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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Previous investigators have noted that patients with cocaine associated chest pain frequently have abnormal electrocardiograms, including ST segment elevation, in the absence of ongoing myocardial ischemia. The effects of these nonischemic ST segment elevations have not been evaluated. We report two patients with cocaine associated chest pain and ST segment elevations who received thrombolytic agents in the absence of myocardial ischemia. Neither patient sustained a myocardial infarction, nor had clinical evidence of reperfusion. The ST segment elevations persisted after resolution of chest pain in both patients, and both of the patients experienced complications of thrombolytic therapy. One patient sustained a hemorrhagic stroke and one had minor oral-pharyngeal bleeding. Given the lack of documented efficacy, concerns about safety, and poor specificity of the electrocardiogram for myocardial ischemia in patients with cocaine associated chest pain, thrombolytic therapy should be used with caution in these patients.
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PMID:Complications from the use of thrombolytic agents in patients with cocaine associated chest pain. 896 96

We studied haemodynamic changes during dobutamine stress echocardiography in 69 patients (mean age 58 years, 6 female, 63 male) referred for investigation of chest pain. We used a standard protocol of 3 min stages using infusion rates of 5, 10, 20, 30 and 40 micrograms/kg/min. Heart rate rose from 74 (13) to 123 (21) beats per min with the major increment occurring during the high dose phase of the study (> 20 micrograms/kg/min). Stroke volume was calculated as the product of left ventricular outflow tract cross-sectional area and the velocity integral of the continuous wave aortic signal. Mean stroke volume increased from 67.5 (22) ml pre-test to 82 (22) ml at 20 micrograms/kg/min dose (P < 0.0001) and 85 (21) ml at 40 micrograms/kg/min (P < 0.00001). Only 15 patients (26%) reached their maximal stroke volume by 10 micrograms/kg/min, 38 patients (65%) reached maximal stroke volume by 20 micrograms/kg/min. Patients with ischaemic responses tended to have a blunted rise in stroke volume from 67 (22) ml to 85 (22) ml at maximum compared with a rise from 69 (23) to 92 (19) ml in those without ischaemic (P = 0.09). In conclusion, the early rise in cardiac output during dobutamine stress was mainly due to a rise in stroke volume and the later due to an increase in heart rate. Individual increases in stroke volume did not adequately differentiate between ischaemic and non-ischaemic results.
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PMID:Haemodynamic changes during dobutamine stress echocardiography in patients with and without ischaemia. 902 30

In rowing, stress fractures are rare. However, the intensity of training has increased in terms of more specific rowing movements throughout the year. Simultaneously, new equipment has been developed resulting in faster rowing over the racing distance with increased risk of injuries on bones, muscles and ligaments. We report five cases of chest pain and one case of pain in the shoulder in national elite rowers, diagnosed as stress fractures of the ribs employing 99mTechnetium-MDP bone scan. In all cases, an increase or alteration in physical activity in the weeks prior to the injury and an increase in specific rowing movements with special emphasis on the new equipment, combined with increased biomechanical stress applied to the thoratic skeleton in the catch and the early part of the drive phase of the stroke, most probably caused the injuries.
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PMID:Increased risk of stress fractures of the ribs in elite rowers. 908 5

Forty-seven patients with unexplained chest pain and normal resting echocardiograms were examined to see whether dynamic mid-ventricular obstruction (MVO) is induced by dobutamine infusion. Dynamic MVO was provoked in 17 patients (MVO group), but not in the other 30 patients (Non-MVO group). Before dobutamine infusion, the blood pressure in the MVO group was higher than that in the Non-MVO group (p < 0.05), but end-diastolic volume index (p < 0.001), end-systolic volume index (p < 0.01), stroke volume index (p < 0.001), cardiac index (p < 0.001), end-diastolic volume (p < 0.01) and end-systolic volume (p < 0.05) of the apical territory of the left ventricle in the MVO group were significantly less than those in the Non-MVO group. The left atrial function, left ventricular ejection fraction and ejection fraction of the apical territory of the left ventricle did not differ between the groups. Seven patients in the MVO group were re-examined by dobutamine stress echocardiography after beta-blocker administration, showing that the dynamic MVO was completely suppressed. The end-diastolic volume tended to increase after beta-blocker administration, but no significant difference was found in any other variables except heart rate. The results suggest that a smaller left ventricle and higher blood pressure are important characteristics in patients with dobutamine-induced dynamic MVO, and additionally, the difference in local myocardial contractility may be an important cause of the induction of dynamic MVO.
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PMID:[Is reduced left ventricular volume related to mechanisms of dynamic mid-ventricular obstruction provoked by dobutamine infusion?]. 912 36

The purpose of the present study was to delineate a health profile of professional Danish army personnel. Two-hundred twenty officers, noncommissioned officers, and gunners on active duty at Varde Barracks, housing the South Jutland Artillery Regiment and the Danish Army Artillery School, were asked about their physical and psychological health, interpersonal relations, and working conditions as well as their dietary, drinking, and smoking habits. Measurements were made of resting pulse rate, blood pressure, height, weight, waist and hip girth, and pulmonary function. The ratio of waist-to-hip girth and body mass index (BMI) were calculated. Psychological well-being was evaluated using the 12-item version of the General Health Questionnaire (GHQ). Psychosomatic symptoms were frequently reported, but very few of those surveyed appeared to have psychiatric disorders as measured by the GHQ. Also, somatic health problems were frequently reported, the most frequent being lower-back pain, mild chest pain, and sensory disorders. Differences in interpretation and reporting of "lasting health problems" may explain the relatively high score for this question. The interpersonal relations, both upward and downward in the hierarchy rank order, received high scores. Compared with the general population, alcohol consumption was very low, whereas smoking-in particular heavy smoking-was much more frequent among professional Danish army personnel. Lung function testing showed significantly poorer mean values of forced expiratory volume in 1st second of expiration and mean forced expiratory flow 25 to 75% of forced vital capacity among smokers compared with nonsmokers, although the mean values for the whole group of both smokers and nonsmokers were well above reference values for all lung function parameters. The frequency of moderately overweight individuals (25 < BMI < or = 30) was significantly higher among the male army personnel than in the general population, whereas this was not the case for obesity (BMI > 30). Abdominal obesity, regarded as an independent risk factor for the development of ischemic heart disease, stroke, diabetes, hypertension, and all-cause mortality, was present in 5%, and 3% belonged to the highest-risk group by having a low BMI as well as abdominal obesity.
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PMID:Health profile of Danish army personnel. 918 68

A 68-year-old man with coronary artery disease was admitted for chest pain and ventricular tachycardia. After electric cardioversion, therapeutic heparinization was started for myocardial ischemia and nontransmural infarction. On day 3, headache and fever developed, followed by an altered sensorium and hyponatremia. Infectious etiology for the fever was excluded, and results of computed tomography of the brain were normal. Later magnetic resonance imaging (Day 10) demonstrated a pituitary macroadenoma with hemorrhage. Treatment for panhypopituitarism with stress-dose steroids stabilized the patient, and the fever and hyponatremia resolved. Transsphenoidal resection of the pituitary adenoma was performed without incident. This is the first reported case of pituitary apoplexy after heparin anticoagulation for acute myocardial infarction, although chronic anticoagulation in other settings has been reported as a precipitant of apoplexy. The uncommon presentation of a "central" fever and confusion in a patient with previously undiagnosed adenoma posed a diagnostic challenge. Subtle presentations of panhypopituitarism, knowledge of which should lead to suspicion and early diagnosis of pituitary apoplexy, will prevent anticoagulant-induced central nervous system catastrophes and potential fatalities.
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PMID:Heparin therapy for myocardial infarction: an unusual trigger for pituitary apoplexy. 936 41

The use of outcome markers other than mortality reduction alone for evaluating thrombolytic agents in patients with acute myocardial infarction (AMI) is discussed. Mortality has been a primary endpoint in clinical trials evaluating thrombolytic agents for treatment of AMI. However, differences in mortality rates among thrombolytics are 1% or less and require tens of thousands of patients to detect. Broadening the endpoints studied will allow for more extensive data collection and more comprehensive cost-effectiveness analysis, enabling clinicians to make better decisions. The Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO-1) trial measured not only mortality but issues related to the patency of the infarct-related artery and complications. Other potentially important outcome markers after AMI are left ventricular function; markers of reperfusion, such as early resolution of ST-segment elevation; and resolution of chest pain. Available long-term data show that the mortality benefit from alteplase is sustained over time and is correlated with enzymatically determined infarct size, left ventricular function, the number of diseased vessels, and Thrombolysis in Myocardial Infarction flow grade at the time of discharge from the hospital. Clinicians must also consider risk factors for stroke. Outcome measures other than mortality alone may help in determining which thrombolytic agent is most effective clinically and in financial decision-making without requiring large, expensive trials.
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PMID:Clinical trials in thrombolytic therapy, Part 1: Outcome markers that go beyond mortality reduction. 939 34

The most common diagnoses of elderly patients in the emergency department (ED) were compared among three age subgroups: 65 to 74, 75 to 84, and 85 and older. The computerized billing records for patient visits to 10 northern New Jersey hospital EDs for the years 1985 to 1991 were retrospectively analyzed. The most frequently occurring ICD-9-CM codes for elderly patients were compared among the three age subgroups. Elderly persons comprised 174, 146 (14% of the total) patient visits. The 176,146 patient visits were assigned 259,440 ICD-9-CM codes. The most common ICD-9-CM codes for medical diagnoses included chest pain, cardiac dysrhythmias, congestive heart failure, syncope, abdominal pain, and dyspnea. Fractures, particularly of the lower limb and upper limb; contusions; open wounds, particularly of the head, neck, and trunk; and falls were among the most common trauma diagnoses. The proportions in the three age subgroups of each diagnosis were statistically significantly different, except for cardiac arrest and contusions of the trunk and of multiple sites. The diagnoses with clinically significant higher relative risks in older age subgroups were atrial fibrillation, congestive heart failure, syncope, hypovolemia/dehydration, gastrointestinal hemorrhage, dyspnea, pneumonia, pulmonary edema, cerebrovascular accident, septicemia, urinary tract infection, fractures, and open wounds of the head, neck, trunk, particularly the scalp, and falls. Clinically significant lower relative risks were found in older age subgroups for chest pain, acute myocardial infarction, hypertension, angina, chronic airway obstruction not elsewhere classified, epistaxis, contusions of the upper limb, and open wounds of the finger.
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PMID:Age-related differences in diagnoses within the elderly population. 945 12

Thrombolytic therapy has changed the approach to management of acute myocardial infarction (AMI). Although its therapeutic benefit has been well established, only about one-third of AMI patients receive lytics. In AMI patients for whom thrombolytics fail to achieve revascularization or for whom lytics are contraindicated, percutaneous transluminal coronary balloon angioplasty (PTCA) can be utilized. However, in a clinical setting of AMI PTCA is less successful and is associated with a higher complication rate than with PTCA for angina alone. This review details a novel application of laser angioplasty; in patients with AMI complicated by continuous chest pain and ischemia, a mid-infrared (2.1 micron) solid-state, pulsed-wave Holmium:YAG coronary laser (Eclipse, Palo Alto, CA) can be utilized for coronary thrombolysis and plaque ablation. In each patient the laser was applied after failure of a thrombolytic agent or when thrombolytics were contraindicated. We have gained experience with 13 lesions, 12 in a coronary artery and 1 in a vein graft. In each case a multifiber with laser catheter (1.4, 1.5, 1.7 or 2.0 mm) was advanced over a guide wire, emitting 250-600 mj/pulse at 5 Hz, followed by adjunctive PTCA. Clinical success (defined as less than or equal to 50% residual stenosis, adequate thrombolysis, no complications [including death, CVA, CABGs, dissection, perforation]) was achieved in all patients. All patients improved clinically, survived the AMI, and were discharged. This initial clinical experience demonstrates the feasibility and safety of Holmium:YAG coronary laser angioplasty in revascularization during AMI.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Holmium laser coronary thrombolysis--a new treatment modality for revascularization in acute myocardial infarction: review. 1014 10

Mechanical revascularization in the acute myocardial infarction by primary angioplasty has several advantages over thrombolytic therapy. The short-term patency rates of the infarct-related artery range from 95 to 99% and a normal flow is achieved in more than 90% of the cases. This prompt and effective reperfusion is probably responsible for the improved prognosis with primary angioplasty. The better outcome after primary angioplasty is observed both in low- and in high-risk patients, in all ages and in patients presenting late (>6 h) after the chest pain. Pooled analysis of randomized studies, show that primary angioplasty as compared to thrombolysis, has a lower incidence of death, stroke and reinfarction. Additional advantages of primary PTCA include the possibility of reperfusion in patients in whom lysis is contraindicated or less effective (e.g. patients in cardiogenic shock, or with prior coronary artery bypass surgery) and the ability to provide prognostic information helpful in the patient triage. Thus, primary PTCA results in better outcome than thrombolysis when performed in centers with success rates comparable to those achieved in the randomized trials. Further studies are still needed to assess its long-term efficacy. Several randomized trials are underway to assess the role of stents and the use of more potent antiplatelet drugs, as the GPIIb/IIIa receptor blockers, in adjunct to balloon angioplasty in the treatment of acute myocardial infarction.
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PMID:Update on mechanical revascularization in acute myocardial infarction: which role and when? 1032 5


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