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Query: UMLS:C0151744 (myocardial ischemia)
 31,282 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The examination was conducted in 100 patients with a cardiac pain syndrome and a normal ECG at rest. Apart from the routine clinical examination, the patients were subjected to ergometric bycycle tests with recording corrected orthogonal electrocardiogrammes and vectorcardiogrammes. All the examined patients were subdivided into 3 groups with reference to their electrocardiographic response to the exercise: group 1 -- 55 persons with physiological changes, group 2 -- 37 persons with pathological changes, and group 3 -- 8 persons with threshold changes on ECG under the exercise. By comparing the vectorcardiogrammes in group 1 and 2 patients vectorcardiographic criteria pathognomonic for ischaemic heart disease were found. With their help the form of the lesion was established in 2 of the 8 patients with threshold changes on ECG under exercises. The method of combined evaluation of ECG and vectorcardiogrammes under exercises. The method of combined evaluation of ECG and vectorcardiogrammes under exercise tests increases their diagnostic potentials in revealing the latent form of ischaemic heart disease.
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PMID:[Possibilities for a complex of corrected orthogenal systems of electro- and vectorcardiograms and the ergometric bicycle test with loading in the diagnosis of the latent form of ischemic heart disease]. 101 73

Pacing-induced myocardial ischemia in 18 patients resulted in an increase of coronary sinus hypoxanthine levels from 1.20 +/- 0.18 micron during control to 2.41 +/- 0.52 micron (p less than 0.025) during pain. In addition, early lactate production occurred frequently before angina was noted. Neither hypoxanthine nor lactate levels changed in seven nonanginal patients, nor were significant alterations in potassium, inorganic phosphate, glucose, or oxygen saturation found in all patients. Myocardial hypoxanthine production seems a useful indicator of ischemia in the human heart.
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PMID:Changes in purine nucleoside content in human myocardial efflux during pacing-induced ischemia. 103 94

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

In the light of 4 personal observations of PPPRINZMETAL's angina, a review has been conducted of the literature in the 15 years since the condition was first described. Although the formal diagnostic criteria for this form of angina simultaneously clinical, biological and electrical - anginal attacks occurring at rest, often at night, during which elevation of the ST segment is recorded which disappears at the end of the attack without any significant rise in enzyme levels (SGOT and CPK) - the frontiers of the syndrome appear to have widened since PRINZMETAL's description: - Severe proximal stenosis of the coronary arteries is not obligatory; they may be only slightly damaged or even healthy. - Prinzmetal's angina is by no means always "spontaneous" but is often induced, either by psychic factors, which explain the fixed time of the attacks, or by organic factors, e.g. cold drinks (Observation No.2). In this event it would appear safer to speak of angina or rest as opposed to angina of effort. - In contrast to what PRINZMETAL thought, effort tests may sometimes induce angina-type pain with elevation of the ST segment, and here the borderline between this syndrome and conventional angina with ST segment elevation after effort test (5% of cases) is less clear-cut. The two nosologic entities probably reflect the same physiopathological situation, i.e. acute myocardial ischemia, and may represent the same affection in different phases of development. The prognosis is equally bad. - Attacks of rinzmetal's angina are often accompanied by severe and sometimes fatal disorders of rhythm, and this influences the therapeutic approach. - The coronary spasm posited by PRINZMETAL and others before the advent of coronarography is indeed, in the majority of cases, the immediate cause of myocardial ischemia and anginal pain, without any preliminary increase in the energy requirements of the heart as in the conventional anginal attack. - A vasoactive substance present in the circulating blood at the beginning of the affection, which may be degraded and subsequently disappear and may be secreted by the pathologic coronary artery, was demonstrated in observation No. 4: this may, in conjunction with vagal hypertonia, be the causative factor in coronary spasm. Study of its pharmacodynamic properties is now in progress.
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PMID:[Prinzmetal's angor. Apropos of 4 cases. Review of the literature]. 108 Aug 80

Twenty four patients were studied: 7 males and 17 females, with an average age of 56 plus and minus 6.93 years, with a main diagnosis of ischaemic heart disease and with an average of at least 7 angina attacks per week. The anti-angina effect of 2 drugs, dipridamol and pentaeritritol was compared using the random double blind technique on parallel groups which were comparable. Pentaertritol administered for 4 weeks reduced, with a statistical significance (P 0.01), the average number of angina attacks of the group, as well as with taking nitroglicerine tablets. The number of pain free days was increased from 1.5 per week to 5.5 in 7 days. The effort capacity of the patients increased (P 0.01), and also the degree of elevation of the ST segment during and post effort. The changes obtained in these same areas with dipiridamol had no statistical significance.
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PMID:[Comparison of the antiangina pectoris action of 2 coronary vasodilators]. 109 98

Diagnostic pacing has proven useful for the study of a great variety of clinical problems. Rapid atrial pacing is an excellent means of stressing the heart, particularly in patients with ischemic heart disease. Pacing-induced tachycardia has been used to provoke typical coronary pain and to produce hemodynamic, metabolic, and left ventricular contractile changes in patients with coronary artery disease. Because this heart stress is reproducible, it has also been valuable in assessing response to medical and surgic al therapy in patients with angina. Electrophysiologically, pacing has been used to clarify mechanisms of normal and abnormal function of the sinus node and A-V conduction. The pre-excitation states have been more precisely defined, and the introduction of programmed electrical stimuli into the cardiac cycle has helped elucidate the nature of re-entry supraventricular tachycardias.
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PMID:Diagnostic uses of electrical pacing. 110 Feb 46

Among 264 consecutive persons (142 men, 122 women) greater than or equal to 35 years of age presenting for multiphasic screening examination, 85 (54 men, 31 women) reported chest pain. In most, the pain was not typical of coronary artery disease. The two-step exercise electrocardiogram (ECG) was positive (greater than or equal to 0.5-mm ischemic ST depression) in 21% of the patients who reported pain and in 19.5% of 66 randomly selected, similarly examined controls without chest pain (36 men, 30 women) (difference not significant). Females with positive ECGs (5-mm or 1-mm depression) predominated over males greater than or equal to 5:1 in the chest pain group and greater than 3:1 in controls. This study indicates that the routine two-step exercise ECG is not helpful in detecting ischemic heart disease in persons reporting chest pain during their multiphasic screening examination.
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PMID:Two-step electrocardiogram for chest pain reported on multiphasic screening. 111 Mar 38

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

Seventeen subjects ranging from 36 to 58 years of age presented with chest pain suggestive of myocardial ischemia. Each patient had a positive double Master's two-step test with ST segment depression of 0.5 mm. or more in the postexercise ECG. In each case coronary angiography and left ventriculography were normal. Hemodynamic and metabolic investigations were carried out during sinus rhythm and atrial pacing. Thirteen patients experienced pain during pacing but only one showed an abnormal hemodynamic response. Two patients showed abnormal myocardial lactate metabolism during the control period and four during pacing-induced tachycardia. The increase in ejection fractions in this group suggests hyperdynamic ventricular contraction which could result in increased oxygen requirements and thus induce ischemic pain in the absence of arteriographically demonstrable coronary artery disease.
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PMID:Angina pectoris with normal coronary arteriograms: hemodynamic and metabolic response to atrial pacing. 119 32

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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