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At least 253 records · Page 14Linked to original sources
PubMed1989

[Echocardiography detection of reversible regional disorders of contraction in patients with unstable angina pectoris and Prinzmetal angina during an attack].

We studied seven patients with Prinzmetal's angina and three patients with unstable angina pectoris type III (according to the criteria of Conti) during and after a spontaneous attack of angina pectoris by two-dimensional echocardiography. All patients underwent coronary angiography. The echocardiographic studies were performed during the attack (phase I), immediately after the attack (phase II), and 24 h after the attack (control). Left ventricular ejection fraction was significantly decreased during the attack (38.1 +/- 11% vs 59.8 +/- 7%), while left ventricular end-diastolic volume was increased (71.9 +/- 28 ml/m2 vs 50.3 +/- 13 ml/m2). The double product of heart rate and systolic blood pressure was equal at the 3 different examination times. In all patients transient regional disturbances of left ventricular contraction could be observed. In six patients the wall motion disturbances had already disappeared at phase II, while in four patients hypokinetic regions could still be found. At control, nine patients showed a normal left ventricular contraction pattern, while one patient with previous anterior myocardial infarction showed a small region of anterior akinesia. In all patients coronary artery obstructions were found in the same region of the left ventricle, where transient wall motion abnormalities occurred. Thus, two-dimensional echocardiography performed during an attack of angina pectoris in patients with Prinzmetal's angina and unstable angina pectoris type III can evaluate the localization, as well as the extent of transient myocardial wall motion abnormalities.

Angina Pectoris↗
PubMed1989

[Effect of conventional medical treatment on the course of unstable angina].

In spite of the frequency of unstable angina, the number of clinical trials which permit to evaluate the value of conventional medical treatments, remains limited, especially because of the difficulties in finding a "specific tracer" of the efficacy of the standard drugs used. The common form of unstable angina is different from the spastic form, in that inducement tests permit, in Prinzmetal angina, better codified selection and monitoring of the patients. The literature is reviewed for each therapeutic family (calcium inhibitors, amiodarone, nitro-compounds, molsidomine, etc.). On a short term basis, the conventional treatment permits, most of the time to perform a coronary angiography under good conditions. On a long term basis, medical treatment and surgical procedure give similar results, except for patients with three-vessels disease in whom surgical revascularization provides a more comfortable life.

Angina Pectoris↗
PubMed1985

Clinical indications for calcium channel blockers.

Ca2+ channel blocking agents have proven to be one of the most exciting groups of drugs for management of many cardiovascular diseases and as potentially first-line agents for treatment of angina pectoris and hypertension. Unlike beta blockers, they can directly relax coronary and peripheral arteries and, therefore, reduce total peripheral resistance and improve tissue perfusion. Ca2+ channel blockers are drugs of choice for patients with Prinzmetal's angina and should be first-line drugs for mixed angina, and can be used alone or with beta blockers for classic angina. These drugs as a group have many potential clinical indications, especially in diseases in which vascular or smooth muscle spasm seems to cause the disease. Although all three Ca2+ channel blockers have a common mechanism of action, their cardiac and hemodynamic effects are different, nifedipine being the least depressant to cardiac function. In choosing the right agent, careful consideration should be given to the patient's characteristics in order to derive maximum benefit with minimal risks.

Adrenergic beta-Antagonists↗
PubMed1986

[Transluminal coronary angioplasty: immediate and short-term results. Apropos of 302 dilated vessels].

This study reports the experience of the Cardiac Hospital of Lille up to the 1st October 1984. Two hundred and sixty-nine patients with a mean age of 51 years underwent transluminal coronary angioplasty for one or more stenotic lesions. Three hundred and two vessels were dilated. The left anterior descending artery was dilated in 72.5% of cases, the right coronary in 17.6% and the left circumflex in 8.6% of cases. The immediate results may be summarised as follows: it was possible to cross the stenosis to be treated in 91.4% of cases; the primary success rate (a gain of more than 20% without complications) was 83%. The narrowing was significantly decreased from 72 +/- 7% to 25 +/- 17%, the average gain in lumen size was 53 +/- 16%. The emergency coronary artery bypass surgery rate was 4.3%, and 3.6% of all the patients developed myocardial infarction. Sixty four per cent of patients had negative maximal exercise stress tests on discharge from hospital. The patients who had positive tests had improved exercise tolerance compared to the stress test performed before angioplasty. Angiographic control at 6 months was performed in about half the patients and showed coronary stenosis in 27%. Sixty eight per cent of the patients were totally asymptomatic.

Adult↗
PubMed1988

[Angina with long-standing coronary T waves].

The clinical significance of long-standing (greater than or equal to 24 hours) coronary T waves without abnormal Q waves was evaluated in 24 patients with angina. They were categorized in two groups; 11 with ST elevation followed by coronary T waves (Group A), and 13 with coronary T waves alone (Group B). 1. The patients had long-standing or repetitive episodes of rest angina, with clinical features of unstable angina in all but one. Fifty-five % of patients in Group A and 85% in Group B had histories of effort angina. 2. Significant (greater than or equal to twice the upper normal) elevation of serum CPK value was observed in 36% of patients in Group A and in 46% in Group B. There was no correlation between the maximum CPK value and the number of leads with the coronary T wave. 3. Coronary angiography demonstrated significant (greater than 50%) coronary artery stenosis in 27% of patients in Group A and in 77% in Group B. The incidence of severe stenosis was greater in Group B than in Group A. Angioplasty was performed in 9% of patients in Group A and in 38% in Group B. 4. During the average follow-up period of 27 months, there was one cardiac event (unstable angina) in Group A, two events (one sudden death and one unstable angina) in Group B. Each cardiac event occurred after the patients themselves discontinued their medications. This was not related to the severity of coronary artery stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Clinical aspects, diagnosis, therapy and course of unstable angina pectoris].

It is reported on 27 patients aged 32-77 years with an unstable angina pectoris, including coronary spasm. All patients showed an anamnesis of less than 3 months, nearly the half of less than 24 hours. The resting electrocardiogram during the attack was pathological in 22 patients, 7 patients showed a Prinzmetal reaction and 11 patients showed intermittent ventricular dysrhythmias. The exercise electrocardiogram in the stable phase was pathological in 16 of 17 patients. Of 23 patients who underwent a selective coronary angiography with laevocardiography 9 patients each showed a disease of one vessel and three vessels, respectively, and 5 patients a disease of two vessels. Only nearly 50% of the patients could be stabilized medicamentously (nitrates, calcium antagonists, rarely beta-blockers). In three patients still during the unstable phase a surgical revascularization was carried out, in 11 patients after stabilization. Five patients suffered an early infarction; one of them died. Altogether, the unstable angina pectoris is even nowadays to be regarded as a clinical picture with a relatively bad prognosis, which demands rapid action.

Adult↗
PubMed1985

Exercise-induced ST-segment elevation possibly caused by coronary artery spasm. A case presentation and review.

A 36-year-old man with classic angina pectoris had marked ST-segment elevation (STE) in the inferior leads on stress-testing in the absence of chest pain. There was no evidence of previous myocardial infarction (MI). Selective coronary arteriography delineated severe obstructions in the right coronary artery (RCA) with additional left circumflex coronary artery (LCx) obstruction. Left ventricular cine-angiography established that there was normal contractility and confirmed the absence of past MI. Coronary artery bypass graft surgery to the RCA and LCx was unfortunately complicated by an acute transmural inferoposterolateral MI. Treadmill stress testing 6 weeks after surgery failed to demonstrate the preoperative ST-segment change. The patient may have developed exercise-induced coronary artery spasm superimposed on the severe proximal RCA stenosis; this in turn may have caused the inferior STE. Exercise-induced STE is reviewed.

Adult↗
PubMed1984

[Therapy of angina pectoris].

Treatment of angina pectoris should follow the clinical course: Stable angina is most often responding to nitropreparations, betablockers or calciumantagonists; differentialtherapy should consider the basic state of the patient: age, heart-rate, hypo- or hypertension, cardiac failure or asthma bronchiale etc. Unstable angina needs more attention and should be transferred to a coronary care unit. Analgetics, sedatives, oxygen and nitrates should be applied under hemodynamic monitoring. Only in rare cases with cardiac failure or with rapid atrial fibrillation glycosides will be necessary. In extreme bradiacardias a pacemaker can be helpful. Captopril might be a new substance in nonresponders.

Adrenergic beta-Antagonists↗