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 randomized, double-blind study, rt-PA vs. placebo treatment in early suspected acute myocardial infarction (AMI) was evaluated in patients both in hospital and prehospitally. The inclusion criteria were as follows: (a) age less than 75 years; and (b) chest pain indicative of AMI, of no longer than 2.75 h duration before first examination. In the prehospital setting a mobile coronary-care unit, accompanied by a cardiologist, was sent out by the ambulance services to 350 patients, of whom 205 (59%) were classified as non-eligible when examined by the cardiologist. Of the 145 patients who fulfilled the inclusion criteria, 44 were excluded due to contraindications to thrombolytic treatment. Thus 101 patients were randomized to blinded treatment outside hospital. The median time interval between onset of pain and treatment was 75 min, 45 min less than for those subjects who were randomized in hospital. The prevalence of confirmed AMI was 42% in the prehospital group, compared to 66% in the hospital group. Bleeding and cardiac complications for prehospital treatment were few, and similar to those for hospital treatment. In conclusion, prehospital thrombolysis was feasible, and delay times prior to treatment were significantly reduced. However, the specificity and diagnostic accuracy were lower than those achieved with in-hospital therapy.
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PMID:Prehospital thrombolysis in suspected acute myocardial infarction: results from the TEAHAT Study. 190 10

The percentage of patients with acute myocardial infarction (AMI) who were eligible for thrombolytic therapy was evaluated prospectively, with analysis of the causes for exclusion, in 857 patients with AMI hospitalized in the Chaim Sheba Medical Center, Tel-Hashomer, in 1988. Thrombolytic therapy was given to 127 patients (14.8%); 99 patients were treated with tissue plasminogen activating factor and 28 patients received streptokinase. Three hundred and sixty patients (42.0%) were rejected because of age (greater than 72 years). Other reasons for exclusion were duration of pain lasting for more than 4 h (28.5%), unknown time of onset of the chest pain (9.7%), absence of ST elevation on admission ECG (8.1%), systemic hypertension (4.4%), and presence of severe congestive heart failure upon admission (10.1%). Restricting thrombolytic therapy only to patients less than 72 years old with chest pain duration of 4 h limits the impact of this treatment on the general welfare of patients with AMI. By raising the age limit and extending the time interval between pain onset and treatment initiation, adding newer indications, and enhancing public awareness for early arrival to hospital, the benefit of thrombolytic therapy may be made available to more patients with AMI.
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PMID:Incidence of and reasons for excluding patients with acute myocardial infarction from thrombolytic therapy. 190 38

In a previous study on the diagnostic efficiency of troponin T measurements in patients with suspected acute myocardial infarction (AMI), the authors found a high variability of troponin T serum concentration changes on day 1 in patients with AMI who underwent thrombolytic treatment. Therefore, the aims of the present study were to investigate the intracellular compartmentation of troponin T and to analyze the effects of AMI reperfusion on the appearance kinetics of cardiac troponin T in serum. Cardiac troponin T was measured with a newly developed bideterminant sandwich assay using cardiospecific, affinity-purified polyclonal antibodies and peroxidase-labeled monoclonal antibody. An unbound cytosolic troponin T pool was found in ultracentrifuged homogenates of myocardial tissue of different species ranging from 0.013 to 0.036 mg/g wet weight. The soluble troponin T molecule had electrophoretic properties identical to troponin T compartmented in the myofibrils. The clinical study group comprised 57 patients with AMI undergoing thrombolytic treatment. Blood flow to the infarct zone and point of time of reperfusion were tested by immediate and late angiography. The appearance of troponin T in serum on day 1 after the onset of AMI depended strongly on reperfusion and on duration of ischemia before reperfusion. Thus, in patients with early reperfused AMI, a marked peak in troponin T serum concentrations was found at 14 hours after the onset of pain. This early troponin T peak was absent in patients with AMI reperfusion occurring greater than 5.5 hours after the onset of pain and in patients with nonreperfused AMI. By contrast, the kinetics of troponin T release after the first day after AMI were unaffected by reperfusion.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Intracellular compartmentation of cardiac troponin T and its release kinetics in patients with reperfused and nonreperfused myocardial infarction. 190 90

In 60 patients with acute myocardial infarction (AMI) treated with brief i.v. infusion of streptokinase, signal averaged surface ECG as well as 24-hour ECG were recorded within the first 6 hours after admission and 5 to 10 days later. Results obtained from a group with presumed reperfusion (early plasma creatine kinase activity peak, cessation of pain, decrease in ST segment elevations, the appearance of "reperfusion arrhythmias"), were compared to those from patients with no reperfusion. The first recording showed a higher incidence of ventricular late potentials (VLP) in the group with reperfusion (77% vs. 44%, p less than 0.01), and a smaller difference in the incidence of complex ventricular arrhythmias (89% vs. 68%, p = 0.06). In the period between the two recordings, the incidence of VLP decreased in higher proportion in the same group (p less than 0.025). The incidence of complex ventricular arrhythmias was similar in both groups in the second recording. The authors conclude that complex ventricular arrhythmias following successful thrombolytic therapy occur together with "reperfusion VLPs", which are a better marker for successful thrombolysis in patients with AMI than a high grade of ventricular ectopic activity.
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PMID:Value of signal averaged electrocardiogram for prediction of successful coronary artery thrombolysis. 191 64

To further evaluate contemporary risk and practice patterns in acute myocardial infarction (AMI), 402 consecutive patients with AMI between July 1, 1988, and June 30, 1989 were studied. The clinical investigations, medical therapy and outcome of patients aged greater than or equal to 70 years (n = 132; group 1) were compared with patients aged less than 70 years (n = 270; group 2). In group 1, 20% of patients had no typical cardiac pain versus 6% in group 2 (p less than 0.01). History of previous AMI, Q-wave AMI and peak creatine kinase were not different in the 2 groups. In-hospital mortality was markedly higher in group 1 (27%) than in group 2 (8%), p less than 0.01. Multivariate analysis revealed previous AMI, presentation without typical pain and age greater than or equal to 70 years to be independently associated with the greatest relative risk. Post-AMI exercise testing, ejection fraction calculations and coronary angiography were all performed less often (p less than 0.01); proven effective medical therapies, including thrombolysis, beta blockers, acetylsalicylic acid and nitrates were all used less frequently (p less than 0.01). The very high mortality and less aggressive management of elderly patients with AMI confirm similar data from our 1987 AMI patient cohort and other recently reported AMI patient outcome analyses. However, it remains uncertain why older patients with AMI are investigated and treated differently from younger patients. Further studies are warranted.
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PMID:Comparison of risk and patterns of practice in patients older and younger than 70 years with acute myocardial infarction in a two-year period (1987-1989) 192 57

Interest in early thrombolysis has prompted a study on the feasibility and time course of prehospital thrombolysis in patients with acute myocardial infarction (AMI) in six centres in Belgium. Patients with clinically suspected AMI and with typical ECG changes presenting within 4 h after onset of pain were treated with 30 units of Anisoylated Plasminogen Streptokinase Activator Complex (APSAC, eminase) intravenously by a mobile intensive care unit (MICU). Sixty-two patients were included in the study and an AMI was confirmed in 60. The mean time (+/- 1 SD) from onset of pain to injection of APSAC was 95 +/- 47 min and the mean estimated time gain, calculated as the time difference between the arrival of the MICU at home and the arrival of the MICU at the emergency department, was 50 +/- 17 min. In the prehospital period four patients developed ventricular fibrillation and one cardiogenic shock. During hospital stay severe complications were observed in four patients. Two events were fatal, one diffuse haemorrhage and one septal rupture; two events were non fatal, one feasible and that an estimated time gain of 50 min can be obtained. Potential risks and benefits remain to be demonstrated in a large controlled clinical trial.
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PMID:Prehospital thrombolysis in acute myocardial infarction: the Belgian eminase prehospital study (BEPS). BEPS Collaborative Group. 193 9

In the past decade, mortality associated with acute myocardial infarction has been reduced to between 5% and 9% in selected groups of patients, largely due to use of early reperfusion. Thrombolytics combined with aggressive mechanical revascularization reduce the likelihood of death both during hospitalization and in the ensuing several years. Overall morbidity is also lessened, although salvage of patients with severe left ventricular dysfunction may make this difficult to demonstrate. Foremost among issues remaining unresolved is the relationship between patency of the infarct vessel and survival. Survival associated with reperfusion is limited primarily to patients with successful reperfusion. Myocardial salvage is more likely in these patients, but the correlation between myocardial salvage and mortality reduction is not determined. Late spontaneous reperfusion occurs in greater than 50% of patients who do not receive a thrombolytic; survival seems to be greater when vessels undergo spontaneous reperfusion. Only a minority of patients can be treated within the first hour after chest pain onset. It is not clear that the time window in which early reperfusion can be accomplished allows benefit to be clinically evident. Resources need to be directed toward agents to augment the rate of lysis and toward improvement of delivery. Mortality is highest in the first 24 hours after thrombolytic administration. Understanding of the underlying mechanisms may promote further reductions in mortality. Intravenous thrombolytic therapy can be given on average 2-3 hours after pain onset. If the myocardial salvage versus time curve is steepest immediately after occlusion, early administration of thrombolytics, such as by paramedics in the field, may be indicated.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Goals of thrombolytic therapy. 195 Nov 8

The recognition of polyarteriitis nodosa is a difficult task for the clinician. The extraordinarily varied symptoms of this illness involve mostly general complaints and the mostley combination of some organic symptoms. In their histologically proved seven cases the most frequent original clinical symptoms were the long lasting feverish condition, the loss of body weight as well as numbness and pain of limbs. The anamnesis of three patients involved the asthma bronchiale. The laboratory findings were characterized first of all by an accelerated erythrocyte sedimentation rate and in four cases anaemia has developed. In four cases eosinophilia and in two ones high blood-pressure were observed. The disease-process of their patients is varying; a 30 year old man's death was caused right after the admission to the hospital by an acute myocardial infarction.
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PMID:[7 cases of polyarteritis nodosa]. 197 16

Pediatric chest pain usually occurs in benign conditions. However, this case portrays the dramatic electrocardiographic appearance of acute myocardial ischemia in a boy with biopsy-proven myocarditis who had only mild chest pain. This underscores the need for eliciting a detailed history when evaluating a patient with chest pain. If the pain cannot be clearly attributed to chest wall phenomena, or if there are historical or physical findings suggestive of an arrhythmia or angina, then further investigation with a chest radiograph and a 12-lead electrocardiogram is recommended. Myocarditis must be considered in the differential diagnosis of any child whose electrocardiogram is indistinguishable from an acute myocardial infarction. Finally, endomyocardial biopsy allows early diagnosis and institution of therapy, which may have beneficial effect on decreasing morbidity and mortality. Further follow-up and research is still needed to evaluate the effect of early treatment of myocarditis on long-term myocardial function and the development of chronic cardiomyopathy.
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PMID:Acute myocarditis simulating myocardial infarction in a child. 198 39

The value of thorough examination of the case history as a diagnostic tool on hospitalization of patients with suspected myocardial infarction was investigated in three independent prospective studies. Use of a limited number of pain-related elements (= 'criteria'), that had already been obtained in the emergency room, could improve the decision on whether or not to admit patients to the coronary-care unit. As an example, in one of the studies, use of such criteria would have reduced the number of 'unnecessary' coronary-care-unit admissions from 298 to 162, a 46% reduction (P less than 0.001). In the same patient sample, use of the criteria could have reduced the number of patients with definite acute myocardial infarction, admitted to the general wards, from 47 to 22, a 53% reduction (P less than 0.01). These favourable results were confirmed in the two independent, smaller-scale studies.
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PMID:Rapid and correct diagnosis of myocardial infarction: standardized case history and clinical examination provide important information for correct referral to monitored beds. 199 40


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