMID:[Preinfarct and prehospital care of myocardial infarction]. 121 38

In order to reduce the oxygen consumption of the myocardium and preserve the areas around the infarction, still alive but undergoing ischemia, 8 patients with early extension of their infarction were placed under circulatory assistance by intra-aortic counter-pulsation. In 8 patients, the pain disappeared and did not recur, permitting left ventriculography and coronary arteriogrpahy. This examination is often considered high risk, but in no patient in our series, during the acute phase of myocardial infarction, were there any complications. 6 patients underwent operation, and aortic counter-pulsation was used during the post-operative period. In all, eight coronary by-pass operations were carried out and, in one case, part of the ventricular wall was resected. All patients are still alive, none have heart failure or residual angina; the follow-up period is now 2 years for the first case.
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PMID:[Emergency myocardial revascularization with assisted circulation for early extension of infarction]. 122 51

A study of 152 patients with transmural or large-focal myocardial infarction was conducted; 82 of them received low doses of Obsidan (40 mg/day) for 14 days during the activization period. The employment of such doses of the drug was found rational for ensuring a more effective activization of the patients who had a persistent pain syndrome, sinus tachycardia, extrasystolic arrhythmias and "ischaemic" changes of ECG in response to definite stages of the kinetic regimen. A decrease of cardiac output noted during the therapy was especially distinct in cases of cardiac aneurysms and corresponded to the alternating conditions of the metabolic processes.
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PMID:[Use of small doses of obsidan in physical rehabilitation of patients with myocardial infarct]. 123 May 29

Short-term results of aggressive surgical management were compared with results of medical management in forty-three patients with preinfarction angina admitted to the coronary-care unit (CCU) over an 18 month period. These patients were selected from 1,609 consecutive admissions to the CCU because they met strict criteria for preinfarction angina: severe chest pain at rest, ST-segment elevation or depression during pain which subsided rapidly after cessation of pain, and normal serum enzymes (CPK, SGOT, and LDH). Twenty-three patients had coronary angiography, done with operating room and pump standby. One patient, who had total occlusion of the left main coronary artery, died during the study. Twenty-one of the remaining patients were considered surgical candidates, and were treated immediately after angiography with 1 to 3 vein bypass grafts. There was one late postoperative death and, of the 20 survivors, 2 had ECG evidence of acute myocardial infarction and one had mild angina at time of discharge. In contrast, of the 21 patients treated medically, 13 sustained acute MI, resulting in 8 instances of congestive heart failure and 4 cases of ventricular fibrillation. Four patients died in cardiogenic shock. With the use of rigid criteria, a small subgroup of patients with variant angina at high risk of developing AMI has been identified and categorized as having preinfarction angina. Our experience suggests that aggressive surgery immediately following coronary angiography offers a lower incidence of MI, morbidity, and death than does medical management.
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PMID:Management of preinfarction angina. Evaluation and comparison of medical versus surgical therapy in 43 patients. 124 46


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