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

More than 400 gravitation plasmapheresis operations conducted in patients with coronary heart disease (CHD) have been analyzed. Plasmapheresis was combined with thrombocytapheresis, erythrocyte oxygenation, plasma sorption and plasma filtration. Removed plasma was substituted for rheologically active solutions and albumin. Gravitation plasmapheresis was used in critical cases when alternative therapeutic methods had failed to provide a favourable outcome. Inclusion of gravitation plasmapheresis into the combined treatment of CHD patients was conductive to decreasing lethality in complicated forms of acute myocardial infarction attended by circulatory insufficiency, stage III-IV, from 82 to 33%. Hypoxia and acytosis are eliminated as a result of normalization of blood circulation and the system of blood aggregation regulation, the functions of the lungs and other internal organs were improved, that was manifested in the clinical course of CHD: pain symptoms disappear, stress tolerance increases, sensitivity to drug therapy rises, lethality decreases.
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PMID:[Effects of gravitation plasmapheresis]. 176 13

It has been demonstrated that treatment with streptokinase (SK) in acute myocardial infarction (AMI) has an effect in reducing the mortality. The object of this study was, by means of a historical cohort study in a Danish Cardiological Department, to illustrate the effect of streptokinase on the course of pain, occurrence of arrhythmia and the lethality. Seventy-six patients with their first AMI treated with SK and low-dosage acetylsalicylic acid were compared with 76 patients with their first AMI who were not treated with SK. The median value of the employment of intravenous analgesics was significantly lower in the SK group (20 mg nicomorphine compared with 41 mg nicomorphine) as compared with the control group. Similarly, the duration of pain was briefer in the SK group (3.5 hours compared with 24 hours). Significantly more patients in the control group developed atrial fibrillation (12 patients compared with two). No differences were observed in the occurrence of arrhythmias endangering life in the two groups. Four patients in the SK group died during hospitalization whereas 14 died in the control group (p = 0.02). It is concluded that administration of SK intravenously combined with low-dosage acetylsalicylic acid in the acute phase of myocardial infarction has the effect of reducing 1) the duration of pain and thus the consumption of analgesics, 2) the number of cases of atrial fibrillation and 3) the lethality during the period of hospitalization.
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PMID:[Streptokinase as routine treatment in acute myocardial infarction. The effect on pain, arrhythmias and mortality assessed by a historical cohort study]. 177 80

ST segment depression in leads V2 to V4 in a clinical and biochemical context of myocardial infarction is usually interpreted as a sign of non-Q wave anterior walls infarction. In order to determine if this clinical electric entity could indicate transmural posterior or posterolateral infarction, as recently suggested, we undertook a prospective study of 328 primary myocardial infarctions. Isolated ST depression in leads V2 to V4 was observed in 28 patients (8.5%). It was maximal in V3 (1.8 +/- 0.7 mm) or V4 (2 +/- 1 mm). The T wave was always positive. All these case had segmental wall motion abnormalities of the left ventricular posterolateral wall on 2D echocardiography. The Q wave confirming the transmural character of the infarct was observed in leads V7, V8 and V9 on average 33 hours after the onset of pain (10-56 hours) as did the increase in the R/S ratio in leads V1 and V2. Coronary angiography performed in 26 patients showed significant disease of the left circumflex artery in all cases. This was isolated (39%) or associated with left anterior descending (15%), right coronary artery disease (19%) or both (27%). In conclusion, isolated ST segment depression in leads V2-V4 in the clinical context of acute myocardial infarction indicates a transmural posterior localisation of the necrosis. It corresponds to reciprocal subepicardial posterior ischaemia. In cases of inferior infarction, it reflects postero-lateral extension rather than associated anterior wall ischemia.
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PMID:[Isolated ST segment depression from V2 to V4 leads, an early electrocardiographic sign of posterior myocardial infarction]. 179 18

The application of the myoglobin-latex test was examined to make an early diagnosis of myocardial necrosis in the prehospital period. As many as 142 patients with suspected acute myocardial infarction were studied. The test was employed in bed patients at home at 1.5-60 hour intervals of the onset of pain. The agglutination test was performed by the 5-score minute scale. The results of the latex-test were randomly monitored by radioimmunoassay. The mean myoglobin levels were 35.4 +/- 7.1 ng/ml (maximum 73.2 ng/ml) in the controls. Acute myocardial infarction was diagnosed in 33 patients (at myoglobin levels of 130.3-459.7 ng/ml) in the first hours of the disease. The test is simple and easy-to-use. Its practical application in emergency care is an important reserve for the early diagnosis of acute myocardial damages.
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PMID:[Early rapid diagnosis of acute manifestations of ischemic heart disease in the pre-hospitalization period using the myoglobin-latex test (correction of hemoglobin-latex-text)]. 180 54

The purpose of the present study was to measure plasma levels of atrial natriuretic peptide (ANP) in patients with acute myocardial infarction without heart failure, and also to assess the temporal sequence of changes of plasma ANP during the first hours of recovery from myocardial infarction. The study was performed in 22 patients who were admitted to the Intensive Care Unit with the diagnosis of acute myocardial ischaemia that had an evolution of less than 6 h. Blood samples were drawn on admission and at 1, 8, and 24 h, and plasma concentrations of ANP, renin, aldosterone, epinephrine, norepinephrine and vasopressin were measured. Compared with control subjects, on admission patients showed increased plasma levels of ANP, as well as increased plasma renin activity (PRA), aldosterone, norepinephrine, epinephrine, dopamine, and antidiuretic hormone (ADH). ANP, but not renin or aldosterone plasma values, decreased with time, and there was a significant correlation between ANP and time after onset of pain. No increase in plasma creatinine was observed during the hospital stay, and the patients showed a negative fluid balance. No relationship was found between the location or extension of the infarction, or morphine treatment and ANP plasma levels. The high levels of ANP seem to counteract the haemodynamic and fluid-retention effects of the vasoconstrictive factors released after myocardial infarction.
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PMID:Atrial natriuretic peptide in patients with acute myocardial infarction without functional heart failure. 182 81

In a randomized trial of the effects on in-hospital mortality of intravenous urokinase plus heparin versus heparin alone, 2,531 patients with acute myocardial infarction in 89 coronary care units were enrolled for greater than 30 months. Patients admitted within 4 hours of the onset of pain were randomized to receive either intravenous urokinase (a bolus dose of 1 million U repeated after 60 minutes) plus heparin (a bolus dose of 10,000 U followed by 1,000 IU/hour for 48 hours) or heparin alone (infused at the same rate). Complete data were obtained in 2,201 patients (1,128 taking urokinase and 1,073 taking heparin). At 16 days, overall hospital mortality was 8% in the urokinase and 8.3% in the heparin group (p = not significant). Among patients with anterior infarction, mortality was 10.3% in the urokinase and 13.9% in the heparin group (p = 0.09; relative risk = 0.73). The incidence of major bleeding (urokinase 0.44%, heparin 0.37%) as well as the overall incidence of stroke (urokinase 0.35%, heparin 0.20%) was similar in the 2 groups. The rates of major in-hospital cardiac complications (reinfarction, postinfarction angina) were also similar.
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PMID:Comparison of intravenous urokinase plus heparin versus heparin alone in acute myocardial infarction. Urochinasi per via Sistemica nell'Infarto Miocardico (USIM) Collaborative Group. 154 77

Treatment of coronary thrombosis with thrombolytic agents was first introduced in the 1950s. Clinical trials, primarily with streptokinase during the 1960s and 1970s, addressed the effects of thrombolysis on mortality rates after acute myocardial infarction, but were inconclusive and largely ignored. In 1976, Chazov et al. from the Soviet Union demonstrated that intracoronary streptokinase could produce prompt recanalization of a totally occluded infarct-related artery. In 1980, DeWood et al. demonstrated that 87% of patients with classic Q-wave myocardial infarction had total occlusion from coronary thrombosis of the infarct-related artery when studied during the first 4 hours of their infarction and that 65% of these arteries were still occluded when patients were studied between 12 and 24 hours after infarction. These observations stimulated renewed interest in thrombolytic therapy for acute myocardial infarction. Mortality trials have subsequently demonstrated that agents such as recombinant tissue plasminogen activator, streptokinase, and anisoylated plasminogen streptokinase activator complex remarkably reduce early mortality rates among patients with acute myocardial infarction when treatment is instituted within the first 6 hours of infarction. Benefit has yet to be demonstrated, however, in patients with acute myocardial infarction characterized by ST-segment depression. This whole area is currently under study by the TIMI investigators. TIMI-3B is a mortality study in which patients with either non-Q-wave myocardial infarction or unstable angina with rest pain are randomly assigned to receive either tissue plasminogen activator or placebo. Results of this trial will help us in the future to determine the appropriate role of thrombolytic therapy in treating acute ischemic syndromes other than transmural myocardial infarction.
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PMID:Overview: rationale of thrombolysis in treating acute myocardial infarction. 189 38

Significant delays in seeking definitive treatment for the signs and symptoms of acute myocardial infarction increase morbidity and mortality. In most studies, delay times average more than 4 hours. The following variables are associated with increased delay: a medical history of angina, diabetes mellitus, or hypertension; older age; black race; seeking advice from a family member or a physician; symptom onset on a weekday; and attempts at self-treatment. Variables associated with reduced delay times are the following: pain recognized as cardiac in origin, hemodynamic instability, severe chest pain, younger age, and consultation with a coworker. Surprisingly, patients who have already experienced a myocardial infarction are just as likely to delay as patients who have not had this experience. These findings provide direction for developing and testing patient and family interventions, establishing community education programs, and reducing patient delay in response to the signs and symptoms of acute myocardial infarction.
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PMID:Treatment-seeking behavior among those with signs and symptoms of acute myocardial infarction. 189 41

Treatment with intravenous streptokinase is known to restore blood flow to the ischaemic myocardium in patients with acute myocardial infarction. However, little is known about its effect on chest pain. In a retrospective cohort study, 76 patients treated with streptokinase were compared to 76 patients not treated with streptokinase. All patients had acute myocardial infarction and less than 6 h of cardiac symptoms. Patients treated with streptokinase had a significantly lower need for nicomorphine (median 20 mg) than patients not treated with streptokinase (median 41 mg). Correspondingly, the median duration (3.5 h) of pain was reduced significantly in patients treated with streptokinase compared to patients not treated (24 h). We conclude that intravenous streptokinase given in the acute phase of myocardial infarction is effective in reducing the duration of cardiac chest pain.
Pain 1991 Jul
PMID:The effect of streptokinase on chest pain in acute myocardial infarction. 189 6

In a randomized, double-blind study, in which recombinant tissue plasminogen activator (rt-PA) administered at an early stage was compared with placebo in patients with suspected acute myocardial infarction (AMI), the effects on pain were studied in 312 patients. Inclusion criteria were as follows: (a) chest pain of duration less than 2 h and 45 min; and (b) age less than 75 years. Chest pain was estimated subjectively by the patients, using a 10-point numerical rating scale, at hourly intervals for the first 24 h, and by the requirement for narcotic analgesics. Compared with placebo, rt-PA treatment resulted in a 43% reduction in mean total pain score (P less than 0.0001), a 26% reduction in pain duration (P less than 0.01), and a 33% reduction in morphine requirement (P = 0.01). Fifty-seven per cent of all patients developed a confirmed AMI. In these subjects rt-PA reduced the pain score by 46% (P less than 0.001). Among patients without confirmed AMI, a 37% reduction in pain score was observed (P = 0.05). The effect on pain was most marked in patients with ST-elevation on the initial ECG. We conclude that early treatment with rt-PA in suspected AMI reduces chest pain considerably. The effect is most marked in patients with ST-elevation on the initial ECG.
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PMID:Effects on chest pain of early thrombolytic treatment in suspected acute myocardial infarction: results from the TEAHAT Study. 190 9


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