[Course of the acute period of myocardial infarction complicated by primary ventricular fibrillation and heart failure].
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Acute Disease↗
SEARCH · PubMed Health
Results for “MYOCARDIAL DISEASES, PRIMARY”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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How effective are rapid access chest pain clinics? Prognosis of incident angina and non-cardiac chest pain in 8762 consecutive patients.
OBJECTIVE: To determine whether rapid access chest pain clinics are clinically effective by comparison of coronary event rates in patients diagnosed with angina with rates in patients diagnosed with non-cardiac chest pain and the general population. DESIGN: Multicentre cohort study of consecutive patients with chest pain attending the rapid access chest pain clinics (RACPCs) of six hospitals in England. PARTICIPANTS: 8762 patients diagnosed with either non-cardiac chest pain (n = 6396) or incident angina without prior myocardial infarction (n = 2366) at first cardiological assessment, followed up for a median of 2.57 (interquartile range 1.96-4.15) years. MAIN OUTCOME MEASURES: Primary end point--death due to coronary heart disease (International Classification of Diseases (ICD)10 I20-I25) or acute coronary syndrome (non-fatal myocardial infarction (ICD10 I21-I23), hospital admission with unstable angina (I24.0, I24.8, I24.9)). Secondary end points--all-cause mortality (ICD I20), cardiovascular death (ICD10 I00-I99), or non-fatal myocardial infarction or non-fatal stroke (I60-I69). RESULTS: The cumulative probability of the primary end point in patients diagnosed with angina was 16.52% (95% confidence interval (CI) 14.88% to 18.32%) after 3 years compared with 2.73% (95% CI 2.29% to 3.25%) in patients with non-cardiac chest pain. Coronary standardised mortality ratios for men and women with angina aged <65 years were 3.52 (95% CI 1.98 to 5.07) and 4.39 (95% CI 1.14 to 7.64). Of the 599 patients who had the primary end point, 194 (32.4%) had been diagnosed with non-cardiac chest pain. These patients were younger, less likely to have typical symptoms, more likely to be south Asian and more likely to have a normal resting electrocardiogram than patients with angina who had the primary end point. CONCLUSION: RACPCs are successful in identifying patients with incident angina who are at high coronary risk, but there is a need to reduce misdiagnosis and improve outcomes in patients diagnosed with non-cardiac chest pain who accounted for nearly one third of cardiac events during follow-up.
Angina Pectoris↗
Combination antithrombotic therapy with antiplatelet agents and anticoagulants for patients with atherosclerotic heart disease.
We reviewed the efficacy and safety of combination antithrombotic therapy with aspirin plus warfarin versus aspirin alone in patients with atherosclerotic heart disease. We performed a comprehensive MEDLINE search of English-language reports published between 1966 and 2002 and search of references and relevant papers. Only clinical research studies on primary or secondary prevention of cardiovascular events in patients at high risk for coronary artery disease or patients experiencing unstable angina or myocardial infarction were included. Despite daily aspirin treatment, many patients break through aspirin treatment and experience cardiovascular events. Individuals at high risk for coronary disease or with established disease benefit from combination therapy with aspirin plus warfarin, if compliance with warfarin is greater than 70% and the target international normalized ratio (INR) of 2.0-2.5 is achieved. Combination therapy within these parameters leads to a 29-45% reduction in the risk of death, reinfarction and/or ischemic stroke. There is a significant increase in the rate of minor and a slight increase in the rate of major bleeding with combination therapy. Other potential indications for combination therapy include myocardial infarction associated with acute left ventricular aneurysm or significant left ventricular systolic dysfunction. In spite of reluctance to use oral anticoagulants, several large, randomized clinical trials support combination therapy with aspirin plus warfarin (INR, 2.0-2.5) in high-risk patients with atherosclerotic heart disease. Combination therapy increases the risk of minor and major bleeding, but not intracranial bleeding.
Angina, Unstable↗
[Clinical evaluation of cardiac valve surgery combined with coronary artery bypass grafting].
Between 1991 and 1999, 23 cases underwent cardiac valve surgery concomitant with myocardial revascularization at our institution. Twelve cases (group I) had a primary valvular disease combined with coronary atherosclerosis, and other 11 cases (group II) were due to ischemic mitral insufficiency. There were 2 hospital deaths in group I (17%) and 4 in group II (36%). Three deaths in group II underwent left ventricular volume reduction surgery. On the basis of this observation, we concluded severe mitral regurgitation with ischemic cardiomyopathy was a particularly difficult management problem with disappointing clinical results. On the other hands, we considered concomitant revascularization should be done in the case of primary valvular disease when angiographically significant coronary artery stenosis was present.
Aged↗
Coronary spasm as a primary cause of myocardial infarction. A preliminary report.
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Coronary Disease↗
Acute coronary syndromes in the United States and United Kingdom: a comparison of approaches. The Antithrombotic Therapy in Acute Coronary Syndromes Research Group.
BACKGROUND: Patients with coronary artery disease are managed differently in different countries. HYPOTHESIS: These variations in patient management may affect clinical outcome, a possibility that should be taken into consideration in multicenter studies. METHODS: In a binational, 3 months study of antithrombotic treatment of patients with unstable angina and non-Q-wave infarction (ATACS), we compared the experience in the four enrollment centers in the United States (US) with the three centers in the United Kingdom (UK). The 59 US patients and the 299 UK patients were similar with regard to age, rates of prior revascularization, prior positive exercise tests, medication use, and aspirin use. RESULTS: US patients were more commonly women (45 vs. 28%), diabetic (30 vs. 4%), or hypertensive (52 vs. 31%), and had a prior coronary angiogram (30 vs. 18%). After enrollment, coronary angiography was performed more frequently in the US than in the UK (61 vs. 22%). Although the distribution of coronary disease was similar, revascularization without recurrent angina (19 vs. 4%, p < 0.001), or following recurrent angina (8 vs. 3%), was significantly more frequent in the US. Combined primary end points (recurrent angina, myocardial infarction, or death) did not differ between US (29%) and UK (25%) patients. CONCLUSION: Therefore, international studies of acute coronary disease need to account for different treatments in different countries. These differences, in the small ATACS study, did not have a major impact on the composite primary outcome variables.
Adult↗
Early ventricular fibrillation in patients with acute myocardial infarction: correlation with coronary angiographic findings.
To define coronary angiographic characteristics of patients experiencing early primary ventricular fibrillation (VF) in the acute phase of myocardial infarction we studied 266 consecutive patients without clinical evidence of heart failure. Twenty-six patients (group 1) experienced early (< 12 h from the onset of symptoms of myocardial infarction) primary VF whereas 240 patients (group 2) with the same clinical characteristics served as an appropriately matched cohort. All patients were catheterized before or soon after hospital discharge (1 to 8 weeks after the acute event). There was no significant difference in left ventricular ejection fraction between the two groups of patients (39.6 +/- 6% vs 36.9 +/- 8%, P = ns). Patients with early VF had a significantly greater number of diseased vessels than those without VF (3.38 +/- 1.05 vs 2.03 +/- 1.25, P < 0.001) and a higher coronary arteriographic Gensini score (29.31 +/- 4.80 vs 20.16 +/- 4.14, P < 0.001). The left anterior descending coronary artery was identified as the infarct-related vessel in 53.6% of group 1 vs 44.5% of group 2 patients (P < 0.05). The mean maximal serum creatine kinase values were not significantly different (1897 +/- 1062 vs 1426 +/- 839 IU.l-1, P = ns) between the two groups. These data indicate that patients with early primary VF in the setting of acute myocardial infarction may have more extensive coronary artery disease than similar patients without VF. A worse prognosis could be anticipated for these patients on the basis of worse coronary anatomy.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
The effect of myocardial preservation technique on operative mortality in complex valvular heart disease.
Between November, 1964 and January, 1983, 70 consecutive patients underwent primary repair of complex valvular heart disease, defined as repair or replacement of two or more cardiac values alone or with other concomitant cardiac procedures. A total of 163 operative procedures were performed on the 70 patients for an average of 2.33 procedures per patient. Review of these cases allowed the patients to be divided into two distinct groups, those receiving systemic hypothermia and cold potassium cardioplegic arrest of the heart (C) and those having other myocardial preservation techniques (NC). Thirty-three patients received C and are compared with 37 patients who received NC. The two patient groups were comparable when considered for preoperative cardiac index and functional classification though patients in C group were older. In the C group, 10 of 32 patients (31%) had associated coronary artery bypass grafting in contrast to 2 of 37 patients (5.4%) in the NC era. The mortality of the C group was 2 of 33 (6%) vs 14 of 37 (37.8%) in the NC group (P less than .001). Of the 14 deaths in the NC patients, 10 were due to low cardiac output syndrome. While other factors have undoubtedly played a role, improved myocardial preservation by the use of C and attention to coronary artery pathology may have contributed to the improved operative mortality in this group of patients with complex valvular heart disease.
Adult↗
Prevalence and management of coronary heart disease in primary care: population-based cross-sectional study using a disease register.
BACKGROUND: Patients with coronary heart disease are at high risk of further coronary events. Hence, one of the main priorities in the National Service Framework for Coronary Heart Disease strategy is the identification and treatment of patients with pre-existing coronary heart disease. We aimed to determine the prevalence of established coronary heart disease in a large primary care population and to compare the management of risk factors in these patients with the standards given in the National Service Framework. METHODS: A population-based cross-sectional study was carried out using data collected from primary care. Sixty-three general practices (total list size 378,021) in four primary care groups in SW London took part. Data collection was confined to 103,613 patients over 44 years of age. We calculated age- and sex-specific and age-standardized prevalence rates, and age-adjusted relative risks for men and women. RESULTS: A total of 6,778 patients with coronary heart disease were identified (8 per cent of men and 5 per cent of women over 44 years of age). There was a history of myocardial infarction in 30 per cent (1204/3991) of men and 22 per cent (613/2787) of women (relative risk 1.57; 1.37-1.81). Coronary revascularization procedures had been performed in 27 per cent (1068/3991) of men and 11 per cent (312/2787) of women (2.02; 1.73-2.35). Most patients had been assessed for hypertension (89 per cent (3538/3991) of men; 90 per cent (2500/ 2787) of women), but in many patients blood pressure was poorly controlled (26 per cent (902/3538) of men; 27 per cent (678/2500) of women). Total cholesterol had been recently measured in 51 per cent (2018/3991) of men and 44 per cent (1218/2787) of women and was elevated in 44 per cent (881/ 2018) of men and 59 per cent (716/1218) of women (0.74; 0.69-0.79). Statins were prescribed to 49 per cent (1967/3991) of men and 38 per cent (1064/2787) of women (1.06; 1.00-1.12). Aspirin was prescribed to 65 per cent (2586/3991) of men and 59 per cent (1631/2787) of women (1.08; 1.03-1.14). Beta-blockers were prescribed to 20 per cent (181/913) of men and 15 per cent (72/499) of women with a history of myocardial infarction (1.11; 0.85-1.44). CONCLUSIONS: Most patients with coronary heart disease in primary care were being treated with aspirin but less than half with statins or beta-blockers. More men than women were treated with aspirin and statins, even though women had higher cholesterol levels than men. Men were also more likely to have a confirmed diagnosis and to have undergone a coronary revascularization procedure. There is considerable scope for improving the secondary prevention of coronary heart disease and addressing gender inequalities in primary care.
Aged↗
Making the coronary care unit cost-effective.
Coronary care units (CCUs) have now been in use for 20 years, and it is generally acknowledged that they have helped to reduce hospital mortality for patients with acute myocardial infarction. In recent years the indications for admission to a CCU have been greatly expanded to include all patients with suspected myocardial infarction and a variety of other manifestations of cardiovascular disease including primary arrhythmias and heart failure. The focus of the CCU has also broadened to include the prevention of major complications and the use of a variety of invasive and noninvasive diagnostic and therapeutic interventions before, as well as in response to, complications. With the changing indications for CCU admissions and the changing use of the CCU, new problems have arisen. The number of patients who might benefit from CCU care is now much larger and may at any given time greatly exceed the number of beds available. Decisions regarding who should be admitted to the CCU, how long a patient should stay in the CCU and which of the large and growing armamentarium of diagnostic and therapeutic interventions should be used are now increasingly important. These decisions have not only medical but also economic implications. Based on a 5-year experience with an intensive care unit computer data bank, strategies for more cost-effective CCU use have been explored. This has involved identification of high- and low-risk subsets of patients and modifications of standard operating procedures. The common clinical problems of chest pain, arrhythmias, syncope, pulmonary edema and myocardial infarction will be used as examples.
Atrial Fibrillation↗
Update on pediatric echocardiography.
PURPOSE OF REVIEW: The past year was dominated by developments in echocardiographic assessment of myocardial function in children, and this paper reviews some of these major advancements in pediatric echocardiography as a guide to those interested in imaging of the pediatric heart and vascular system. RECENT FINDINGS: Characterization of myocardial function using Doppler tissue imaging, both in the normal child and in the child with congenital or acquired heart disease, was a primary focus of pediatric echocardiographic investigation. Other new technologies, including integrated backscatter analysis and three-dimensional echocardiography, appear to hold significant promise as tools to improve myocardial assessment echocardiographically. Three-dimensional echocardiography also is developing into a powerful technique in fetal echocardiography, allowing rapid data acquisition and extensive image postprocessing with opportunities for both anatomic and functional assessment. Childhood fitness and diseases have a significant impact on the heart and vascular bed, and descriptions of echocardiographic findings in obese children, children engaged in athletic activities, children with renal disease, children who have undergone cardiac transplantation, and those with aortic valve disease were better characterized by investigations published over the past year. SUMMARY: Pediatric echocardiography has clearly expanded from a diagnostic tool used to describe anatomic abnormalities associated with congenital heart disease to a noninvasive myocardial monitoring tool that allows serial assessment of the pathologic effects of both cardiac and noncardiac disease.
Child↗
Final report on the aspirin component of the ongoing Physicians' Health Study.
The Physicians' Health Study is a randomized, double-blind, placebo-controlled trial designed to determine whether low-dose aspirin (325 mg every other day) decreases cardiovascular mortality and whether beta carotene reduces the incidence of cancer. The aspirin component was terminated earlier than scheduled, and the preliminary findings were published. We now present detailed analyses of the cardiovascular component for 22,071 participants, at an average follow-up time of 60.2 months. There was a 44 percent reduction in the risk of myocardial infarction (relative risk, 0.56; 95 percent confidence interval, 0.45 to 0.70; P less than 0.00001) in the aspirin group (254.8 per 100,000 per year as compared with 439.7 in the placebo group). A slightly increased risk of stroke among those taking aspirin was not statistically significant; this trend was observed primarily in the subgroup with hemorrhagic stroke (relative risk, 2.14; 95 percent confidence interval, 0.96 to 4.77; P = 0.06). No reduction in mortality from all cardiovascular causes was associated with aspirin (relative risk, 0.96; 95 percent confidence interval, 0.60 to 1.54). Further analyses showed that the reduction in the risk of myocardial infarction was apparent only among those who were 50 years of age and older. The benefit was present at all levels of cholesterol, but appeared greatest at low levels. The relative risk of ulcer in the aspirin group was 1.22 (169 in the aspirin group as compared with 138 in the placebo group; 95 percent confidence interval, 0.98 to 1.53; P = 0.08), and the relative risk of requiring a blood transfusion was 1.71. This trial of aspirin for the primary prevention of cardiovascular disease demonstrates a conclusive reduction in the risk of myocardial infarction, but the evidence concerning stroke and total cardiovascular deaths remains inconclusive because of the inadequate numbers of physicians with these end points.
Adult↗
[Comparison of the results of serial determination of CPK activity with electrocardiographic and clinical data in patients with acute myocardial infarction].
Correlations between clinical pattern of the disease, electrocardiographic evidence of necrosis from standard leads and the size of infarction expressed in CPK gram-equivalents were examined in 92 patients with acute primary transmural myocardial infarction. In addition, maximum total CPK activity and the pattern of the curve obtained through serial measurements were assessed. The patients were divided in five groups depending on electrocardiographic evidence of necrotic spread, which differed significantly in terms of both enzyme activity and clinical pattern of the disease.
Adult↗
[Retrospective evaluation of angina pectoris in patients with primary and recurrent myocardial infarct].
Retrospective analysis of information on 283 patients with myocardial infarction (186 males and 97 females) showed that 64.7% of persons who had suffered from the disease for the first time and 88.6% of those with recurrent myocardial infarction had a history of anginose pain. Exacerbation of angina pectoris had occurred in 56.0% of patients with no previous myocardial infarction and in 71,4% of those with recurrent infarction. A preinfarction state was encountered in primary and recurrent myocardial infarction with equal frequency (in 73.0 and 74.7% of cases, respectively). Nitroglycerin efficacy diminishes in the month preceding myocardial infarction. During exacerbation of angina pectoris, 39.8% of patients who had no previous myocardial infarction and 73.8% of those with a history of the disease applied for medical advice.
Adult↗
Aspirin for primary prevention of coronary heart disease: safety and absolute benefit related to coronary risk derived from meta-analysis of randomised trials.
OBJECTIVE: To determine the cardiovascular and coronary risk thresholds at which aspirin for primary prevention of coronary heart disease is safe and worthwhile. DESIGN: Meta-analysis of four randomised controlled trials of aspirin for primary prevention. The benefit and harm from aspirin treatment were examined to determine: (1) the cardiovascular and coronary risk threshold at which benefit in prevention of myocardial infarction exceeds harm from significant bleeding; and (2) the absolute benefit expressed as number needed to treat (NNT) for aspirin net of cerebral haemorrhage and other bleeding complications at different levels of coronary risk. MAIN OUTCOME MEASURES: Benefit from aspirin, expressed as reduction in cardiovascular events, myocardial infarctions, strokes, and total mortality; harm caused by aspirin in relation to significant bleeds and major haemorrhages. RESULTS: Aspirin for primary prevention significantly reduced all cardiovascular events by 15% (95% confidence interval (CI) 6% to 22%) and myocardial infarctions by 30% (95% CI 21% to 38%), and non-significantly reduced all deaths by 6% (95% CI -4% to 15%). Aspirin non-significantly increased strokes by 6% (95% CI -24% to 9%) and significantly increased bleeding complications by 69% (95% CI 38% to 107%). The risk of major bleeding balanced the reduction in cardiovascular events when cardiovascular event risk was 0.22%/year. The upper 95% CI for this estimate suggests that harm from aspirin is unlikely to outweigh benefit provided the cardiovascular event risk is 0.8%/year, equivalent to a coronary risk of 0.6%/year. At coronary event risk 1.5%/year, the five year NNT was 44 to prevent a myocardial infarction, and 77 to prevent a myocardial infarction net of any important bleeding complication. At coronary event risk 1%/year the NNT was 67 to prevent a myocardial infarction, and 182 to prevent a myocardial infarction net of important bleeding. CONCLUSIONS: Aspirin treatment for primary prevention is safe and worthwhile at coronary event risk >/= 1.5%/year; safe but of limited value at coronary risk 1%/year; and unsafe at coronary event risk 0.5%/year. Advice on aspirin for primary prevention requires formal accurate estimation of absolute coronary event risk.
Aspirin↗
Myocardial infarction and multiple thromboses in a child with primary thrombocytosis.
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Blood Platelets↗
[Primary and secondary prevention of coronary heart disease: what can we afford?].
In secondary prevention, statins are cost-effective and even more cost-effective than other lipd lowering drugs. Statins are especially favorable in patients with previous myocardial infarction compared to those with angina pectoris. For secondary prevention of coronary heart disease, statins should be administered generously. In primary prevention, statins are effective but not cost-efficient. Unfavorable results have to be expected especially in premenopausal women, younger patients, and in those with a low risk factor profile. For population based primary prevention, only dietary measures can be advocated; however, apart from a serious lack of compliance their efficiency has not yet been proven. Preventive measures have their own prize; in general they are considered not to prevent coronary heart disease but retard it. Therefore, such therapeutic interventions can be assumed not to reduce but rather to increase the "direct" medical costs. Furthermore, successful prevention of coronary heart disease leads, due to life-prolongation, to an increase in people out of work and in disabled patients due to age and/or disease. Therefore, an increase especially of the "indirect" costs for unemployment, pension, nursing homes, etc. must be expected.
Coronary Disease↗
Echocardiographic patterns in scleroderma.
The echocardiograms of two patients with sclerodermatous cardiac disease are described. In one patient the pattern was that of a congestive cardiomyopathy with ventricular dilatation and reduced wall motion. In the second patient the pattern was that of an infiltrative cardiomyopathy with thickened walls and reduced wall motion in the absence of ventricular dilatation. Echocardiographic studies are useful in the early detection of pericardial involvement and primary or secondary myocardial involvement by scleroderma and in following the progression of the disease process.
Adult↗