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)

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

Systolic time intervals and the a/H ratio were recorded in 20 patients with uncomplicated acute myocardial infarction over a period of five days. The initial high heart rate and systolic blood pressure and the short PEP and ICT indicating a sympathetic overactivity were spontaneously normalized during the first week of infarction. LVET was reduced indicating a fall in stroke volume and the a/H ratio was unchanged at the high levels suggestive of elevated preload or LVEDP. In 10 patients with acute myocardial infarction and recurrent chest pain recordings on noninvasive parameters were made before and 30 min after intravenous injection of practolol. In addition, 7 patients with chest pain, classified as acute myocardial infarction, were given practolol. The average dose of practolol was 17.9 mg ranging from 5 to 30 mg. An almost immediate and pronounced relief of pain was observed in all patients and no signs of impaired left ventricular function appeared. The product of systolic blood pressure and heart rate was decreased by practolol and the PEP and the ICT were prolonged to normal values while no changes were seen in LVET and a/H ratio. On 126 occasions practolol was given in dosages ranging from 5 to 30 mg (mean 8 mg) to 75 patients with acute myocardial infarction and recurrent chest pain. A satisfactory pain relief was seen on 108 occasions. It is suggested that an inappropriate sympathetic overactivity is an important factor in provoking recurrent chest pain in acute myocardial infarction. Administration of the beta-adrenergic blocking agent practolol resulted in pain relief due to reduction of heart work and in severity of myocardial ischemia. The beta-blocking agent was well tolerated in the present study. Continuous beta-blockade during the whole hospital stay to patients with acute myocardial infarction seems to be a very attractive therapy in order to preserve the ischemic myocardium and limit the size of infarction.
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PMID:Effect of cardioselective beta-blockade on heart function and chest pain in acute myocardial infarction. 106 28

For a critical evaluation regarding surgical therapy of coronary heart disease, we quote from important publications to the following points: Early mortality due to surgical treatment, by estimating the severity of the disease as determinated by the criterions of the New York Heart Association, or by the number of the diseased coronary vessels, or by important parameters of the function of the left ventricle (0% to 12%). Frequency of acute myocardial infarction, intra-or postoperatively (10% to 15% of the survivers, 50% of the lethal cases). Frequency of occlusion, of an aorto-coronary saphenous vein bypass (up to 30%). Amelioration of ischemic heart pain by surgical treatment (up to 90%). Prevention of the progression of coronary heart disease (not proved). Natural history of patients with coronary heart disease without surgical treatment, by estimating the number of the diseased vessels (2% for one-, 6% for two-, and 10% for three vessel diseases; 30% mortality rate due to stenosis of the left main coronary artery). Comparison of the mortality rates of surgically treated patients against those without surgery for coronary heart disease with equal severity (no difference). We investigated the connection between the severity of coronary heart disease (determinated by coronary angiography), and the mortality rate in our own patient material. A fundamental conformity appeared, with the results as quoted in the literature. Finally we difined the indications for surgical treatment of coronary heart disease due to angina pectoris, which cannot be managed conservatively and which makes a normal live difficult or impossible. Moreover, the function of the left ventricle should be fairly good. An absolute indication is a stenosis of the left main coronary artery.
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PMID:[The natural course of coronary heart disease]. 108 96

Nitrous oxide in a concentration of 35% has been shown to ameliorate the pain of acute myocardial infarction. This conclusion was reached on the basis of a double-blind study in 69 patients and a clinical study in an additional 42 patients. The use of nitrous oxide was not accompanied by hemodynamic changes or significant adverse reactions.
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PMID:Nitrous oxide as an analgesic in acute myocardial infarction. 110 12

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 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

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

In patients with stable coronary artery disease, a GIK solution may increase arterial glucose and the arterial-coronary sinus difference of glucose across the myocardium. In the same patients, GIK may reduce arterial free fatty acids as well as the arterial-coronary sinus difference of free fatty acids across the myocardium. As the arterial values of free fatty acids fall, so does the arterial-coronary sinus difference of free fatty acid across the myocardium, defining a myocardial threshold for free fatty acids of approximately 200 mEq/L. Glucose-insulin-potassium may lower free fatty acid values to near or below myocardial threshold in patients with acute myocardial infarction despite recurrent pain. Preliminary data suggest that GIK in the concentration and infusion rates used in this study may favorably influence survival in patients with acute myocardial infarction.
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PMID:Glucose-insulin-potassium, free fatty acids and acute myocardial infarction in man. 125 62

Over the span of two or three days in August, 1972, in two separate communities in eastern Massachusetts two men, one aged 39, the other 66, each without previous overt heart disease, were stung by wasps. Each went into shock rapidly after an interval of over a half-hour developed chest pain and, later, sequential electrocardiographic changes diagnostic of acute myocardial infarction. Each survived; each had normal electrocardiograms before the sting. Though preexistent coronary artery disease can be excluded in neither, the view is favored that acute myocardial infarction in each was caused by deficient coronary perfusion secondary to anaphylactic shock induced by the wasp stings. An intriguing case was just recently reported58 of a 62-year-old man with previous angina who developed pulmonary edema but no chest pain following wasp sting and went on to show rapidly reversed electrocardiographic changes attributable to subendocardial ischemia or infarction. In a sense, this sequence fills the gap as an intermediate phase between the normal and the two individuals described here who developed pain after anaphylactic shock, then proceeded, perhaps through this phase, to develop transmural infarction.
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PMID:Acute myocardial infarction following wasp sting. Report of two cases and critical survey of the literature. 125 36

The clinical and laboratory findings diagnostic of acute myocardial infarction include at least two of the following: (1) a history of pain consistent with myocardial ischemia, (2) electorcardiographic findings consistent with infarction, and (3) a rise in the serum level of specific cardiac enzymes. By the 4th or 5th day of illness, specific criteria can be applied to assign certain patients to a subset with "uncomplicated completed acute myocardial infarction." These criteria include the absence of evidence of (1) continuing cardiac ischemia, (2) left ventricular failure, (3) shock, (4) important cardiac arrhythmias, (5) conduction disturbances, and (6) other serious illnesses in patients with an established acute myocardial infarction. In terms of prognosis and management, patients in this subset should be regarded as substantively different from patients in other subsets. They should respond favorably to short periods of immobilization and hospitalization than those generally used. They may remain at bed rest (modified in regard to sitting and the use of a commode) for 4 days. Subsequently, mobilization with a program of progressive activity over the ensuing 5 to 10 days should reduce the duration of hospitalization to less than the current average of 17.5 to 20.8 days for patients with acute myocardial infarction. Nine to 14 days should suffice in most instances. Current and future trials may indicate that still earlier mobilization and shorter hospitalization periods can be applied to certain patient groups, but the evidence on this point is incomplete. For the individual patient, many factors will determine the optimal duration of bed rest and hospital stay. The patient's physician must consider the therapeutic benefits that may attend earlier mobilization and shorter hospitalization while weighing potential disadvantages. When the responsible physician does not regularly care for the patient, consultation with an experienced cardiologist is desirable. Patients whose condition is classified as "uncomplicated" may manifest deterioration during their illness and require assignment to a subset with a different prognosis and requiring different forms of treatment. For patients with uncomplicated acute myocardial infarction, as well as those in other subsets, absolute rules for therapy are unwise and application of broader principles by the alert physician is more likely to be beneficial.
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PMID:Duration of hospitalization in "uncomplicated completed acute myocardial infarction". An Ad Hoc Committee review. 125 73


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